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Prevalence and Factors Associated With Financial Toxicity Among Patients With GI Cancer in Pakistan
Sehar Salim Virani1,2, Fatima Shaukat3, Asfia Arham Khursheed1
1Department of Surgery, Aga Khan University, Karachi, Pakistan.
JCO Global Oncology
|May 15, 2026
Summary
Financial toxicity (FT) significantly impacts cancer patients in low- and middle-income countries (LMICs). Nearly 85% of gastrointestinal cancer patients experienced FT, with younger age and lower socioeconomic status being key risk factors.
Area of Science:
- Oncology
- Health Economics
- Public Health
Background:
- Financial toxicity (FT) poses a significant challenge to cancer care globally, particularly in low- and middle-income countries (LMICs).
- FT impacts treatment adherence, quality of life, and overall patient outcomes.
- Understanding FT prevalence and its determinants is crucial for developing effective support strategies.
Purpose of the Study:
- To assess the prevalence of financial toxicity (FT) among patients with gastrointestinal cancer in Pakistan.
- To identify factors associated with FT across different healthcare systems (private, public, subsidized).
Main Methods:
- A cross-sectional study involving 375 gastrointestinal cancer patients from three tertiary care centers in Karachi.
- Financial toxicity assessed using the Urdu version of the Comprehensive Score for FT-Functional Assessment of Chronic Illness Therapy (COST-FACIT).
- Multivariable negative binomial regression used to identify factors associated with high FT.
Main Results:
- Nearly 85% of patients experienced financial toxicity (FT), with 41.9% facing moderate FT (COST-FACIT score ≤14).
- Factors associated with increased FT included delaying/forgoing care, borrowing money, selling assets, and cutting essentials.
- Higher FT was reported at a private, fee-for-service hospital (AKUH) compared to a public hospital (JPMC).
- Younger patients (21-50 years) and those receiving chemotherapy experienced higher FT.
- Female gender and higher socioeconomic status were associated with lower FT.
Conclusions:
- A high prevalence of financial toxicity (FT) affects gastrointestinal cancer patients in Pakistan, underscoring a critical issue in LMICs.
- Younger age, male gender, lower socioeconomic status, and systemic therapy are significant risk factors for FT.
- Implementing subsidized care, financial support programs, and institution-specific strategies is essential to mitigate FT in LMIC healthcare settings.
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