We are delighted to continue the Academic Express section, which aims to facilitate academic exchanges and further the development of oncology nursing. In every issue, we present groundbreaking research contributions from esteemed members in the field.

In this issue, we are privileged to feature a significant study led by Dr. Binbin Xu from the School of Nursing, Hunan University of Chinese Medicine, and Prof. Winnie KW So from the Nethersole School of Nursing, The Chinese University of Hong Kong. Their research, titled 'Mediating Role of Financial Toxicity in the Relationships Between Health-Related Quality of Life and Its Risk Factors in Chinese Patients with Cancer,' offers an insightful analysis into the financial challenges faced by cancer patients and how these impact their quality of life. This study is a notable addition to the ongoing conversation about improving patient care and outcomes in oncology nursing.

As researchers in oncology nursing, we recognize that cancer care extends beyond medical treatments. Financial toxicity (FT)—the financial strain caused by cancer care costs—significantly burdens patients and their families, compromising patients’ health-related quality of life (HRQoL). Many of the factors that influence HRQoL also impact FT, and the strong association between the two suggests that FT may mediate the relationship between HRQoL and its risk factors in patients with cancer. By exploring this mediating role of FT, our goal is to enhance understanding within the healthcare system about the impact of specific risk factors on HRQoL and to advocate for a more comprehensive, patient-centered approach to cancer care that addresses both medical and financial challenges, ultimately enhancing patients’ HRQoL.

What We Discovered?

We examined the mediating role of FT in the relationships between HRQoL and its risk factors in a large sample (N = 1208) of Chinese patients with cancer. Our findings revealed that FT predominantly mediated the relationships between HRQoL and both annual household income and the level of the hospital (secondary and tertiary under hospital classification in Chinese Mainland) where treatment was received. Patients with lower household incomes or those treated in tertiary hospitals (compared with secondary hospitals) experienced greater FT, which in turn led to worse HRQoL outcomes. Additionally, the number of treatment modalities, social support, perceived stress, discussions with healthcare providers about cancer care costs, and social medical insurance influenced HRQoL both directly and indirectly through FT.

Implications for Cancer Care

Our findings highlight the need for a comprehensive approach to cancer care that includes FT as an integral part. A key takeaway from our research is the need for healthcare systems to improve cost discussions with patients. Many patients avoid or delay these conversations out of fear or lack of knowledge, but our study suggests that open, transparent discussions about treatment costs hold the potential to help patients make informed financial decisions and mitigate FT. Furthermore, addressing the challenges posed by FT requires a more holistic approach that focuses not only on a patient’s financial issues but also on other aspects of distress. Comprehensive psychological management is expected to enhance patients’ overall psychological state, enabling them to better cope with FT.

Future healthcare policies and research on HRQoL in cancer populations should prioritize FT management, particularly for individuals with low incomes or inadequate health insurance. Policymakers and healthcare providers should focus on enhancing access to health insurance and financial assistance programs. Further research is needed to explore innovative interventions, such as financial navigation, financial counseling, insurance education, and other strategies, to mitigate FT and reduce its impact on HRQoL.

We hope this study sparks a conversation about the importance of comprehensive cancer care that goes beyond treating the disease itself to also address FT.

Reference:

Xu B, So WKW, Choi KC, Huang Y, Liu M, Qiu L, Tan J, Tao H, Yan K, Yang F. Mediating Role of Financial Toxicity in the Relationships Between Health-Related Quality of Life and Its Risk Factors in Chinese Patients With Cancer. Cancer Nurs. 2024 Dec 10. doi: 10.1097/NCC.0000000000001432. Epub ahead of print. Financial toxicity and its risk factors among patients with cancer in China: A nationwide multisite study — ScienceDirect