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

Abstract

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.