Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2026
Financial toxicity in insured cancer patients: association with global health status in a prospective Brazilian Cohort.
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Nunes Natalia Cristina Cardoso, Monteiro Mariana Ribeiro, de Souza Carvalho Giselle, Pecoraro Juliana Pompeu, de Almeida Vieira Ferreira Thamirez, Dos Santos Paola Kelly Martins, Azevedo Debora Cristina Victorino, Victorino Ana Paula, de Lima Araujo Luiz Henrique
Аннотация
PURPOSE: Financial toxicity is increasingly recognized as a clinically relevant patient-reported outcome in oncology, yet prospective data from Latin America remain limited, particularly among privately insured populations. We evaluated the prevalence and predictors of Q28-based financial burden (FB) and financial toxicity (FT), and their association with global health status (GHS), in Brazilian cancer patients treated in the supplementary healthcare sector.
METHODS: This secondary analysis pooled data from four prospective observational cohorts of patients with breast, prostate, colorectal, and lung cancer treated at Américas Oncologia (Rio de Janeiro and São Paulo, Brazil). FB was assessed using item 28 (Q28) of the EORTC QLQ-C30 at baseline and 6 months and defined as any self-reported financial difficulty (scores 2-4). FT was operationalized pragmatically as new or worsening financial difficulty at 6 months compared with baseline. GHS (items 29-30) was linearly transformed to a 0-100 scale. Logistic regression and exploratory Cox proportional hazards models were used to evaluate factors associated with FB/FT and overall survival (OS).
RESULTS: Among 1,343 patients, 23% reported FB at baseline and 25% at 6 months; 16% developed Q28-based FT. In multivariable models, younger age independently predicted both FB and FT, and baseline FB strongly predicted FB at 6 months (OR 5.86; 95% CI 4.31-8.01). FB and FT were independently associated with lower GHS at 6 months. FT was not independently associated with OS in multivariable analysis (adjusted HR 0.97; 95% CI 0.54-1.74), whereas higher GHS at 6 months was independently associated with improved OS.
CONCLUSION: Q28-based FB and FT are common even among privately insured cancer patients in Brazil and are associated with worse GHS. Routine screening for financial distress may help identify vulnerable patients and inform supportive care strategies, particularly for younger individuals.
METHODS: This secondary analysis pooled data from four prospective observational cohorts of patients with breast, prostate, colorectal, and lung cancer treated at Américas Oncologia (Rio de Janeiro and São Paulo, Brazil). FB was assessed using item 28 (Q28) of the EORTC QLQ-C30 at baseline and 6 months and defined as any self-reported financial difficulty (scores 2-4). FT was operationalized pragmatically as new or worsening financial difficulty at 6 months compared with baseline. GHS (items 29-30) was linearly transformed to a 0-100 scale. Logistic regression and exploratory Cox proportional hazards models were used to evaluate factors associated with FB/FT and overall survival (OS).
RESULTS: Among 1,343 patients, 23% reported FB at baseline and 25% at 6 months; 16% developed Q28-based FT. In multivariable models, younger age independently predicted both FB and FT, and baseline FB strongly predicted FB at 6 months (OR 5.86; 95% CI 4.31-8.01). FB and FT were independently associated with lower GHS at 6 months. FT was not independently associated with OS in multivariable analysis (adjusted HR 0.97; 95% CI 0.54-1.74), whereas higher GHS at 6 months was independently associated with improved OS.
CONCLUSION: Q28-based FB and FT are common even among privately insured cancer patients in Brazil and are associated with worse GHS. Routine screening for financial distress may help identify vulnerable patients and inform supportive care strategies, particularly for younger individuals.