Background: As cancer treatments become more complex, financial toxicity has emerged. This term encompasses direct and indirect costs to patients and their families from cancer diagnosis to treatment.1 Our group’s recent study of public Australian cancer patients showed a substantial proportion experienced financial toxicity and an associated poorer quality of life.2 A better understanding is needed of the source of financial toxicity to allow identification of interventions.
Objective: To undertake a comprehensive, exploratory study to understand the source and impact of financial toxicity in Australian public patients receiving anti-cancer therapy in public hospitals. Specifically, to explore the spectrum of out-of-pocket costs, restrictions on non-health related expenditures, impact of return to work and compliance with treatment.
Method: Cross-sectional, qualitative study. Semi-structured telephone interviews of patients purposively sampled to demonstrate financial toxicity (COST questionnaire score ≥ 18).2 Interviews were audio-recorded, transcribed, coded using NVivo3 and inductively thematically analysed.
Results: Twelve patients were interviewed when data saturation was reached. Average age of 54.8 years, 66.7% women. Three key themes: (1) increased cancer-related out-of-pocket costs including cost of diagnostic imaging, General Practitioner and specialist follow-up, treatment-related complications such as lymphoedema, parking and personal expenses (2) reduction in financial resources from loss of employment opportunities and productivity and (3) mitigation strategies including restrictions on non-health related expenditures such as luxuries and travel, access to sickness benefits and use of savings.
Conclusion: Cancer patients treated in a universal health care setting face a significant burden of unexpected out-of-pocket costs related to their diagnosis and therapy. These arise from multiple sources including diagnostic tests, medications, treatment complications, travel and income loss. Measures are needed to increase awareness and facilitate access to strategies that mitigate financial toxicity. This has implications on adherence to treatment, psychosocial wellbeing and provision of holistic care to cancer patients and their families.