Financial toxicity among cancer survivors: a conceptual model based on a feedback perspective

Experiencing financial toxicity following a cancer diagnosis is a circular and complex process. We investigate the circular causal mechanisms that either reinforce or balance financial toxicity dynamics.

We conducted a literature review, expert interviews, a participatory modeling process, and exploratory interviews with N = 11 adults with cancer living in Switzerland. We sampled participants purposively based on health-related and sociodemographic characteristics.

We describe a conceptual model based on the triangulation of cancer survivor narratives, expert perspectives, and a literature review. This model distinguishes between the reinforcing and balancing feedback loops that drive the dynamics of financial toxicity. It includes the topics "Coping with cancer and employment," "Coping with limited economic resources," and "Maintaining care resources while facing economic pressure." For each topic, we identify a necessary condition for cancer survivors to avoid reinforcing financial toxicity.

The results allow us to reconstruct participant narratives regarding cancer-related financial toxicity. Based on comparison with scientific literature from Western Europe and North America, we hypothesize the validity of the model beyond the population covered by the sample. The results highlight the importance of screening for the risk of financial toxicity in the clinical context and individual risk and resource assessment in social counseling.

These results can raise cancer survivors' awareness of risks related to financial toxicity and strengthen their resources for coping with financial burden successfully.