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July 8, 2026

Evaluation of psychological distress and financial toxicity in dyads of cancer patients undergoing chemotherapy and their caregivers at tertiary care hospitals in Western India

ARAditi RoyBharati Vidyapeeth Deemed University ARAsawari RautBharati Vidyapeeth Deemed University ACAman ChaudharyPost Graduate Institute of Medical Education and Research

Key Points

This study aims to investigate the levels of psychological distress and financial toxicity among cancer patients and their caregivers during chemotherapy.
Cross-sectional analysis of 357 patient-caregiver dyads receiving chemotherapy.
Assessment tools included NCCN Distress Thermometer for distress and COST-FACIT for financial toxicity.
Used multivariable logistic regression and Actor-Partner Interdependence Model to study relationships.
Clinically significant distress was present in 55.74% of patients and 10.92% of caregivers.
Nearly 70% of both groups experienced mild-to-moderate financial toxicity.
Significant associations were found between patient distress and adverse drug reactions (AOR = 2.208, p<0.05).

Abstract

PURPOSE: This study examined psychological distress and financial toxicity among cancer patient-caregiver dyads receiving chemotherapy in Western India, focusing on emotional and financial interdependence. METHODS: In this cross-sectional study of 357 chemotherapy patient-caregiver dyads, psychological distress (NCCN Distress Thermometer), financial toxicity (COST-FACIT), and adverse drug reactions (standard causality and severity scales) were assessed, with patient predictors analyzed by multivariable logistic regression and dyadic effects examined using the Actor-Partner Interdependence Model. RESULTS: Clinically significant distress was reported by 55.74% of patients and 10.92% of caregivers, while nearly 70% of both groups experienced mild-to-moderate financial toxicity. Patient distress was significantly associated with adverse drug reactions (AOR = 2.208), higher patient financial toxicity (AOR = 0.895), caregiver financial toxicity (AOR = 1.056), and caregiver distress (AOR = 1.951). Caregiver distress was significantly associated with caregiver financial toxicity (AOR = 1.19), patient distress (AOR = 0.72), breadwinner status, and marital status. APIM showed strong actor effects for patients (β = 0.446) and caregivers (β = 0.366), and partner effects indicating cross-dyad influence (β = 0.157; β = 0.168). CONCLUSIONS: Psychological distress and financial toxicity are prevalent, and addressing patient-caregiver interdependence-particularly in primary caregivers and patients with treatment toxicities-may improve outcomes.

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