Background Poverty is correlated with negative health outcomes in pediatric primary care, and is emerging as a negative prognostic indicator in pediatric oncology. However, measures of poverty amenable to targeted intervention, such as household material hardship (HMH)—including food, energy, and housing insecurity—have not been described in pediatric oncology. We describe the trajectory of family reported HMH and income poverty at a pediatric oncology referral center in New England with high psychosocial supports. Procedure Single site, prospective cohort study including 99 English‐speaking families of children receiving chemotherapy for primary cancer. Families completed face‐to‐face surveys at two time‐points: (1) Within 30 days of child's diagnosis (T1) (N = 99, response rate 88%); (2) 6‐months following diagnosis (T2) (N = 93, response rate 94%). HMH was assessed in three domains: food, energy, and housing insecurity. Results Twenty percent of families reported low‐income (≤200% Federal Poverty Level) and at least one HMH prior to their child's diagnosis. At T2, 25% of families lost >40% annual household income secondary to treatment‐related work disruptions, and 29% of families reported HMH despite utilization of psychosocial supports. Conclusions Low‐income and HMH are prevalent in a significant proportion of newly diagnosed pediatric oncology families at a large referral center. Despite psychosocial supports, the proportion of families experiencing unmet basic needs increases during chemotherapy to nearly one in three families. HMH provides a quantifiable and remediable measure of poverty in pediatric oncology. Interventions to ameliorate this concrete component of poverty could benefit a significant proportion of pediatric oncology families. Pediatr Blood Cancer © 2015 Wiley Periodicals, Inc.