Improving outcomes of patients with advanced prostate cancer through a better understanding of clinical factors contributing to financial toxicity: a qualitative study.

[PURPOSE] Patients with advanced prostate cancer (aPC) often face significant treatment-related financial hardship. Given the critical role non-physician clinicians play in helping patients access prescribed treatments, we sought to explore their perspectives on factors contributing to treatment-related financial toxicity.

[METHODS] We conducted semi-structured interviews with non-physician clinicians who care for patients with aPC. We used purposive sampling to capture diverse perspectives across practice types (academic, community), and settings (rural, urban, suburban). Participants described their perceptions and experiences regarding delivering aPC treatment, managing prior authorizations, handling insurance-related concerns, and aligning treatment preferences. We conducted content analysis with theme generation, with 30% of transcripts double coded to ensure rigor and trustworthiness in theme identification.

[RESULTS] We interviewed 20 non-physician clinicians, including social workers, financial navigators, pharmacists, and nurses. Four themes emerged from the coded interviews. First, a lack of trust and/or empowerment in patient-clinician relationships left patients lacking support to navigate financial challenges. Second, inefficient resource allocation-including financial, educational, and institutional support-intensified the financial burden on patients. Third, communication gaps between clinicians, patients, and payers hindered treatment coordination and access to assistance. Last, variability across clinical practices, patient demographics and needs, and insurance policies contributed to an unpredictable treatment environment, furthering financial distress and potential inequities in care.

[CONCLUSION] Lack of trust and empowerment, resource gaps, poor communication, and systemic variability all contribute to financial toxicity for patients with aPC. Targeted strategies to improve trust, resource allocation, and communication can better support patients with aPC in managing treatment-related financial burden.