Mediating Role of Financial Toxicity in the Relationships Between Health-Related Quality of Life and Its Risk Factors in Chinese Patients With Cancer.

Abstract

Background: Factors influencing health-related quality of life (HRQoL) and financial toxicity (FT) have been found to overlap, and the robust correlation between HRQoL and FT raises the possibility that FT mediates the relationships between the shared risk factors and HRQoL. However, empirical evidence supporting this hypothesis is limited.

Objective: This study aimed to explore whether FT mediates the relationships between HRQoL and its risk factors.

Methods: A cross-sectional study was conducted, with 1208 participants from 12 hospitals (6 tertiary, 6 secondary) in 6 cities across 3 income-level-diverse provinces in China from February to October 2022. FT and HRQoL were measured using the COmprehensive Score for financial Toxicity and the Functional Assessment of Cancer Therapy-General. Twenty-two risk factors for both HRQoL and FT were included for analysis. Mediation analyses were conducted using Mplus 8.3.

Results: FT predominantly mediated the relationships between HRQoL and both annual household income and hospital level. Meanwhile, it partially mediated the relationships of HRQoL with the number of treatment modalities, social support, perceived stress, healthcare provider-patient discussion regarding cancer care costs, and social medical insurance, and the mediating effect accounted for 19.7%, 7.8%, 10.7%, 22.3%, and 46.8% of the total effect, respectively.

Conclusions: FT plays a significant mediating role in the associations between HRQoL and some of its risk factors among patients with cancer.

Implications for practice: Developing a more comprehensive and patient-centered approach to cancer care that addresses the unique challenges posed by cancer-related FT is urgently needed to improve the HRQoL among this population.