Treatment-related adverse events as a source of financial hardship in young adults with breast cancer: a qualitative study.

Purpose: Rates of breast cancer are increasing among young adult (YA) women aged ≤ 40 years. YAs face unique challenges, including being at high risk for financial hardship. Treatment-related adverse events may represent a modifiable and often overlooked source of financial hardship. In this interview-based study, the narratives of YAs with breast cancer were analyzed to understand how treatment-related adverse events contributed to medical and non-medical costs and long-term economic burden.

Methods: In this secondary analysis of semi-structured interviews characterizing financial toxicity among adult women with stage I-IV breast cancer treated at The Ohio State University Comprehensive Cancer Center (OSUCCC) between 1/1/2015 and 12/31/2019, previously transcribed and coded data from women ≤ 40 years old was analyzed using inductive and deductive approaches.

Results: Twenty breast cancer survivors aged ≤ 40 years participated. Treatment-related adverse events emerged as an important factor contributing to financial toxicity. Participants described complications in nearly every organ system, many of which were disabling and required intervention. While indirect (e.g., job loss, reduced work hours) and direct sources (e.g., compression garments for lymphedema) of costs were noted to cause psychological distress and impact treatment adherence, participants did articulate possible solutions for reducing financial hardship (e.g., direct cash transfer, financial navigation).

Conclusion: Treatment-related adverse events can contribute to financial toxicity after breast cancer through direct and indirect costs. Among young adults, indirect costs can include those that result from vocational disruption. Strategies to reduce the risk of financial toxicity should be included in care pathways to address complications of treatment itself.