Regional economic level moderates the impact of patients' and family carers' cancer-related work changes and hospital level on financial toxicity in China: A multi-centre cross-sectional study.

Purpose: To explore how regional economic levels moderate the relationships between cancer-related financial toxicity (FT) and its associated risk factors.

Methods: A secondary analysis was conducted using data from a cross-sectional survey of 1208 adult patients with cancer, conducted in six tertiary and six secondary hospitals across three Chinese provinces from February to October 2022. The interactions between the regional economic level-categorised as high- or low-/middle-income based on the gross domestic product per capita- and 13 previously identified risk factors for FT were examined via moderation analysis using the PROCESS macro for SPSS software.

Results: Regional economic level moderated the impacts of both patients' and family carers' negative work changes due to cancer and the hospital level on FT (all p-values for interaction effect <0.05). Job changes had more severe effects on FT in high-income regions (patients: B = -2.07, standard error [SE] = 0.67, p = 0.002; carers: B = -1.58, SE = 0.66, p = 0.017), while treatment in tertiary hospitals had a stronger negative impact on FT in low-/middle-income regions (B = 1.81, SE = 0.87, p = 0.037).

Conclusions: These findings highlight the need for region-specific FT mitigation strategies. In high-income regions, more attention could be paid to managing the adverse work-related effects of cancer on patients and their families. In low-/middle-income regions, increased awareness and management of cancer-related FT in tertiary hospitals is needed. Future research should explore other risk factors associated with FT that may be moderated by regional economic levels.