Financial hardship after cancer: revision of a conceptual model and development of patient-reported outcome measures

Future Sci OA. 2024 May 14;10(1):FSO983. doi: 10.2144/fsoa-2023-0229. eCollection 2024.

Abstract

Aim: This qualitative study refined a conceptual model of financial hardship and developed measures corresponding to model constructs. Methods: Eighteen women with breast cancer recruited through a comprehensive cancer center completed interviews. A qualitative framework analysis was conducted of the interviews. Results: Participants experienced varying levels of financial hardship. Protective factors included good health insurance, work accommodations and social support. Participants worried about cancer care costs and employment. Programs for alleviating financial hardship had high administrative burdens. Four preliminary financial hardship measures were developed: coping, impacts, depression and worry. Conclusion: Reducing administrative barriers to benefits could reduce financial hardship after cancer. More research is needed on the effects of out-of-network/formulary care and denials of coverage and to validate the measures.

Keywords: administrative burden; administrative hurdles; economic burden; economic wellbeing; financial burden; financial toxicity.

Plain language summary

Financial hardship is common after cancer diagnosis. This study interviewed women with breast cancer about financial hardship. Financial hardship included how participants coped with healthcare costs and reduced income. Worry and depression were also aspects of financial hardship. Administrative burdens led to financial hardship. Administrative burdens were actions patients had to take to access financial support. This study also created surveys to measure financial hardship in cancer.

Grants and funding

This work was funded by the American Cancer Society. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.