Prevalence and Factors Associated With Financial Toxicity Among Patients With GI Cancer in Pakistan

Financial toxicity (FT) affects cancer care in low- and middle-income countries (LMICs), affecting treatment adherence and quality of life. This study assesses FT prevalence and associated factors among patients with gastrointestinal cancer across distinct health care systems in Pakistan.

A cross-sectional study was conducted across three tertiary care centers in Karachi: Aga Khan University Hospital (AKUH, private, fee-for-service), Jinnah Postgraduate Medical Centre (JPMC, public, free), and Cancer Foundation Hospital (CFH, private-philanthropy, subsidized). FT was assessed using the Urdu version of the Comprehensive Score for FT-Functional Assessment of Chronic Illness Therapy (COST-FACIT). Multivariable negative binomial regression identified factors linked to high FT.

Of 375 patients, 44.5% were from AKUH, 33.6% from JPMC, and 21.9% from CFH. Mean age was 50.8 ± 14.4 years, with 62.4% males. Only 8.3% had health insurance, and median International Wealth Index was 79.9 (IQR, 57.1-95.1). Catastrophic health care expenditure affected 41.7%. Mean COST-FACIT score was 16.0 ± 7.4; 46.1% experienced mild FT (score: 14-26) and 41.9% moderate FT (score: ≤14). Delaying or forgoing care, borrowing money, selling assets, and cutting essentials were strongly associated with increased FT (P < .001). Patients at AKUH reported higher FT than JPMC (incidence rate ratio [IRR], 0.84 [95% CI, 0.74 to 0.97]). Younger patients (21-50 years; IRR, 0.66 [95% CI, 0.46 to 0.95]) and those receiving chemotherapy (IRR, 0.89 [95% CI, 0.81 to 0.98]) experienced higher FT. Females (IRR, 1.36 [95% CI, 1.17 to 1.58]) and higher socioeconomic status (IRR, 1.39 [95% CI, 1.06 to 1.83]) were associated with lower FT.

Nearly 85% of patients with GI cancer faced FT. Younger age, male gender, lower socioeconomic status, and systemic therapy were associated with higher FT. Subsidized care, financial support, and institution-specific strategies are critical to mitigating FT in LMIC health care systems.