Financial Hardship and Unhealthy Lifestyles: Perspectives and Solutions From Breast Cancer Survivors and Their Care Teams.

IntroductionFinancial hardship may undermine healthy lifestyle behaviors that are important for preventing avoidable recurrence and death during survivorship after breast cancer diagnosis. Significant research has characterized these challenges and disparities, but relatively little research has identified which strategies patients and their teams may prefer to overcome these challenges. We employ an assets lens to highlight patient-identified strategies to circumvent barriers across Social-Ecological Model (SEM) levels.MethodsWe conducted a secondary qualitative analysis of semi-structured interviews with 26 Black/Latina breast cancer survivors and 10 oncology providers recruited from a single health system (2019-2020). Transcripts (English/Spanish) were coded using deductive and inductive approaches, and these codes were subsequently organized into themes and mapped to SEM levels.ResultsSurvivors used multi-level strategies to maintain healthy behaviors while navigating financial hardship. At the individual level, women budgeted proactively, substituted canned/frozen vegetables for fresh produce, and relied on home-based exercise, often supported by emotion-focused coping. Interpersonal strategies drew on family and friends for transportation, childcare, and accountability. Community-based solutions included church-based aid, food pantries, public benefits, and transportation vouchers, frequently facilitated by social workers. Organizational solutions centered on multidisciplinary survivorship clinics that provided financial navigation, consolidated appointments, and cost-tailored lifestyle counseling. Providers corroborated these strategies and emphasized clinic-level interventions (e.g., consolidated appointment scheduling, proactive financial and nutritional screening) to reduce financial hardships.ConclusionBlack and Latina breast cancer survivors and their providers deploy pragmatic strategies across multiple SEM levels to sustain healthy behaviors under financial hardship. However, community- and organization-level solutions remain underutilized in interventions, and few trials have integrated financial navigation with lifestyle interventions. Embedding proactive financial and nutrition security screening, bilingual financial navigation, and community partnerships into lifestyle interventions and survivorship care could reduce structural barriers, improve lifestyle guideline adherence, and advance equity in cancer outcomes.