Financial hardship among patients with lung cancer and their family caregivers: A comparative study of two institution-based samples from Hong Kong and Mainland China

Objective: To investigate and compare the severity and prevalence of financial hardship among lung cancer patients and their caregivers in two institution-based samples from Hong Kong and Mainland China, emphasizing regional differences in healthcare systems and socioeconomic contexts. Methods:A cross-sectional survey of 355 patient-caregiver pairs (Hong Kong: 50; Mainland China: 305) collected data on sociodemographic and clinical characteristics, financial hardship, quality of life (QoL), and distress.Comparisons were made using independent sample t-tests, Chi-square tests, and Ordinary Least Squares (OLS) regression.Results: Financial hardship was prevalent and severe in both Hong Kong and Mainland China for both patients (52.0%vs.. 42.3%, Mean COST score: 15.04 vs.. 16.48) and Caregivers (28.0%vs.. 25.2%; Mean COST score: 18.36 vs.. 19.82).Patients' and caregivers' COST scores were strongly correlated (P < 0.05).Greater financial hardship was associated with higher psychological distress and poorer QoL.OLS analysis identified younger age, lower education, advanced cancer stage, and region income interactions as significant determinants for both J o u r n a l P r e -p r o o f patients and caregivers.High-income participants (CNY 20,001-30,000 and > CNY 30,000) in Mainland China reported less hardship than their Hong Kong counterparts ( HKD 30,000), while low-income participants (< CNY 5,000) experienced greater hardship (P < 0.05).Region employment interactions indicated that caregivers in Mainland China faced elevated financial vulnerability across employment groups.Sensitivity analysis confirmed the robustness of these findings.Conclusions: Financial hardship is prevalent among lung cancer patients and caregivers across regions, shaped by the interplay of socioeconomic position and healthcare system design.Early screening, family-centered support, and policies addressing socioeconomic inequities are essential to mitigate financial hardship across diverse healthcare settings.