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Coping mechanisms for financial toxicity: a qualitative study of cancer patients’ experiences in Germany

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Abstract

Purpose

The coping mechanisms employed to deal with objective financial burden following a cancer diagnosis are considered mediators of financial toxicity, specifically for the relationship between increased costs and health outcomes. Using qualitative research, the aim of the study was to explore the financial adjustments experienced by cancer patients and identify key coping mechanisms.

Methods

Semistructured interviews with 39 cancer patients (aged from 40 to 86 years) were conducted between May 2017 and April 2018 in Germany. Narratives were transcribed verbatim and analysed via qualitative content analysis.

Results

In all, 28 participants reported that they made financial adjustments related to two major categories: (1) reducing expenditures related to basic needs, luxury needs, and health-related decisions, and (2) increasing financial resources by saving less, using savings, investing manpower, obtaining help from third parties, incurring bank debt, and making health-related decisions. Typically, cancer patients both reduced expenditures and increased financial resources, but no typical patterns of combinations of coping mechanisms could be identified. However, reducing spending on basic and luxury needs was found to occur more typically than increasing the available money through incurring bank debt, making health-related decisions, or investing manpower.

Conclusions

This qualitative study provides a comprehensive understanding of the complexity of the coping mechanisms used by patients to address either higher costs or changed needs and priorities following a cancer diagnosis. With regard to understanding patients’ experiences of subjective financial stress, both increasing financial resources and reducing expenditures, particularly those relating to basic needs and luxury needs as distinct categories, might be relevant and should be considered. The financial situation impacts the treatment of cancer patients since health-related decisions were reported to be made with the aim of increasing financial resources by maintaining an ability to work or reducing expenditures through non-adherence.

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References

  1. Carrera PM, Kantarjian HM, Blinder VS (2018) The financial burden and distress of patients with cancer. CA Cancer J Clin 68(2):153–165. https://doi.org/10.3322/caac.21443

    Article  PubMed  PubMed Central  Google Scholar 

  2. Gordon LG, Merollini KMD, Lowe A, Chan RJ (2017) A systematic review of financial toxicity among cancer survivors. Patient 10(3):295–309. https://doi.org/10.1007/s40271-016-0204-x

    Article  PubMed  Google Scholar 

  3. Azzani M, Roslani AC, Su TT (2015) The perceived cancer-related financial hardship among patients and their families: a systematic review. Support Care Cancer 23(3):889–898. https://doi.org/10.1007/s00520-014-2474-y

    Article  PubMed  Google Scholar 

  4. Kale HP, Carroll NV (2016) Self-reported financial burden of cancer care and its effect on physical and mental health-related quality of life among US cancer survivors. Cancer 122(8):283–289. https://doi.org/10.1002/cncr.29808

    Article  PubMed  Google Scholar 

  5. Ramsey SD, Bansal A, Fedorenko CR, Blough DK, Overstreet KA, Shankaran V, Newcomb P (2016) Financial insolvency as a risk factor for early mortality among patients with cancer. J Clin Oncol 34(9):980–986. https://doi.org/10.1200/JCO.2015.64.6620

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Banegas MP, Dickerson JF, Kent EE, de Moor JS, Virgo KS, Guy GP, Ekwueme DU, Zheng Z, Nutt S, Pace L, Varga A, Waiwaiole L, Schneider J, Robin Yabroff K (2018) Exploring barriers to the receipt of necessary medical care among cancer survivors under age 65 years. J Cancer Surviv 12(1):28–37. https://doi.org/10.1007/s11764-017-0640-1

    Article  PubMed  Google Scholar 

  7. Yabroff KR, Dowling EC, Guy GP Jr et al (2016) Financial hardship associated with cancer in the United States: findings from a population-based sample of adult cancer survivors. J Clin Oncol 34(3):259–267. https://doi.org/10.1200/JCO.2015.62.0468

    Article  PubMed  Google Scholar 

  8. Shankaran V, Jolly S, Blough D, Ramsey SD (2012) Risk factors for financial hardship in patients receiving adjuvant chemotherapy for colon cancer: a population-based exploratory analysis. J Clin Oncol 30(14):1608–1614. https://doi.org/10.1200/JCO.2011.37.9511

    Article  PubMed  Google Scholar 

  9. Whitney RL, Bell JF, Reed SC, Lash R, Bold RJ, Kim KK, Davis A, Copenhaver D, Joseph JG (2016) Predictors of financial difficulties and work modifications among cancer survivors in the United States. J Cancer Surviv 10(2):241–250. https://doi.org/10.1007/s11764-015-0470-y

    Article  PubMed  Google Scholar 

  10. Regenbogen SE, Veenstra CM, Hawley ST, Banerjee M, Ward KC, Kato I, Morris AM (2014) The personal financial burden of complications after colorectal cancer surgery. Cancer 120(19):3074–3081. https://doi.org/10.1002/cncr.28812

    Article  PubMed  Google Scholar 

  11. Zafar SY, Peppercorn JM, Schrag D, Taylor DH, Goetzinger AM, Zhong X, Abernethy AP (2013) The financial toxicity of cancer treatment: a pilot study assessing out-of-pocket expenses and the insured cancer patient’s experience. Oncologist 18(4):381–390. https://doi.org/10.1634/theoncologist.2012-0279

    Article  PubMed  PubMed Central  Google Scholar 

  12. Nipp RD, Zullig LL, Samsa G, Peppercorn JM, Schrag D, Taylor DH Jr, Abernethy AP, Zafar SY (2016) Identifying cancer patients who alter care or lifestyle due to treatment-related financial distress. Psycho-oncology 25(6):719–725. https://doi.org/10.1002/pon.3911

    Article  PubMed  Google Scholar 

  13. Altice CK, Banegas MP, Tucker-Seeley RD, Yabroff KR (2017) Financial hardships experienced by cancer survivors. J Natl Cancer Inst 109(2):djw205. https://doi.org/10.1093/jnci/djw205

    Article  PubMed  Google Scholar 

  14. Timmons A, Gooberman-Hill R, Sharp L (2013) “It’s at a time in your life when you are most vulnerable”: a qualitative exploration of the financial impact of a cancer diagnosis and implications for financial protection in health. PLoS One 8(11):e77549. https://doi.org/10.1371/journal.pone.0077549

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Amir Z, Wilson K, Hennings J, Young A (2012) The meaning of cancer: implications for family finances and consequent impact on lifestyle, activities, roles and relationships. Psychooncology 21(11):1167–1174. https://doi.org/10.1002/pon.2021

    Article  PubMed  Google Scholar 

  16. Bradley S, Sherwood PR, Donovan HS, Hamilton R, Rosenzweig M, Hricik A, Newberry A, Bender C (2007) I could lose everything: understanding the cost of a brain tumor. J Neuro-Oncol 85(3):329–338. https://doi.org/10.1007/s11060-007-9425-0

    Article  Google Scholar 

  17. Head B, Harris L, Kayser K, Martin A, Smith L (2018) As if the disease was not enough. Support Care Cancer 26(3):975–987. https://doi.org/10.1007/s00520-017-3918-y

    Article  PubMed  Google Scholar 

  18. Büttner M, König H-H, Löbner M, Briest S, Konnopka A, Dietz A, Riedel-Heller S, Singer S (2018) Out-of-pocket-payments and the financial burden of 502 cancer patients of working age in Germany. Support Care Cancer 27:2221–2228. https://doi.org/10.1007/s00520-018-4498-1

    Article  PubMed  Google Scholar 

  19. Barbaret C, Brosse C, Rhondali W, Ruer M, Monsarrat L, Michaud P, Schott AM, Delgado-Guay M, Bruera E, Sanchez S, Filbet M (2017) Financial distress in patients with advanced cancer. PLoS One 12(5):e0176470. https://doi.org/10.1371/journal.pone.0176470

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Schreier M (2012) Qualitative content analysis in practice, 1st edn. Sage, Los Angeles

    Google Scholar 

  21. Moffatt S, Noble E, Exley C (2010) “Done more for me in a fortnight than anybody done in all me life.” How welfare rights advice can help people with cancer. BMC Health Serv Res 10:259. https://doi.org/10.1186/1472-6963-10-259

    Article  PubMed  PubMed Central  Google Scholar 

  22. Céilleachair AÓ, Costello L, Finn C et al (2012) Inter-relationships between the economic and emotional consequences of colorectal cancer for patients and their families: a qualitative study. BMC Gastroenterol 12:62. https://doi.org/10.1186/1471-230X-12-62

    Article  PubMed  Google Scholar 

  23. McGrath P (2015) Informal financial assistance for patients with a hematological malignancy: implications for oncology social work practice. Soc Work Health Care 54(10):892–908. https://doi.org/10.1080/00981389.2015.1061088

    Article  PubMed  Google Scholar 

  24. McNulty J, Khera N (2015) Financial hardship—an unwanted consequence of cancer treatment. Curr Hematol Malig Rep 10(3):205–212. https://doi.org/10.1007/s11899-015-0266-1

    Article  PubMed  Google Scholar 

  25. Timmons A, Gooberman-Hill R, Sharp L (2013) The multidimensional nature of the financial and economic burden of a cancer diagnosis on patients and their families: qualitative findings from a country with a mixed public-private healthcare system. Support Care Cancer 21(1):107–117. https://doi.org/10.1007/s00520-012-1498-4

    Article  PubMed  Google Scholar 

  26. Lazarus RS (1999) Stress and emotion. A new synthesis. Free Assoc. Books, London

    Google Scholar 

  27. Longo CJ, Fitch M, Grignon M, McAndrew A (2016) Understanding the full breadth of cancer-related patient costs in Ontario: a qualitative exploration. Support Care Cancer 24(11):4541–4548. https://doi.org/10.1007/s00520-016-3293-0

    Article  PubMed  Google Scholar 

  28. Goldstein DA (2017) Financial toxicity in cancer care-edging toward solutions. Cancer 123(8):1301–1302. https://doi.org/10.1002/cncr.30555

    Article  PubMed  Google Scholar 

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Acknowledgements

We thank the patients who participated in this study and shared their experiences regarding this personal topic with us. For their assistance with recruiting patients for this study, we acknowledge scientific assistants Julia Faltus and Johannes Niebuhr and our cooperation partners within the outpatient departments and doctors’ practices. We thank Jürgen Walther and Marie Rösler from the German Cancer Society and Sven Weise from the Cancer Society of Saxony-Anhalt for their topical discussions on and insights into the issue of financial toxicity from the viewpoint of social counselling.

Funding

We thank the German Cancer Aid for financing the study (grant number 70112452).

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Authors and Affiliations

  1. Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle (Saale), Germany

    Sara Lena Schröder, Nadine Schumann, Astrid Fink & Matthias Richter

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  1. Sara Lena Schröder
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  2. Nadine Schumann
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Correspondence to Sara Lena Schröder.

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Informed consent was obtained from all individual participants included in the study.

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Schröder, S.L., Schumann, N., Fink, A. et al. Coping mechanisms for financial toxicity: a qualitative study of cancer patients’ experiences in Germany. Support Care Cancer 28, 1131–1139 (2020). https://doi.org/10.1007/s00520-019-04915-w

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