Surveys in patient records portal can help screen young cancer patients for financial toxicity

Adolescents and young adults (AYAs) with cancer face numerous challenges, including financial toxicity due to the high cost of medical care. This encompasses not only the impact of direct, out-of-pocket expenses for cancer treatment, but also indirect costs due to disruptions in education or employment, resulting psychological distress, and the behaviors with which an individual or household responds to these challenges.  

To identify young patients who might benefit from resources and interventions to address financial hardship, Columbia University School of Nursing researchers tested a method to screen AYAs for financial toxicity in a clinical setting. Results were published in a JCO Oncology Practice paper titled “Implementing financial screening for AYAs treated in the outpatient oncology setting,” on June 9, 2025.  

For the study, Assistant Professor Melissa Beauchemin, PhD’19, and her colleagues delivered survey questions to AYAs using the patient electronic health records’ portal at an urban academic cancer center. Using survey responses and interviews with patients and clinicians, they evaluated the feasibility of screening and prevalence of financial hardship. 

Among the 286 AYAs who responded to the screening questions with the help of a family caregiver, 74% exhibited signs of financial toxicity, with higher rates among individuals who identified as male, Black, Hispanic, Asian, or Spanish-speaking.  

“The diverse nature of our AYA population and the prevalence of financial hardship underscores the importance of equitable development and implementation of financial screening initiatives,” the researchers report.  

“Our findings demonstrate the feasibility of systematic financial screening in complex care settings, such as those for AYAs with cancer. Because AYAs often rely on family caregivers, tailoring screening processes and responses is essential. Establishing valid financial screening items, determining the respondent (patient or caregiver), and addressing positive responses are key steps for broader implementation.”