Prevalence and impact of financial toxicity in older patients with cancer: a prospective observational study in India.

PURPOSE

We aimed to assess the prevalence of financial toxicity in older Indian patients with cancer and evaluate the association with quality of life (QoL), distress, vulnerabilities in the geriatric assessment, and factors impacting financial toxicity.

METHODS

This was a prospective observational study at the Tata Memorial Center (Mumbai, India) in patients aged 60 years and over, planned for cancer-directed therapy. We used the COST-FACIT and CFPB Financial Well-Being Scales to assess financial toxicity. QoL was assessed with the European Organization for Research and Treatment of Cancer (EORTC) QLQ C30 questionnaire, and distress with the NCCN distress thermometer.

RESULTS

Between June 2022 and September 2023, we enrolled 953 patients. The median age was 66 (IQR 63-72) years; 277 patients (29.1%) were over 70 years old, 737 (77.3%) were male, and 135 (14.2%) had health insurance. Therapy was planned with palliative intent in 607 (63.7%) patients. The prevalence of financial toxicity was 73.7% as per the COST-FACIT scale (n = 703), and 66% as per the CFPB (n = 629). Higher financial toxicity on the COST-FACIT scale was associated with poor financial well-being on the CFPB scale. Financial toxicity was associated with poor QoL and higher distress. Factors associated with significantly greater financial toxicity included history of tobacco chewing, monthly family income less than ₹50,000, lack of health insurance, illiteracy, depression, and cognitive impairment.

CONCLUSIONS

Identifying the factors contributing to financial toxicity will help make the cancer treatment journey smoother, more accessible and improve compliance to therapy for older patients.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov Identifier: CTRI/2020/04/024675.

© 2025. The Author(s).