As many as 71% of patients with advanced cancer—most of whom have healthcare insurance—experience major financial hardship because of their disease, according to study findings published in the Journal of the National Cancer Institute.

Researchers from the SWOG Cancer Research Network surveyed a diverse national cohort of 380 patients with newly diagnosed metastatic colorectal cancer about their finances and quality of life within four months of diagnosis and then every three months thereafter for a year. Of the sample, 98% were insured, 78% were White, 63% were younger than age 65, 58% were married or had a partner, and 57% had an annual income of $50,000 or less.

Within 12 months of beginning treatment, nearly three-quarters of the patients experienced major financial hardship, which the researchers defined as accumulating debt of any amount, borrowing money from family or friends, selling or refinancing a home, or having a 20% or more decline in personal income. Approximately 25% of the patients started experiencing financial difficulty within the first three months of treatment, and they also reported lower social functioning and quality of life at six months than the patients who didn’t start struggling financially until later in their treatment trajectory.

“These findings underscore the need for clinic and policy solutions that protect cancer patients from financial harm,” the authors wrote. They also reinforce the need for oncology nurses to assess patients’ financial health as well as their physical symptoms—even those with health insurance.

Learn more about financial toxicity and costs of care on the Oncology Nursing Podcast Episode 2: Financial Toxicity in Patients With Cancer.