Examining Psychological Moderators of the Relationships between Financial Toxicity and Symptoms in Patients with Cancer

Abstract

Financial toxicity, which includes both the objective financial burden and subjective financial distress related to cancer treatment, has been linked to decrements in patient well-being. Drawing on the Transactional Model of Stress and Coping, this study examines relationships between cancer-related financial toxicity and changes in physical and psychological symptoms over time. Additionally, perceived injustice and acceptance-based coping were examined as potential moderators of these relationships. Patients (N=200) with early-stage solid tumors and at least mild financial toxicity were recruited from Indiana hospitals. Patients were undergoing cancer treatment or had completed treatment within the past 6 months. Assessments were completed at baseline and two months later and included self-report measures of financial toxicity, perceived injustice, acceptance-based coping, and symptoms (anxiety, depressive symptoms, fatigue, sleep disturbance, and pain). I used path analysis to evaluate direct and moderated relationships between financial toxicity and symptoms while adjusting for theoretically relevant demographic and medical covariates. Results showed that higher financial toxicity was significantly correlated with increased depressive symptoms over time (B=-0.19, p<.01) but was not associated with changes in pain, fatigue, sleep disturbance, or anxiety. Contrary to hypotheses, perceived injustice and acceptance-based coping did not moderate these relationships. However, perceived injustice was significantly associated with heightened anxiety (B=2.16, p<.01), depressive symptoms (B=2.41, p<.01), and sleep disturbance (B=1.27, p=.02), and acceptance-based coping was linked to reduced depressive symptoms (B=-1.19, p=.03). Findings contribute to limited longitudinal findings on the detrimental effect of financial toxicity on mental health. Other symptoms were relatively stable over time, and limited variance may have contributed to null findings. Limitations include the primarily non-Hispanic White sample, short follow-up duration, and potential self-report biases. Despite these limitations, results underscore the prevalence of financial toxicity and the need to develop and evaluate interventions that jointly address financial and mental well-being. Next steps also include examining mechanisms linking financial toxicity to mental health outcomes.