The association between fear of disease progression and financial toxicity in patients with chronic osteomyelitis: a cross-sectional study.

Chronic osteomyelitis (COM) is a persistent and refractory bone infection associated with substantial physical, psychological, and economic burdens. However, evidence linking financial toxicity (FT) to fear of disease progression (FoP) in patients with COM remains scarce. In this cross-sectional study, we recruited 214 patients with COM from a tertiary hospital in Nanchong, China, between June 2024 and June 2025. Participants completed electronic questionnaires assessing demographic/clinical characteristics, FoP (Fear of Progression Questionnaire-Short Form), and FT (Comprehensive Score for Financial Toxicity). The mean FoP score was 38.31 ± 7.18. Notably, 77.1% (165/214) of patients exhibited clinically relevant levels of FoP (score ≥ 34), indicating a high prevalence of psychological distress. Spearman's rank correlation was observed between FoP and COST scores (r s = -0.599, p < 0.001), indicating that higher financial toxicity (lower COST scores) was associated with higher FoP. Hierarchical multiple linear regression identified longer disease duration, higher pain intensity, the presence of complications, and lower COST scores (B = -0.279, p < 0.001) as independent factors associated with elevated FoP (all p < 0.05). These findings underscore a critical interplay between economic and psychological distress in COM and highlight the urgent need for integrated clinical strategies that combine psychosocial support with financial navigation to mitigate FoP and improve patient wellbeing.