# Financial toxicity, family resilience and symptom burden in liver cancer patients: a cross-sectional study

## TL;DR

This study explores how financial stress affects liver cancer patients in China and finds that family resilience helps reduce this stress, while psychological distress worsens it.

## Contribution

The study identifies family resilience as a protective factor against financial toxicity in liver cancer patients.

## Key findings

- Higher family resilience significantly reduces financial toxicity in liver cancer patients.
- Psychological distress and advanced disease stage are strong predictors of increased financial toxicity.
- Greater symptom burden is unexpectedly linked to less severe financial toxicity.

## Abstract

Financial toxicity has emerged as a critical concern in oncology care, reflecting the severe economic and psychological distress patients experience due to treatment costs. While socioeconomic factors are known contributors, the potential protective role of psychosocial assets, such as family resilience, remains underexplored. This study aimed to investigate the prevalence and predictors of financial toxicity among liver cancer patients in China, with a specific focus on the roles of family resilience, psychological distress, and symptom burden.

Participants were required to complete comprehensive scores for financial toxicity based on the patient-reported outcome measures (COST-PROM), the Chinese version of family resilience assessment scale (FRAS-C), the validated Edmonton symptom assessment scale (ESAS) and the patient health questionnaire-4 (PHQ-4). Data of demographic and clinical characteristics were also collected. Descriptive statistics, correlation analyses, and hierarchical multiple linear regression were used to analyze the data. This study adhered to the STROBE guidelines.

The mean financial toxicity score was 20.36 ± 3.95. Hierarchical regression revealed a significant model (R2 = 0.601, p < 0.001) for financial toxicity. Key risk factors included psychological distress (β = −0.594, p < 0.001), advanced disease stage (β = −0.339, p < 0.001), and recent diagnosis (β = −0.325, p < 0.001). Conversely, higher family resilience was a significant protective factor (β = 0.207, p < 0.001). A counterintuitive finding was that greater symptom burden was associated with higher FT scores (indicating less severe FT) (β = 0.159, p = 0.002). Several socioeconomic factors (e.g., lower income, living alone) were also significant predictors.

Financial toxicity is prevalent among Chinese liver cancer patients and is influenced by a complex interplay of economic, clinical, and psychosocial factors. The findings underscore that family resilience is a key buffer against financial distress, while psychological distress is a powerful amplifier. This study highlights the necessity for integrated supportive care interventions that address not only the economic but also the psychological and familial dimensions of cancer care to effectively mitigate financial toxicity.