The Experience of Cancer Related Financial Hardship Among Individuals with Chronic Myeloid Leukemia in the Rural Southeast

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PROJECT SUMMARY Almost one-third of all oncology patients experience financial hardship (FH) related to their cancer care costs. People who experience FH have worse health outcomes, early mortality, increased stress, and decreased quality of life (QOL). Cancer patients living in rural areas are disproportionately affected by FH due to structural and individual level social determinants of health (SDOH) that are associated with living in a rural area, and more cancer survivors in rural areas report FH than their urban counterparts. However, little is known about the unique experience of FH for rural populations. The cost and the chronicity of Chronic Myeloid Leukemia (CML) treatment generates an ideal group to study to better understand the experience of FH. Tyrosine Kinase Inhibitors (TKIs) have incredibly extended life expectancy of CML patients, but these drugs can be extremely costly and usually are taken indefinitely. This results in risk for FH, nonadherence, and potential poor health outcomes. Further exploration of the experience of FH is needed to inform rural specific interventions to reduce the risk of FH and health inequities for this population. The purpose of this project is to explore the experience of FH for people with CML who live in rural areas of the Southeast. This project will also explore healthcare team member perceptions of the FH experience for rural CML patients. Information from both patients and healthcare team members supporting rural patients (such as nurses, pharmacists, financial navigators, and social workers) is needed to better identify current practices, gaps in care, and to inform interventions to reduce FH and health inequities for rural populations. A qualitative descriptive approach will be used to elicit deep description of experiences and perceptions. Approximately 25 participants with CML who are taking a TKI, living in a rural southeastern 4+ Rural-Urban Continuum Code county, and experiencing FH as measured by the Comprehensive Score for Financial Toxicity (COST), and approximately 10 healthcare team members who care for rural CML patients in the Southeast will be recruited. Data will be collected by semi-structured in- depth interviews. The first aim for this study is to explore the experience of FH in people with CML who live in rural areas by a) describing the impact of cancer care costs on material conditions, psychological responses, and coping behaviors related to financial hardship and b) exploring unique aspects of living in a rural area as they relate to financial hardship of cancer care. The second aim for this study is to explore healthcare staff perceptions of the FH experience for CML patients who live in rural areas by a) describing how structural and individual level risk factors impact FH for the rural CML population and b) describe strategies and resources currently available in clinical settings, areas of need to relieve FH, and recommend intervention strategies to address FH in rural areas. This study will address a gap in the literature for an at-risk population that is challenged by the costs of cancer care while providing evidence that will lead to rural specific interventions to reduce the risk of FH and improve health outcomes and QOL for rural cancer patients.