Financial Toxicity in Greek Cancer Patients: Social Determinants of Health and Clinical Factors

Abstract

Introduction: Cancer imposes patients and their families to substantial financial strain, known as financial toxicity, encompassing both treatment costs and related emotional distress. Despite Greece’s public healthcare system, indirect expenses and weakened social support following the economic crisis and COVID-19 pandemic have heightened patients’ vulnerability. While global awareness of financial toxicity is increasing, research within the Greek oncology settings remains limited.

Aim: The aim of this study was to examine the relationship between financial toxicity and both clinical and social determinants of health among patients undergoing cancer treatment in Greece.

Method: A multicenter cross-sectional study was conducted from April 2023 to April 2024 in four tertiary hospitals in Greece, involving patients with solid tumors. Financial toxicity was assessed using the validated Greek version of the COmprehensive Score for Financial Toxicity (FACIT-COST), data normality was tested with the Kolmogorov–Smirnov test, associations between the Financial Toxicity scale and participants’ characteristics was examined via the Mann-Whitney test, the Kruskal-Wallis test or Spearman correlation coefficients (rho). Multiple linear regression analysis in a stepwise method (p for entry 0.05, p for removal 0.10), with the Financial Toxicity scale as the dependent variable was conducted. All reported p-values are two-tailed. Statistical significance was set at p<0.05 and analyses were conducted using SPSS statistical software (version 27.0).

Results: The study included 400 patients (49.3% male, mean age  of 61.7 years, SD=12.5). The mean financial toxicity score was 20.83 (SD = 7.90). Financial toxicity did not significantly differ by cancer type or metastatic status but was significantly lower among patients with stage I disease (p = 0.037) and those reporting better self-perceived health (p = 0.005). Longer duration of immunotherapy was weakly but significantly associated with reduced toxicity (rho = 0.17, p = 0.043). In multivariate analysis, higher education (β = 0.033, p < 0.001) and better health status (β = 0.038, p = 0.027) were significantly associated with less toxicity, while greater activity limitations associated with higher financial toxicity (p < 0.001).

Conclusion: This study demonstrates that financial toxicity is a multidimensional phenomenon influenced by both clinical and socioeconomic factors, particularly education and perceived health status. Integrating financial screening and support into oncology care can help mitigate financial distress and improve patients’ overall quality of life.