AccScience Publishing / HPR / Online First / DOI: 10.36922/hpr.0477
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RESEARCH ARTICLE

Financial toxicity among public oncology patients in Australia: A qualitative analysis

Luke S. McLean1,2,3 ,  Thivagar Yogaparan1 ,  Sue-Anne McLachlan1,2*
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1 Department of Medical Oncology, St. Vincent’s Hospital, Fitzroy, Victoria, Australia
2 SVHM Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
3 Department of Medical Oncology, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
HPR, 0477 https://doi.org/10.36922/hpr.0477
Received: 7 January 2026 | Revised: 25 March 2026 | Accepted: 26 March 2026 | Published online: 16 June 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

Background

As cancer treatments become more complex, financial toxicity—encompassing direct and indirect costs to patients and families—has emerged as a significant issue. In our recent study of public patients with cancer in Australia, we found that a substantial proportion experienced financial toxicity, which was associated with poorer quality of life. A deeper understanding of its sources is needed to inform interventions.

Objective

This study explored the spectrum of costs, restrictions on spending, impact on work, and treatment adherence among public patients receiving anti-cancer therapy.

Methods

A cross-sectional qualitative study was conducted using semi-structured telephone interviews with patients purposively sampled from those with the highest levels of financial toxicity, based on Comprehensive Score for Financial Toxicity questionnaire scores. Interviews were audio-recorded, transcribed, coded in NVivo, and analyzed using inductive thematic analysis.

Results

Twelve patients were interviewed; data saturation was reached at the 12th interview (median age = 52.7 years; 66.7% women). Three key themes emerged: (i) increased cancer-related out-of-pocket costs, including diagnostic imaging, general practitioner and specialist follow-up, treatment complications (e.g., lymphedema), parking, and personal expenses; (ii) reduced financial resources from lost employment and productivity; and (iii) mitigation strategies, such as restricting non-health expenditures (e.g., luxuries, travel), accessing sickness benefits, and drawing on savings.

Conclusion

Even within a universal healthcare system, patients with cancer face significant, unexpected out-of-pocket costs from diagnostic tests, medications, treatment complications, travel, and income loss. Participant narratives suggest that these financial pressures may influence treatment adherence, psychosocial well-being, and holistic care. Greater awareness and improved access to mitigating strategies are needed to reduce financial toxicity and its impact on patients and families.

Keywords
Financial toxicity
Comprehensive Score for Financial Toxicity
Cancer
Public health
Interviews
Funding
Luke S. McLean received financial support through the James Best Research Fellowship at the University of Melbourne.
Conflict of interest
The authors declare no conflicts of interest.
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