Abstract
Purpose
Financial toxicity is a multidimensional side effect of cancer treatment. Yet, most relevant research has focused on individual-level determinants of financial toxicity and characterized only patient perspectives. This study examined the multilevel determinants of financial toxicity from the perspectives of Latina breast cancer survivors and healthcare professionals.
Methods
We analyzed qualitative data from focus groups with 19 Latina breast cancer survivors and interviews with 10 healthcare professionals recruited through community partners and venues in Chicago.
Results
At the individual-level, the lack of knowledge and prioritization regarding financial aspects of care (e.g., costs of treatment, insurance coverage) was identified as important determinants of financial toxicity. However, healthcare professionals emphasized the need for early financial planning, while survivors prioritized survival over financial concerns immediately after diagnosis. At the interpersonal-level, social networks were identified as important platforms for disseminating information on financial resources. At the community-level, community norms and dynamics were identified as important barriers to seeking financial assistance. Access to culturally astute community-based organizations was considered one potential solution to eliminate these barriers. At the organizational/healthcare policy-level, financial assistance programs’ restrictive eligibility criteria, lack of coverage post-treatment, limited availability, and instability were identified as major determinants of financial toxicity.
Conclusion
Our findings suggest that multilevel interventions at the individual-, interpersonal-, community-, and organizational/healthcare policy-levels are needed to adequately address financial toxicity among Latina and other survivors from disadvantaged communities.
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Acknowledgments
The authors would like to thank study participants for their time, effort, and perspectives. They would also like to thank Mr. Hunter T. Norris for editorial support.
Funding
This work was supported by the University of Illinois at Chicago’s Institute for Race Research and Public Policy under a 2018–2019 Policy & Social Engagement Fellowship as well as by the National Cancer Institute under grant number K01CA154938. YM was also supported by the University of Illinois Cancer Center and Center for Research on Women and Gender.
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Chebli, P., Lemus, J., Avila, C. et al. Multilevel determinants of financial toxicity in breast cancer care: perspectives of healthcare professionals and Latina survivors. Support Care Cancer 28, 3179–3188 (2020). https://doi.org/10.1007/s00520-019-05119-y
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DOI: https://doi.org/10.1007/s00520-019-05119-y