The numbers behind that roadmap are staggering. In 2025, an estimated 18.6 million people in the United States were living as cancer survivors, a figure projected to climb to 26 million by 2040. Roughly two million new diagnoses are made annually, and with five-year survival rates now at 70 percent and ten-year survival at 48 percent, caring for the long-term physical, psychological, social, and functional consequences of cancer has become a central challenge of modern oncology. Yet implementation of evidence-based survivorship care has lagged. Nationwide surveys show that only about 31 percent of Commission on Cancer accredited facilities and 41 percent of NCI Community Oncology Research Program institutions operate dedicated survivorship clinics, leaving most care to already stretched treatment teams with limited survivorship specialization.

The new study, led by Marguerite A. Webster and colleagues at the University of Kentucky Markey Cancer Center, is among the first to measure how clinical practice aligns with the national standards directly from the survivor’s perspective. The researchers conducted a convergent mixed-methods investigation at a university-based NCI Designated Comprehensive Cancer Center in the southeastern United States, combining standardized surveys with semi-structured interviews. Between February and August 2025, 150 survivors recruited from four outpatient solid tumor clinics completed roughly 30-minute surveys. Participants ranged in age from 22 to 83, with a mean of about 59 years, and were purposively sampled to ensure balanced representation across treatment phase, disease stage, and rural versus nonrural residence. A subset of 17 survivors then completed in-depth interviews averaging 24 minutes, which were analyzed using directed content analysis anchored to the national standards.

The survey instrument, modeled on the Patient-Centered Survivorship Care Index, asked participants how often their care team asked about six domains of concern: physical, emotional, practical, social, financial, and insurance. Survivors were counted as assessed only if they reported being asked at most or every visit, reflecting the standards’ expectation that survivors be evaluated at multiple points across their care. The results revealed a striking hierarchy of attention. Physical concerns topped the list, with 91 percent of participants reporting regular assessment, followed by tobacco use at 87 percent, physical activity at 79 percent, emotional concerns at 79 percent, and diet at 74 percent. Financial hardship fell to 29 percent and insurance concerns to 22 percent, making money-related matters the least screened domains by a wide margin.

Encouragingly, once a concern was voiced, the care system largely delivered. Among survivors who reported experiencing and communicating a concern, management through advice, help, or referral was nearly universal: 97 percent for physical concerns, 96 percent for emotional concerns, and a full 100 percent for financial, insurance, and social concerns. Lifestyle behaviors fared somewhat less well, with diet advice reaching 94 percent of those asked but tobacco counseling only 70 percent. The pattern suggests the fundamental machinery of referral and support exists within the cancer center; the bottleneck is not the response but the question. Concerns that survivors never mention—because no one asks—are concerns the system never addresses.

That bottleneck appears to fall unevenly on already vulnerable populations. Rural survivors in the sample reported significantly lower rates of assessment for physical concerns (89 percent versus 97 percent) and financial concerns (23 percent versus 38 percent) compared with nonrural peers, and were less likely to say they were listened to about practical and social matters. They were also less likely to be asked about diet, physical activity, and alcohol use. The authors speculate that care teams may assume rural patients prefer not to discuss personal financial matters, an unspoken cultural assumption that risks leaving financial toxicity undetected where it may be most severe. By contrast, treatment phase and disease stage made little difference in screening practices, with one notable exception: 96 percent of actively treated survivors received help with practical concerns such as transportation, compared with none of the post-treatment survivors.

The interviews added texture to these statistics. Survivors described assessments that were often generic—repeated questions like “Is there anything you need?”—rather than structured, focused screening beyond routine check-ins about pain and depression. Symptom and wellbeing questionnaires were frequently administered through the patient portal or by nursing staff before appointments, with inconsistent follow-up by physicians. Many participants were unaware that the cancer center offered dedicated survivorship visits at all, and few recalled being offered a meeting with a survivorship nurse after finishing treatment. When problems were identified, however, survivors praised the care teams’ responsiveness, describing multidisciplinary referrals to social workers, nutritionists, genetic counselors, and physical therapists, and emphasizing the value of approachable providers who practiced genuine shared decision-making. As one participant put it, “I’m not a number. They actually care.”

The financial blind spot carries real consequences. Financial toxicity—the hardship caused by the cost of medical care—affects between 28 and 48 percent of cancer survivors and is associated with active treatment, late-stage diagnosis, and longer time since diagnosis. It is tightly intertwined with insurance problems, employment disruption, and mounting debt, and it can delay or derail treatment in ways that directly worsen outcomes. Paradoxically, national studies of NCI Community Oncology Research Program and NCCN sites report that 72 to 78 percent of institutions claim to have financial screening processes in place, yet other research shows 58 percent of breast cancer survivors were never asked about financial stressors by their care team. Policy and process, in other words, do not guarantee reach. The authors argue that even where screening mandates exist, implementation may fail at the individual patient level—particularly for rural and other underserved survivors.

The solution, the researchers contend, cannot rest on patients’ willingness to advocate for themselves. Social determinants such as insurance coverage, travel distance, and financial hardship can disrupt care delivery and degrade cancer outcomes, so the onus should fall on the health system. They recommend proactive, standardized assessment of financial and insurance concerns at multiple points in care, expanded access to financial navigation, empathetic provider communication about money, and periodic audits to verify that screening tools are actually working. Cancer centers should also operationalize the national standards into clearly defined steps and benchmarks, since the standards currently describe important processes but offer little guidance for measurement. Quality improvement frameworks such as Plan-Do-Study-Act cycles could help institutions implement the standards systematically, with special focus on financial matters.

The study has limitations worth noting. It measured only a subset of the standards’ process indicators, relied on self-reported data vulnerable to recall and social desirability bias, used face-valid survey items rather than psychometrically validated instruments, and drew its sample from a single cancer center, limiting generalizability. The interview subset of 17 participants was small, and qualitative findings should be read as an expansion of survey results rather than a definitive population portrait. Still, as one of the first direct assessments of the new national standards from survivors’ own experiences, the work delivers an unambiguous message: the health system has learned to ask about the body and the mind, but until it routinely asks about the wallet, survivorship care will remain incomplete for millions of Americans facing cancer’s long financial shadow.

Subject of Research: Assessment of financial and insurance concerns in cancer survivorship care under the 2024 National Standards for Cancer Survivorship Care

Article Title: Financial concerns: a critical gap in survivors’ experience of the implementation of the national standards for cancer survivorship care

Article References: Financial concerns: a critical gap in survivors’ experience of the implementation of the national standards for cancer survivorship care. (n.d.). https://doi.org/10.1007/s11764-026-02126-x

Image Credits: AI Generated

DOI: 10.1007/s11764-026-02126-x

Keywords: cancer survivorship, financial toxicity, National Standards for Cancer Survivorship Care, health insurance concerns, rural health disparities, mixed-methods research, survivorship care standards, financial screening, quality improvement, oncology care delivery, NCI Comprehensive Cancer Center, patient-reported outcomes