Purpose

Metastatic breast cancer (MBC) patients often face substantial financial burden due to prolonged and expensive therapy. However, in-depth experiences of financial burden among MBC patients are not well understood.

Methods

Qualitative interviews were conducted to describe the experiences of financial burden for MBC patients, focusing on the drivers of financial burden, their experience using their health insurance, accessing financial assistance, and any resulting cost-coping behaviors. Interviews were transcribed and qualitatively analyzed using a descriptive phenomenological approach to thematic analysis.

Results

A total of n = 11 MBC patients or caregiver representatives participated in the study. MBC patients were on average 50.2 years of age (range: 28–65) and 72.7% non-Hispanic White. MBC patients were diagnosed as metastatic an average of 3.1 years (range: 1–9) before participating in the study. Qualitative analysis resulted in four themes including (1) causes of financial burden, (2) financial assistance mechanisms, (3) health insurance and financial burden, and (4) cost-coping behaviors. Both medical and non-medical costs drove financial burden among participants. All participants reported challenges navigating their health insurance and applying for financial assistance. Regardless of gaining access to assistance, financial burden persisted for nearly all patients and resulted in cost-coping behaviors.

Conclusion

Our findings suggest that current systems for health insurance and financial assistance are complex and difficult to meet patient needs. Even when MBC patients accessed assistance, excess financial burden persisted necessitating use of financial coping-behaviors such as altering medication use, maintaining employment, and taking on debt.

中文翻译：

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转移性乳腺癌患者的经济负担：对费用、经济援助、健康保险和经济应对行为的定性调查

目的

由于长期且昂贵的治疗，转移性乳腺癌（MBC）患者常常面临巨大的经济负担。然而，MBC 患者的经济负担的深入体验尚不清楚。

方法

进行定性访谈来描述 MBC 患者的经济负担经历，重点关注经济负担的驱动因素、他们使用健康保险、获得经济援助的经历以及由此产生的任何成本应对行为。使用描述性现象学方法进行主题分析，对访谈进行转录和定性分析。

结果

共有n  = 11 名 MBC 患者或护理人员代表参与了该研究。MBC 患者平均年龄为 50.2 岁（范围：28-65 岁），其中 72.7% 为非西班牙裔白人。MBC 患者在参与研究前平均 3.1 年（范围：1-9）被诊断为转移。定性分析得出四个主题，包括（1）财务负担的原因，（2）财务援助机制，（3）健康保险和财务负担，以及（4）成本应对行为。医疗和非医疗费用都增加了参与者的经济负担。所有参与者都报告了在健康保险和申请经济援助方面遇到的挑战。无论是否获得援助，几乎所有患者都面临着经济负担，并导致了成本应对行为。

结论

我们的研究结果表明，当前的健康保险和财务援助系统很复杂，难以满足患者的需求。即使 MBC 患者获得援助，过度的经济负担仍然存在，需要采取财务应对行为，例如改变药物使用、维持就业和承担债务。