Financial Burden Experiences of Black/African American Breast Cancer Survivors: A Meta-ethnography

Breast cancer is a leading cause of cancer-related morbidity and mortality and imposes substantial financial strain on individuals and society. Minoritized groups, particularly Black/African American (AA) women, face a heightened risk of financial toxicity during treatment, even after accounting for socioeconomic differences.

The aim of this study was to explore and provide meaningful interpretations of the financial experiences of Black/AA breast cancer survivors (BCSs).

We conducted a systematic search to synthesize qualitative studies, published from 2009 to 2024, on the financial experiences of Black/AA BCSs during treatment. The Meta-Ethnography Reporting Guidance was used to follow Noblit and Hare's 7 phases of meta-ethnography. Quality assessment of the studies was done using the Joanna Briggs Institute critical appraisal tool.

Five studies involving 135 participants (102 Black women), aged 28 to 80 years, were analyzed. Five themes were formed: (1) insurance/systemic gatekeeping and the conditionality of care, (2) psychological stress, (3) reduced adherence and possible missed appointments, (4) from bills to barriers, and (5) coping strategies to manage financial burden.

This review highlights substantial financial challenges faced by Black/AA BCSs, extending beyond medical expenses, affecting treatment adherence, psychological well-being, and long-term quality of life.

Oncology nurses play a critical role in reducing financial disparities by screening for financial distress, providing referrals, and delivering culturally sensitive care. Nurse and peer navigation programs, although not universally accessible, show promise in mitigating financial hardship and improving adherence and survivorship outcomes. Expanding such programs into survivorship care planning is essential to advancing equity in oncology.