The financial toll of cancer: uncovering the links between financial toxicity and symptom burden

Purpose: This prospective observational study investigated the relationship between financial toxicity, symptom burden, disease characteristics and out-of-pocket (OOP) medication use in patients with cancer across 5 Italian institutions. Methods: A cross-sectional survey assessed financial toxicity, symptom burden and OOP costs sustained by patients with cancer using validated questionnaires (COST, PERSONS). Associations between financial toxicity (COST score), symptom burden (PERSONS score) and clinical variables were explored. Results: Among 211 respondents, mean COST score was 23 (SD 9.1) and 128 (60%) scored < 26, indicating financial toxicity. Symptom burden measured by the PERSONS score was associated with a higher OOP medications use (r = 0.449, P < .001) and inversely related to financial toxicity (r = -0.431; P < .001). In our study population, median number of OOP drug was 2 (IQR 1-2), most commonly analgesics and laxatives. There was a significantly worse COST score among patients using OOP analgesic: 19.8 (SD 9.5) vs 25.6 (SD 7.9), P < .001 and laxatives: 19.2 (SD 8.2) vs 24.4 [(SD 9.1), P < .00]. Overall, OOP drugs were linked to higher symptom burden (P < .001) and financial toxicity (P < .001). Conclusions: The severity of symptoms and their management with OOP medications was significantly associated with patients' financial toxicity. These findings highlight the importance of integrating financial toxicity assessment into routine cancer care to optimize patient outcomes and well-being.