Prevalence of and factors associated with financial toxicity among gastrointestinal cancer patients in Pakistan.

1616 Background: Financial toxicity (FT) impacts 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 gastrointestinal (GI) cancer patients across distinct healthcare systems in Pakistan. Methods: 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 Center (JPMC, public, free), and Cancer Foundation Hospital (CFH, private-philanthropy, subsidized). FT was assessed using the Urdu version of the Comprehensive Score for Financial Toxicity–Functional Assessment of Chronic Illness Therapy (COST-FACIT). Multivariable negative binomial regression identified factors linked to high FT. Results: 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 the median International Wealth Index (IWI) was 79.9 (IQR: 57.1–95.1). Catastrophic healthcare expenditure affected 41.7%. The mean COST-FACIT score was 16.0 ± 7.4, with 46.1% experiencing mild FT (score: 14–26) and 41.9% moderate FT (score: ≤14). Patients delaying or forgoing care had higher FT (p < 0.001). Borrowing money, selling assets, or cutting essential expenses were strongly associated with increased FT (p < 0.001). Patients at AKUH reported higher FT than JPMC (IRR = 0.84, 95% CI: 0.74–0.97). Younger patients (21–50 years) (IRR = 0.66, 95% CI: 0.46–0.95) and those receiving chemotherapy (IRR = 0.89, 95% CI: 0.81–0.98) experienced higher FT. Females (IRR = 1.36, 95% CI: 1.17–1.58) and higher socioeconomic status (IRR = 1.39, 95% CI: 1.06–1.83) were associated with lower FT. Conclusions: Nearly 85% of GI cancer patients 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 healthcare systems. Patient characteristics and treatment costs across hospitals. AKUH JPMC CFH Gender, n (%) Male Female 109 (65.3)58 (34.7) 73 (57.9)53 (42.1) 52 (63.4)30 (36.6) Age (yrs), mean (SD) 54.3 (1.1) 44.2 (1.3) 53.6 (1.4) IWI score, mean (SD) 84.0 (1.5) 52.8 (2.6) 80.4 (2.0) COST-FACIT score, mean (SD) 16.7 (7.9) 15.3 (7.6) 15.7 (5.8) EORTC QLQ summary score (Quality of Life score), mean (SD) 78.1 (15.5) 79.3 (17.9) 75.1 (16.0) Monthly household income (USD), median (IQR) 358.4 (179.2-716.8) 107.5 (43.0-179.2) 233.0 (71.7-358.4) Out of pocket costs (USD), median (IQR) Surgery and associated inpatient Chemotherapy Radiotherapy 2509.0 (1003.6-4569.89)1433.7 (573.5-3225.8)896.1 (255.4-2150.5) 0 (0-0)0 (0-304.7)0 (0-0) 1433.7 (1075.3-1792.1)1469.5 (358.4-1881.7)1075.3 (716.8-1792.1) *Costs converted using 1 USD = 279 Pakistani Rupee.