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Financial Toxicity, Hope, and Satisfaction With Life in Patients Receiving Ambulatory Cancer Care
Grace L Smith1,2, David B Feldman3,4, Hilary Ma5
1Department of GI Radiation Oncology, MD Anderson Cancer Center, Houston, Texas.
JAMA Network Open
|February 5, 2026
Summary
Financial toxicity in cancer patients is linked to lower life satisfaction. Hopefulness and social support help mediate this impact, suggesting interventions should bolster these resilience factors.
Area of Science:
- Oncology
- Psychosocial Oncology
- Health Economics
Background:
- Financial toxicity significantly impacts cancer patients' lives, affecting treatment adherence, outcomes, and satisfaction with life (SWL).
- Understanding mediators of psychological distress, such as hopefulness and social support, is crucial for developing effective interventions.
Purpose of the Study:
- To investigate the association between financial toxicity, hopefulness, social support, and SWL in cancer patients.
- To examine the mediating roles of hopefulness and social support in the relationship between financial toxicity and SWL.
Main Methods:
- A cross-sectional analysis of 519 adult cancer patients from the prospective, multisite ENRICh-II study.
- Financial toxicity was assessed using the ENRICh instrument; SWL, hopefulness, and social support were measured using validated scales.
- Multiple mediation analysis using a bootstrapping approach controlled for demographic and clinical covariates.
Main Results:
- Higher financial toxicity was significantly associated with lower SWL (r = -0.34, P < .001).
- Hopefulness and social support partially mediated this association (social support: -0.03 [95% CI, -0.06 to -0.01]; hope: -0.08 [95% CI, -0.12 to -0.03]).
- These mediating effects were significant even when considering combined mediation pathways and specific financial toxicity domains.
Conclusions:
- Greater financial toxicity burden is linked to reduced life satisfaction in cancer patients.
- Hopefulness and social support act as significant mediators, highlighting their role in psychosocial resilience.
- Interventions should integrate strategies to enhance psychosocial resilience alongside financial assistance to mitigate the adverse effects of cancer-related financial toxicity.
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