Association between Resilience and Financial Toxicity: The Moderating Role of Age, Race and Socioeconomic Factors
- 1University of Alabama at Birmingham School of Nursing
Abstract
PURPOSEWomen with metastatic breast cancer (MBC) are at risk of developing financial toxicity due to prolonged treatment. Resilience has been identified as a key protective factor associated with better quality of life among cancer populations. However, it is unknown if resilience is associated with financial toxicity. We sought to examine the relationship between resilience and financial toxicity among women with MBC and explore whether socioeconomic factors moderate this association.
PATIENTS AND METHODSOur sample included 209 women with MBC who completed self-reported questionnaires of the Resilience Scale Specific to Cancer (RS-SC) and the Comprehensive Score for Financial Toxicity (COST). Participants (n=2) with missing data were excluded from analysis. We conducted multiple linear regression to examine the association of resilience with financial toxicity. Interaction terms were used to test moderating effects of age (18-39, 40-64 and [≥]65 years), race, education, health insurance, household income and employment status.
RESULTSOf the sample, 56.5% were aged 40-64 years, 76.6% were White, and 79.9% had a college or masters degree or above. Women reported moderately high resilience with mean RS-SC score of 34.49 (SD = 6.67), and moderate financial toxicity (mean COST score =21.01 [SD = 10.51]). Adjusting for covariates, higher resilience was linked to better financial well-being (b = 0.37, SE= 0.11, 95% CI [0.14, 0.59], P < 0.01). Age, education and health insurance moderated this relationship, with resilience more strongly associated with better financial well-being among those aged 40-64 years, with college/masters degree or above and private insurance. Race, household income, and employment status did not moderate the association between resilience and financial toxicity.
CONCLUSIONWomen with MBC who reported higher resilience are more likely to experience better financial well-being, but the strength of this association varied by socioeconomic factors. Further research is needed to confirm these findings. Our results have important implications for incorporating resilience into financial toxicity interventions and tailoring such interventions based on individual socioeconomic characteristics.
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BibTeX
@misc{zhan2026association,
title = {{Association between Resilience and Financial Toxicity: The Moderating Role of Age, Race and Socioeconomic Factors}},
author = {Y. Zhan and R. Wells and T. Knobf and L. Shan and M. B. Lustberg and H.-L. Wang},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.19.26365649},
url = {https://www.medrxiv.org/content/10.64898/2026.10.19.26365649v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Association between Resilience and Financial Toxicity: The Moderating Role of Age, Race and Socioeconomic Factors
AU - Y. Zhan
AU - R. Wells
AU - T. Knobf
AU - L. Shan
AU - M. B. Lustberg
AU - H.-L. Wang
PY - 2026
DA - 2026/10/19
PB - medRxiv
DO - 10.64898/2026.10.19.26365649
UR - https://www.medrxiv.org/content/10.64898/2026.10.19.26365649v1
AB - PURPOSEWomen with metastatic breast cancer (MBC) are at risk of developing financial toxicity due to prolonged treatment. Resilience has been identified as a key protective factor associated with better quality of life among cancer populations. However, it is unknown if resilience is associated with financial toxicity. We sought to examine the relationship between resilience and financial toxicity among women with MBC and explore whether socioeconomic factors moderate this association. PATIENTS AND METHODSOur sample included 209 women with MBC who completed self-reported questionnaires of the Resilience Scale Specific to Cancer (RS-SC) and the Comprehensive Score for Financial Toxicity (COST). Participants (n=2) with missing data were excluded from analysis. We conducted multiple linear regression to examine the association of resilience with financial toxicity. Interaction terms were used to test moderating effects of age (18-39, 40-64 and [≥]65 years), race, education, health insurance, household income and employment status. RESULTSOf the sample, 56.5% were aged 40-64 years, 76.6% were White, and 79.9% had a college or masters degree or above. Women reported moderately high resilience with mean RS-SC score of 34.49 (SD = 6.67), and moderate financial toxicity (mean COST score =21.01 [SD = 10.51]). Adjusting for covariates, higher resilience was linked to better financial well-being (b = 0.37, SE= 0.11, 95% CI [0.14, 0.59], P < 0.01). Age, education and health insurance moderated this relationship, with resilience more strongly associated with better financial well-being among those aged 40-64 years, with college/masters degree or above and private insurance. Race, household income, and employment status did not moderate the association between resilience and financial toxicity. CONCLUSIONWomen with MBC who reported higher resilience are more likely to experience better financial well-being, but the strength of this association varied by socioeconomic factors. Further research is needed to confirm these findings. Our results have important implications for incorporating resilience into financial toxicity interventions and tailoring such interventions based on individual socioeconomic characteristics.
ER -