Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Eileen K. Fry-Bowers, PhD, JD, RN, CPNP, FAAN, Chairperson; Kathleen M Stacy, PhD, RN, APRN-CNS, Committee Member; Alison Sanchez, PhD, Committee Member


Cancer, Oncology, distress, clinical nursing care, financial toxicity, financial burden, adherence to treatment


Purpose/Aims: For adult participants who have received or are receiving treatment for hematologic and solid tumor malignancies given orally, this study describes the relationship between participants’ experience of financial toxicity (FT), the participants’ perception of distress associated with FT, and participants’ self-identified adherence to prescribed treatments in the context of FT.

Background: FT has emerged as an additional source of distress for cancer patients. The costs of treatments given orally can be prohibitively expensive for patients. Therefore, these patients may experience considerable distress and may not adhere to treatments as prescribed.

Method: Descriptive cross-sectional correlational design study of a sample of adult cancer patients treated with therapy given orally. Study data was analyzed using descriptive and bivariate correlation statistics.

Findings: Data from 136 participants included participant perceptions of FT, distress and adherence at seven days and six months post start of treatment. At both timepoints, patients had moderate scores for FT, according to COST instrument data. At both timepoints for distress, 39-42% of patients had high distress scores related to FT. There was no correlation between FT and distress. Responding to specific COST instrument questions, 80% or participants responded that they feel they have no choice about the cost of care. At seven days post start of treatment, 67.1% of patients reported that OOP expenses were higher than anticipated. At six months post start of treatment 59.4% of patients reported that OOP expenses were higher than anticipated. Most correlations among variables were weak with the exception of a strong correlation between help from pharmaceutical companies/foundations and percentage of financial help from those funding sources (r = .869, p =

Implications for Nursing: Despite this sample data showing minimal statistically significant correlations, FT has clinical significance. Nurses can mitigate the impact of FT on patients and caregivers by including FT assessment as a component of clinical assessment, referring patients to healthcare FT experts and resources and providing patients and families with support to alleviate FT as a patient stress.

Document Type

Dissertation: Open Access