# Financial toxicity, social support, and negative emotions among caregivers of children with cancer: a cross-sectional study in Western China

## TL;DR

Caregivers of children with cancer in Western China face moderate financial stress, linked to economic hardship and low social support.

## Contribution

This study identifies key factors associated with financial toxicity among caregivers of pediatric cancer patients in Western China.

## Key findings

- Financial toxicity was moderately high, with a mean COST-PROM score of 12.24.
- Higher financial toxicity was linked to increased anxiety, depression, and lower social support.
- Factors like high medical expenses and insufficient income were significant predictors of financial toxicity.

## Abstract

To assess the level of financial toxicity (FT) experienced by carers of children with cancer in Western China, identify associated factors.

A cross-sectional survey was conducted at a large tertiary hospital (N = 304 carers). Data included sociodemographic, Comprehensive Score for Financial Toxicity – Patient-Reported Outcome Measure (COST-PROM), perceived social support (PSSS), and anxiety/depression (HADS). Univariate analyses were employed to compare FT scores across groups, Pearson correlations to examine associations between continuous variables, and hierarchical multiple linear regression analysis to identify predictors of FT.

The mean COST-PROM score was 12.24 (SD = 8.44), indicating moderate FT. Elevated FT demonstrated significant correlations with heightened anxiety (r = −0.44), depression (r = −0.47), and diminished total social support (r = 0.32) (all p < 0.01). The final regression model (Adjusted R2 = 0.309, p < 0.001) revealed that factors significantly associated with increased FT included: carers’ employment change (β = −0.113), out-of-pocket medical expenses exceeding 40% of annual household income (β = −0.112), and the presence of loans (β = −0.135). Conversely, the perception that family income was sufficient to cover treatment costs (β = 0.257) and greater perceived support from friends (PSSS; β = 0.234) were significantly associated with decreased FT. In addition, both anxiety and depression scores were significantly correlated with higher FT.

Carers in this sample experience moderate FT, which is strongly linked to economic hardship, and diminished social support (particularly from friends). Interventions should address modifiable factors like social support, anxiety, depression, alongside financial navigation and psychological support services.