Financial toxicity and coping strategies in gastrointestinal cancer patients - Evidence from Vietnam

Abstract

Objective: Cancer imposes a major financial strain on patients due to high personal expenses and related challenges. Financial toxicity (FT) refers to the adverse effects of cancer treatment costs on individuals. While the financial burden of cancer is well-documented, assessing its severity and determining influencing factors in different settings remains essential. This study evaluates the FT faced by patients with gastrointestinal cancer (GIC) in Vietnam and associated factors, as well as coping behaviors related to cancer treatment costs. Methods: A cross-sectional study was carried out among patients with GIC at a tertiary public hospital. Data collection involved direct interviews using structured questionnaire and medical records. FT was measured by the Comprehensive Score for Financial Toxicity (COST) Version 2. Multivariable linear regression was performed to determine factors affecting COST scores. Poisson regression was used to estimate risk ratios (RRs) for coping strategies across different FT levels. Results: Among 158 participants, 50% experienced severe FT, 35.44% moderate FT, and 14.56% had no FT. The median COST score was 13.5 (IQR, 11 to 20). In multivariable analysis, higher education levels (β, 6.61; 95% CI, 3.66 to 9.55 primary school; β, 5.99; 95% CI, 2.89 to 9.11 secondary and highschool; β, 9.66; 95% CI, 2.94 to 16.38 college/vocational) and urban residence (β, 2.84; 95% CI, 0.66 to 5.62) were significantly associated with lower FT. Conversely, female patients (β, -4.06; 95% CI, -6.26 to -1.86), unstable income (β, -5.94; 95% CI, -10.32 to -1.56) were linked to more severe FT. Patients experiencing FT were more likely to adopt lifestyle modifications (RR 2.04; 95% CI, 1.27 to 3.27 severe; RR, 2.01; 95% CI, 1.25 to 3.25 moderate) and use passive financial resources (RR 2.7; 95% CI, 1.44 to 5.07 severe; RR, 2.46; 95% CI, 1.30 to 4.66 moderate) as coping mechanisms compared to those without FT. Conclusion: In Vietnam, a large number of cancer patients experience significant FT, which is linked to certain coping behaviors. Using the COST tool, we identified several factors contributing to FT among GIC patients. These findings offer valuable insights for cancer policy development in the country