Financial Toxicity and psychological distress in Adults with Cancer: A Treatment-based Analysis

Disparities in cancer-related financial toxicity across economically diverse provinces in China: A multi-center cross-sectional study

Objective

China's diverse economic landscape across its regions may contribute to disparities in cancer-related financial toxicity (FT), but empirical evidence is lacking. This study examined regional disparities in cancer-related FT across economically diverse provinces in China.

Methods

A cross-sectional study was conducted among adult patients with cancer from six tertiary and six secondary hospitals across three Chinese provinces with varying economic statuses (high-, middle-, and low-income). FT was assessed using the COmprehensive Score for financial Toxicity (COST). Hierarchical regression analysis was employed to compare FT among participants from different economic regions, controlling for 13 patient-level sociodemographic and clinical risk factors.

Results

From February to October 2022, 1208 participants completed the survey (response rate ​= ​97.3%). Mean COST scores were 21.99 ​± ​6.37 (high-income), 20.38 ​± ​8.01 (middle-income), and 19.20 ​± ​5.14 (low-income), showing significant differences (P ​< ​0.001), with lower scores indicating more severe FT. After adjusting for covariates, regional economic level was significantly associated with FT, with more severe FT in middle- (B: -1.515; 95% CI: -2.250, -0.780) and low-income regions (B: -2.159; 95% CI: -2.899, -1.418) than in high-income regions.

Conclusions

This study reveals significant disparities in cancer-related FT across economically diverse provinces in China. The findings underscore the need for targeted policies and interventions to improve health equity in cancer care, with a focus on not neglecting middle-income regions. Oncology nurses are expected to enhance awareness of FT management, voice the needs of patients, and advocate for policy reforms to address these disparities.

Financial toxicity and its influencing factors in young and middle-aged cancer patients: a latent profile analysis

PURPOSE

Financial toxicity has become a global public health problem. The purpose of this study was to identify categories of financial toxicity in young and middle-aged cancer patients, where patients can be classified according to their level of financial toxicity, and to explore the factors influencing the level of financial toxicity.

METHODS

In this cross-sectional study, paper-pencil questionnaires were administered to 244 young and middle-aged cancer patients. Participants completed a general information questionnaire, the Comprehensive Score for Financial Toxicity questionnaire, the Chinese version of the Demoralization Syndrome-II Scale, and the Brief 2-Way Social Support Scale. A latent profile analysis was applied to explore financial toxicity. Multi-categorical unordered logistic regression analyses were used to assess the effects of factors on the financial toxicity.

RESULTS

Financial toxicity among the young and middle-aged cancer patients was categorized into 3 groups: low financial toxicity (10.7%), medium financial toxicity (34.8%), and high financial toxicity (54.5%). Multi-categorical unordered logistic regression analyses showed that education level, time since diagnosis, household disposable savings, cost of treatment in the last 3 months, receiving emotional support, receiving instrumental support score, meaning and purpose score, and suffering and coping score were the factors influencing the level of financial toxicity in young and middle-aged cancer patients.

CONCLUSIONS

The financial toxicity of young and middle-aged cancer patients in this study can be categorized into three potential categories, each of which is influenced by multiple factors. These can help healthcare professionals to develop targeted interventions based on their categorical characteristics in different profiles.

Prevalence and impact of financial toxicity in older patients with cancer: a prospective observational study in India

PURPOSE

We aimed to assess the prevalence of financial toxicity in older Indian patients with cancer and evaluate the association with quality of life (QoL), distress, vulnerabilities in the geriatric assessment, and factors impacting financial toxicity.

METHODS

This was a prospective observational study at the Tata Memorial Center (Mumbai, India) in patients aged 60 years and over, planned for cancer-directed therapy. We used the COST-FACIT and CFPB Financial Well-Being Scales to assess financial toxicity. QoL was assessed with the European Organization for Research and Treatment of Cancer (EORTC) QLQ C30 questionnaire, and distress with the NCCN distress thermometer.

RESULTS

Between June 2022 and September 2023, we enrolled 953 patients. The median age was 66 (IQR 63-72) years; 277 patients (29.1%) were over 70 years old, 737 (77.3%) were male, and 135 (14.2%) had health insurance. Therapy was planned with palliative intent in 607 (63.7%) patients. The prevalence of financial toxicity was 73.7% as per the COST-FACIT scale (n = 703), and 66% as per the CFPB (n = 629). Higher financial toxicity on the COST-FACIT scale was associated with poor financial well-being on the CFPB scale. Financial toxicity was associated with poor QoL and higher distress. Factors associated with significantly greater financial toxicity included history of tobacco chewing, monthly family income less than ₹50,000, lack of health insurance, illiteracy, depression, and cognitive impairment.

CONCLUSIONS

Identifying the factors contributing to financial toxicity will help make the cancer treatment journey smoother, more accessible and improve compliance to therapy for older patients.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov Identifier: CTRI/2020/04/024675.

Experiences and coping strategies related to financial toxicity among frail older colorectal cancer survivors in China: a qualitative study

PURPOSE

Cancer-related financial toxicity (FT) plays a key role in patients' disease prognosis, well-being, and quality of life. This study aimed to explore the experiences and coping strategies related to FT among frail older colorectal cancer (CRC) survivors in China.

METHODS

This study adopted a descriptive qualitative approach. Individual interviews were performed with 10 frail older CRC patients at a local hospital from March 2024 to August 2024. Relevant data were analyzed using the Colaizzi's phenomenological analysis.

RESULTS

The experiences of FT among frail older CRC patients included (1) insufficient economic income and inadequate medical security; (2) long course of cancer treatment and unaffordability of financial burden; (3) the vulnerability of household economies; and (4) under high psychological pressure and a sense of financial uncertainty. Meanwhile, the coping strategies to mitigate the impacts of FT in this population were as follows: (1) utilizing medical security and insurance policies to reduce FT; (2) financial planning, support, and sharing of responsibilities among family members; and (3) self-psychological adjustment and family members' emotional support.

CONCLUSION

Mitigating FT in frail older CRC survivors is crucial for improving their disease outcomes and quality of life. Understanding the experiences related to FT and identifying relevant coping strategies in this population may contribute to formulating medical and health policies for protecting these patients and their families from the adverse effects of FT. Future studies should be placed on developing effective interventions and providing personalized support for this population to alleviate FT.

Financial Toxicity and Its Association with the Quality of Life of Greek Patients with Cancer: A Cross-Sectional Study

Background/Objectives: Greek cancer patients deal with high out-of-pocket medical expenses in comparison with the European Union average. All these high costs affect the quality of life of cancer patients, leading to financial toxicity. The purpose of this study is to investigate the association between financial toxicity and quality of life in patients undergoing cancer treatment. Methods: A cross-sectional study was conducted in four hospitals in Greece. The Comprehensive Score for Financial Toxicity (COST) Scale was used for the evaluation of financial toxicity, and the EORTC Core Quality of Life questionnaire (EORTC QLQ-C30) was used for the assessment of quality of life. Quantitative variables were first tested for normality using the Kolmogorov-Smirnov criterion. Spearman correlation coefficients (rho) were used to explore the association of two continuous variables. Multiple linear regression analysis was used with dependent the QoL subscales. Logarithmic transformations of the QoL scales were used for the regression analyses. Internal consistency reliability was determined by the calculation of Cronbach's α coefficient. All reported p values are two-tailed. Statistical significance was set at p < 0.05 and analyses were conducted using SPSS statistical software (version 27.0). Results: Greater financial toxicity score, i.e., lower toxicity, was significantly associated with greater global health status (rho = 0.34; p < 0.001) and greater physical (rho = 0.37; p < 0.001), role (rho = 0.17; p = 0.001), emotional (rho = 0.34; p < 0.001), cognitive (rho = 0.22; p < 0.001), and social (rho = 0.27; p < 0.001) functioning. Conclusions: There is a strong correlation between a greater financial toxicity score and the quality of life of Greek cancer patients, meaning the lower their financial toxicity, the better their quality of life.

The mediating role of frequent mental distress in the relationship between adverse childhood experiences and cognitive disability in emerging adults

Adverse Childhood Experiences (ACEs) may have an impact on cognitive disability through multiple pathways. Frequent Mental Distress (FMD) could result in cognitive disability through different aspects, but the potential mediating role of FMD in the associations remained unclear. So we aimed to investigate not only the association between self-reported ACEs and cognitive disability, but also the mediating effect of FMD between ACEs and cognitive disability. A cross-sectional analysis of respondents aged 18-25 years old in the 2020 and 2021 Behavioral Risk Factor Surveillance System (BRFSS) was performed. Weighted multivariate logistic regression models were used to assess the association of ACEs with FMD and cognitive disability. Mediation effects were used to investigate FMD as mediation between ACEs and cognitive disability in emerging adults. Among the 10,309 respondents, the prevalence of cognitive disability was 15.8%, and 71.6% of them experienced ACEs. We found experienced ACEs, self-reported FMD were significantly associated with 4.05 and 5.61 times increased risk of cognitive disability, respectively. The more types of ACEs respondents experienced, the higher risks of cognitive disability. And mediating effect analysis found FMD mediated the associations between ACEs and cognitive disability. Our study indicated a strong association between ACEs and cognitive disability in emerging adults. Furthermore, FMD plays a mediating role in the associations.

Worse Depression Profiles Are Associated With Higher Symptom Burden and Poorer Quality of Life in Patients With Gynecologic Cancer

BACKGROUND

Depression is a pervasive symptom in patients with gynecological cancer undergoing chemotherapy.

OBJECTIVES

Purposes were to identify subgroups of patients with distinct depression profiles and evaluate for differences in demographic and clinical characteristics, severity of common symptoms, and quality of life (QOL) outcomes among these subgroups.

METHODS

Patients with gynecological cancer (n = 231) completed the Center for Epidemiologic Studies-Depression Scale 6 times over 2 cycles of chemotherapy. All of the other measures were completed prior to the second or third cycle of chemotherapy. Latent profile analysis was done to identify the distinct depression profiles. Differences were evaluated using parametric and nonparametric tests.

RESULTS

Three distinct profiles were identified: low (60.1%), high (35.1%), and very high (4.8%). Compared with low class, the other 2 classes had lower functional status and were more likely to self-report a diagnosis of depression. Patients in the 2 worse profiles reported a higher comorbidity burden, higher levels of trait and state anxiety, sleep disturbance, and fatigue, as well as lower levels of cognitive function and poorer QOL. State and trait anxiety, evening fatigue, and sleep disturbance scores exhibit a "dose-response effect" (ie, as the depression profile worsened, the severity of these symptoms increased).

CONCLUSIONS

Almost 40% of our sample experienced high or very high levels of depression across 2 cycles of chemotherapy.

IMPLICATIONS FOR PRACTICE

Clinicians can use the identified risk factors to identify high patients risk and provide tailored psychological interventions aimed to decrease symptom burden and prevent decrements in QOL.

Effects of Virtual Reality Therapy for Patients With Breast Cancer During Chemotherapy: Randomized Controlled Trial

Background

Patients with breast cancer endure high levels of psychological and physical pain. Virtual reality (VR) may be an acceptable, safe intervention to alleviate the negative emotions and pain of patients with cancer.

Objective

We aimed to test the long-term effects of VR on psychological distress and quality of life (QOL) with traditional care in Chinese patients with breast cancer. We also explored the intervention mechanism and the acceptability of VR.

Methods

A total of 327 eligible participants were randomly assigned to a VR intervention group or a control group. The Distress Thermometer, QLQ-C30 (Quality of Life Questionnaire version 3.0), and Virtual Reality Symptom Questionnaire were assessed at baseline, postintervention (3 mo), and follow-up (6 mo). Analysis followed the intention-to-treat (ITT) principle. The generalized estimating equations model was used to analyze the longitudinal data, and the PROCESS macro was used to analyze the mediating effect.

Results

Compared with the control group, patients with breast cancer in the VR group had lower distress scores (P=.007), and higher health-related QOL scores (physical, role, emotional, cognitive, and social functioning) after 6 months (P<.05). Psychological distress had mediating effects on the longitudinal association between VR and the health-related QOL (indirect effect=4.572-6.672, all P<.05).

Conclusions

VR intervention technology may help reduce distress and improve QOL for patients with breast cancer over time. By incorporating a mediating analysis, we showed that the QOL benefits of VR intervention was manifested through positive effects on psychological distress risk factors.

Information needs preferences of Chinese colorectal cancer patients receiving chemotherapy: A discrete choice experiment

Objective

The study aims to investigate the information needs and preferences of colorectal cancer (CRC) patients undergoing chemotherapy using a discrete choice experiment (DCE) to optimize and improve the information support strategy for these patients.

Methods

Between May and July 2023, 165 patients with CRC who were receiving chemotherapy at a single hospital in China completed the questionnaire. The survey instruments included a general information questionnaire, a DCE questionnaire, and the Brief Health Literacy Screening Scale. A conditional logit model was used with Stata 16.0 software to analyze patients' preferences.

Results

A total of 159 valid questionnaires were collected, and the questionnaire response rate was 96.4%. All 7 included attributes had an impact on patients' information needs preference (P < 0.05). Among them, information providers, knowledge content, and social support had high relative importance, which were 12.16%, 7.57% and 2.25%, respectively. Patients showed a preference for attending doctors (β = 1.9439, P < 0.05) and primary nurses (β = 1.7985, P < 0.05). Providing knowledge related to disease basis, treatment, and health promotion also had a significant impact (β = 1.6224, P < 0.05).

Conclusions

Healthcare professionals should be the primary information source for patients and improve the accessibility of information by establishing professional information platforms or identifying reliable channels. It is recommended to provide continuous information on treatment and health promotion to CRC patients at various stages of chemotherapy. Attention should be paid to identifying and providing measures to alleviate the economic and psychological burden and to meet the social support needs of patients.

Influence of age on financial toxicity in cancer patients

Objective

The aim of this study was to assess the level of financial toxicity (FT) experienced by the following three age groups of cancer patients in China: young working-aged patients (age < 40 years), middle-aged patients (40-64 years), and older patients (≥ 65 years).

Methods

The data used for this study were collected via a cross-sectional survey conducted in China. FT was assessed using the Comprehensive Score for Financial Toxicity (COST). ANOVA was used to examine the differences in FT status between age groups. Multivariate linear regression models were employed to assess the association between age and FT, adjusted by socioeconomic and other clinical characteristics.

Results

A total of 556 cancer patients completed the survey. Approximately 54.3% of the participants were male and 45.7% were female. The majority (61.5%) were aged 40-64 years, while 27.7% were aged 65 or older. The mean FT scores for young patients (< 40 years), middle-aged patients (40-64 years), and older patients (≥ 65 years) were 16.7, 12.8, and 12.4, respectively. The results of the regression analysis revealed that, without adjusting for background characteristics, young patients had significantly higher mean COST scores. This suggests they experienced lower levels of FT compared to patients in other age groups. Stratified analysis revealed that, for older patients, only educational level and type of insurance scheme were significant factors in predicting the COST score.

Conclusions

This study provides empirical evidence for developing targeted interventions and policies to reduce the FT for patients in different age groups. Given that FT is complicated, a longitudinal study should be conducted to explore the long-term impact of FT on cancer patients' quality of life and well-being.

Cancer cost-related subjective financial distress among breast cancer: a scoping review

PURPOSE

This article provided a comprehensive scoping review, synthesizing existing literature on the financial distress faced by breast cancer patients. It examined the factors contributing to financial distress, the impact on patients, coping mechanisms employed, and potential alleviation methods. The goal was to organize existing evidence and highlight possible directions for future research.

METHODS

We followed the scoping review framework proposed by the Joanna Briggs Institute (JBI) to synthesize and report evidence. We searched electronic databases, including PubMed, Web of Science, Embase, and Cochrane Library, for relevant literature. We included English articles that met the following criteria: (a) the research topic was financial distress or financial toxicity, (b) the research subjects were adult breast cancer patients, and (c) the article type was quantitative, qualitative, or mixed-methods research. We then extracted and integrated relevant information for reporting.

RESULTS

After removing duplicates, 5459 articles were retrieved, and 43 articles were included based on the inclusion and exclusion criteria. The articles addressed four main themes related to financial distress: factors associated with financial distress, impact on breast cancer patients, coping mechanisms, and potential methods for alleviation. The impact of financial distress on patients was observed in six dimensions: financial expenses, financial resources, social-psychological reactions, support seeking, coping care, and coping lifestyle. While some studies reported potential methods for alleviation, few discussed the feasibility of these solutions.

CONCLUSIONS

Breast cancer patients experience significant financial distress with multidimensional impacts. Comprehensive consideration of possible confounding factors is essential when measuring financial distress. Future research should focus on exploring and validating methods to alleviate or resolve this issue.

Assessment of Financial Toxicity and Coping Strategies Associated With Cancer Treatment Among Caregivers of Patients With Cancer From a Lower-Middle-Income Country

PURPOSE

The rising cost of cancer treatment causes out-of-pocket spending among patients or caregivers in lower-middle-income countries, resulting in acute misery and insolvency. This study aimed to assess the financial toxicity associated with cancer treatment and the coping strategies for cancer treatment adopted among the caregivers of patients with cancer in a tertiary cancer care center.

MATERIALS AND METHODS

This prospective cross-sectional study was conducted among the primary caregivers of patients with cancer undergoing curative treatment from March to June 2023. The estimated sample size was 403 caregivers. The financial toxicity was assessed using a modified Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy tool, and coping strategies were explored using a validated questionnaire of 20 questions. Univariate and multivariate analyses investigated the associations and factors influencing financial toxicity.

RESULTS

The caregivers recruited in the study were 403; 83.8% were younger than 50 years, and 66.5% were male. The common cancer types included were breast cancer (27.3%), GI cancer (17.9%), head and neck cancer (12.4%), and gynecological cancer (11.6%). The mean financial toxicity score was 22.32 (standard deviation, 9.55), with 64% experiencing moderate to severe financial toxicity. The most common coping strategies used were spending a portion or all of the savings, borrowing money from others, restructuring their spending habits, seeking financial assistance from the cancer center, and resorting to gold loans.

CONCLUSION

Screening patients and their primary caregivers using a modified COST tool can help identify families experiencing severe financial toxicity and provide necessary intervention.

Exploring the economic toxicity experiences and coping styles of patients with colorectal cancer fistula in Jiangsu province, China: a qualitative study

OBJECTIVES

In recent years, economic toxicity has significantly affected the physical and mental health as well as the quality of life of patients with colorectal cancer. However, this issue has not garnered adequate attention from healthcare professionals. This study aims to investigate the experiences of economic toxicity and coping strategies among patients with colorectal cancer fistula. The findings are intended to inform the development of suitable and effective intervention programmes to address economic toxicity within this patient population.

DESIGN

A descriptive phenomenological approach was employed in this qualitative research, using a semistructured method for data collection and analysis of interview data. Traditional content analysis methods were applied, encompassing coding, categorisation and theme distillation. Data analysis continued until thematic saturation was achieved, with no new themes emerging.

SETTING

Nanjing Medical University Lianyungang Clinical Medical College.

PARTICIPANTS

A total of 21 patients with colorectal cancer fistula were selected as interview subjects through purposive sampling. The selection took place from May 2022 to May 2023, involving patients during their stay at a tertiary hospital in Lianyungang city, Jiangsu province, China.

RESULTS

In total, three pieces and eight subthemes were distilled: subjective feelings (worries about treatment costs, concerns about uncertainty about the future, worries about daily life), coping styles (coping alone, unwillingness to help, prepurchased insurance, dealing with illness, giving up treatment, inability to afford costs) and needs and aspirations (need for health policies, need for social support).

CONCLUSIONS

Patients with colorectal cancer fistulae experience economic toxicity, leading to significant impairment in both physical and mental health. Despite employing various coping strategies, healthcare professionals must prioritise addressing the economic toxicity issue in patients. Implementing rational and effective interventions can greatly assist patients in effectively managing economic toxicity.

Financial toxicity in allogeneic haematopoietic stem cell transplant patients from a social determinants of health perspective

PURPOSE

Financial toxicity (FT) refers to the subjective perception of financial distress resulting from objective economic strain due to illness, exerting a detrimental influence on health outcomes. This study aimed to describe FT among allogeneic haematopoietic stem cell transplant (allo-HSCT) recipients within a public health framework, employing a social determinants of health approach.

METHODS

A multi-centre cross-sectional study involving adult allo-HSCT patients was conducted across three public hospitals in Madrid. FT was assessed using a validated COST scale (range 0-44; lower scores indicating higher FT). Patient-administered paper/online questionnaires were utilized to collect data on sociodemographic, socioeconomic, clinical, and healthcare access variables. Descriptive, non-parametric univariate statistical analysis and multiple linear regression models were performed.

RESULTS

Sixty-six patients, with a mean age: 52.5 years (SD: 11.5), 50% women, 28.7% displaced to Madrid for HSCT, and 71.4% lacking financial support were included. The median FT score was 20 points (IQR 12-27.25). Independent factors associated with higher FT included being females (Coef = -3.26; p = 0.079), perceived income loss after HSCT (Coef = -6.81; p < 0.001) and a monthly household income of ≤1000 € compared to 1001-2500€ (Coef = 8.29; p = 0.005) or >2500 € (Coef = 15.75; p < 0.001).

CONCLUSIONS

Despite the limited sample size, our findings underscore the presence of financial toxicity among allo-HSCT patients, shaped by social determinants of health. Recognizing and addressing FT within the HSCT process is essential to mitigate social inequalities in health.

Financial toxicity and its influencing factors in patients with non-Hodgkin lymphoma: A cross-sectional study

PURPOSE

Financial toxicity has emerged as a prevalent psychosocial problem in cancer patients, but data on non-Hodgkin lymphoma patients receiving chemotherapy remain limited. The present study aims to explore financial toxicity and its influencing factors among non-Hodgkin lymphoma patients.

METHODS

A total of 236 non-Hodgkin lymphoma patients were enrolled from March to June 2023 in the oncology department of a tertiary grade-A hospital in China. Hierarchical regression analysis was used to analyze potential influences on financial, including general information, symptom burden, family and social support.

RESULTS

The financial toxicity score for non-Hodgkin lymphoma patients was (19.24 ± 6.97). Among them, 92 participants (38.98%) were classified as experiencing high levels of financial toxicity, with a COST score of ≤17.5 points. Hierarchical regression analysis revealed that symptom burden accounting for 11.0% of the variance in financial toxicity, while family functioning and social support explained 5.8% and 4.9%, respectively.

CONCLUSION

The financial toxicity of non-Hodgkin lymphoma patients needs to be further improved. Patients with low household income, unemployment, high symptom burden, and inadequate family and social support may experience severe financial toxicity. Financial toxicity of non-Hodgkin's lymphoma patients must be assessed and targeted interventions must be implemented to reduce their financial burden.

Financial toxicity in early-onset colorectal cancer: A National Health Interview Survey study

BACKGROUND

Financial toxicity is increasingly recognized as a devastating outcome of cancer treatment but is poorly characterized in patients with early-onset colorectal cancer. Young patients are particularly vulnerable to financial toxicity as they are frequently underinsured and may suffer significant disruptions to professional and financial growth. We hypothesized that financial toxicity associated with colorectal cancer treatment confers long-lasting effects on patients' well-being and disproportionately impacts patients diagnosed at <50 years of age.

METHODS

A retrospective cross-sectional analysis of the National Health Interview Survey from years 2019 to 2021 was performed. Patients with a history of colorectal cancer were included and stratified by age at diagnosis. Randomly selected age-matched controls with no cancer history were used for comparison. The primary endpoint was financial toxicity, as assessed by a composite score formulated from 12 National Health Interview Survey items. The secondary endpoint was food security assessed by the United States Department of Agriculture's food security scale, embedded in the National Health Interview Survey.

RESULTS

When compared to age-matched controls, patients with colorectal cancer experienced significant financial toxicity, as reflected by a composite financial toxicity score (P = .027). Within patients with colorectal cancer, female sex (adjusted odds ratio = 1.46, P = .046) and early-onset disease (adjusted odds ratio = 2.11, P = .002) were found to significantly increase the risk of financial toxicity. Patients with early-onset colorectal cancer more frequently experienced food insecurity (P = .011), delayed necessary medical care (P = .053), mental health counseling (P = .043), and filling prescriptions (P = .007) due to cost when compared to patients with average-onset colorectal cancer.

CONCLUSION

Colorectal cancer is associated with significant long-term financial toxicity, which disproportionately impacts patients diagnosed at <50 years of age. Targeted interventions are warranted to reduce financial toxicity for patients with high-risk colorectal cancer.

Financial toxicity and its risk factors among patients with cancer in China: A nationwide multisite study

Objective

We assessed financial toxicity (FT) among Chinese patients with cancer and investigated associated risk factors guided by a multilevel conceptual framework.

Methods

Applying multistage stratified sampling, we selected six tertiary and six secondary hospitals across three economically diverse provinces in China. From February to October 2022, 1208 patients with cancer participated. FT was measured using the COmprehensive Score for financial Toxicity (COST), with 28 potential risk factors identified at multilevel. Multiple regression analysis was used for risk factor identification.

Results

FT prevalence was 82.6% (95% confidence interval [CI]: 80.5%, 84.8%), with high FT (COST score ≤ 18.5) observed in 40.9% of participants (95% CI: 38.1%, 43.7%). Significant risk factors included younger age at cancer diagnosis, unmarried status, low annual household income, negative impact of cancer on participants' or family caregiver's work, advanced cancer stage, longer hospital stay for cancer treatment or treatment-related side effects, high perceived stress, poor emotional/informational support, lack of social medical insurance or having urban and rural resident basic medical insurance, lack of commercial medical insurance, tertiary hospital treatment, and inadequate cost discussions with healthcare providers (all P < 0.05).

Conclusions

Cancer-related FT is prevalent in China, contributing to disparities in cancer care access and health-related outcomes. The risk factors associated with cancer-related FT encompasses multilevel, including patient/family, provider/practice, and payer/policy levels. There is an urgent need for collective efforts by patients, healthcare providers, policymakers, and insurers to safeguard the financial security and well-being of individuals affected by cancer, promoting health equities in the realm of cancer care.

Post-surgery financial toxicity and its influencing factors in colorectal cancer care: A cross-sectional study

PURPOSE

This study aimed to investigate the influence factors of financial toxicity experienced by colorectal cancer patients after surgery. The results will provide deep insights for developing effective intervention strategies to address this common issue of colorectal cancer care.

METHODS

In this cross-sectional study, we recruited 213 postoperative patients with colorectal cancer from February 2023 to July 2023 in two major public hospitals. Patients completed the General Information Questionnaire, Comprehensive Scores for Financial Toxicity (COST), Self-perceived Burden Scale (SPBS), Family Resilience Questionnaire (FaREQ), and Social Support Rating Scale (SSRS). A multiple linear regression model was used to investigate the influence factors of financial toxicity.

RESULTS

The mean score of financial toxicity was medium (18.91 ± 7.90) in this study. Financial toxicity score was negatively correlated with self-perceived burden (r = -0.333, P < 0.01) and positively associated with family resilience (r = 0.365, P < 0.01) and social support (r = 0.388, P < 0.01). Via multiple linear regression analysis, we identified seven significant factors associated with financial toxicity, including family income [(95 %CI: 1.075-3.123); P = 0.000], self-perceived burden [(95 %CI: 0.300∼-0.038); P = 0.012], stoma [(95 %CI: 5.309∼-1.682); P = 0.000], social support [(95 %CI:0.058-0.407); P = 0.009], cancer stage [(95 %CI: 2.178∼-0.170); P = 0.022], postoperative duration [(95 %CI: 1.900∼-0.332); P = 0.005], and family resilience [(95 %CI: 0.028-0.203); P = 0.010].

CONCLUSIONS

Financial toxicity was prevalent among postoperative colorectal cancer patients. Additional support and early interventions should be given to high-risk patients, including those with stomas, advanced disease stages, or experiencing longer postoperative duration. Apart from demographic factors, we identified that self-perceived burden, family resilience, and social support were also associated with financial toxicity, providing a new perspective for developing effective strategies against financial toxicity.

Determination of a cut-off COmprehensive Score for financial Toxicity (COST) for identifying cost-related treatment nonadherence and impaired health-related quality of life among Chinese patients with cancer

PURPOSE

This study aimed to determine a cut-off for the simplified Chinese version of the COmprehensive Score for financial Toxicity (COST) that could identify cost-related treatment nonadherence among Chinese patients with cancer. The study also sought to validate this cut-off score by using it to assess impaired health-related quality of life (HRQoL) in the same population.

METHODS

A secondary analysis was conducted using data from a cross-sectional survey of 1208 Chinese patients with cancer who were recruited from 12 hospitals in six cities across three provinces of the Chinese mainland. Sociodemographic information and data on financial toxicity (FT), cost-related treatment nonadherence, and HRQoL were used in the analysis. Receiver operating characteristic (ROC) analysis was used to determine the optimal cut-off for the simplified Chinese version of the COST.

RESULTS

The ROC analysis identified a COST cut-off of 18.5 for identifying cost-related treatment nonadherence, yielding a sensitivity of 76.5% and specificity of 71.4%. In the validation study, this cut-off score yielded a sensitivity of 64.2% and a specificity of 67.1% for identifying impaired HRQoL.

CONCLUSION

Early and dynamic assessment of cancer-related FT in routine clinical practice may play a crucial role in the early identification and management of FT. Accordingly, a COST cut-off of 18.5 was identified to indicate cost-related treatment nonadherence and impaired HRQoL in a population of patients with cancer from the Chinese mainland. This finding may facilitate the implementation of universal FT screening among patients with cancer in specific settings such as the Chinese mainland.

Level of caregiving burden and affecting factors in family caregivers of patients with lung cancer: A cross-sectional study

PURPOSE

To determine the caregiving burden level and affecting factors of family members caring for patients with lung cancer (LC).

METHODS

This study used a cross-sectional design and a convenience sampling method. The study was conducted between April 2023 and August 2023 with the LC patients (n = 448) and their caregivers (n = 448) who met the inclusion criteria and were followed up in seven clinics of a specialized hospital for pulmonary diseases in Turkey. Data were collected by using (1) a demographic questionnaire (for patient and caregiver), (2) the Zarit Burden Interview (ZBI), (3) the Beck Depression Inventory (BDI), and (4) the Caregiver Quality of Life Index-Cancer (CQoLC).

RESULTS

The study included 448 caregivers, with a mean age of 45.09 ± 13.48 years, and 71.4% were female. The mean ZBI score of 31.45 ± 16.71 indicated mild to moderate burden. Pearson correlation analysis showed that caregivers' depression levels increased and quality of life decreased significantly as the care burden increased. Multiple regression analysis indicated a significant relationship between the caregiver burden and the patient's age (p < 0.05), caregiver's chronic disease (p < 0.05), type of treatment given to the patient (p < 0.05), patient's metastasis status (p < 0.05) and caregiver's quality of life (p < 0.01).

CONCLUSION

The fact that most of the risk factors identified in this study are non-modifiable highlights the necessity of identifying caregiver burden early by nurses and initiating the appropriate support processes.

Evaluation of financial toxicity and associated factors in female patients with breast cancer: a systematic review and meta-analysis

PURPOSE

These systematic review and meta-analysis were conducted to discuss the financial toxicity (FT) level among breast cancer (BC) patients and the associated demographic and economic factors.

METHODS

A systematic review and meta-analysis of single means were used by following the Joanna Briggs Institute guidelines and PRISMA guidance. Untransformed means (MRAW) were used to estimate the confidence interval for individual studies, while I2 and tau2 statistics were used to examine heterogeneity among pooled studies. Electronic databases were PubMed, CINAHL, Web of Science, Scopus, Cochrane Library, Ovid MEDLINE(R), Science Direct, and Turkish databases were used to find relevant studies published in the last 15 years (between 2008 and 2023).

RESULTS

A total of 50 studies were reviewed in the systematic review, and 11 were included in the overall and subgroup meta-analyses. The majority of reviewed studies were from the USA (38 studies), while there were four studies from China and eight studies from other countries having different types of health systems. The overall estimated FT level based on 11 pooled studies was 23.19, meaning mild level FT in the range of four categories (no FT score > 25, mild FT score 14-25, moderate FT score 1-13, and severe FT score equal to 0), with a 95% CI of 20.66-25.72. The results of subgroup meta-analyses showed that the estimated FT levels were higher among those patients who were single, with lower education levels, stage 3 patients, younger, lower income, unemployed, and living in other countries compared to those who were married, more educated, and stages 1 and 2 patients, more aged, more income, employed, and patients in the USA.

CONCLUSION

The cost-effectiveness of the treatment strategies of BC depends on the continuity of care. However, FT is one of the leading factors causing BC patients to use the required care irregularly, and it has a negative effect on adherence to treatment. So, removing the economic barriers by taking appropriate measures to decrease FT will increase the efficiency of already allocated resources to BC treatments and improve the health outcomes of BC patients.

Financial toxicity assessment and associated factors analysis of patients with cancer in China

PURPOSE

Cancer-related expenditures present a lasting economic burden on patients and their families and may exert long-term adverse effects on the patients' life and quality of life. In this study, the comprehensive score for financial toxicity (COST) was used to investigate the financial toxicity (FT) levels and related risk factors in Chinese patients with cancer.

METHODS

Quantitative data were collected through a questionnaire covering three aspects: sociodemographic information, economic and behavioral cost-coping strategies, and the COST scale. Univariate and multivariate analyses were performed to identify factors associated with FT.

RESULTS

According to 594 completed questionnaires, the COST score ranged 0-41, with a median of 18 (mean±SD, 17.98±7.978). Over 80% of patients with cancer reported at least moderate FT (COST score <26). A multivariate model showed that urban residents, coverage by other health insurance policies, and higher household income and consumption expenditures were significantly associated with higher COST scores, indicative of lower FT. The middle-aged (45-59 years old), higher out-of-pocket (OOP) medication expenditures and hospitalizations, borrowed money, and forgone treatment were all significantly associated with lower COST scores, indicating higher FT.

CONCLUSION

Severe FT was associated with sociodemographic factors among Chinese patients with cancer, family financial factors, and economic and behavioral cost-coping strategies. Government should identify and manage the patients with high-risk characteristics of FT and work out better health policies for them.

Greater financial toxicity correlates with increased psychological distress and lower quality of life among Turkish cancer patients

PURPOSE

This study aims to investigate the factors that influence financial toxicity and its effects on both quality of life and psychological distress in Turkish cancer patients.

METHODS

Data from 400 cancer patients receiving chemotherapy at a public university in Turkey was analyzed. The Comprehensive Score for Financial Toxicity (COST), Patient Health Questionnaire for Depression and Anxiety (PHQ-4), and Functional Assessment of Cancer Therapy-General (FACT-G) were used to measure financial toxicity, psychological distress, and health quality of life, respectively.

RESULTS

Patients' median COST score was 22 (SD = 10.1; range: 1-44) and was consistent with mild financial toxicity. Financial toxicity was associated with lower education level (p < 0.001), lower monthly income (p < 0.001), being a woman (p = 0.021), living in another city (p = 0.012), and previous cancer surgery (p = 0.02). A negative and statistically significant correlation was found between financial toxicity and quality of life (r =  - 0.139; p = 0.005) and psychological distress (r =  - 0.398; p < 0.001).

CONCLUSION

This investigation demonstrated that financial toxicity was a significant determinant of quality of life and psychological distress.

Financial toxicity following surgical treatment for colorectal cancer: a cross-sectional study

PURPOSE

Financial toxicity has become a global public health issue. The purpose of the study is to investigate and analyze the influencing factors of financial toxicity in patients with non-metastatic colorectal cancer.

METHODS

A convenient sample of 250 patients with stage I-III colorectal cancer was investigated in the study. They completed a set of questionnaires, including the Comprehensive Score for Financial Toxicity questionnaire, the Perceived Social Support Scale, and the Hospital Anxiety and Depression Scale. Univariate and multivariate linear regression were performed to investigate the influencing factors of financial toxicity.

RESULTS

Over half (52.8%, n = 132) of the colorectal cancer survivors experienced financial toxicity. Multivariate regression analysis showed that the factors associated with financial toxicity were young age, unemployment, low annual household income, chemotherapy, and the lack of sufficient social support (p < 0.05).

CONCLUSIONS

Financial toxicity is common among non-metastatic colorectal cancer survivors. Young age, lower annual household income, unemployment, chemotherapy, and insufficient social support were associated with financial toxicity.