Cancer Care Teams Confront the Hidden Financial Costs That Push Survivors Into Debt

When a person finishes cancer treatment, the medical bills are only part of the story. A new qualitative study from Indonesia’s national cancer hospital reveals that the financial damage inflicted by cancer extends far beyond the cost of chemotherapy drugs or radiotherapy sessions. Transportation to the hospital, accommodation near treatment centers, food expenses during long stays, and the loss of family income when a breadwinner can no longer work all combine to create what researchers call financial toxicity, a burden that can be as corrosive to a survivor’s wellbeing as any physical side effect. The study, published in BMC Health Services Research, offers a rare inside view of how the professionals who manage cancer survivorship care experience and struggle with this challenge.

Financial toxicity is a term that has gained traction in oncology over the past decade, describing the cumulative financial hardship that cancer diagnosis and treatment impose on patients and families. It encompasses out-of-pocket costs, income loss, and debt, and it has been linked to treatment non-adherence, reduced quality of life, and even higher mortality. While most research has focused on measuring the problem from the patient’s perspective, the new study flips the lens, asking the clinicians, administrators, and support staff who deliver care how they identify, manage, and navigate this burden in daily practice.

The research team, led by Yati Afiyanti of Universitas Indonesia with collaborators from Universitas Ichsan Satya, the Chinese University of Hong Kong, Universitas Airlangga, and Taipei Medical University, grounded their investigation in Heidegger’s hermeneutic phenomenology, a qualitative tradition that seeks to understand lived experience through interpretation rather than measurement. Fifteen multidisciplinary professionals took part, including oncology nurses, oncologists, nutritionists, cancer navigators, social workers, health insurance officers, and nurse managers. Participants were recruited through purposive sampling to capture the range of roles involved in survivorship care at the national cancer hospital.

Data collection ran from June to November 2024 and combined two focus group discussions with four semi-structured interviews, followed by four additional confirmatory interviews to test emerging findings. The researchers analyzed the material using Heideggerian hermeneutic analysis, a method that involves repeated readings of transcripts to uncover the meanings, assumptions, and contextual forces embedded in participants’ accounts. The study received ethics approval from the Dharmais National Cancer Hospital ethics committee and was conducted in line with the Declaration of Helsinki, with informed consent obtained from all participants.

What emerged was a picture of financial toxicity as a system-driven, multidimensional problem rather than a simple consequence of expensive treatment. Participants described the burden as arising not only from treatment-related costs but also from transportation, accommodation, and food expenses, family income loss, inefficient referral pathways, and limited institutional coordination. In a health system where patients may travel long distances for specialized care and referral chains can be slow and convoluted, every stage of the cancer journey adds financial friction that clinicians see accumulating in real time.

Five interrelated themes crystallized from the analysis. The first was a pervasive feeling of being unprepared for non-medical and extra treatment-related expenses, costs that fall outside the clinical gaze and therefore outside routine screening. The second concerned system-level barriers within health insurance and referral pathways, where bureaucratic complexity and coverage gaps leave patients exposed. The third highlighted multidisciplinary team dynamics and role ambiguity, with professionals uncertain about who bears responsibility for detecting and addressing financial hardship. The fourth pointed to institutional infrastructure and programmatic gaps, including the absence of formal financial navigation programs. The fifth described a heavy reliance on external and informal support systems, such as charity and family networks, to fill the void left by fragmented institutional support.

Participants were strikingly candid about the insufficiency of existing supports, which they described as fragmented, reactive, and inadequate to address patients’ needs comprehensively. Rather than proactive screening for financial distress, help tends to arrive only after a crisis has already materialized, when a patient has sold assets, dropped out of treatment, or fallen into severe debt. This reactive posture, the study suggests, is itself a product of structural barriers and the lack of coordination between sectors, meaning that even well-intentioned professionals operate within a system that makes early identification of financial toxicity exceptionally difficult.

The role ambiguity theme carries particular technical weight for health services research. In multidisciplinary cancer care, tasks are distributed across professions, but financial toxicity management has no clearly assigned owner. Oncologists focus on treatment, nurses on symptom management, social workers on psychosocial support, and insurance officers on coverage administration. Without a designated navigator or a formal screening protocol, financial distress can slip through the cracks between these roles, surfacing only when a patient volunteers the information or when the consequences become clinically visible. The study’s findings align with a growing international consensus that financial navigation, in which trained personnel proactively assess costs, connect patients to assistance, and coordinate benefits, should be embedded as a formal component of survivorship care.

The authors conclude that reducing financial hardship among cancer survivors requires strengthening early screening and identification, establishing formal navigation pathways, fostering genuine multidisciplinary collaboration, and building intersectoral partnerships that reach beyond the hospital walls. These recommendations are especially relevant for low- and middle-income countries, where out-of-pocket spending dominates health financing and social safety nets are thinner, but they resonate in any system where survivorship care has not yet caught up with the financial realities of modern cancer treatment. As cancer survival rates improve worldwide, the study argues, the profession’s duty to protect survivors from financial ruin must evolve from informal goodwill into structured, accountable, and coordinated care.

Subject of Research: Financial toxicity management in cancer survivorship care from multidisciplinary professional perspectives

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

Article References: Afiyanti, Y., Juliastuti, D., So, W. K. W., Xiao, S., Prawesti, A. D., Kurniawati, P., & Arifin, H. (2026). Multidisciplinary perspectives on financial toxicity management in cancer survivorship care: an interpretive phenomenological study. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15670-0

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15670-0

Keywords: financial toxicity, cancer survivorship, multidisciplinary care, financial navigation, hermeneutic phenomenology, qualitative research, health services research, oncology nursing, referral pathways, health insurance, Indonesia, BMC Health Services Research