# Assessment of financial toxicity in patients with cancer in Slovenia

## TL;DR

This study in Slovenia found that about a quarter of cancer patients experience financial difficulties after diagnosis, with younger, female, and lower-income patients being more affected.

## Contribution

This is the first comprehensive assessment of financial toxicity in cancer patients in Slovenia, using perceived financial strain and out-of-pocket expenditures.

## Key findings

- About 27% of patients reported a decline in financial satisfaction after diagnosis.
- Younger, female, and lower-income patients were at higher risk for financial toxicity.
- Patients with certain cancers reported higher financial toxicity than others.

## Abstract

The aim of this study was to assess the extent of financial toxicity in patients with cancer in Slovenia, measured as perceived financial strain and out-of-pocket expenditures.

The prospective, cross-sectional study was done at Institute of Oncology Ljubljana from June to October 2023. A newly created individual questionnaire was utilized to obtain data on financial toxicity. Patients completed the questionnaire either on paper or online, with or without the assistance of a researcher. The statistical analysis was based on descriptive and inferential statistics.

A total of 901 surveys were disseminated, of which 659 were returned, corresponding to a response rate of 73%. Most patients had compulsory health insurance and were diagnosed in the public healthcare system. Following a cancer diagnosis, 178 (27%) patients reported a decline in financial satisfaction (subjective assessment), while 150 (22.7%) patients observed a change in their financial capability (objective assessment). Younger patients (p < 0.001), female patients (p < 0.004), patients with lower net household income (p < 0.001), and patients who were employed before the diagnosis (p < 0.001) were at a greater risk for financial toxicity. Patients with breast cancer and colorectal, endometrial, skin (including melanoma), esophageal, stomach, kidney, bladder cancers, and lymphoma had higher self-reported subjective and objective financial toxicity than patients with prostate, lung, and head and neck cancer.

This article represents the first comprehensive assessment of financial toxicity among patients with cancer in Slovenia, using perceived financial strain and out-of-pocket expenditures. Most patients reported no significant out-of-pocket costs for the treatment they received. About a quarter of patients with cancer experience financial difficulties.

The online version contains supplementary material available at 10.1007/s00520-025-09591-7.