The financial impacts of cancer have been widely reported, with landmark studies demonstrating how objective and subjective financial distress affect patients’ adherence to treatment and survival. Identifying the exact mechanisms linking these together has been hard, especially given the complexities in how finances intersect with other social determinants of health. Racism, stagnant income growth, housing shortages, and a web of social factors all compound the impacts of cancer.
In a new study, published in Cancer Nursing, Anita F. Oppong, MSN, BSc, from the University of Connecticut School of Nursing, performed a meta-ethnography to synthesize qualitative studies describing financial issues patients with breast cancer experience. This study identified five qualitative studies that described the financial issues of 135 patients (including 102 Black/African American women) with breast cancer. They used a robust methodology to consider both the quotations listed in each study and re-examine the original interpretations for the purpose of merging findings. After they completed this richer analysis, they summarized six major ways finances impacted patients’ cancer care.
- How insurance seemed like systematic gatekeeping. Patients reported feeling like the type of cancer care they received was conditional based on their insurance. Even with insurance, large out-of-pocket costs and managing bills caused significant stress. Often, patients did not meet the financial requirements for certain aid, leaving them still vulnerable but unable to access resources.
- Psychologic stress. Fear of losing jobs, feeling alone and lost, and an overwhelming sense of stress were common across studies.
- Reduced adherence and missed appointments. Patients had to prioritize their needs, sometimes opting not to fill prescriptions or attend appointments due to the costs associated with each.
- Bills creating barriers. Patients had to balance cutting work hours with the reduced wages and impacts on health insurance. This pressure sometimes required patients to sell their homes, take on additional work for pay, or apply for disability.
- Future barriers. Patients often made decisions to manage their finances that impacted their financial future, including downsizing their lifestyle and not pursuing opportunities that required them to invest money. Patients’ credit scores often dipped due to debt and other financial changes, causing long-lasting changes to the patients’ financial future.
- Coping strategies. Patients often became resourceful, finding community and family strategies to offset bills, directly contacting pharmaceutical companies, and taking advantage of navigators or peer support.