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Financial toxicity is associated with negative patient outcomes, and rural populations are disproportionately affected by the high costs of cancer care compared to urban populations. Our objective was to (1) understand cancer programs’ perceptions of rural–urban differences in cancer patients’ experiences of financial hardship, (2) evaluate the resources available to cancer patients across the rural–urban continuum, and (3) determine how rural and urban health care teams assess and address financial distress in cancer patients.


Seven research teams within the Cancer Prevention and Research Control Network conducted semi-structured interviews with cancer program staff who have a role in connecting cancer patients with financial assistance services in both rural and urban counties. Interviews were audio-recorded and transcribed. We identified themes using descriptive content and thematic analysis.


We interviewed 35 staffs across 29 cancer care programs in seven states, with roughly half of respondents from programs in rural counties. Participants identified differences in rural and urban patients’ experiences of financial hardship related to distance required to travel for treatment, underinsurance, and low socioeconomic status. Insufficient staffing was an identified barrier to addressing rural and urban patients’ financial concerns.


Improved financial navigation services could mitigate the effects of financial toxicity experienced by cancer patients, particularly rural patients, throughout treatment and survivorship. Future research is needed to improve how cancer programs assess financial hardship in patients and to expand financial navigation services to better serve rural cancer patients.

Petermann, V., Zahnd, W., Vanderpool, R., Eberth, J., Rohweder, C., Teal, R., Vu, M., Stradtman, L., Frost, E., Trapl, E., Gonzalez, S., Vu, T., Ko, L., Cole, A., Farris, P., Shannon, J., Lee, J., Askelson, N., Seegmiller, L., White, A., Edward, J., Davis, M., & Wheeler, S. How Cancer Programs Identify and Address the Financial Burdens of Rural Cancer Patients .