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Urban–rural differences in financial toxicity and its effect on cancer survivors’ health-related quality of life and emotional status: a latent class analysis

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Abstract

Objective

This study aimed to investigate the urban–rural differences in associations between financial toxicity (FT), physical health-related quality of life (HRQoL), negative emotional status, and the effect of patients’ socioeconomic status and clinical and cost-related characteristics on the levels of FT in a sample of Chinese cancer survivors.

Methods

Data were obtained from a cross-sectional survey conducted by the oncology department at two tertiary level hospitals in China. The COmprehensive Score for financial Toxicity, Euroqol five-level instrument (EQ-5D), and Depression Anxiety Stress Scale – 21 (DASS-21) were used to measure patients’ FT, physical HRQoL, and negative emotional status. A latent class analysis was used to identify patient subgroups with distinct symptom experiences based on self-reported data on symptom occurrence using the EQ-5D and DASS-21.

Results

Four distinct latent classes were identified: all low (47.6%); high physical and low psych (18.6%); low physical and high psych (17.1%); and all high (17.1%). Rural patients younger than 50 years showed a statistically significantly higher FT than urban patients. Rural patients who were male, highly educated, insured, first hospitalization, new cases, received surgery or immunotherapy, and had low cancer-related costs in all low classes showed a higher FT than urban patients.

Conclusions

Rural patients with cancer suffered from higher FT than their urban counterparts, and the negative impact of psychological distress on FT was higher than that of physical HRQoL.

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Availability of data and materials

Derived data supporting the findings of this study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

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Funding

This project was supported by the Guangdong Basic and Applied Basic Research Foundation (2021A1515011973).

the guangdong basic and applied basic research foundation,2021A1515011973,Dong Wang

Author information

Authors and Affiliations

  1. Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China

    Richard Huan Xu

  2. JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China

    Richard Huan Xu & Eliza Lai-yi Wong

  3. Department of Blood Transfusion Medicine, School of Medicine, Jinling Hospital, Nanjing University, Nanjing, China

    Ling-ling Wang

  4. Department of Human Resource, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China

    Ling-ming Zhou

  5. School of Health Management, Southern Medical University, Guangzhou, China

    Dong Wang

Authors
  1. Richard Huan Xu
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  2. Ling-ling Wang
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  3. Ling-ming Zhou
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  4. Eliza Lai-yi Wong
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  5. Dong Wang
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Contributions

Conceptualization, Richard Huan Xu, Eliza Lai-yi Wong, and Dong Wang; data curation, Richard Huan Xu, Ling-ling Wang, and Ling-ming Zhou; formal analysis, Richard Huan Xu; funding acquisition, Dong Wang; investigation, Ling-ling Wang and Ling-ming Zhou; methodology, Richard Huan Xu and Eliza Lai-yi Wong; project administration, Ling-ling Wang; resources, Ling-ming Zhou; supervision, Ling-ling Wang, Eliza Lai-yi Wong, and Dong Wang; writing—original draft, Richard Huan Xu; writing—review and editing, Richard Huan Xu, Ling-ling Wang, Ling-ming Zhou, Eliza Lai-yi Wong, and Dong Wang.

Corresponding authors

Correspondence to Richard Huan Xu or Dong Wang.

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Ethics approval

The study protocol and informed consent were approved by the Human Research Ethics Committee of the Chinese University of Hong Kong (Ref No.: SBRE-20–137).

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Written informed consent was obtained from all participants.

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Not applicable.

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The authors declare no competing interests.

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Xu, R.H., Wang, Ll., Zhou, Lm. et al. Urban–rural differences in financial toxicity and its effect on cancer survivors’ health-related quality of life and emotional status: a latent class analysis. Support Care Cancer 30, 4219–4229 (2022). https://doi.org/10.1007/s00520-021-06762-0

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  • DOI: https://doi.org/10.1007/s00520-021-06762-0

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