Background Cancer patients may experience financial distress as a side effect of their care. Little is known about which patients are at greatest risk for altering their care or lifestyle due to treatment‐related financial distress. Methods We conducted a cross‐sectional survey study to determine which patients are at greatest risk for altering their care or lifestyle due to treatment‐related financial distress. Eligible patients were adults receiving cancer treatment enrolled between June 2010 and May 2011. We grouped coping strategies as lifestyle altering or care altering. We assessed coping strategies and relationships between covariates using descriptive statistics and analysis of variance. Results Among 174 participants, 89% used at least one lifestyle‐altering coping strategy, while 39% used a care‐altering strategy. Care‐altering coping strategies adopted by patients included the following: not filling a prescription (28%) and taking less medication than prescribed (23%). Lifestyle‐altering strategies included the following: spending less on leisure activities (77%), spending less on basics like food and clothing (57%), borrowing money (54%), and spending savings (50%). Younger patients were more likely than older patients to use coping strategies (p < 0.001). Lower‐income patients adopted care‐altering strategies more than higher‐income patients (p = 0.03). Participants with more education and shorter duration of chemotherapy used lifestyle‐altering strategies more than their counterparts (both p < 0.05). Conclusions As a means of coping with treatment‐related financial distress, patients were more likely to use lifestyle‐altering approaches, but more than one‐third adopted potentially harmful care‐altering strategies. Younger age, lower income, higher education, and shorter duration of chemotherapy were characteristics associated with greater use of coping strategies. Copyright © 2015 John Wiley & Sons, Ltd.