Financial toxicity trajectories and their association with short-term and long-term health outcomes in Chinese patients with cancer: a prospective cohort study.

PURPOSE: The trajectories of financial toxicity and their associations with short- and long-term health outcomes remain poorly characterized. This study aimed to identify distinct financial toxicity trajectories and to evaluate their associations with health outcomes among Chinese patients with cancer. METHODS: We recruited patients with newly diagnosed cancer from three tertiary cancer hospitals between March 2017 and December 2018 and followed the cohort until March 12, 2021. The Comprehensive Score for Financial Toxicity (COST) and health-related quality of life (HRQoL) were assessed at baseline, 6 months, and 12 months. Group-based trajectory model (GBTM) was applied to identify distinct financial toxicity trajectories based on COST scores. Linear mixed models were fitted to estimate the average effect size, examining the association between COST trajectory groups and HRQoL. Cox proportional hazards models were used to evaluate the association between financial toxicity trajectories and all-cause mortality. RESULTS: Three trajectories of financial toxicity were identified: a "low rising-declining" group (26.18%), a "moderately stable"group (62.91%), and an "elevated decreasing-rising"group (10.91%). Compared with the low rising-declining trajectory group, both the moderately stable trajectory group (β = 6.86, 95% CI 3.75-9.98; P < 0.001) and the elevated decreasing-rising trajectory group (β = 12.43, 95% CI 8.05-16.81; P < 0.001) had significantly higher HRQoL scores. After multivariable adjustment for demographic and clinical covariates, no significant association was observed between financial toxicity trajectory groups and all-cause mortality. CONCLUSIONS: Financial toxicity tends to follow a moderately stable trajectory and persists throughout cancer treatment. It also excerts an adverse effect on HRQoL. Further investigation is needed to clarify the association between financial toxicity trajectories and long-term survival among patients with cancer.