Table 2.

Qualitative responses on aspects of material, coping, and psychological financial toxicity during cognitive interviewing and linguistic validation, translated from Spanish.

Hardships
Depletion/lack of pre-existing assets
“Without working, the finances are gone, and you depend on people’s help.”
“I cannot provide like—like what we need at home. Let’s say, if we need to buy something additional for our home, or if I need emergency money, I do not have it. I cannot do that because I paying for everything else.”
“I don’t have any savings from the time I used to work.”
Lack of credit and credit card access
“We do not use credit cards.”
“I don’t have credit cards.”
“I don’t have a credit card.”
Food insecurity
“Once every fifteen days, thank God, a church provides us with food.”
“As I have paid for gas, to come here—I have paid for gas, I have—well, I’ve been hungry and not wanting to buy any little thing, and that’s where all the money is going.”
Transportation difficulties
“Well, I don’t drive. I don’t have the—I drive, but I don’t have a car. I have to depend on someone else to get me around.”
“A lot of people do struggle, for instance, to find transportation to come to the hospital. Or many people do not have the ten dollars or the six—eight dollars that they charge you for parking.”
“Sometimes I don’t have anybody who can give me a ride to the hospital, and I have to spend my money to pay for taxis or transportation.”
Immigration difficulties
“If you don’t have a backup, an insurance, which you cannot have as Hispanic and immigrant here, undocumented, unfortunately—I mean, it gets very difficult.”

Burdens
Medical bills
“When I was first diagnosed, I did not have insurance, as I told you, and what they needed was urgent because it was a stage four cancer with metastasis, and I needed to get the treatment immediately. And so just in order to start getting treatment, I needed an average of 5,000 dollars, which I didn’t have.”
“Yes, because before getting sick, I never had medical expenses, and now I have a pending bill of 4,000 dollars.”
Lack of insurance
“At the beginning, it was a hard blow, and it affected me a lot because I didn’t have medical insurance; I didn’t have anywhere—nothing to help me cover the expenses of a disease like this one.”
Income loss
“The cancer caused me to have bone problems, and I fractured my back. Imagine how hard it was to work. I fractured my back twice, three vertebrae, and the last time I fractured two vertebrae, and I cannot work. It is even harder because it is a construction job. And that affects me.”
“When this began, I had to stop working, and therefore, I stopped having money, you know?”
“I went from earning, let’s say, 5,000 dollars per month, to earning—to maybe earning 100 dollars per day, in the—when I started the treatment—the disease. So there were times when I could not do anything.”
“When I got sick, I had to quit my job.”
Impairment in caregiving responsibilities
“I can no longer take care of her. It did affect my ability to take care of my child.”
“Always—all the time, since I started this treatment—this case—the responsibility has fallen more on her, on my wife, because when it was the two of us—that is, 100 percent—it was less of a burden on both of us.”
“It is supposed to be me who should be taking care of the cousins when my aunt is not there, but I struggle a lot.”

Mitigating factors
Social network support resources
“I borrowed money from relatives, friends in order to start with the treatment because I didn’t have any type of insurance.”
“Well, they helped me with my groceries, people from the church. They gave me food, thank God.”
“Like churches—they help you with a percentage.”
“Right now, I cannot work. Sometimes I have to pay for the rent or for the food to my aunt. My dad got in a very bad financial state when he had to pay for the chemo, so I’m nervous that they are going to—to lose my insurance or something like that.”
Formal assistance resources
“Thank God my wife was able to find—well, she applied to get the gold card (public clinic financial assistance program), and I was lucky that they gave it to me, right?”
“The gold card (public clinic financial assistance program), yes. I get that help.”