Financial Toxicity Among Breast Cancer Patients: A Scoping Review of Risk Factors and Outcomes

The development and preliminary evaluation of a financial navigation program among patients with breast cancer in China

Objective

This study aims to develop a financial navigation program among patients with breast cancer in China and assess its feasibility, acceptability, and preliminary effects on cost-related health literacy and financial toxicity (FT).

Methods

The Medical Research Council (MRC) framework were adopted to guide the development of the financial navigation program, providing a structured approach to complex intervention development and evaluation. It consisted of three phases: evidence identification via a scoping review, intervention content modeling through qualitative study analysis, and outcome mapping based on social stress theory. The feasibility, acceptability and primary effectiveness were examined in a single-center, assessor-blinded pilot randomized controlled trial with 26 recruited patients.

Results

The financial navigation program consists of needs assessment, cost-related health education, resource/service referral and personalized counseling. The consent rate and a 1-month attrition rate for the feasibility study of the intervention were 55.9% and 7.7%, respectively. Most (91.7%) participants were satisfied with the program and perceived benefits. The intervention significantly improved cost-related health literacy, although no statistically significant between-group difference in FT was observed.

Conclusions

The MRC framework serves as a useful scientific basis for developing financial navigation program with a culturally sensitive approach. The financial navigation program was feasible, acceptable, effective in improving cost-related health literacy and has the potential to enhance FT among patients with breast cancer in China.

Trial registration

ClinicalTrials.gov Identifier NCT06355440.

Potential profile analysis of financial toxicity and its related factors among lung cancer patients

BACKGROUND

Financial Toxicity (FT) is prevalent among lung cancer patients. Identifying high-risk groups and implementing comprehensive, targeted interventions can alleviate FT and improve patients' quality of life. Hence, the objective of this study was to analyze the status and potential profiles of FT in lung cancer patients and explore the related factors of FT levels in different categories of lung cancer patients.

METHODS

A cross-sectional design was used in this study. A total of 421 patients with lung cancer hospitalized in the oncology department of a Grade A general hospital and a provincial oncology hospital in Shandong Province from October to December 2023 were selected by convenience sampling. General data questionnaires, FT scale for reported outcomes of cancer patients, Chinese version of the Quality of Life Scale for lung cancer patients, Social Support Rating Scale and simplified version of the Mental Resilience Scale were used. Potential profile analysis of FT levels in lung cancer patients was performed, and multiple logistic regression was used to analyze the related factors of FT levels in different categories.

RESULTS

Among 421 lung cancer patients, the median FT (FT) score was 16 (IQR: 9-24). Latent profile analysis identified four distinct FT patterns: mild (19.5%), moderate resource-deficient (7.8%), moderate balanced (35.6%), and severe (37.1%). Multivariate analysis revealed significant associations between FT severity and hospitalization frequency, lifestyle modifications, employment status, insurance coverage, education level, social support, emotional distress, family resilience, problem-solving capacity, and social resource utilization.

CONCLUSION

FT demonstrates high prevalence and substantial heterogeneity in lung cancer patients, with over 70% experiencing moderate-to-severe levels. Clinical interventions should prioritize early screening and stratified management through psychological support, financial navigation programs, cost-containment strategies, and enhanced health literacy to alleviate economic burdens and optimize treatment outcomes.

Trajectories and predictors of financial toxicity in breast cancer patients: A multicenter longitudinal study in China

BACKGROUND

Patients with breast cancer experience varying levels of financial toxicity (FT), but the factors contributing to sustained financial toxicity remain poorly understood.

METHODS

This longitudinal study was conducted from November 2022 to March 2024 in China. Participants were recruited from four Tertiary Level A hospitals using convenient sampling. FT was assessed using the Comprehensive Score for Financial Toxicity (COST) at baseline (T1), 3 months (T2), 6 months (T3), and 12 months (T4) post-surgery. Growth Mixture Modeling was used to identify the different trajectories of the FT. Multivariable logistic regression were employed to explore the predictive factors with different trajectory categories.

RESULTS

Among 378 participants (all women; median [SD] age, 48.9 [9.97] years), the COST score was lowest at T2. Three distinct FT trajectories were identified: 91 patients (24 %) in the "Severe FT with Gradual Relief" group (trajectory 1), 190 patients (50 %) in the "Persistently Low-Level FT" group (trajectory 2), and 97 patients (26 %) in the "Moderate FT with Gradual Worsening" group (trajectory 3). Using trajectory 2 as the reference, predictors for trajectory 1 included symptom burden, location, cancer stage, cost-related health literacy, resilience, and difficulty affording basic expenses. For trajectory 3, predictors included monthly household income, symptom burden, location, and cancer stage.

CONCLUSIONS

The FT experienced by breast cancer patients changes over time and follows distinct dynamic trajectories, influenced by multiple factors. In future clinical practice, early identification and intervention for high-risk FT groups should be prioritized.

Financial toxicity-related factors in patients with nasopharyngeal carfcinoma: a cross-sectional study

PURPOSE

This cross-sectional study aimed to investigate the incidence and related factors of financial toxicity among nasopharyngeal carcinoma (NPC) patients and propose strategies for improvement.

METHODS

Patients with nasopharyngeal carcinoma were recruited from December 2022 to June 2023 in Changsha, Hunan Province, China, using convenience sampling. A questionnaire survey focusing on financial toxicity among patients with nasopharyngeal carcinoma was conducted. The assessment tools used in this study include Comprehensive Scores for Financial Toxicity Based on the Patient-Reported Outcome Measures (COST-PROM), Medical Coping Modes Questionnaire (MCMQ), and Perceived Social Support Scale (PSSS).

RESULTS

A total of 155 patients with nasopharyngeal carcinoma were included in the study. The incidence of financial toxicity among participants was found to be 65.8%, with an average COST score of 22.45 ± 7.91. A significant negative correlation was shown between MCMQ scores and financial toxicity in patients (r = -0.235, p = 0.003), while a significant positive correlation was demonstrated between the PSSS scores and financial toxicity (r = 0274, p = 0.001). The multiple linear regression analysis showed that personal monthly income, MCMQ scores, and PSSS scores were related to financial toxicity in patients with nasopharyngeal carcinoma.

CONCLUSION

This study revealed a high prevalence of financial toxicity in patients with nasopharyngeal carcinoma. The medical staff needs to identify the financial toxicity early and adopt appropriate strategies to help patients with nasopharyngeal carcinoma return to work, guide them to choose positive medical coping modes, and access more excellent social support.

Clinically meaningful classes of financial toxicity for patients with diabetes

AIMS

This study aims to improve the interpretability and clinical utility of the COmprehensive Score for financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) by identifying distinct financial toxicity classes in adults with diabetes.

METHODS

Data included a sample of 600 adults with Type 1 or Type 2 diabetes and high A1c. Latent Class Analysis was used to identify subgroups of patients based on COST-FACIT score patterns.

RESULTS

We identified 3 financial toxicity classes (high, medium and low) with strong indicators of membership classification. Multiple indicators of financial stress, maladaptive cost-coping behaviors, more comorbidities, more prescribed medications, more diabetes distress, more depressive symptoms, closer to the federal poverty level, female, having lower educational attainment and being single were all significant predictors of high financial toxicity class membership. A score of 26 on the COST-FACIT was the strongest threshold for sorting high vs. medium/low financial toxicity, with a positive predictive value (PPV) of 76% and negative predictive value (NPV) of 93%.

CONCLUSION

The COST-FACIT can be used to reliably identify people with diabetes that have high financial toxicity. Integrating this new cut-score into clinical practice may help clinical teams identify people in need of additional support due to financial toxicity.

Financial Toxicity among Patients with Breast Cancer during the COVID-19 Pandemic in the United States

This study reported the prevalence of financial distress (financial toxicity (FT)) and COVID-19-related economic stress in patients with breast cancer (BC). Patients with BC were recruited from the Ciitizen platform, Breastcancer.org, and patient advocacy groups between 30 March and 6 July 2021. FT was assessed with the COmprehensive Score for financial Toxicity (COST) instrument. COVID-19-related economic stress was assessed with the COVID-19 Stress Scale. Among the 669 patients, the mean age was 51.6 years; 9.4% reported a COVID-19 diagnosis. The prevalence rates of mild and moderate/severe FT were 36.8% and 22.4%, respectively. FT was more prevalent in patients with metastatic versus early BC (p < 0.001). The factors associated with FT included income ≤ USD 49,999 (adjusted odds ratio (adj OR) 6.271, p < 0.0001) and USD 50,000-USD 149,999 (adj OR 2.722, p < 0.0001); aged <50 years (adj OR 3.061, p = 0.0012) and 50-64 years (adj OR 3.444, p = 0.0002); living alone (adj OR 1.603, p = 0.0476); and greater depression severity (adj OR 1.155, p < 0.0001). Black patients (adj OR 2.165, p = 0.0133), patients with income ≤ USD 49,999 (adj OR 1.921, p = 0.0432), or greater depression severity (adj OR 1.090, p < 0.0001) were more likely to experience COVID-19-related economic stress. FT was common in patients with BC, particularly metastatic disease, during COVID-19. Multiple factors, especially lower income and greater depression severity were associated with financial difficulties during COVID-19.

Interventions for financial toxicity among cancer survivors: A scoping review

INTRODUCTION

Financial toxicity impairs cancer survivors' material condition, psychological wellbeing and quality of life. This scoping review aimed to identify interventions for reducing cancer-related financial toxicity (FT), and to summarize their main findings.

METHODS

A systematic search was performed in PubMed, Web of Science, EMBASE, CINAHL, Clinical Trials, China National Knowledge Internet, Wanfang and SinoMed from January 2010 to September 2022 following the PRISMA-ScR checklist.

RESULTS

From 2842 identified articles, a total of 15 were included in this review. Existing interventions can be classified into four types: financial navigation, financial counseling, insurance education and others. Previous interventions preliminarily affirmed the feasibility, satisfaction, and improvement in financial worries and knowledge. However, the effectiveness on FT was controversial.

CONCLUSIONS

Previous interventions affirmed the feasibility and primary effect of these interventions. Studies with more rigorous design are needed to evaluate the effectiveness and generalizability of interventions on FT across diverse healthcare systems.