Determinants and experiences of financial toxicity among oral cancer patients in a public hospital in India

Financial toxicity (FT) refers to the financial hardship experienced by patients and families due to medical costs, particularly in chronic illnesses like cancer. While treatment in public hospitals is free in India, patients with cancer may still face significant financial burdens due to indirect costs and socioeconomic vulnerabilities. The objective of this study was to measure FT in oral cancer patients and identify the associated factors. A mixed-methods study was conducted at a public tertiary hospital in Delhi between November 2023 and May 2024. A quantitative survey of 116 oral cancer patients was conducted using the COST tool, followed by in-depth interviews with 11 participants. Descriptive and inferential statistics were used to analyze the quantitative data, while interviews were transcribed, and thematic analysis was done. The majority of participants were male (87.9%) and unemployed (89.7%), with a median family income of USD 92.9/month. Most (92.2%) experienced some degree of FT. Higher levels of FT were significantly associated with younger age, unemployment, low income, low household savings, debt, and lower socioeconomic status ( p < 0.05). The optimized regression model explained 43.5% of the variance in COST scores. Qualitative findings highlighted impacts on employment, education, debt, nutrition, psychological stress, and social isolation not fully captured by the COST tool. Significant FT exists even in public hospital settings in India. Policymaking should account for indirect costs and sociocultural factors, with expanded financial protection mechanisms for cancer-affected households.