Exploring the current status and influencing factors of financial toxicity among hospitalized cancer patients in district and county-level hospitals

Introduction: Financial toxicity disproportionately burdens rural and semi-urban cancer populations in resource-limited settings, yet evidence from district/county-level hospitals remains scarce. Objective: This study aimed to investigate the prevalence and determinants of financial toxicity among cancer patients hospitalized in district- and county-level medical institutions, with a focus on identifying modifiable factors to alleviate economic burdens in this vulnerable population. Methods: A cross-sectional study was conducted using cluster sampling to recruit hospitalized cancer patients. Validated questionnaires were administered to assess financial toxicity, social support (including subjective, objective, and support utilization dimensions), and psychological resilience. Descriptive statistics were utilized to characterize the prevalence of financial toxicity, while (analysis of variance and t-tests were performed to compare differences across demographic and socioeconomic subgroups. Multivariable linear regression models were subsequently developed to identify independent predictors of financial toxicity severity, controlling for potential confounding variables. Results: The study included 300 participants, predominantly characterized by low socioeconomic status: 82.34% had attained a junior high school education or less, and 94.66% reported an annual personal income below 50,000 CNY (approximately 7,000 USD). The mean financial toxicity score was 15.54 ± 4.64 (range: 5 – 25), indicating a moderate-to-severe economic strain. Income level emerged as a critical determinant, with lower annual income correlating significantly with heightened financial toxicity (F = 5.406, p=0.001). Multivariable regression analysis identified four protective factors: advanced age (β = −0.18, p<0.05), higher personal income (β = −0.32, p<0.01), greater objective social support (β = −0.21, p<0.05), and enrollment in commercial insurance (β = −0.25, p<0.01), all independently associated with reduced financial toxicity. Conclusion: The findings highlight a high prevalence of financial toxicity among low-income, less-educated cancer patients receiving care in regional healthcare settings. Structural socioeconomic disparities, particularly limited income and inadequate insurance coverage, significantly contribute to treatment-related financial hardships. Policy interventions to expand commercial insurance accessibility, coupled with community-based support programs to strengthen objective social support networks, may effectively mitigate financial toxicity in this population. Future longitudinal studies are warranted to validate these associations and evaluate targeted intervention strategies.