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Financial burden among metastatic breast cancer patients: a qualitative inquiry of costs, financial assistance, health insurance, and financial coping behaviors

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Abstract

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.

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Data availability

The data that support the findings of this study are available from the senior author, SBW, upon reasonable request.

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Funding

This work was supported by the National Comprehensive Cancer Network, Pfizer Independent Grants for Learning & Change, and the National Cancer Institute (3R01CA240092-03S1 and 5R01CA240092-02). Austin R. Waters is supported by the National Cancer Institute’s National Research Service Award sponsored by the Lineberger Comprehensive Cancer Center at the University of North Carolina (T32 CA116339).

Author information

Authors and Affiliations

  1. Gillings School of Global Public Health, Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Austin R. Waters, Arrianna Marie Planey, Lisa P. Spees & Stephanie B. Wheeler

  2. Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Austin R. Waters, Victoria M. Petermann, Michelle Manning, Lisa P. Spees, Donald L. Rosenstein, Mindy Gellin, Neda Padilla, Katherine E. Reeder-Hayes & Stephanie B. Wheeler

  3. University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC, USA

    Victoria M. Petermann

  4. Dell Medical School, University of Texas at Austin, Austin, TX, USA

    Jennifer C. Spencer

  5. School of Medicine, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Donald L. Rosenstein

  6. School of Medicine, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Donald L. Rosenstein

  7. Division of Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Katherine E. Reeder-Hayes

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  1. Austin R. Waters
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Contributions

Conception and design: SBW, DLR, JCS, CBB, LPS, MG, NP, CASR, and KRH; Financial support: DLR, SBW; Administrative support: MM, MLG, NP; Collection and assembly of data: MM, JCS, MG, and NP; Data analysis and interpretation: ARW, VMP, AMP, and CBB; Manuscript writing: ARW, VMP, AMP, MM, JCS, CBB, LPS, DLR, MG, NP, CASR, KRH, SBW.

Corresponding author

Correspondence to Austin R. Waters.

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Competing interest

The authors declare no competing interests.

Ethical approval

All study procedures were approved by the University of North Carolina at Chapel Hill Institutional Review Board (IRB#16-0783 and 20-1997).

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Waters, A.R., Petermann, V.M., Planey, A.M. et al. Financial burden among metastatic breast cancer patients: a qualitative inquiry of costs, financial assistance, health insurance, and financial coping behaviors. Cancer Causes Control (2024). https://doi.org/10.1007/s10552-024-01854-8

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  • DOI: https://doi.org/10.1007/s10552-024-01854-8

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