Sociodemographic Factors related to Financial Toxicity among Cancer Patients and Survivors:“The Second Cancer Patient Experience Survey” — A Nationwide Study in Japan

PURPOSE: Financial toxicity (FT) refers to increased risk of treatment discontinuation and anxiety in daily life due to the cost burden of cancer treatment. However, little is known about which groups of patients are more likely to experience FT under universal health coverage. Thus, we aimed to explore demographics and psychological factors associated with FT among adult cancer patients in Japan. METHODS: We analyzed responses from the Patient Experience Survey, a self-administered questionnaire conducted by the National Cancer Center in 2018. Outcome indicators were aligned with the Phase 4 Basic Plan to Promote Cancer Control Programs in Japan. We used a modified Poisson regression model to analyze the association between patient demographics and FT, estimating the Prevalence Ratio (PR) and conducting subgroup analysis by sex. RESULTS: Of 6766 responses received, approximately 30% of patients reported FT. FT was categorized into "FT impacted on daily life (FT_Life)," "FT impacted on treatment-receiving behavior (FT_Tx)," and "FT led to treatment change or discontinuation (FT_DisTx)." Across all FT categories, younger age (< 40 vs. 65 + ; male: PR = 2.26 [95% CI, 0.98-5.23]; female: PR = 1.79 [95% CI, 1.01-3.17]), and those with no-one to talk to (vs. with; male: PR = 2.04 [95% CI, 1.05-3.94]; female: PR = 2.07 [95% CI, 1.09-3.93]) were consistently associated with FT. CONCLUSION: These results identify groups that require financial assistance due to cancer treatment, including younger patients, individuals with unstable employment, and those with limited interpersonal support. Strengthening social support systems is critical to enable these patients to manage treatment costs and maintain daily life.