Financial Toxicity Among Chinese Cancer Families: A Qualitative Exploration of Multilevel Determinants and Public Health Implications

Purpose This study was designed to explore the experiences of financial toxicity (FT) among families of cancer survivors and the coping strategies they employ. Methods Adhering to the Consolidated Criteria for Reporting Qualitative Research (COREQ), we conducted one-on-one semi-structured interviews with cancer survivors and their family members. After transcription, the data were analyzed using direct content analysis. Results A total of 22 interviews were completed, involving 11 patients and 11 caregivers. The analysis yielded three primary thematic categories: (1) the experienced financial burden, (2) financial coping strategies, and (3) addressing the needs and expectations regarding financial toxicity. Regarding the financial burden, three subcategories emerged: (a) undertaking multifaceted living pressures, (b) employment disruption, and (c) underinsurance and out-of-pocket non-healthcare cancer-related costs. The financial coping strategies theme encompassed (a) reallocating household budgets, (b) seeking external financial support, (c) rationalizing treatment decisions, (d) applying for outpatient special disease benefits, (e) participating in clinical trials, and (f) returning to work. The third thematic category included (a) incorporating out-of-pocket expenses into medical insurance reimbursement and (b) extending discharge medication cycles. Conclusions Financial toxicity significantly impacts the families of cancer survivors, affecting their physical and mental well-being and prompting the implementation of various coping strategies. The Chinese government should expand the scope of health insurance coverage and enhance the fairness of healthcare policies. Healthcare professionals must actively monitor financial toxicity in these patients, strengthening health education and considering their needs and preferences. A multifaceted approach is essential to mitigate the impact of financial toxicity on the families of cancer survivors.