Financial toxicity among breast cancer survivors receiving care during the pandemic.

PURPOSE: To appraise financial toxicity (FT) among women receiving care for breast cancer during the COVID-19 pandemic and determine sociodemographic, clinical, psychosocial, and care-disruption factors linked to greater financial hardship.

METHODS

Forty-eight survivors (mean age = 45.3 ± 10.9 years; 42% Black, 42% non-Hispanic White, 17% Hispanic/Latina) completed an online survey. FT was measured with the COST-FACIT. Additional instruments assessed perceived stress (PSS-10), coping (Brief-COPE), self-efficacy (CBI-B), social isolation (PROMIS-SF-4a), health-related quality of life (FACT-B), and pandemic-related delays or changes in cancer care. Pearson correlations explored bivariate associations; backward-selection regression identified predictors of FT.

RESULTS

Mean COST score was 21.77 ± 12.33 and 58.3% of survivors met the threshold for mild or moderate FT (< 26). Worse FT correlated with higher psychological distress (p = 0.001), greater social isolation (p = 0.005), and more care disruptions (p < 0.001). Financial security correlated with greater self-efficacy (p = 0.019) and higher health-related quality of life (p < 0.001). In multiple regression analysis (R2 = 0.69), survivors reporting worse quality of life, lower income, and less education reported greater financial toxicity.

CONCLUSIONS

Breast cancer survivors experienced substantial FT while navigating care during the pandemic, with greater burden associated with psychological distress, social isolation, care disruptions, and lower socioeconomic status. FT was attenuated among those with higher health-related quality of life and self-efficacy. Integrating proactive financial navigation, psychosocial screening, and targeted support for socioeconomically vulnerable survivors into routine oncology care may mitigate financial hardship and improve overall well-being.