{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T04:48:31Z","timestamp":1782276511004,"version":"3.54.5"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:00Z","timestamp":1779840000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Most research about the high costs of cancer care has focused on characterizing and mitigating the financial hardship patients and families experience after cancer-directed therapy. Few studies have examined how these costs prospectively influence treatment decision-making. Even fewer address how costs impact decisions about symptom-directed therapies. We aim to describe how patient-facing costs of care influence decisions about cancer-directed and symptom-directed therapies for advanced cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>We analyzed semi-structured interviews with patients, care partners, clinicians, and health system leaders and clinical observations collected by investigators at 3 National Care Institute\u2013designated US cancer centers between July 2019 and May 2021. Two analysts conducted thematic analysis based on the Model of Financial Burden After Cancer Diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Analysis of 157 interviews and 92 observations identified 4 themes: (1) insurance influenced treatment choice and location; (2) medical costs influenced treatment choice, location, and timing; (3) non-medical costs influenced treatment location and timing; and (4) employment changes influenced treatment choice and timing. Patients and care partners emphasized costs of symptom-directed therapies; staff focused on costs of cancer-directed therapies. Patients and care partners described how employment influenced decisions about starting or continuing cancer-directed therapy, while staff noted how employment affected decisions about symptom-directed therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Patient-facing costs profoundly influence treatment decisions in advanced cancer care, but differences in perspective among patients, care partners, and clinicians can lead to oversights in treatment decision-making. Eliciting and incorporating patients\u2019 varied priorities into treatment decisions can minimize these oversights, better align treatment with goals of care, and reduce financial hardship.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/oncolo\/oyag207","type":"journal-article","created":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T11:47:55Z","timestamp":1779882475000},"source":"Crossref","is-referenced-by-count":0,"title":["Advanced cancer treatment decisions and their patient-facing financial burdens: a thematic analysis"],"prefix":"10.1093","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9938-4830","authenticated-orcid":false,"given":"Rachel C","family":"Forcino","sequence":"first","affiliation":[{"name":"University of Kansas School of Medicine Department of Population Health, , Kansas City, KS, 66160,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diya","family":"Mathur","sequence":"additional","affiliation":[{"name":"Geisel School of Medicine at Dartmouth , Hanover, NH, 03755,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda N","family":"Perry","sequence":"additional","affiliation":[{"name":"Geisel School of Medicine at Dartmouth The Dartmouth Institute for Health Policy & Clinical Practice, , Lebanon, NH, 03766,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garrett T","family":"Wasp","sequence":"additional","affiliation":[{"name":"Dartmouth Cancer Center, Geisel School of Medicine at Dartmouth Section of Hematology-Oncology, , Lebanon, NH, 03766,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amber E","family":"Barnato","sequence":"additional","affiliation":[{"name":"Geisel School of Medicine at Dartmouth The Dartmouth Institute for Health Policy & Clinical Practice, , Lebanon, NH, 03766,","place":["United States"]},{"name":"Department of Medicine, Dartmouth Health and Geisel School of Medicine Section of Palliative Care, , Lebanon, NH, 03766,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,5,27]]},"reference":[{"key":"2026062400112696300_oyag207-B1","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1377\/hlthaff.2015.0830","article-title":"For working-age cancer survivors, medical debt and bankruptcy create financial hardships","volume":"35","author":"Banegas","year":"2016","journal-title":"Health Aff (Millwood)"},{"key":"2026062400112696300_oyag207-B2","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1377\/hlthaff.2012.1263","article-title":"Washington state cancer patients found to be at greater risk for bankruptcy than people without a cancer 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