Impact of Financial Toxicity on the Health-Related Quality of Life and Financial Well-Being of Cancer Patients and Survivors: A Comparative Study of the United Kingdom and United States.

Background: This study investigated and compared the impact of financial toxicity (FT) on the health-related quality of life (HRQoL) and financial well-being of cancer patients and survivors in the United Kingdom (UK) and United States (US).

Methods: UK & US participants (n = 600) completed an online questionnaire that consisted of a validated FT instrument (COmprehensive Score for financial Toxicity-COST), a standardised HRQoL instrument (EQ-5D-5L) and questions related to their financial well-being. Tobit regression models and descriptive statistics plus χ tests were used to analyse the association between FT and (i) HRQoL whilst controlling for sociodemographic characteristics; and (ii) financial well-being.

Results: In the UK, health utilities of participants with no assessed experience of FT, mild FT, and moderate/severe FT were 0.81, 0.66, and 0.41, respectively, compared to 0.88, 0.71, and 0.53 in the US. Among those with moderate/severe FT, US participants had significantly higher health utilities compared to their peers in the UK (Mann Whitney test, p = 0.0369). In a pooled analysis of UK and US and after controlling for sociodemographic and clinical characteristics, mild and moderate/severe FT was negatively associated with health utilities (β coff = -0.13, 95% CI: -0.18, -0.08 and β coff = -0.28, 95% CI: -0.34, -0.21, respectively). Over half (54%) of US participants with FT were in debt with median (IQR) debt at I$11,500 (23,000), compared to 32% in the UK with median (IQR) debt at I$ 7200 (12,960). US participants with FT were 2.48 times more likely to be in debt than UK participants with FT (OR = 2.48, 95% CI: 1.46-4.21).

Conclusions: FT is associated with poorer financial well-being and HRQoL among cancer patients/survivors in the US and UK. The impact of FT on financial well-being is larger in the US while the impact on HRQoL is worse in the UK. Further studies using prospective data are required to investigate the nature and extent of these relationships.