Financial toxicity and distress among prostate cancer patients in Lebanon: a cross-sectional study

Financial toxicity is a major component of the cancer experience. Prostate cancer often requires prolonged treatment and follow-up, increasing financial and psychological burden. Lebanon's economic crisis has disrupted health-care financing and insurance coverage, potentially worsening these burdens. This study evaluated financial toxicity among male patients with prostate cancer in Lebanon and its relationship with psychological distress.

We conducted a cross-sectional telephone survey of adult males (≥18 years) with confirmed prostate cancer receiving active treatment or with prior prostate surgery. Validated Arabic Functional Assessment of Chronic Illness Therapy-Cost (FACIT-COST) and Patient Health Questionnaire-4 (PHQ-4) were administered, and sociodemographic, financial, and clinical data were obtained from medical records and self-report. Linear regression assessed associations with financial toxicity and psychological distress, and a multivariate model evaluated their relationship while controlling for other variables.

We enrolled 147 patients (mean age 71.8 ± 8.3 years). Limited treatment coverage, treatment disruptions, and lower household income were independently associated with higher financial toxicity. Treatment disruptions and lower household income were associated with higher psychological distress. Financial toxicity was significantly associated with psychological distress (β = -0.21 per unit increase in FACIT-COST; p < 0.001), and this association was not explained by clinical or sociodemographic factors.

Financial toxicity is prevalent among men with prostate cancer in Lebanon and is strongly associated with psychological distress. Household income and treatment continuity appear more influential than disease severity, highlighting the need for economic support systems and stable insurance coverage in crisis-affected settings.