ORIGINAL ARTICLE As if the disease was not enough: coping with the financial consequences of cancer Barbara Head 1,2 & Lesley Harris 2 & Karen Kayser 2 & Amy Martin 1 & Lisa Smith 2 Received: 20 April 2017 /Accepted: 2 October 2017 # Springer-Verlag GmbH Germany 2017 Abstract Purpose The goal of this research was to understand how cancer survivors cope with the financial consequences of their disease. Methods Twenty-six cancer survivors who self-identified as having experienced financial hardship related to their disease were interviewed. Transcripts of these interviews were ana- lyzed using constructivist grounded theory approach. An anal- ysis of codes related to coping strategies was conducted, and findings were stratified based on established coping theories (Lazarus and Folkman and Moos and Holahan) previously applied to coping with serious/chronic illnesses. Results Participants used both person-oriented/emotion-fo- cused and task/problem-focused coping skills to confront the financial consequences of their disease trajectory. Problem- focused skills included dealing with debt, accessing financial assistance, making lifestyle changes, seeking information and education, altering treatment protocols, being proactive, and negotiating insurance. Emotion-focused tasks included using personal strengths, expressing emotion, accessing social sup- port, being determined, and taking care of oneself. Results were further analyzed using Moos and Holahan’ s framework of coping skills; examples of each of these coping skills were identified in the interview data. Conclusions Facing serious financial ramifications due to a cancer diagnosis calls forth coping skills and tasks that can be categorized using coping theories traditionally applied to coping with the illness itself. Cancer patients are often confronted with dual threats: the physical and emotional im- pact of the illness and the loss of financial security and the lifestyle that they have worked to maintain. Interventions with cancer survivors should include facilitating effective coping with the financial implications of the disease. Keywords Coping . Cancer . Financial consequences . Financial toxicity . Financial burden Introduction A diagnosis of cancer is accompanied not only by the physical ramifications of the disease and its treatment but also by fears of the impact of personal costs and loss of income [1]. These fears are not unfounded. According to the National Patient Advocate Foundation, 28 million Americans have exhausted their savings because of medical debt, 21 million Americans have incurred large credit card debt, and 21 million Americans will forego necessities because of medical bills [ 2 ]. Advancements in the field of cancer treatment (especially technology and pharmaceuticals) have resulted in escalating costs for both insurers and patients [3]. Often changes in em- ployment result due to the disease and its treatment further compounding the financial distress experienced by survivors. A substantial proportion of patients and families experiences considerable distress related to the costs of their cancer care [4]. Some report adverse psychological outcomes such as de- pression and anxiety [5], loss of independence, and relation- ship breakdowns due to the financial stress. * Barbara Head barbara.head@louisville.edu 1 University of Louisville School of Medicine, 501 East Broadway, Suite 330B, Louisville, KY 40202, USA 2 Kent School of Social Work, University of Louisville, Oppenheimer Hall, Louisville, KY 40292, USA Support Care Cancer https://doi.org/10.1007/s00520-017-3918-y