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.