# “You're really walking along the razor's edge”: A meta-synthesis on the existential cost of breast cancer related to financial toxicity

## TL;DR

This study explores how breast cancer survivors experience financial stress and identifies ways to improve communication and support.

## Contribution

The paper introduces an interpretative model of cancer-related financial toxicity and highlights gaps in European research.

## Key findings

- An interpretative model of cancer-related financial toxicity was developed based on 32 qualitative studies.
- Five key themes emerged, including the existential cost of cancer and the impact of insurance complexity.
- The study emphasizes the need for tailored information and economic navigators for breast cancer patients.

## Abstract

Cancer-related financial toxicity (FT) is a challenge of living with and beyond breast cancer (BC). A systematic review and meta-synthesis was conducted to report the experience of individuals with BC regarding cancer-related FT. Data were searched in MEDLINE, Embase, Cinahl, Scopus, PsycINFO, and Web of Science from inception. Eligibility was restricted to original qualitative studies. We performed a meta-synthesis by generating interpretative themes and a model of cancer-related FT. Thirty-two studies were included, encompassing 1080 individuals with BC. Of these studies, 17 were conducted in North America (719 individuals), nine in South, East, and West Asia (238 individuals), two in Oceania (53 individuals), and four in Northwest Africa (70 individuals). Five themes were identified: (i) the existential cost of cancer, (ii) the impact of insurance complexity, (iii) the need for timely and accessible information, (iv) seeking possible help, (v) negotiating daily life. The review highlights the lack of original qualitative studies conducted in Europe. Socioeconomic status, insurance, and employment amplify inequalities and shape the experience of FT. The interpretative model could support individuals with BC and providers’ communication.

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•Individuals with breast cancer experience cancer-related financial toxicity.•We provided an interpretative model to describe their experiences.•This model improves communication between patients and professionals.•Tailored information and a navigator of economic aspects are patients' needs.•Primary qualitative studies across European countries are needed.

Individuals with breast cancer experience cancer-related financial toxicity.

We provided an interpretative model to describe their experiences.

This model improves communication between patients and professionals.

Tailored information and a navigator of economic aspects are patients' needs.

Primary qualitative studies across European countries are needed.