Financial toxicity as logistical and relational burden across the lifespan during autologous transplant preparation

Financial toxicity, the material, psychological and social burden associated with the cost of cancer care, can meaningfully affect patients preparing for autologous stem cell transplant (ASCT) for multiple myeloma. This study examines how financial toxicity emerges within treatment preparation using a secondary qualitative analysis of data from the Ready for Transplant study. The dataset included approximately 150 hours of ethnographic observation of 70 nurse–patient education encounters and semistructured interviews with 35 patients. Transcripts and field memos were coded to identify how financial burden was expressed and negotiated. Financial toxicity rarely appeared as explicit cost talk; instead, it surfaced indirectly through work and income disruption, repeated travel and scheduling demands, and caregiver time burden including concerns about imposing financial or emotional burden on family members. These relational and logistical expressions of financial strain influenced treatment readiness and decision-making, underscoring the need for proactive financial navigation during ASCT preparation.