Almost a third of U.S. cancer survivors face financial burdens, and physical and metal health tends to be worse for those who do, according to a new study.

There are more than 14 million cancer survivors in the U.S., the authors wrote in a paper released by the journal Cancer.

"We found that cancer survivors with three or more financial problems had clinically meaningful differences in their physical and mental health-related quality of life and were two to three times more likely to report depressed mood and six to eight times more likely to worry about cancer recurrence," lead author Hrishikesh P. Kale of Virginia Commonwealth University in Richmond told Reuters Health by email.

"Financial burden results from the high cost of cancer care," added senior author Norman V. Carroll, also of Virginia Commonwealth University. "This is especially true for the newer, biologically-derived specialty drugs," which can require patient copays of several hundred dollars per month, Carroll said.

Loss of ability to work due to illness and treatment, transportation costs to get treatment, and loss of a spouse's income if the spouse must take time off from work for caregiving can also contribute, said Dr. Scott D. Ramsey, director of the Hutchinson Institute for Cancer Outcomes Research, who was not part of the new study.

"Finally, if a person loses their job and therefore their employer-based insurance in the course of treatment, things get much worse," Ramsey told Reuters Health by email.

The new findings are drawn from the 2011 Medical Expenditure Panel Survey, which included 1,380 people who self-reported ever being diagnosed with cancer. Survey questions addressed a history of borrowing money, going into debt, filing for bankruptcy, making financial sacrifices, worrying about paying large medical bills and being unable to cover the cost of medical care.

In addition, 12 survey items assessed current physical and mental health and health-related quality of life.

Almost eight percent of cancer survivors had borrowed money, incurred debt or declared bankruptcy. One in five were worried about paying large medical bills, one in ten were unable to cover the cost of medical care visits, and almost one in ten had made other financial sacrifices.

"These findings are consistent with numerous other studies that have called attention in recent years to the financial burden of cancer diagnosis and treatment," said Dr. Reshma Jagsi of the University of Michigan Health System in Ann Arbor.

"Although many cancer survivors are able to return to work, research from our group and others has suggested that a substantial minority of cancer patients do lose their jobs after cancer diagnosis and are unable to find work again," Jagsi, who was not part of the new study, told Reuters Health by email.

Those who were younger at diagnosis, female, a member of a racial or ethnic minority, and who had short-survival cancers were more likely than others to face financial burden.

As financial problems increased, health-related quality of life decreased, the authors report. Financial burden increased the risk of depressed mood and worrying about cancer recurrence, and those with three or more financial problems had clinically significant poorer physical and mental health compared to others.

Eight percent of cancer survivors did not have insurance during the course of their cancer care and such cancer survivors were twice as likely to report financial burden compared to those with access to insurance, Kale said.

"Even among insured cancer survivors, 29% reported cancer-related financial burden," he said.

"We did not analyze if cancer survivors were able to return to work in our study," he said. "However, future research could study if cancer survivors are able to return to work at the same level and if they have better or worse productivity."

Cancer survivors should educate themselves regarding survivorship issues, coverage and benefit design of their health plans and organizations that provide financial assistance, Kale said.

"Further, cancer survivorship care programs can identify survivors with the greatest financial burden and focus on helping them cope with psychological stress, anxiety and depression throughout their journey with cancer," he said.

"We recommend hiring a financial planner or seeking assistance with finances," Ramsey said. "Some cancer centers are starting to offer this, but it is relatively rare."

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