Experiences and coping with financial toxicity among older cancer patients and caregivers: A qualitative study

Background Financial toxicity imposes a heavy burden on older cancer patients and their families. In Confucian societies, cultural norms fundamentally shape how financial burden is experienced, communicated, and managed—caregivers feel duty-bound to bear treatment costs, while older patients often conceal financial concerns to avoid burdening their families. This renders financial toxicity a dyadic, relational phenomenon rather than a purely individual economic stressor. Yet how patients and caregivers together experience and cope with this culturally embedded stress remains poorly understood. Aims To investigate the experiences and coping mechanisms of older cancer patients and their caregivers regarding financial toxicity from a dyadic perspective. Design A descriptive qualitative study was conducted from May to August 2025 with 12 purposively sampled older cancer patient-caregiver dyads from two tertiary cancer hospitals, using semi-structured, in-depth face-to-face interviews. Data were analyzed following Braun and Clarke’s thematic data analysis guide. Ethical Considerations The study protocol was approved by the ethics committee and adhered to ethical principles. Findings Four themes comprising ten sub-themes were extracted and organized into two overarching domains. Regarding the experience of financial toxicity, two themes emerged: (1) ethical dilemmas and relational strains as the double-edged sword of familial obligation; (2) survival erosion and family resilience while negotiating the multidimensional impact. Regarding coping mechanisms, two themes emerged: (3) familial survival logic of resilience and adaptation; (4) familial praxis logic in navigating resource allocation. Conclusion Rooted in traditional Chinese family culture, where Confucian ethics predominate, financial toxicity imposes a shared burden on patients and caregivers, creating a family-level crisis. Healthcare providers should recognize its profound impact on both caregivers and families. Given the confluence of rapid population aging, family-centered care expectations, and insurance gaps in China, targeted interventions should be developed through a multi-tiered approach, helping cancer-affected families mitigate financial toxicity and improve quality of life.