A new multicenter study reports that nearly one-third of families with children undergoing chemotherapy for acute lymphoblastic leukemia (ALL) develop substantial financial hardships during the 2 years of treatment. These difficulties—defined as the inability to pay for housing, food, or utilities, or losing at least 25% of household income—can emerge early and often worsen as treatment continues. The findings come from a prospective analysis embedded in the Dana-Farber Cancer Institute ALL 16-001 trial, representing the first pediatric oncology study to track household material hardship over time. They were presented by Daniel Zheng, MD, of Children’s Hospital of Philadelphia, at the 2025 American Society of Hematology (ASH) Annual Meeting & Exposition (Abstract 710).
Financial Difficulties Emerge Within Months of Diagnosis
Among 422 participating families, 19.3% reported challenges covering basic living expenses by 6 months after diagnosis, and 20.3% had lost at least a quarter of their household income. By the end of chemotherapy treatment at 24 months, 30% of the families could not maintain essential living costs, and 31.5% had lost 25% or more of their income. Even families who initially reported no hardships were significantly affected: nearly one-quarter struggled later to meet basic expenses, and more than one-quarter ultimately lost substantial income.
The importance of quantifying these burdens was emphasized by Dr. Zheng: “To our knowledge, this is the first study in pediatric oncology to examine the financial impact associated with cancer treatment by measuring household material hardship and income loss over time.” He stated. “It was striking to us that by 24 months, nearly a third of the families were unable to meet basic living costs at some point during their child’s ALL treatment.”
Vulnerable Groups Disproportionately Affected
The study population reflected substantial socioeconomic diversity. A total of 15% of families identified as Hispanic, 7% as non-Hispanic Black, 23% were single-parent households, and 40% had incomes below 200% of the federal poverty level. Families with lower income, public insurance (eg, Medicaid), single-parent structure, a primary language other than English, or children identified as Hispanic or non-Hispanic Black were more likely to develop new hardships during treatment. Investigators noted that these inequities amplify the disruptions already inherent in pediatric cancer care, including time away from work for clinic visits, hospitalizations, and caregiving responsibilities.
Findings Underscore the Need for Targeted Interventions
While survival for pediatric ALL now exceeds 90%, the demands of treatment—frequent visits to clinics, prolonged therapy, and associated caregiving challenges—place significant strain on families. The authors emphasize the urgent need to develop and test interventions aimed at mitigating these burdens. Ongoing trials led by co-investigators are evaluating benefits counseling and direct cash assistance as strategies to reduce hardship among low-income families. Continued research will be critical to addressing these systemic challenges and supporting families throughout the treatment journey.
Disclosure: For full disclosures of all study authors, visit hematology.org.
