Financial difficulties in breast cancer survivors with and without migration background in Germany—results from the prospective multicentre cohort study BRENDA II

Abstract

Purpose We aimed to explore the trajectory of financial difficulties among breast cancer survivors in the German health system and its association with migration background. Methods In a multicentre prospective study, breast cancer survivors were approached four times (before surgery, before and after adjuvant therapy, five years after surgery) and asked about their migration history and financial difficulties. Migrants were defined as born/resided outside Germany or having citizenship/nationality other than German. Financial difficulties were ascertained with the financial difficulties item of the European Organisation for Research and Treatment of Cancer Core Instrument (EORTC QLQ-C30) at each time-point (cut-off > 17). Financial difficulties were classified in trajectories: always (every time-point), never (no time-point), initial (first, not fourth), delayed (only fourth), and acquired (second and/or third, not first). A logistic regression was conducted with the trajectories of financial difficulties as outcome and migration background as exposure. Age, trends in partnership status, and educational level were considered as confounders. Results Of the 363 participants included, 49% reported financial difficulties at at least one time-point. Financial difficulties were reported always by 7% of the participants, initially by 5%, delayed by 10%, and acquired by 21%. Migrants were almost four times more likely to report delayed (odds ratio [OR] = 3.7; 95% confidence interval [CI] 1.3, 10.5) or acquired (OR = 3.6; 95% CI 1.6, 8.4) financial difficulties compared to non-migrant participants. Conclusion Survivors with a migration background are more likely to suffer from financial difficulties, especially in later stages of the follow-up. A linguistically/culturally competent active enquiry about financial difficulties and information material regarding supporting services/insurances should be considered.

Burden of Financial Hardship Among Breast Cancer Survivors in Maharashtra, India

“…Multiple studies have reported FH and distress among BCS in developed countries [13,[16][17][18][19][20][21]. However, there is very limited research reported in low-and middle-income countries (LMICs) [22].…”

Experience of office-based haematologists and oncologists with outpatient psycho-social support services for cancer patients with and without migration background in Germany

“…No conclusive information is available on whether participation in psycho-social support services varies based on the migration background of the patients in Germany (Singer et al 2022 ; Zeissig et al 2015 ). However, patients with cancer and migration background are considered to be more likely to have higher psycho-social difficulties (Riccetti et al 2022a ; Tibubos et al 2018 ), as well as higher barriers to access supportive care services than non-migrant patients (Riccetti et al 2022a , b ; Riccetti et al 2020 ; Sze et al 2015 ). Linguistically and culturally competent psycho-social support services are not available in every region (Schulz et al 2018 ), often leading to friends and/or relatives acting as translators, with further difficulties and barriers for patients in discussing their need for psycho-social support (Hermes-Moll et al 2022a ).…”