Financial toxicity in breast cancer patients during radiotherapy - A German multicenter analysis

Financial toxicity, defined as the financial burden and distress caused by cancer treatment, has emerged as a critical issue in oncology care. While most research originates from the U.S., data from countries with publicly funded healthcare systems remain limited, particularly regarding breast cancer patients receiving radiotherapy. This study investigates financial toxicity in radiation-treated breast cancer patients in the German healthcare system.

A retrospective, multicenter, cross-sectional study was conducted with 279 breast cancer patients from 11 certified German breast cancer centers. Data were collected via self-report questionnaires assessing financial distress, treatment-related costs, income loss, psychosocial distress, and global quality of life at the end of radiotherapy. Ordinal regression and moderation analyses were used to identify predictors and interactions. Group comparisons were performed using chi-square and Mann-Whitney U tests.

106 of 271 participants (39.1 %) reported financial toxicity, mostly at mild levels. Significant predictors included lower household income, higher direct treatment costs, and income loss. Income did not moderate the relationship between costs/income loss and financial toxicity. Patients with financial toxicity reported global lower quality of life and higher psychosocial distress. No differences were found by insurance and employment status, radiotherapy regimen, or concurrent systemic therapy.

Despite universal healthcare coverage and treatment in certified centers, a substantial proportion of breast cancer patients experienced financial toxicity. The findings suggest that socioeconomic consequences of treatment remain under-addressed in structured cancer care. Broader interventions are needed to mitigate financial distress in breast cancer patients undergoing radiation therapy.