Background: The financial impacts of cancer are recognised as a growing problem; however, the unique financial challenges of those with a metastatic diagnosis are less understood.
Aim: To explore the experiences of financial toxicity in women living with metastatic breast cancer (MBC) and the elements contributing to financial hardship.
Methods: In-depth, semi-structured interviews with women living with MBC in Australia (n=38). Participants were interviewed up to three times over a 12-month period (August 2017-January 2020). Data relating to the financial impacts of their MBC diagnosis were identified and analysed using thematic analysis.
Results: MBC is associated with unique financial pressures and challenges owing to its incurability and the need for lifelong treatment. Many participants expressed deep-rooted anxiety in planning and managing their finances due to prognostic uncertainty. An MBC diagnosis resulted in some individuals facing periods of significant financial hardship. Several factors were identified that contributed to financial precarity. First, receiving care through the private healthcare system, a decision that was not always fully informed in terms of cost implications and one that appeared hard for participants to reverse owing to concerns (often unfounded) about public sector care. Second, poor employer understanding of metastatic cancer meant appropriate accommodations such as reduced or flexible hours or role changes were often not available. Third, for some, the need to access drugs that were not subsidised by the government and their limited knowledge (and that of their care team) of the systems that could provide affordable drug access (e.g. pharmaceutical compassionate access schemes; clinical trials). And finally, a social security system that is poorly adapted to the needs of those with metastatic cancer.
Conclusion: The lifelong treatment and prognostic uncertainty associated with MBC can lead to increased financial pressures. Financial support tools attuned to the multidimensional complexities of MBC are urgently needed.