Material and Administrative Components of Financial Toxicity and Survivorship Well-Being: A Cross-Sectional Analysis...

Financial toxicity is a multidimensional construct shaped by material, psychological, and administrative pressures. This study examines how two components, namely, material burden and a narrow administrative indicator (insurance denial), are associated with cancer survivors' depression symptom severity and self-perceived general health.

We analyzed data from 959 cancer survivors in the Health Information National Trends Survey (HINTS; weighted n = 39,925,127). Material burden was measured by self-reported financial harm due to cancer, and administrative burden by insurance denial. Depression symptom severity was assessed using the Patient Health Questionnaire-4, and general health via self-perceived health. Multivariate logistic and linear regression models evaluated associations between burdens and outcomes.

Nearly half (41.6%) of survivors reported financial harm from cancer, while 6.3% reported insurance denial. Material burden was significantly associated with increased depression symptom severity (odds ratio: 1.33; 95% CI: 1.01-1.70) and poorer self-perceived health (B: -0.208; SE: 0.049; p < 0.001). Insurance denial showed no significant association with either outcome.

Material burden was associated with survivors' mental and physical well-being, underscoring the need for interventions that reduce financial strain. Insurance denial, while not directly associated with outcomes in this study, remains an important indicator of administrative burden. Future work should incorporate broader measures of administrative complexity to clarify its role in financial toxicity and survivorship outcomes.