Toxicidade financeira e impactos na saúde mental de pacientes com câncer de mama

Abstract

Breast cancer (BC) is the most prevalent cancer among women and one of the most costly, which highlights the need to investigate financial toxicity (FT), a construct that encompasses the financial distress caused by treatment costs. The aim of this dissertation was to understand FT in the context of BC, including its relationship with psychological, sociodemographic, and clinical variables. To achieve this, three studies were conducted. The first was a theoretical review of FT, which highlighted the high direct and indirect costs of cancer treatment, with impacts such as FT, which in turn is associated with poorer treatment adherence and worse levels of quality of life and mental health. The study highlighted vulnerabilities of the Brazilian population to FT, such as higher indirect costs, marked social inequalities, barriers to access, and difficulties in the implementation of policies, despite the existence of a public health system and a set of laws aimed at reducing costs and access to treatment. The second study was a scoping review that systematized evidence on FT in patients with BC, covering clinical, sociodemographic, and psychological variables. Publications were concentrated in the United States and China; the most used instrument was the Comprehensive Score for Financial Toxicity. The most vulnerable groups were young women with low income and education and those who were unemployed, with a greater association between FT and advanced staging, aggressive tumor subtypes, prolonged treatments, surgeries, and complex therapies. FT was bidirectionally associated with anxiety and depression, negatively correlated with quality of life, and influenced by coping strategies, affecting treatment adherence. It was also related to fear and stress, aggravated by low social support, while adequate social support and resilience acted as protective factors. The third study, with a cross-sectional design, measured the association between anxiety, depression, and FT, as well as sociodemographic and clinical factors in patients treated in three public hospitals in Sergipe. FT was the variable that most impacted psychiatric outcomes, such that the higher the FT, the greater the anxious and 12 depressive symptomatology. The findings of these studies suggest that FT is a phenomenon that deserves attention from psychologists and health professionals, given its multiple impacts on the mental health of patients with BC. It is expected that this dissertation will contribute to providing support for individualized interventions aimed at preventing the psychological impacts associated with FT and to the planning of public policies aimed at reducing inequalities in access to and adherence to cancer treatment and promoting mental health among women with BC.