Cancer during adolescence or young adulthood can interrupt education, employment, relationships and independence at the moment when many people are beginning to build their adult lives. A new survivor-perspective article in the Journal of Cancer Survivorship argues that the economic consequences may persist long after treatment ends, creating a form of “financial toxicity” that is often overlooked in clinical care. Written by Samantha Watson, a 25-year cancer survivor and founder of a financial-support organization for young adult patients, the article describes how medical bills, disrupted education and long-term survivorship expenses can combine into a lasting burden. Its central message is direct: surviving cancer does not necessarily mean escaping its financial consequences.
Watson recounts experiencing cancer as a young adult while attending college, a period already associated with tuition costs, limited income and dependence on family or student borrowing. Treatment added expenses that extended beyond hospital charges. Transportation, medications, food, lodging, insurance payments and other out-of-pocket costs can accumulate even when a patient has health coverage. At the same time, illness can reduce the ability to work, attend classes or complete a degree on schedule. From an economic perspective, this creates both direct and indirect costs. Direct costs arise from care itself, while indirect costs include lost wages, delayed graduation, reduced career opportunities and the financial support required from relatives.
The article becomes even more striking because Watson later faced a second cancer diagnosis and another course of treatment only a few years after the first. A recurrent or second primary cancer can reactivate expenses that a young survivor may still be trying to repay or recover from. The timing is particularly important: early adulthood is when people commonly begin establishing credit, entering the workforce, moving away from home and making decisions about housing or further education. A prolonged health crisis can disrupt each of these transitions. Instead of building savings, patients may accumulate debt; instead of gaining professional experience, they may face interruptions that influence future earnings. These effects can remain invisible in medical records while shaping a survivor’s life for decades.
Researchers use the term financial toxicity to describe the material and psychological harm caused by the cost of cancer care. It is not limited to bankruptcy or unpaid medical bills. Financial toxicity can include difficulty paying for necessities, depletion of savings, borrowing from family, increased debt, treatment-related employment loss and anxiety about future expenses. The condition can also influence health behavior. Patients under financial pressure may delay appointments, skip medications, avoid recommended tests or choose less expensive treatment-related options. In this way, economic stress can become clinically relevant: it may affect treatment adherence, mental health, quality of life and the risk of further health complications.
For adolescent and young adult, or AYA, patients, these effects may be amplified because they often have fewer financial reserves and less stable employment than older adults. Some are uninsured or underinsured, while others rely on plans with deductibles, co-payments or coverage limits. A diagnosis can also interfere with eligibility for employment-based insurance or make it difficult to maintain coverage during periods away from work. Even when treatment is technically covered, patients may confront expenses that insurance does not fully reimburse. These can include travel to specialized cancer centers, fertility preservation, rehabilitation, mental-health services, prosthetics, fertility treatment or management of late effects. The result is a complex financial profile that cannot be captured by the hospital bill alone.
Watson’s experience led her to create The SAMFund, an organization designed to provide financial assistance to young adult cancer survivors. The organization is now part of the Expect Miracles Foundation. According to the article, the assistance offered through this work revealed how widely financial hardship varies among survivors. Some applicants need help with immediate treatment-related bills, while others require support for education, transportation, fertility care, housing or expenses associated with long-term recovery. These cases demonstrate that financial needs do not end when chemotherapy, radiation or surgery concludes. They may continue as survivors return to school, seek employment, manage chronic symptoms or attempt to rebuild lives interrupted by cancer.
The article distinguishes these immediate pressures from what Watson calls a “second wave” of costs. The first wave is associated with acute diagnosis and treatment: medical bills, travel, lost wages and the everyday expenses of receiving care. The second wave emerges during survivorship and may be less visible but more persistent. Survivors can require ongoing surveillance, specialist visits, medications, counseling and treatment for late effects. Some experience chronic pain, fatigue, organ damage, infertility, cognitive changes or other complications that affect their ability to work. Career limitations can be especially consequential for people diagnosed before they have completed education or entered a profession. A survivor may therefore face a lifetime economic penalty even after being declared free of active disease.
From a public-health perspective, the article calls for financial toxicity to be treated as part of cancer survivorship rather than as a private problem for patients to solve alone. Screening could include questions about transportation, employment, debt, insurance, housing and the ability to pay for prescriptions. Clinicians and care teams may then connect patients with social workers, benefits specialists, charitable funds, legal assistance and educational resources. Early intervention matters because financial stress can intensify rapidly when income falls at the same time that expenses rise. Integrating financial counseling into oncology care would not eliminate the economic burden, but it could help identify risks before they influence treatment decisions or undermine recovery.
The publication arrives alongside growing attention to the financial experiences of AYA cancer survivors. An editor’s note in the journal explains that experts were separately invited to examine the subject through a scoping review, while Watson was asked to provide a survivor’s perspective. Together, these approaches highlight why both evidence and lived experience are necessary. Economic models can measure costs, employment changes and health-care utilization, but personal accounts reveal how those costs affect identity, education, relationships and future plans. Watson’s article offers no new dataset—the author states that no datasets were generated or analyzed—but its value lies in documenting a long-term experience and showing how practical financial assistance can become a form of survivorship care.
The broader implication is that cancer’s impact should be measured not only by survival rates, remission and recurrence, but also by whether survivors can return to education, find stable work, afford follow-up care and regain financial independence. For young people, surviving cancer may represent the beginning of a new medical chapter rather than the end of the disease’s consequences. The article urges cancer professionals, policymakers and institutions to recognize that economic recovery is part of health recovery. Without that recognition, a patient may survive the cancer yet continue living with its financial shadow long after the final treatment.
Subject of Research: The long-term financial impact of cancer on adolescent and young adult survivors, including treatment costs, disrupted education and employment, financial toxicity, and survivorship-related expenses.
Article Title: It’s hard enough having cancer as an adolescent or young adult, but what about its financial impact?
Article References: Watson, S. “It’s hard enough having cancer as an adolescent or young adult, but what about its financial impact?” Journal of Cancer Survivorship (2026).
Image Credits: AI Generated
DOI: 10.1007/s11764-026-02089-z
Keywords: Financial toxicity; adolescent and young adult cancer; AYA cancer; cancer survivorship; costs of care; medical debt; employment disruption; long-term cancer effects
