PURPOSE: To conduct a longitudinal analysis of out-of-pocket expenditure (OOPE) trajectories for the assessment of cancer’s lasting financial impact. METHODS: We identified newly diagnosed patients with cancer from the 2002-2018 Health and Retirement Study and constructed a matched non-cancer control group. Outcomes included monthly OOPE for prescription drugs (RX-OOPE) and OOPE for all medical services other than drugs (non-RX OOPE) in the past 2 years, consumer debt and new individual retirement account (IRA) withdrawals. Generalized linear models were used to compare RX-OOPE and non-RX OOPE between the cancer and matched control group before, during, and after diagnosis. Logistic regression models were used to compare household-level consumer debt or early IRA withdrawal. Subgroup analysis stratified patients by age (< 65 vs. ≥ 65), health status, and median household income, with the low-income group stratified by Medicaid coverage. RESULTS: The study cohort included 2,022 patients with cancer and 10,110 matched non-cancer controls. Mean non-RX OOPE of patients with cancer was similar to the mean of matched controls before diagnosis, but statistically significantly higher at diagnosis ($1,157, P<0.001), and 2 ($511, P<0.001), 4 ($360, P=0.006), and 6 years ($430, P=0.010) after diagnosis. A similar pattern was observed in RX-OOPE. A significantly higher proportion of cancer patients incurred consumer debt at diagnosis (34.5% vs. 29.9%, P<0.001) and 2 years after (32.5% vs. 28.2%, P=0.002). There was no statistically significant difference in new IRA withdrawals. CONCLUSIONS: Patients experienced lasting financial consequences following cancer diagnosis and were most pronounced among patients ≥65, in good-to-excellent health at baseline, and with low income, but without Medicaid coverage. Remedies include policies to reduce cancer care costs and expand patient insurance coverage options while reducing cost-sharing.