On Mother's Day in 2013, just a few weeks before she died of breast cancer, Carol Pirolli cheered from the sidelines as her close-knit clan ran through a park, raising more than $2,000 to donate to the charity of her choice.

That was the seed that grew into Cousins for Carol, a tiny, all-volunteer nonprofit based in Doylestown and led by Pirolli's 20 nieces and nephews. The charity is dedicated to relieving a well-known but often-overlooked complication of cancer treatment: financial hardship.

Over the past two years, Cousins has raised more than $20,000 through fun runs and other events to help hard-pressed cancer patients cover basic expenses such as rent and utilities. Grant recipients are screened and referred by Fox Chase Cancer Center, where Ms. Pirolli was treated.  Recipients — eight families so far — get up to $2,500.

"We were intent on finding a way to celebrate Aunt Carol's legacy and the impact she had on our lives, as well as find  a way to heal," Cousins explains on its website.

Cancer-related financial hardship -- also called financial "toxicity" --  has been documented by many studies and even has an informational page on the National Cancer Institute's website. Research aside, it's easy to understand how patients facing expensive treatments, high out-of-pocket costs,  and periods of being too sick to work can wind up clobbered by debt — especially if they don't have savings to draw on.

Ms. Pirolli, a nurse who worked for many years in the emergency room  at Holy Redeemer Hospital, did not face such desperate straits before her death at 56, said her niece, Maria Visco, of Collingswood, NJ.

"She didn't, and that was one of the things we felt lucky about," said Visco, who leads the organization's board of directors, made up of seven cousins. "At the end, she was able to stay with one of her sisters. We all took turns taking her to chemotherapy."

For the circle of nieces and nephews — which grew to include nine grand-nieces and grand-nephews — Aunt Carol was a constant.

"She never married, but she was our second mom," Visco said. "She was at all our birthday parties, all the family holidays, always with gifts. When we got older, we took trips together. The last one was to Savannah, Ga."

Sheila Amrhein, a clinical social worker at Fox Chase Cancer Center, acts as a liaison between Cousins and grant applicants.  Because Fox Chase verifies their financial need, Cousins' application does not require extensive income documentation. Cousins hopes to grow enough to establish similar cooperative relationships with other cancer centers.

"They help with some of the softer financial stressors — the electric bill or a mortgage payment that you can't pay because you didn't get back to work when you thought you would," Amrhein said. "This is how they're honoring their aunt.  It's a wonderful legacy."

Visco recalled making a home visit to the first family that Cousins helped.

"The mother had ovarian cancer. She had three kids, and two were autistic," said Visco, who works with autistic children as a school behavioral health analyst. "She'd been out of work since Hurricane Sandy, and was living with her boyfriend. We paid the utility bills and rent and even a cable bill, because TV is so important in keeping autistic childrens' anxiety low."

Some  established philanthropies, including the Cancer Financial Assistance Coalition and Cancer Care,  help patients who are struggling with cancer-related costs, including transportation, home care and child care. Visco said the cousins  decided not to join an existing organization.

"We did think about it," she said, "but because it was so personal to us, we wanted to be the ones giving money directly to people in need."

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