Disparities in cancer-related financial toxicity across economically diverse provinces in China: A multi-center cross-sectional study

Objective: China's diverse economic landscape across its regions may contribute to disparities in cancer-related financial toxicity (FT), but empirical evidence is lacking. This study examined regional disparities in cancer-related FT across economically diverse provinces in China.

Methods: A cross-sectional study was conducted among adult patients with cancer from six tertiary and six secondary hospitals across three Chinese provinces with varying economic statuses (high-, middle-, and low-income). FT was assessed using the COmprehensive Score for financial Toxicity (COST). Hierarchical regression analysis was employed to compare FT among participants from different economic regions, controlling for 13 patient-level sociodemographic and clinical risk factors.

Results: From February to October 2022, 1208 participants completed the survey (response rate ​= ​97.3%). Mean COST scores were 21.99 ​± ​6.37 (high-income), 20.38 ​± ​8.01 (middle-income), and 19.20 ​± ​5.14 (low-income), showing significant differences (P ​< ​0.001), with lower scores indicating more severe FT. After adjusting for covariates, regional economic level was significantly associated with FT, with more severe FT in middle- (B: -1.515; 95% CI: -2.250, -0.780) and low-income regions (B: -2.159; 95% CI: -2.899, -1.418) than in high-income regions.

Conclusions: This study reveals significant disparities in cancer-related FT across economically diverse provinces in China. The findings underscore the need for targeted policies and interventions to improve health equity in cancer care, with a focus on not neglecting middle-income regions. Oncology nurses are expected to enhance awareness of FT management, voice the needs of patients, and advocate for policy reforms to address these disparities.