e23180 Background: Adolescents and young adults with cancer experience substantial financial toxicity (FT) and health-related social needs (HRSN), particularly in low and middle-income countries. These hardships also extend to their caregivers, yet quantitative evidence is limited. This study aimed to assess the extent and determinants of FT and HRSN among AYA cancer patients and their caregivers and their correlation. Methods: A cross-sectional study was conducted among consecutively enrolled AYA cancer patients at a tertiary care cancer hospital. Financial toxicity was assessed using the Comprehensive Score for Financial Toxicity (COST-FACIT) questionnaire and health-related social needs using the AHC-HRSN core instrument. The sociodemographic data and responses were collected. Moderate-severe FT was defined as COST scores < 13. Multivariable logistic regression was used to identify independent predictors of FT, adjusting for socioeconomic factors. Results: Among 399 participants enrolled between August and October, 2025, the mean COST score recorded was 13.39 ± 6.11. 40.9% participants reported mild while 55.1% participants reported moderate to severe financial toxicity. Female gender (p = 0.039), rural household(p = 0.003), and level of education (p = 0.005) showed significant association with COST toxicity categories. Internal consistency of COST was excellent (α = 0.838). At least one unmet social need was reported by 62.4% of participants, with food insecurity (41.4%) and housing instability (29.6%) being most prevalent. All the domains of health-related social needs showed significant association with financial toxicity (p < 0.05). Multivariable analysis when adjusting for socio-economic factors found that cumulative needs were independently associated with moderate–severe FT (adjusted OR 2.00, CI 1.54-2.59, p < 0.001), while other factors were not significant after adjustment. On sensitivity analyses, unmet social needs remained significantly associated with lower COST scores (B = −2.20, p < 0.001). A moderate inverse correlation was found with COST scores and number of unmet needs (r = –0.328, p < 0.001), indicating a dose dependent effect. Furthermore, it was found that 98.2% of the caregivers used to stay at the hospital, for a median of 10 days, providing appreciable support. Conclusions: It was found that financial toxicity and health-related social needs were highly significant in this cohort, confirming the hypothesis. Unmet health-related social needs are the dominant independent predictor of clinically significant financial toxicity among AYA cancer patients in India, exceeding the influence of traditional sociodemographic factors. These findings emphasize the critical need for integrated financial and social support assessment for adolescents and young adults and their caregivers. Future research work is required to evaluate long-term outcomes in lower- and middle-income countries.
Kumar et al. (Thu,) studied this question.