Influence of financial toxicity on quality of life in lung cancer patients undergoing immunotherapy: the mediating effect of self-perceived burden

Abstract

Abstract Background Although immunotherapy has the potential to prolong the median survival time and overall survival of patients with lung cancer, it is also a driver of immune related adverse events, which may directly affect the therapeutic effect and reduce quality of life (QOL). Attention to measure QOL in lung cancer patients undergoing immunotherapy is under-explored because of the therapy’s relative novelty. And a great deal of empirical researches has indicated the important influence of financial toxicity (FT) and self-perceived burden (SPB) on QOL. However, yet no research has ever clarified the relationship among FT, SPB, and QOL simultaneously. Hence, the purpose of this study is to understand the level of QOL of lung cancer patients undergoing immunotherapy, and attempt to clarify the potential mediating roles of SPB on the relationship between FT and QOL. Methods A convenience sample of 342 lung cancer patients undergoing immunotherapy was recruited from a cancer hospital from October 2022 to April 2023 in this cross-sectional study. Participants were requested to complete the structured questionnaires: sociodemographic and clinical questionnaire, Functional Assessment of Cancer Therapy–Lung (FACT-L), Self -Perceived Burden Scale (SPBS) and COmprehensive Score for financial Toxicity (COST). Data were subjected to Pearson correlation analysis and bootstrapping analysis in the structural equation modelling. Results The total score of FACT-L was (79.90 ± 15.84) points in 322 lung cancer patients administrated with immunotherapy. FT (β = 0.37, P < 0.01) and SPB (β = -0.27, P < 0.01) had a direct effect on QOL. In addition, SPB partly mediated the association between FT and QOL, and the standardized indirect effect was 0.19, accounting for 33.9% of the total effect. Conclusions The present study revealed that lung cancer patients undergoing immunotherapy experienced a lower QOL. And higher financial burden resulted in greater self-perceived burden, thus associated with inferior QOL. It is imperative for healthcare providers to routinely assessed QOL, financial toxicity or risk and self- perceived burden for lung cancer patients undergoing immunotherapy, and assist those patients in understanding the potential financial risk of each choice and help them take more active roles in their routine clinical care.