Multidisciplinary perspectives on financial toxicity management in cancer survivorship care: an interpretive phenomenological study

Abstract

To explore multidisciplinary professionals’ experiences in identifying, managing, and navigating financial toxicity among cancer survivors. A qualitative study grounded in Heidegger’s hermeneutic phenomenological approach was conducted at national cancer hospital in Indonesia. Fifteen multidisciplinary professionals (oncology nurses, oncologists, nutritionists, cancer navigators, social workers, health insurance officers, and nurse managers) were recruited using purposive sampling. Data were collected from June to November 2024 through two focus group discussions and four semi-structured interviews. Four follow-up interviews were conducted to confirm emerging findings. Data were analyzed using Heideggerian hermeneutic analysis. Participants described financial toxicity as a multifaceted challenge arising not only from treatment-related costs, but also from transportation, accommodation, food expenses, family income loss, inefficient referral pathways, and limited institutional coordination. Existing supports were described as fragmented, reactive, and insufficient to address patients’ needs comprehensively. Five interrelated themes were identified: (1) feeling unprepared for non-medical and extra treatment-related expenses; (2) system-level barriers within health insurance and referral pathways; (3) multidisciplinary team dynamic and role ambiguity; (4) institutional infrastructure and programmatic gaps; and (5) reliance on external and informal support systems. Financial toxicity in cancer survivorship care is a multidimensional, system-driven challenge influenced by structural barriers and lack of coordination. Strengthening early screening and identification, formal navigation pathways, multidisciplinary collaboration, and intersectoral partnerships is essential to reduce financial hardship and improve continuity of care among this vulnerable population.