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Financial toxicity in insured cancer patients: association with global health status in a prospective Brazilian Cohort.

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Τίτλος: Financial toxicity in insured cancer patients: association with global health status in a prospective Brazilian Cohort.
Συγγραφείς: Nunes NCC; Instituto Americas, Rua Jorge Curi, 550, Barra da Tijuca, Rio de Janeiro, Brazil. nccnunes@gmail.com.; Americas Oncologia, Rio de Janeiro, Brazil. nccnunes@gmail.com., Monteiro MR; Instituto Americas, Rua Jorge Curi, 550, Barra da Tijuca, Rio de Janeiro, Brazil.; Americas Oncologia, Rio de Janeiro, Brazil.; Hospital Samaritano, Americas Oncologia, Sao Paulo, Brazil., de Souza Carvalho G; Instituto Americas, Rua Jorge Curi, 550, Barra da Tijuca, Rio de Janeiro, Brazil.; Americas Oncologia, Rio de Janeiro, Brazil., Pecoraro JP; Instituto Americas, Rua Jorge Curi, 550, Barra da Tijuca, Rio de Janeiro, Brazil., de Almeida Vieira Ferreira T; Instituto Americas, Rua Jorge Curi, 550, Barra da Tijuca, Rio de Janeiro, Brazil., Dos Santos PKM; Instituto Americas, Rua Jorge Curi, 550, Barra da Tijuca, Rio de Janeiro, Brazil., Azevedo DCV; Instituto Americas, Rua Jorge Curi, 550, Barra da Tijuca, Rio de Janeiro, Brazil., Victorino AP; Instituto Americas, Rua Jorge Curi, 550, Barra da Tijuca, Rio de Janeiro, Brazil.; Americas Oncologia, Rio de Janeiro, Brazil., de Lima Araujo LH; Instituto Americas, Rua Jorge Curi, 550, Barra da Tijuca, Rio de Janeiro, Brazil.; Americas Oncologia, Rio de Janeiro, Brazil.
Πηγή: Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer [Support Care Cancer] 2026 Jul 17; Vol. 34 (8). Date of Electronic Publication: 2026 Jul 17.
Τύπος έκδοσης: Journal Article; Observational Study
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Springer International Country of Publication: Germany NLM ID: 9302957 Publication Model: Electronic Cited Medium: Internet ISSN: 1433-7339 (Electronic) Linking ISSN: 09414355 NLM ISO Abbreviation: Support Care Cancer Subsets: MEDLINE
Imprint Name(s): Original Publication: Berlin : Springer International, c1993-
Ιατρικοί όροι (MeSH): Neoplasms*/economics , Neoplasms*/therapy , Insurance, Health*/economics , Financial Stress*/epidemiology , Health Status* , Cost of Illness*, Humans ; Brazil ; Female ; Male ; Prospective Studies ; Middle Aged ; Aged ; Adult ; Quality of Life ; Proportional Hazards Models ; Patient Reported Outcome Measures
Περίληψη: Purpose: Financial toxicity is increasingly recognized as a clinically relevant patient-reported outcome in oncology, yet prospective data from Latin America remain limited, particularly among privately insured populations. We evaluated the prevalence and predictors of Q28-based financial burden (FB) and financial toxicity (FT), and their association with global health status (GHS), in Brazilian cancer patients treated in the supplementary healthcare sector.
Methods: This secondary analysis pooled data from four prospective observational cohorts of patients with breast, prostate, colorectal, and lung cancer treated at Américas Oncologia (Rio de Janeiro and São Paulo, Brazil). FB was assessed using item 28 (Q28) of the EORTC QLQ-C30 at baseline and 6 months and defined as any self-reported financial difficulty (scores 2-4). FT was operationalized pragmatically as new or worsening financial difficulty at 6 months compared with baseline. GHS (items 29-30) was linearly transformed to a 0-100 scale. Logistic regression and exploratory Cox proportional hazards models were used to evaluate factors associated with FB/FT and overall survival (OS).
Results: Among 1,343 patients, 23% reported FB at baseline and 25% at 6 months; 16% developed Q28-based FT. In multivariable models, younger age independently predicted both FB and FT, and baseline FB strongly predicted FB at 6 months (OR 5.86; 95% CI 4.31-8.01). FB and FT were independently associated with lower GHS at 6 months. FT was not independently associated with OS in multivariable analysis (adjusted HR 0.97; 95% CI 0.54-1.74), whereas higher GHS at 6 months was independently associated with improved OS.
Conclusion: Q28-based FB and FT are common even among privately insured cancer patients in Brazil and are associated with worse GHS. Routine screening for financial distress may help identify vulnerable patients and inform supportive care strategies, particularly for younger individuals.
(© 2026. The Author(s).)
Competing Interests: Declarations. Ethics approval: The study protocol was reviewed and approved by the local Institutional Review Board (IRB; reference number 12747119.5.0000.5533) and was conducted in accordance with the ethical standards of the institutional research committee and with the 1964 Declaration of Helsinki and its later amendments. Consent to participate: All participants provided written and oral informed consent prior to study inclusion. Consent to publish: The manuscript does not contain any individual person’s identifiable data. All participants consented to the use of anonymized data for research purposes. Competing interests: The authors declare no competing interests.
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Contributed Indexing: Keywords: Brazil; Cancer care; Financial toxicity; Global health status; Patient-reported outcomes; Quality of life
Entry Date(s): Date Created: 20260716 Date Completed: 20260717 Latest Revision: 20260726
Update Code: 20260726
PubMed Central ID: PMC13375932
DOI: 10.1007/s00520-026-11014-0
PMID: 42463517
Βάση Δεδομένων: MEDLINE
Περιγραφή
ISSN:1433-7339
DOI:10.1007/s00520-026-11014-0