Social Capital and Financial Toxicity in Caregivers of Patients With Advanced Cancer: Associations With Health-Related Quality of Life and Psychological Distress

BACKGROUND: Informal caregivers of patients with advanced cancer face increasing psychosocial and financial burdens; however, their health-related needs remain underrecognized. Although prior studies have examined social capital and financial toxicity separately, their combined impact on caregiver well-being is less understood. This study examined how social capital and financial toxicity are associated with caregivers' health-related quality of life (HRQoL), psychological distress, and overall health. PATIENTS AND METHODS: We conducted a cross-sectional survey of 200 caregivers of patients with advanced cancer at a tertiary hospital. Social capital was measured by social connectedness, group participation, and trust, whereas financial toxicity was evaluated as material burden and psychological distress related to financial concerns. Stepwise multivariate logistic regression identified factors associated with caregiver HRQoL, anxiety, depression, and self-rated health status. RESULTS: The median age of caregivers was 50 years (IQR, 41-60); most were women (70.5%) and either a spouse or child of the patient. Approximately 50% of caregivers experienced high financial toxicity, 43% had low participation in social groups, and 42% reported low social trust. Low social connectedness (adjusted odds ratio aOR, 2.36; 95% CI, 1.21-4.63) and high psychological distress related to financial concerns (aOR, 8.35; 95% CI, 4.27-16.31) were each significantly associated with poor HRQoL. Depression was more likely to occur among caregivers with limited social participation (aOR, 3.77; 95% CI, 1.79-7.95) and with both higher psychological distress related to financial concerns (aOR, 7.44; 95% CI, 3.79-14.60) and material burden (aOR, 2.67; 95% CI, 1.30-5.46). CONCLUSIONS: Our findings indicate that social connectedness with friends and participation in social groups were associated with better HRQoL and mental health, whereas psychological distress related to financial burden was strongly associated with poorer outcomes across all domains. Interventions designed to strengthen social support networks and alleviate financial stress may therefore be essential components of comprehensive cancer care.