JCO Glob Oncol. 2026 Jul;12(7):e2500688. doi: 10.1200/GO-25-00688. Epub 2026 Jul 29.
ABSTRACT
PURPOSE: Lebanon’s ongoing economic collapse has severely disrupted access to cancer care and increased out-of-pocket financial burden for patients. Financial toxicity and psychological distress are recognized barriers to treatment experience and adherence, yet little is known about how these factors interact within collapsing health systems. This study assessed whether psychological distress is indirectly associated between financial toxicity and treatment satisfaction among Lebanese adults with cancer.
METHODS: A cross-sectional survey was conducted among 308 adult patients with cancer receiving or recently completing treatment across Lebanon. Participants completed validated Arabic versions of the Comprehensive Score of Financial Toxicity Functional Assessment of Chronic Illness Therapy (COST-FACIT; financial toxicity; lower scores indicate greater toxicity), PHQ-4 (anxiety/depression), FACIT-TS-G (treatment satisfaction), and Multidimensional Scale of Perceived Social Support (social support). Descriptive statistics, bivariate analyses, and multivariable linear regression were performed. Indirect associations were tested using Hayes’ PROCESS Model 4 with 5,000 bias-corrected bootstrap samples, adjusting for relevant sociodemographic and clinical covariates including age, insurance status, and treatment variables.
RESULTS: Participants had a mean age of 47.9 years; 58.4% was female. Lower COST scores (greater financial toxicity) were significantly associated with higher psychological distress (P < .001). Higher distress was significantly associated with lower treatment satisfaction (P < .001). In multivariable models, financial toxicity, psychological distress, social support, and insurance coverage were independent predictors of treatment satisfaction. Indirect analysis indicated a significant indirect association between financial toxicity and treatment satisfaction through psychological distress. The direct association remained significant, indicating mediation.
CONCLUSION: Among patients with cancer living through Lebanon’s economic crisis, greater financial toxicity was associated with higher psychological distress and lower treatment satisfaction. Psychological distress accounted for this relationship. These findings underscore the need for integrated psychosocial support and financial navigation within resource-constrained oncology settings.
PMID:42525910 | DOI:10.1200/GO-25-00688
