Financial hardship among patients with lung cancer and their family caregivers: A comparative study of two institution-based samples from Hong Kong and Mainland China.

OBJECTIVE

To investigate and compare the severity and prevalence of financial hardship among lung cancer patients and their caregivers in two institution-based samples from Hong Kong and Mainland China, emphasizing regional differences in healthcare systems and socioeconomic contexts.

METHODS

A cross-sectional survey of 355 patient-caregiver pairs (Hong Kong: 50; Mainland China: 305) collected data on sociodemographic and clinical characteristics, financial hardship, quality of life (QoL), and distress. Comparisons were made using independent sample t-tests, Chi-square tests, and Ordinary Least Squares (OLS) regression.

RESULTS

Financial hardship was prevalent and severe in both Hong Kong and Mainland China for both patients (52.0% vs. 42.3%, Mean COST score: 15.04 vs. 16.48) and Caregivers (28.0% vs. 25.2%; Mean COST score: 18.36 vs. 19.82). Patients' and caregivers' COST scores were strongly correlated (P < 0.05). Greater financial hardship was associated with higher psychological distress and poorer QoL. OLS analysis identified younger age, lower education, advanced cancer stage, and region × income interactions as significant determinants for both patients and caregivers. High-income participants (CNY 20,001-30,000 and > CNY 30,000) in Mainland China reported less hardship than their Hong Kong counterparts (≥ HKD 30,000), while low-income participants (< CNY 5000) experienced greater hardship (P < 0.05). Region × employment interactions indicated that caregivers in Mainland China faced elevated financial vulnerability across employment groups. Sensitivity analysis confirmed the robustness of these findings.

CONCLUSIONS

Financial hardship is prevalent among lung cancer patients and caregivers across regions, shaped by the interplay of socioeconomic position and healthcare system design. Early screening, family-centered support, and policies addressing socioeconomic inequities are essential to mitigate financial hardship across diverse healthcare settings.