Coping Mechanisms for Financial Toxicity and Its Association With Health-Related Quality of Life in Esophageal Cancer Survivors

Background The majority of cancer patients face financial toxicity (FT) to varying degrees. However, there is a notable absence of research specifically investigating FT in patients with esophageal cancer. This study aimed to assess FT in esophageal cancer survivors, exploring risk factors, coping mechanisms, and its impact on health-related quality of life (HRQoL). Methods A survey was conducted for 2692 patients who underwent esophagectomy between January 1, 2017, and December 30, 2023. The survey included the COmprehensive Score for Financial Toxicity (COST), HRQoL, and coping mechanisms questionnaires. Patient demographics, clinical characteristics, and coping strategies were compared between those experiencing low FT (COST >22) and high FT (COST ≤22). Multivariate linear regression was used to assess the clinical features associated with FT and its impact on HRQoL domains. Results A total of 311 patients completed the survey, with 107 (34.4%) reporting high fatigue (FT). Multivariate analysis identified urban residence, annual household income over ¥80,000 as factors linked to higher COST scores, while cervical esophageal cancer, treatment-related debt, recurrence, and unemployment were risk factors for FT. High FT correlated with poorer social functioning, greater pain interference, increased anxiety, and higher depression levels. Treatment-related debt was associated with poorer sleep, reduced social participation, and increased anxiety. Patients with higher FT were also more likely to reduce spending on necessities and medical care. Conclusion Esophageal cancer survivors faced significant financial burdens, with several identifiable risk factors. Prolonged exposure to FT is associated with poorer HRQoL and increased reliance on financial coping strategies. Understanding the impact of FT on esophageal cancer survivors is essential for shaping shared decision-making approaches and interventions designed to mitigate FT within this group.