Pediatric Leukemia Treatment Pushes Many Families Into Financial Crisis | ASH 2025

Approximately one-third of families (32%) with a child diagnosed with acute lymphoblastic leukemia (ALL) experienced catastrophic income loss during treatment, defined as a loss of 25% or more of annual household income, according to an abstract by Daniel Zheng, M.D., an attending oncologist with the Cancer Center at Children’s Hospital of Philadelphia and faculty member at PolicyLab at Children's Hospital of Philadelphia, presented this morning at the 67th American Society of Hematology (ASH) Annual Meeting and Exposition.

“What's particularly notable is that one in four families who had no household material hardship at diagnosis went on to develop new household material hardship and/or catastrophic income loss by the end of chemotherapy,” Zheng said during his presentation.

Acute lymphoblastic leukemia affects the blood and bone marrow and is caused by a mutation in the cell’s DNA. The mutation causes the cells to grow and divide uncontrollably, which leads to the production of immature blood cells called lymphoblasts that crowd out healthy cells. Symptoms may include fatigue, bleeding gums and fever.

Pediatric ALL is the most common childhood cancer and while treatment success rates are 90%, it often requires more than two years of therapy, consisting of an estimated 200 outpatient sessions and 40 inpatient days. Aside from affecting a family’s day to day life, this also creates a large financial burden. Treatments for ALL include chemotherapy, radiation or chemotherapy with stem cell transplant.

Zheng’s study focused on 422 families with children newly diagnosed with ALL, who were followed for two years of chemotherapy. Approximately a quarter were single-parent households and 40% had an annual income of 200% below the federal poverty line. To assess financial burden, caregivers completed surveys at four different points, answering questions about the cost of their housing, food and utilities. Questions asked included:

1. Was there a time you were not able to pay the rent or mortgage on time?
2. We worried whether our food would run out before we got the money to buy more.
3. Has the gas/electric/oil company sent you a letter threatening to shut off the gas/electric/oil to the house for not paying bills?

Housing insecurity was the biggest concern for 22% of families, followed by food (16%) and utilities (9%).

Zheng urged the importance of family-centered care, a healthcare decision-making process that occurs between the family and the provider. It is considered a standard of care for many pediatric practices, but implementation is inconsistent in clinical practice.

“I think one immediate takeaway is that it's really clinically important to standardize repeated longitudinal financial screening over the course of cancer treatment,” Zheng said. “This can't be the type of thing where you meet a family at diagnosis, they get an initial screen, and then you just assume that the family is going to be fine for the subsequent two years.”

Zheng will present the full abstract, titled ‘Cumulative incidence of household material hardship and income loss as measures of financial toxicity during pediatric acute lymphoblastic leukemia (ALL) treatment: A report from the DFCI ALL 16-001 Trial,’ on December 7.

ASH 2025 is being held in Orlando from December 6 – 9.