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Short-term and long-term financial toxicity from breast cancer treatment: a qualitative study

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Abstract

Purpose

The rising cost of breast cancer treatment has increased patients’ financial burden, intensifying an already stressful treatment process. Although researchers increasingly recognize the harmful impact of medical and nonmedical costs associated with cancer treatment, understanding patients’ perspectives of financial toxicity is limited. We aimed to explore the topic of financial toxicity through the lived experiences of patients with breast cancer from groups at risk of social and economic marginalization.

Methods

We conducted semi-structured interviews with 50 women with breast cancer from four specific groups: Black women, Medicaid enrollees, rural residents, and women age ≤ 40. We transcribed, coded, and analyzed the data using deductive and inductive approaches.

Results

Two overarching themes captured patients’ experiences of financial toxicity: short-term and long-term impacts. Short-term stressors included direct medical (e.g., co-pays, premiums), nonmedical (e.g., transportation, lodging), and indirect (e.g., job loss, reduced work hours) costs. Early in their treatments, patients’ focus on survival took precedence over financial concerns. However, as the treatment course progressed, fear of consequences from compounding costs of care and financial distress negatively impacted patients’ lifestyles and outlooks for the future.

Conclusion

Programs addressing financial toxicity that look beyond early-phase interventions are needed. Specifically, patients struggling with the accumulation of treatment costs and the resultant stress require ongoing support. Long-term support is especially needed for groups vulnerable to financial instability and social marginalization.

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Funding

This research leading to these results was funded by Paul Calabresi Career Development Award (K12 CA133250).

Author information

Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA

    Sandy Lee, William E. Carson, JC Chen & Samilia Obeng-Gyasi

  2. CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus, OH, USA

    Ramona G. Olvera, Karen Shiu-Yee, Laura J. Rush, Willi L. Tarver & Ann Scheck McAlearney

  3. Department of Internal Medicine, College of Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA

    Willi L. Tarver & Electra D. Paskett

  4. Department of Psychology, The Ohio State University, Columbus, OH, USA

    Tessa Blevins & Barbara L. Andersen

  5. Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA

    Ann Scheck McAlearney

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  1. Sandy Lee
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Contributions

Conceptualization: Samilia Obeng-Gyasi

Methodology: Karen Shiu-Yee, Laura J. Rush, Ann Scheck McAlearney, Samila Obeng-Gyasi

Formal analysis and investigation: Sandy Lee, Ramona G. Olvera, Karen Shiu-Yee, Laura J. Rush, Willi L. Tarver, Tessa Blevins, Ann Scheck McAlearney, Samilia Obeng-Gyasi

Writing — original draft preparation: Sandy Lee, Ramona G. Olvera

Writing — review and editing: all authors

Funding acquisition: Samilia Obeng-Gyasi

Resources and supervision: Ann Scheck McAlearney, Barbara L. Andersen, Electra D. Paskett, William E. Carson, Samilia Obeng-Gyasi

Corresponding author

Correspondence to Ramona G. Olvera.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Board of The Ohio State University (Date 11/17/2020/No. 2020C0174).

Consent to participate

Verbal informed consent was obtained prior to interviews.

Conflict of interest

SOG is funded by the Paul Calabresi Career Development Award (K12 CA133250), Conquer Cancer Breast Cancer Research Foundation Advanced Clinical Research Award for Diversity and Inclusion in Breast Cancer Research, The Society of University Surgeons, and the American Cancer Society (RSG-22-106-01-CSCT). EDP is the MPI on grants to the institution from Merck Foundation, Pfizer, Genentech, and Guardant Health. She is also an advisor to Glaxo-Smith Klein. JCC receives funding from The Ohio State University Comprehensive Cancer Center Pelotonia Grant. SL, RGO, KSY, LJR, WLT, TB, ASM, BLA, and WEC have no relevant financial or non-financial interests to disclose.

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Sandy Lee and Ramona G. Olvera are shared first authors.

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Lee, S., Olvera, R.G., Shiu-Yee, K. et al. Short-term and long-term financial toxicity from breast cancer treatment: a qualitative study. Support Care Cancer 32, 24 (2024). https://doi.org/10.1007/s00520-023-08199-z

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