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Published in final edited form as: Support Care Cancer. 2026 Feb 2;34(2):152. doi: 10.1007/s00520-026-10384-9 Search in PMC Search in PubMed View in NLM Catalog Add to search Improving outcomes of patients with advanced prostate cancer through a better understanding of clinical factors contributing to financial toxicity: a qualitative study Ebunoluwa Olunuga Ebunoluwa Olunuga 1 Duke University School of Medicine, Durham, NC, USA Find articles by Ebunoluwa Olunuga 1 , Jeremy Kurnot Jeremy Kurnot 2 Department of Urology, Duke University, Durham, NC, USA Find articles by Jeremy Kurnot 2 , Samantha Zhu Samantha Zhu 3 Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA Find articles by Samantha Zhu 3 , Daniel George Daniel George 5 Duke Cancer Institute, Durham, NC, USA 8 Division of Medical Oncology, Department of Medicine, Duke University, Durham, NC, USA Find articles by Daniel George 5, 8 , Sharron Docherty Sharron Docherty 7 School of Nursing, Duke University, Durham, NC, USA Find articles by Sharron Docherty 7 , Deborah R Kaye Deborah R Kaye 2 Department of Urology, Duke University, Durham, NC, USA 4 Duke-Margolis Center for Public Policy, Duke University, Durham, NC, USA 5 Duke Cancer Institute, Durham, NC, USA 6 Duke Clinical Research Institute, Durham, NC, USA Find articles by Deborah R Kaye 2, 4, 5, 6 Author information Article notes Copyright and License information 1 Duke University School of Medicine, Durham, NC, USA 2 Department of Urology, Duke University, Durham, NC, USA 3 Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA 4 Duke-Margolis Center for Public Policy, Duke University, Durham, NC, USA 5 Duke Cancer Institute, Durham, NC, USA 6 Duke Clinical Research Institute, Durham, NC, USA 7 School of Nursing, Duke University, Durham, NC, USA 8 Division of Medical Oncology, Department of Medicine, Duke University, Durham, NC, USA ✉ Corresponding Author: Deborah Kaye, MD, MS, 20 Duke Medicine Cir, Durham, NC 27710, [email protected] Collection date 2026 Feb 2. PMC Copyright notice PMCID: PMC13063317 NIHMSID: NIHMS2144344 PMID: 41627480 The publisher's version of this article is available at Support Care Cancer Abstract Purpose Patients with advanced prostate cancer (aPC) often face significant treatment-related financial hardship. Given the critical role non-physician clinicians play in helping patients access prescribed treatments, we sought to explore their perspectives on factors contributing to treatment-related financial toxicity. Methods We conducted semi-structured interviews with non-physician clinicians who care for patients with aPC. We used purposive sampling to capture diverse perspectives across practice types (academic, community), and settings (rural, urban, suburban). Participants described their perceptions and experiences regarding delivering aPC treatment, managing prior authorizations, handling insurance-related concerns, and aligning treatment preferences. We conducted content analysis with theme generation, with 30% of transcripts double coded to ensure rigor and trustworthiness in theme identification. Results We interviewed 20 non-physician clinicians, including social workers, financial navigators, pharmacists, and nurses. Four themes emerged from the coded interviews. First, a lack of trust and/or empowerment in patient-clinician relationships left patients lacking support to navigate financial challenges. Second, inefficient resource allocation—including financial, educational, and institutional support—intensified the financial burden on patients. Third, communication gaps between clinicians, patients, and payers hindered treatment coordination and access to assistance. Last, variability across clinical practices, patient demographics and needs, and insurance policies contributed to an unpredictable treatment environment, furthering financial distress and potential inequities in care. Conclusion Lack of trust and empowerment, resource gaps, poor communication, and systemic variability all contribute to financial toxicity for patients with aPC. Targeted strategies to improve trust, resource allocation, and communication can better support patients with aPC in managing treatment-related financial burden. Introduction Prostate cancer is the most common nonskin malignancy and the second leading cause of cancer-related deaths among men in the United States.[ 1 ] The treatment landscape for advanced prostate cancer has evolved rapidly in recent years, with a growing reliance on oral therapies and novel agents that have improved outcomes but also contributed to rising treatment costs.[ 2 , 3 ] The cost of treating advanced prostate cancer (aPC) is notably high, with significant variability across different drug types.[ 4 , 5 ] These cost variations, compounded by differences in insurance coverage and patient demographics, substantially elevate the risk of financial hardship. In addition to high drug costs, the pathway from a clinician prescribing treatment to the patient actually receiving treatment is highly complex with multiple parties and processes (i.e. physicians, financial counselors, nurses, insurance companies, and prior authorization processes) involved along the way. Each step can introduce delays and add layers of uncertainty and expense, further contributing to what is known as “financial toxicity.”[ 6 ] Financial toxicity not only represents the direct financial burden but also encompasses the broader psychosocial consequences that impact the quality of life of cancer patients.[ 7 , 8 ] Notably, nearly fifty percent of patients with metastatic castration-resistant prostate cancer (mCRPC) experience some level of treatment-related financial hardship.[ 9 ] Large-scale efforts are underway to explore strategies to alleviate this burden, yet much of the existing research has focused on patient factors and/or physician–patient cost discussions, with limited attention on the insights of non-physician clinicians. Financial counselors, nurses, social workers, and other healthcare professionals play a pivotal role in treatment coordination, receipt, and financial navigation. Their perspectives are essential to understanding the systemic, institutional, and interpersonal factors that drive financial toxicity. To address this gap, we conducted a qualitative analysis of non-physician clinician perspectives on the contributors to financial toxicity in the treatment of patients with aPC. By examining how these clinicians perceive the complex interplay of cost factors—from the prescription stage through the multiple administrative steps involved in treatment delivery—our study aims to uncover novel insights and identify potential interventions that can be implemented at both clinical and policy levels to mitigate financial toxicity and improve patient outcomes. Methods Study Design We recruited non-physician clinicians from Urology and Medical Oncology practices, including nurses, pharmacists, social workers, and financial navigators. Using purposive sampling, we selected participants based on specific characteristics or experiences, rather than at random. The goal of using this sampling methodology is to achieve informational representation rather than statistical representation.[ 10 ] We emphasized diversity across various clinician roles, practice location (urban/rural/suburban), academic/nonacademic centers, and practice funding (private equity/hospital corporation/private practice). Initial recruitment was conducted through a convenience sample drawn from the Duke Cancer Network (DCN) and the Association of Cancer Care Centers (ACCC). Emails were sent to selected non-physician clinicians describing the study and asking for permission to be interviewed. We then followed up with snowball sampling, whereby participants identified additional clinicians for possible recruitment. Recruitment and data collection continued until we reached thematic saturation, defined as the point at which no new concepts emerged from each interview topic.[ 11 ] Participants were excluded from this study if they did not regularly work with patients with aPC. Weekly meetings between the interviewers and the study team were held during data collection to determine whether thematic saturation had been achieved. Non-Physician Clinician Interviews We developed a semi-structured interview guide focusing on the experiences of non-physician clinicians relating to costs of advanced prostate cancer care. The guide was developed by multiple authors with expertise in prostate cancer, qualitative methods, and health care costs. Between January and July 2024, 2 authors (S.Z., J.K.) conducted one-on-one and two-on-one semi-structured interviews over Zoom. We reviewed and updated the guide after the first several interviews to improve content and clarity. Interviews lasted 60 to 90 minutes, and participants were offered $30 gift cards for study participation. At the start of the interview, we asked each interviewee basic demographic questions. Interviews were securely audio recorded. Early interviews were conducted by a primary interviewer accompanied by a second listener and notetaker. Later interviews were then conducted with a single interviewer. We used open-ended questions to elicit information on factors contributing to financial toxicity of patients with advanced prostate cancer, focusing specifically on clinician and system practices contributing to or alleviating the burden. We also examined tools, interventions, and processes, including procedures for obtaining prior authorization, to reduce or mitigate financial toxicity at large. All clinicians participating in the study provided informed consent through e-mail, which was verbally confirmed over Zoom during the interview. This study was approved by Duke University’s Institutional Review Board. Content Analysis All recorded interview sessions were transcribed using a professional transcription service. Our research team reviewed and checked the accuracy of each transcription before coding. We conducted a qualitative descriptive study to better understand an individual’s experiences in a unique context. Four independent trained coders (S.Z., J. K., DK and E.O.) analyzed the transcripts, using a thematic analysis approach. The research team met regularly to refine codes and definitions and incorporated inductively derived codes based on novel concepts emerging from the data. To ensure reliability, 30% of transcripts were double coded. Coded statements were grouped into conceptual categories. Statements from each category were reviewed to identify domains across clinician perspectives. We then condensed these domains into major themes, including prominent sentiments within each category. We adhered to the four criteria of rigor (credibility, transferability, dependability, and confirmability) by including multidisciplinary experts to devise and revise questions, using multiple coders and analyzers, triangulation across participants, and providing details when presenting study findings. Results 61 non-physician clinicians were contacted to participate in the study, with twenty participants consenting to study participation. Six clinicians denied participation; no response was received from the remaining contacts. We did not observe any clear differences in participation likelihood by clinician type. Table 1 describes participant demographics. Four participants (20%) were care coordinators, five (25%) financial support staff, eight (40%) nursing professionals, and three (15%) pharmacy/business staff. Thematic analysis identified four major themes centered on (1) the limited trust and shared decision-making in patient-physician interactions, (2) inefficient use and distribution of resources, (3) challenges in communication, and (4) heterogeneity across practices, patients, and insurance plans ( Table 2 ). Table 1. Participant Demographics (N = 20) Overall (N=20) Age Mean (SD) 47.7 (12.3) Median [Min, Max] 49.5 [29.0, 68.0] Sex Female 19 (95.0%) Male 1 (5.0%) Race White 17 (85.0%) Black 1 (5.0%) Asian 2 (10.0%) Ethnicity Hispanic 1 (5.0%) Non-Hispanic 19 (95.0%) General Role Care Coordinator 4 (20.0%) Financial Support Staff 5 (25.0%) Nursing Professional 8 (40.0%) Pharmacy/Business Staff 3 (15.0%) Practice Setting Rural 6 (30.0%) Suburban 3 (15.0%) Urban 10 (50.0%) All 1 (5.0%) Practice Type Academic 11 (55.0%) Non-academic 9 (45.0%) Practice Funding Hospital Corporation 14 (70.0%) Mixed 2 (10.0%) Nonprofit 1 (5.0%) Private Practice 3 (15.0%) Open in a new tab Table 2. Themes and selected quotes Domain Illustrative Quotes Theme 1: Lack of trust and/or empowerment in patient-clinician relationships often leaves patients without the necessary support to navigate financial challenges. Establishing Trust - “The approach and the communication style has to be that the patient trusts you to understand that you’re just here trying to help them” (P15) - “I think providing that emotional support early on so they kind of know they can trust us to not put them in a bad position goes a long way.” (P18) - “[Patients] are with us a couple of hours in a day, there’s a trust factor they build with us.” (P19) Non-physician Clinician and Patient Empowerment - “As advocates we have to truly understand insurance and billing so that we can help the patient.” (P15) - “So our goal with this and I think this is with every financial toxicity program where we want to eliminate that is we do not want to be reactive. We want to be proactive.” (P16) - “As a seasoned veteran in this, I think it’s my job to try and communicate to others and teach the younger population, even the physicians...” (P10) Theme 2: Inefficient resource allocation, including financial, educational, and institutional support, intensifies the financial burden on patients. Financial Resources - “I feel like with prostate cancer specifically there hasn’t been a lot of grants opened. It’s a grant that is highly used so it can open and close within five minutes.” (P11) - “Because it’s such a prominent cancer and there’s so many people with it and it is tied to financial toxicity, the funding goes quickly. They probably allocate a lot of funding for it, but it goes quickly.” (P16) - There’s so many people with prostate cancer that those grants are never open usually and they’re only ever open usually on the first of the year, so you have to try and snag those up before it closes because they have a limited amount that they can give out to people. (P3) Educational Resources - “I would, definitely would love more education on like the prescription coverage and all that so I think knowing, like maybe like doing an educational training for the nurses about financial assistance or something...” (P9) - “I really think [education about financial toxicity] needs to begin, and I know this is hard, in their early education, you know, and I have taken some of my time to... I used to work with the fellows really closely in clinic. There needs to be more education about that in their learning process.” (P10) Institutional Resources - “A lot of times our providers are just kind of, I don’t want to say rushing but .... they have a lot of patients to see so they’ll sometimes just go in there with the resident and just know what medication that they want and yeah, and then later on we don’t find out until processing that they can’t afford this medication.” (P9) - “I feel like if we had more people we could be a little bit more dedicated” (P15) Theme 3: Communication and knowledge gaps among and between clinicians, patients, and payers hinders treatment coordination and access to assistance, thus contributing to financial toxicity. Role Delineation - I tell patients, providers, nurses, residents that they can just refer the patient directly, they can give the patient my contact information and invite them to call me at their convenience. It happens so infrequently, I don’t get it. It’s as if there’s this modus operandi of protecting the referral source removing the access that patient would otherwise have had to the problem solver. (P1) - “Where I would call it less efficient is again the fact that there are so many of us looped in on things that don’t necessarily apply to us... for example, I am looped into every step of the prior authorization process even if I never end up having to be involved.” (P7) - “Well, my frustration in my clinic setting is that I don’t see a lot of involvement from my financial navigator and I may not completely understand their job but I do not see a lot of involvement in working on that aspect of care.” (P4) Delayed Communication - “If [patients are] in network with some outside pharmacy that we don’t have internal relationships with and we have to send over there, so we’re not able to easily communicate with the pharmacy.” (P20) - “I mean our facility has what their preferred products are based on their cost and reimbursement and that doesn’t always align with what the insurance companies want, so you just have to play the game.” (P13) - “[Insurance algorithms are] just additional work that I think delays patient care intentionally to help insurance companies save a couple extra dollars” (P3) Internal Communication - “We would greatly benefit from having a financial navigator in place in the office that could meet with patients. We do not have that. There, there are no financial navigators on site. Excuse me. Within our entire hospital system. They all work from home.” (P4) - “They don’t always update me with what they’re doing in the office, but usually I’ll catch wind of it from my patients, [they] kind of tell me what’s going on.” (P2) - “It’s difficult in that I can’t always see the documentation that has occurred with the financial team and the patient.” (P10) - Many times I get the referral when [the patient] cannot afford [their treatment]. It doesn’t come to me at the time of diagnosis. I wish I could have started the process earlier because then it’s almost a delay - you’re waiting to complete the application and pick up the problem in a later state. If we did some kind of financial toxicity screening earlier on perhaps we could have avoided waiting until the patient is saying I cannot afford this (P14) Theme 4: Variability across clinical practices, patient demographics and needs, and insurance policies created an unpredictable treatment environment, amplifying patients’ financial distress and contributing to inequities in care. Practice environment - “I feel like my providers that came from a private practice, I just feel like they’re more in tune to just insurance, financial, all that stuff.” (P15) - “You know, we’re at an academic medical center which I think really helps. I’ve certainly worked in more community private practice settings where the resources are not nearly as robust as what we have here and so I think that can certainly be, you know, a bigger challenge for people working in different settings.” (P8) Patient factors - “The older population they get a little leery of disclosing [financial information], even though our people identify themselves.... It’s not a personal thing anymore. A lot of this is being done electronic so or by phone and so that population is a little concerned about that.” (P10) - “They don’t know how to navigate it because a large volume of them are 70 to 80 years old, don’t have access to the internet or don’t understand it.” (P10) - “I was just saying that I think that demographic, they’re easily persuaded and so I think, if they get a sales person that’s trying to pitch state insurance it might not be great and then they fall into that. They say it’s going to be good and then their copays are crazy or their deductible is astronomical.” (P12) Insurance Factors - “It varies from insurance to insurance and what’s covered from plan to plan. That can be one of the more challenging aspects, is unfortunately insurances being able to dictate treatment options for patients.” (P11) - “I would say more the insurance companies play a big part in, in slowing down the process of getting patients treated timely and they’re denials and, and the hoops that they make us go through, but that’s all affecting treatment.” (P6) - “The first thing I look at before I even start diving into the data is his insurance, which is sad but it’s true” (P5) - “Even with different Medicare plans it does seem like there are some patients that get lucky and they’re able to get a lower copay every once in a while and I can’t speak to which plans are actually the ones that do that” (P3) Open in a new tab Theme 1: Lack of trust and/or empowerment in patient-clinician relationships often leaves patients without the necessary support to navigate financial challenges. Establishing Trust Building a foundation of trust was critical in effectively providing financial guidance. Identifying eligible patients for available financial assistance programs and grants was often challenging due to patients’ reluctance to disclose their income. Without this information, clinicians struggled to determine eligibility and connect patients with appropriate resources. Participants noted that patients who felt empowered and had confidence in the healthcare system were more likely to openly discuss financial concerns, leading to better access to support services and improved medication receipt. Non-physician Clinician and Patient Empowerment Many clinicians emphasized that fostering patient trust was a crucial step towards patient empowerment. Clinician empowerment, through confidence, advocacy, and proactive engagement, was viewed as equally important. Empowerment was reflected in clinicians having the knowledge and confidence to navigate insurance and billing systems, advocate effectively for patients, and educate colleagues to promote sustainable change. Empowered clinicians sought to move from reactive to proactive approaches in identifying and addressing patient financial barriers early, which they felt ultimately fostered greater patient trust and improved patient outcomes. Creating environments that foster mutual trust and empowerment between patients, clinicians, and the wider healthcare team was considered critical to alleviating financial toxicity. When non-physician clinicians felt empowered to address financial concerns, and perceived that their patients felt supported and understood, participants reported that the healthcare system became better equipped to navigate the financial complexities of care. Theme 2: Inefficient resource allocation, including financial, educational, and institutional support, intensifies the financial burden on patients. Financial Resources Financial resources, such as grants to help offset patient costs, were often cited as inadequate to meet the high demand. Internal hospital grants and external funding sources, such as those provided by pharmaceutical companies, were described as difficult to navigate and highly competitive, particularly for aPC. This deficit left many patients struggling to afford necessary treatments, further compounding their financial strain. Educational Resources A lack of educational resources for both clinicians and patients also contributed to financial toxicity. Participants highlighted gaps in physician education, such as new drug availability and medication costs as contributing to financial toxicity. Participants observed that poor patient education, including a lack of understanding of insurance policies, treatment plans, and financial options often exacerbated financial toxicity for patients, leaving them ill-equipped to advocate for themselves. They emphasized the need for targeted educational resources to help patients better understand financial systems, prescription coverage, and cost-saving strategies. Institutional Constraints A shortage of personnel was a major barrier to providing financial support. Many non-physician clinicians reported taking on multiple roles, making it difficult to dedicate sufficient time to each patient’s financial concerns. The imbalance between staff availability and patient needs not only limited the level of assistance patients received but also contributed to clinician burnout and poor role delineation. Theme 3: Communication and knowledge gaps among and between clinicians, patients, and payers hinders treatment coordination and access to assistance, thus contributing to financial toxicity. Role Delineation The absence of well-defined roles within clinical and administrative teams contributed to financial toxicity. Many participants described ambiguity regarding clinical responsibilities (e.g., determining who should follow up with pharmacies to ensure patients received their medications and who was responsible for submitting or tracking authorization claims). This ambiguity led to delays, miscommunication, and missed opportunities to address financial concerns, thus exacerbating patients’ financial burdens. Delayed Communication Delays in communication with insurance companies were a recurring issue. Participants described delays in receiving insurance approvals and time-consuming “back-and-forth” processes required to secure authorizations or clarify coverage details. One common cause of these delays was the misalignment between the physician’s prescribed treatment and the insurance company’s preferred or approved options. This often manifested through step therapy, a process where patients must try and fail an insurer’s preferred treatment before gaining approval for the originally prescribed option. These inefficiencies frequently postponed treatment initiation, prolonging patient distress. Internal Communication Lack of coordination and transparency between clinical and support teams also contributed to financial toxicity. Many participants described working in isolation, with little insight into other clinical conversations. Non-physician clinicians often could not access documentation or track prior discussions about a patient’s financial concerns, making it difficult to ensure continuity of support. Mode of communication was also cited as a key factor. Teams working in the same physical space reported stronger communication and greater effectiveness at identifying at-risk patients and coordinating timely interventions. In contrast, those relying solely on electronic messaging or working remotely expressed frustration over not knowing who to contact or how best to navigate financial discussions. Theme 4: Variability across clinical practices, patient demographics and needs, and insurance policies creates an unpredictable treatment environment, amplifying patients’ financial distress and contributing to inequities in care. The heterogeneity across factors makes establishing standardized workflows and pathways challenging. The inconsistencies across patient demographics, needs and insurance policies often left both patients and non-physician clinicians navigating complex and fragmented systems with little clarity or predictability. Practice Environment Differing sites of care influenced variability in clinical practices; each setting required clinics to function in distinct ways. These structural differences often dictated how teams approached patient care, financial assistance, and administrative processes, leading to significant disparities in patient experiences and outcomes. Differences in the size of practices influenced the availability of financial resources and the level of financial assistance available to patients. Patient Factors Clinicians consistently described how patient demographics such as age, socioeconomic status, cultural background, and health literacy further complicated workflows. Patients with lower levels of health literacy or limited resources often required additional time and support to navigate the healthcare system. Participants also noted that patients living in more rural areas faced unique barriers, including limited exposure to healthcare and a sense of distrust towards the medical system, which sometimes discouraged engagement with financial resources. Additionally, they observed that patients who had previously been healthy their whole lives often lacked familiarity with insurance processes. Insurance Factors Insurance policies add another layer of complexity. Insurance type determines subsequent clinic processes. Some insurance companies had more straightforward authorization practices, enabling quicker access to treatment, while others imposed additional requirements leading to significant delays. Participants noted that these discrepancies could result in extended waiting times to begin treatment, which not only increased financial strain but also jeopardized health outcomes. Financial resources to cover medications were also closely tied to insurance policies; patients on certain plans had greater access to grants or assistance programs compared to others on different plans. Discussion This study explored non-physician clinician perspectives on factors contributing to treatment-related financial toxicity in advanced prostate cancer (aPC). Despite their direct role in treatment coordination and financial navigation, the insights of non-physician clinicians remain underexamined. Existing literature has largely focused on patient factors and physician–patient cost discussions, with limited attention given to the perspectives of financial counselors, nurses, and other non-physician healthcare clinicians; key players in potentially reducing an individual’s financial burden. The themes identified in our study—trust and empowerment in patient–clinician relationships, inefficient resource allocation, communication and knowledge gaps, and the unpredictability of the treatment environment—align with existing research while also raising questions about broader structural barriers influencing financial burden in cancer care. The role of trust in the medical profession and in shared decision-making between patients and physicians is well established.[ 12 , 13 ] However, limited data exist on how trust extends beyond physician-patient interactions to encompass relationships with non-physician clinicians, and how this trust influences financial toxicity. In this study, non-physician clinicians identified various elements of trust and empowerment that can affect financial toxicity. Notably, distrust from patients in the healthcare system was cited as a contributor to financial distress. Medical mistrust has previously been shown to contribute to cancer health inequities and increased mortality rates.[ 14 , 15 ] Specifically, for prostate cancer, research has demonstrated differing levels of trust across racial groups, mirroring similar disparities in financial toxicity.[ 16 – 20 ] The cumulative impact of these financial barriers may further perpetuate disparities in cancer outcomes, underscoring the need for interventions that build trust and improve access to financial resources across diverse patient populations. Although clinicians in our study reported that empowered patients were better equipped to seek financial assistance, patient-level interventions alone are insufficient to mitigate financial toxicity, particularly when structural barriers such as inadequate insurance coverage or high out-of-pocket costs remain unaddressed.[ 21 , 22 ] In this context, trust emerges as a critical facilitator of financial discussions, yet it should be paired with robust institutional and policy-level interventions to be truly effective—a point that is further supported by our finding that deficiencies in systemic-level resources contribute significantly to financial toxicity. Specifically, participants described hospital and externally funded grants as valuable but often limited in duration or rapidly depleted. This nuance, where resources exist but are insufficiently sustained, is not well reflected in the broader literature and highlights the need for more durable and scalable support mechanisms for patients with advanced prostate cancer and the clinicians assisting them. Communication is another well-established theme in the financial toxicity literature, though many studies focus predominantly on patient–physician interactions and shared decision-making. For example, one study found that their cohort of financial navigation staff also identified communication barriers as a significant challenge in addressing financial toxicity.[ 23 ] Consistent with our findings, financial support staff emphasized the importance of clinician awareness and proactive communication in facilitating treatment planning and referrals to financial assistance programs. Our findings build upon this literature by highlighting barriers in interprofessional communication that can ultimately increase patients’ risks of financial toxicity. Lastly, our findings regarding the variability of treatment environments underscore the significant impact of differences in clinical practices, patient demographics, and insurance policies on financial distress. This variability creates an unpredictable treatment landscape that complicates treatment planning and could potentially exacerbate existing inequities. The observed differences in financial needs and available resources documented across participants in this study further emphasize the necessity for tailored interventions. The results of this study should be considered in light of certain limitations. This study focused exclusively on non-physician clinicians, encompassing a broad spectrum of responsibilities, and scopes of practice. This study did not aim to compare these subgroups, and the small sample size and qualitative design limit the ability to identify how perspectives might change across clinician type. Therefore, while thematic saturation was achieved, these results should not be interpreted as capturing the full breadth of experiences among non-physician clinicians. Rather, they reflect common themes identified among a diverse sample of participants. Additionally, participation may have been influenced by self-selection bias. Clinicians who chose to participate may have been more engaged or interested in issues related to financial toxicity, potentially underrepresenting the perspectives of those less familiar with or less concerned about this issue. Consequently, our findings may underestimate some barriers or challenges faced in clinical practice. While various perspectives were included in this study, we notably did not include physicians or patients. Physicians, who prescribe the medications, may offer additional perspectives on treatment-related financial toxicity, while patients are the ones directly experiencing its effects. By not directly including patients, we cannot fully elucidate how they navigate financial costs. However, the purpose of this manuscript was specifically to understand the perspectives of non-physician clinicians on financial toxicity. Strengths of this study include the diversity of perspectives among non-physician clinicians and a robust sample size that enabled thematic saturation. Additionally, semi-structured qualitative interviews provided in-depth insights into the complex interplay of factors contributing to financial toxicity. The results of this study contribute to the growing discourse on financial toxicity by identifying key elements that may place patients with aPC at elevated risk for experiencing financial toxicity. 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