Psycho-oncology · 2026
Financial Toxicity and Follow-Up Quality of Life Among Breast Cancer Survivors in the BOLD Cohort.
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Wu Ivan H C, Vogel Rachel I, Jewett Patricia I, Blaes Anne H
Аннотация
BACKGROUND: Financial toxicity is prevalent in cancer survivorship and has been associated with poorer health-related quality of life (HRQOL), yet longitudinal evidence remains limited. We examined associations between financial toxicity and HRQOL at baseline and 4-month follow-up among breast cancer survivors in the BOLD cohort.
METHODS: Data were drawn from self-report questionnaires completed by 182 breast cancer survivors at baseline, of whom 146 completed 4-month follow-up surveys. Financial toxicity was assessed at baseline using the Comprehensive Score for Financial Toxicity (COST). HRQOL outcomes were assessed at baseline and approximately 4 months later using the Functional Assessment of Cancer Therapy-General (FACT-G) subscales and total score, and a single-item measure of sleep disturbance. Multivariable linear regression models estimated adjusted cross-sectional associations and longitudinal associations between baseline financial toxicity and follow-up outcomes, adjusting for baseline levels of the corresponding outcome. Longitudinal measurement invariance of the COST was evaluated.
RESULTS: Greater baseline financial toxicity was associated with lower baseline physical, social/family, emotional, and functional well-being, lower FACT-G total score, and greater sleep disturbance. In longitudinal models, higher baseline financial toxicity was associated with lower follow-up physical, social/family, emotional, and functional well-being and lower FACT-G total score after adjustment for demographic and clinical covariates and the corresponding baseline outcome. Baseline financial toxicity was not associated with follow-up sleep disturbance.
CONCLUSIONS: Financial toxicity was associated with poorer HRQOL at baseline and with lower physical, social/family, emotional, functional, and overall HRQOL at follow-up. These findings support greater attention to financial toxicity in survivorship care.
METHODS: Data were drawn from self-report questionnaires completed by 182 breast cancer survivors at baseline, of whom 146 completed 4-month follow-up surveys. Financial toxicity was assessed at baseline using the Comprehensive Score for Financial Toxicity (COST). HRQOL outcomes were assessed at baseline and approximately 4 months later using the Functional Assessment of Cancer Therapy-General (FACT-G) subscales and total score, and a single-item measure of sleep disturbance. Multivariable linear regression models estimated adjusted cross-sectional associations and longitudinal associations between baseline financial toxicity and follow-up outcomes, adjusting for baseline levels of the corresponding outcome. Longitudinal measurement invariance of the COST was evaluated.
RESULTS: Greater baseline financial toxicity was associated with lower baseline physical, social/family, emotional, and functional well-being, lower FACT-G total score, and greater sleep disturbance. In longitudinal models, higher baseline financial toxicity was associated with lower follow-up physical, social/family, emotional, and functional well-being and lower FACT-G total score after adjustment for demographic and clinical covariates and the corresponding baseline outcome. Baseline financial toxicity was not associated with follow-up sleep disturbance.
CONCLUSIONS: Financial toxicity was associated with poorer HRQOL at baseline and with lower physical, social/family, emotional, functional, and overall HRQOL at follow-up. These findings support greater attention to financial toxicity in survivorship care.