Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle (Saale), Germany.
Support Care Cancer. 2020 Mar;28(3):1131-1139. doi: 10.1007/s00520-019-04915-w. Epub 2019 Jun 14.
The coping mechanisms employed to deal with objective financial burden following a cancer diagnosis are considered mediators of financial toxicity, specifically for the relationship between increased costs and health outcomes. Using qualitative research, the aim of the study was to explore the financial adjustments experienced by cancer patients and identify key coping mechanisms.
Semistructured interviews with 39 cancer patients (aged from 40 to 86 years) were conducted between May 2017 and April 2018 in Germany. Narratives were transcribed verbatim and analysed via qualitative content analysis.
In all, 28 participants reported that they made financial adjustments related to two major categories: (1) reducing expenditures related to basic needs, luxury needs, and health-related decisions, and (2) increasing financial resources by saving less, using savings, investing manpower, obtaining help from third parties, incurring bank debt, and making health-related decisions. Typically, cancer patients both reduced expenditures and increased financial resources, but no typical patterns of combinations of coping mechanisms could be identified. However, reducing spending on basic and luxury needs was found to occur more typically than increasing the available money through incurring bank debt, making health-related decisions, or investing manpower.
This qualitative study provides a comprehensive understanding of the complexity of the coping mechanisms used by patients to address either higher costs or changed needs and priorities following a cancer diagnosis. With regard to understanding patients' experiences of subjective financial stress, both increasing financial resources and reducing expenditures, particularly those relating to basic needs and luxury needs as distinct categories, might be relevant and should be considered. The financial situation impacts the treatment of cancer patients since health-related decisions were reported to be made with the aim of increasing financial resources by maintaining an ability to work or reducing expenditures through non-adherence.
应对癌症诊断后客观经济负担的应对机制被认为是财务毒性的中介因素，特别是对于成本增加与健康结果之间的关系。本研究采用定性研究方法，旨在探讨癌症患者所经历的财务调整，并确定关键的应对机制。
2017 年 5 月至 2018 年 4 月期间，在德国对 39 名年龄在 40 至 86 岁之间的癌症患者进行了半结构化访谈。对访谈记录进行了逐字转录，并通过定性内容分析进行了分析。
共有 28 名参与者报告说，他们进行了与两个主要类别相关的财务调整：（1）减少与基本需求、奢侈品需求和与健康相关的决策相关的支出，（2）通过减少储蓄、使用储蓄、投资人力、从第三方获得帮助、产生银行债务和做出与健康相关的决策来增加财务资源。通常，癌症患者既减少支出又增加财务资源，但无法确定典型的应对机制组合模式。然而，与通过产生银行债务、做出与健康相关的决策或投资人力来增加可用资金相比，减少基本和奢侈品需求方面的支出更为常见。
这项定性研究全面了解了患者在癌症诊断后应对更高成本或改变的需求和优先事项时所使用的应对机制的复杂性。关于理解患者主观财务压力的体验，增加财务资源和减少支出都可能是相关的，尤其是那些与基本需求和奢侈品需求作为不同类别相关的支出，应该加以考虑。财务状况影响癌症患者的治疗，因为据报道，为了增加财务资源而保持工作能力或通过不遵守规定来减少支出，会做出与健康相关的决策。
