title: The multidimensional nature of the financial and economic burden of a cancer diagnosis on patients and their families: qualitative findings from a country with a mixed public-private healthcare system.
abstract: OBJECTIVE
  Although awareness is increasing that cancer can have an adverse financial and economic impact for patients, the overall burden remains poorly understood. To elucidate these issues, we used qualitative methods to explore the financial impact of a cancer diagnosis in Ireland, which has a mixed public-private healthcare system and where sick leave and sick pay are at employers' discretion.
  
  
  METHODS
  Face-to-face semi-structured interviews were conducted with hospital-based oncology social workers (OSWs; 21 OSWs from 11 hospitals) and patients (20 from eight hospitals; 11 breast, 5 prostate and 4 lung cancer). Participants were asked about the (1) extra expenses incurred, (2) cancer's impact on work and income, and (3) accessing financial assistance/social welfare benefits. The two interview sets were analysed separately using thematic analysis.
  
  
  RESULTS
  Broad themes that emerged included the wide range of additional cancer-related medical and non-medical expenses incurred by all patients, including those with medical cards (which entitle the bearer to receive health services free of charge) and those with private health insurance; the major impact of cancer and its treatment on work and patient/household income (all patients who were working at diagnosis experienced a drop in income); and difficulties in accessing medical cards and benefits.
  
  
  CONCLUSIONS
  This study reveals the complex, multidimensional nature of the financial and economic burden cancer imposes on patients and the whole family unit. Changes in income post-cancer exacerbate the effects of cancer-related out-of-pocket expenses. These findings have implications for healthcare professionals, service providers and policy makers.
authors.affiliation: National Cancer Registry, Building 6800, Cork Airport Business Park, Kinsale Road, Cork, Ireland. a.timmons@ncri.ie
authors.forename: Aileen
authors.initials: A
authors.lastname: Timmons
authors.forename: Rachael
authors.initials: R
authors.lastname: Gooberman-Hill
authors.forename: Linda
authors.initials: L
authors.lastname: Sharp
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000191:economics*; D017281:Cost of Illness; D004651:Employment; D005190:Family; D005260:Female; D005382:Financing, Personal; D006264:Health Benefit Plans, Employee; D006801:Humans; D007182:Income; D019458:Insurance Coverage; D007494:Ireland; D008175:Lung Neoplasms / Q000191:economics*; D008297:Male; D008483:Medical Assistance; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000191:economics*; D036301:Qualitative Research