Financial Toxicity and Follow‐Up Quality of Life Among Breast Cancer Survivors in the BOLD Cohort

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Abstract
Background: Financial toxicity is prevalent in cancer survivorship and has been associated with poorer health‐related quality of life (HRQOL), yet longitudinal evidence remains limited. We examined associations between financial toxicity and HRQOL at baseline and 4‐month follow‐up among breast cancer survivors in the BOLD cohort. Methods: Data were drawn from self‐report questionnaires completed by 182 breast cancer survivors at baseline, of whom 146 completed 4‐month follow‐up surveys. Financial toxicity was assessed at baseline using the Comprehensive Score for Financial Toxicity (COST). HRQOL outcomes were assessed at baseline and approximately 4 months later using the Functional Assessment of Cancer Therapy–General (FACT‐G) subscales and total score, and a single‐item measure of sleep disturbance. Multivariable linear regression models estimated adjusted cross‐sectional associations and longitudinal associations between baseline financial toxicity and follow‐up outcomes, adjusting for baseline levels of the corresponding outcome. Longitudinal measurement invariance of the COST was evaluated. Results: Greater baseline financial toxicity was associated with lower baseline physical, social/family, emotional, and functional well‐being, lower FACT‐G total score, and greater sleep disturbance. In longitudinal models, higher baseline financial toxicity was associated with lower follow‐up physical, social/family, emotional, and functional well‐being and lower FACT‐G total score after adjustment for demographic and clinical covariates and the corresponding baseline outcome. Baseline financial toxicity was not associated with follow‐up sleep disturbance. Conclusions: Financial toxicity was associated with poorer HRQOL at baseline and with lower physical, social/family, emotional, functional, and overall HRQOL at follow‐up. These findings support greater attention to financial toxicity in survivorship care.
Funding Information
  • National Cancer Institute (P30 CA77598)
  • National Institute on Minority Health and Health Disparities (R00MD015296)

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