Cancer-related financial toxicity among Latinas with breast cancer in a rural area of the United States: a qualitative study.
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BACKGROUND: Financial toxicity, or the adverse impact of cancer diagnoses on survivors' financial well-being, is an increasing global concern. In the United States, it is disproportionately high among racial/ethnic minorities. Latina breast cancer patients encounter greater financial burdens than their non-Latina White counterparts, which can lead to discontinuation of medical treatment, poor quality of life, or early mortality. In particular, cancer patients in rural regions are at a greater risk for financial toxicity due to a lack of resources and structural barriers. Despite its magnitude, financial toxicity among Latina breast cancer patients who reside in rural areas is understudied. This study aims to fill this gap by exploring financial toxicity from the perspectives of Latina breast cancer patients, family members, and healthcare professionals. METHODS: This qualitative, cross-sectional study aimed to address this gap in the literature through in-depth interviews with 47 participants, including Latina breast cancer patients (n = 21), their family members/caregivers (n = 14), and healthcare professionals (n = 12), all from a rural agricultural region, with a focus on contributing factors and impacts of financial toxicity. Qualitative data were analyzed using a thematic analysis approach. Demographic data were analyzed using descriptive statistics. RESULTS: The main themes relating to contributions to changes in patient financial situations included (1) employment disruption (e.g., reduced working hours and quitting the job) post breast cancer diagnosis, and (2) medical-related (out-of-pocket costs, co-payment) and non-medical related financial costs (transportation, childcare). The impacts of financial toxicity were multi-faceted. Patients struggled to meet basic needs (e.g., food, paying bills) and experienced psychological distress. Coordinating patient support care (e.g., transportation, caretaking) to accommodate their financial needs negatively impacted their families' work schedules and routines. It also affected family relationships, leading to family conflicts, including marital conflict, as well as patients' continuum of cancer care. CONCLUSIONS: Financial toxicity encountered by rural Latina breast cancer patients is complex, and its adverse effects are multifaceted. Culturally appropriate interventions targeting patients and families to address their personal, psychological, and familial issues related to financial toxicity are needed.