Greater material, psychological, and behavioural financial toxicity among young and middle-aged patients versus older patients with cancer: A multicentre cross-sectional study

PURPOSE: Although financial toxicity (FT) is a crucial dimension of cancer care, differences in its psychological, material, and behavioural manifestations with age remain underexplored in China. This study examined age differences in multidimensional FT among patients with cancer. METHODS: Data for this secondary analysis were obtained from a multicentre cross-sectional survey of 1208 adult patients with cancer recruited from 12 hospitals across three Chinese provinces between February and October 2022. Psychological, material, and behavioural domains of FT were assessed using validated instruments. Patients were categorised as young (18-39 years), middle-aged (40-59 years), or older (≥60 years). The FT domains were compared across age groups using multiple linear and binary logistic regression analyses adjusted for sociodemographic and clinical covariates. RESULTS: Young and middle-aged patients reported significantly greater psychological FT than older adults, as indicated by lower comprehensive FT scores. Compared with older patients, young patients faced the highest risk, with increased odds ratios (ORs) of 2.17 (95% confidence interval [CI]: 1.10 to 4.30) and 2.76 (95% CI: 1.49 to 5.13) for material and behavioural FT, respectively. Middle-aged patients also demonstrated higher odds of behavioural FT (OR = 1.57, 95% CI: 1.06 to 2.33) relative to older patients, despite no significant difference in material FT. CONCLUSION: FT varies with age among Chinese patients with cancer, with young patients experiencing the greatest multidimensional burden. Integrating age-sensitive FT screening into routine oncology nursing practice and designing tailored interventions may help to mitigate FT and improve supportive care outcomes across the cancer trajectory.