Financial toxicity in patients with newly diagnosed hepatocellular carcinoma: a cross-sectional study

Financial toxicity (FT) among patients with cancer has been associated with significantly worse outcomes, however little is known about FT specifically in the context of hepatocellular carcinoma (HCC). We sought to cross-sectionally assess patient-reported FT in newly-diagnosed HCC and identify patient-, disease-, and treatment-related factors associated with FT.

Patients were recruited pre-treatment initiation at a multidisciplinary liver cancer clinic between January 2023 and November 2024. The Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT), a validated survey evaluating financial distress in cancer, was completed during the initial visit. Baseline sociodemographic, clinical, and planned treatment characteristics were evaluated by questionnaires or medical record review. Quality of life (QOL) was evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ)-HCC18. Mean COST-FACIT scores were compared across these characteristics via t-test or analysis of variance (ANOVA).

A total of 38/50 (76%) enrolled patients completed the COST-FACIT. Younger age (<65 vs. ≥65 years; mean, 21.2 vs. 28.6; P=0.04), Hispanic ethnicity (Hispanic vs. non-Hispanic ethnicity; mean, 16.1 vs. 27.3; P=0.05), non-English primary language (non-English vs. English; mean, 16.2 vs. 27.6; P=0.03), lack of employment (not employed vs. retired vs. employed; mean, 15.5 vs. 30.5 vs. 24.8; P=0.03), less completed education (high school or earlier vs. college or beyond; mean, 23.0 vs. 32.6; P=0.01), worse QOL (EORTC QLQ-HCC18 score > cohort median vs. ≤ cohort median; mean, 22.1 vs. 29.3; P=0.04), and no plan for surgical treatment (no plan vs. planned; mean, 24.6 vs. 35.6; P=0.03) were significantly associated with worse FT. Lower household income (<$50,000 vs. $50,000-$99,999 vs. ≥$100,000; mean, 25.0 vs. 23.1 vs. 33.0; P=0.09) trended towards worse FT.

Among patients with newly-diagnosed HCC, significantly higher patient-reported FT is associated with younger age, Hispanic ethnicity, non-English primary language, lack of employment, less completed education, no plan for surgical treatment, and worse QOL. The study cohort is being longitudinally followed to assess the course of self-reported FT over 1-year follow-up and its associations with treatment adherence and survival.