Financial toxicity profiles and associated factors among lung cancer patients receiving immunotherapy: a latent profile analysis
- 1Department of Thoracic Surgery, Huashan Hospital, Fudan University
Abstract
Objectives: To identify latent profiles of patient-reported financial toxicity and factors associated with profile membership among lung cancer patients receiving immunotherapy.
Methods: A total of 331 lung cancer patients receiving immunotherapy were recruited by convenience sampling. Financial toxicity, perceived social support, and psychological resilience were assessed using the Comprehensive Score for Financial Toxicity (COST-PROM), Perceived Social Support Scale (PSSS), and Connor-Davidson Resilience Scale (CD-RISC), respectively. Latent profile analysis (LPA) based on the 11 COST-PROM items was used to identify financial-toxicity profiles. Factors associated with profile membership were examined using the Mplus three-step R3STEP procedure, which accounts for classification uncertainty. A conventional multinomial logistic regression based on most-likely class assignment was used as a sensitivity analysis. Additional analyses examined the robustness of the LPA solution, an R3STEP model including all available covariates, collinearity, and possible nonlinear effects of PSSS and CD-RISC.
Results: Three profiles were identified: Severe Financial Toxicity (28.7%), Moderate Financial Toxicity (39.9%), and Mild Financial Toxicity (31.4%). In R3STEP analyses, lower monthly income, out-of-pocket payment, and non-working status were associated with higher odds of Severe Financial Toxicity profile membership ( p < 0.05), whereas higher PSSS and CD-RISC scores were associated with lower odds ( p < 0.05). The modal-assignment sensitivity analysis yielded materially consistent findings. The three classes differed mainly in overall severity, with broadly parallel item profiles. Average posterior probabilities were 0.989, 0.982, and 0.992 for the Severe, Moderate, and Mild classes, respectively. Both alternative LPA models retained three classes, and the additional multivariable R3STEP model produced similar results.
Conclusion: Patient-reported financial toxicity was heterogeneous among lung cancer patients receiving immunotherapy. Socioeconomic vulnerability and psychosocial characteristics were associated with profile membership. Routine financial-distress screening and financial navigation may be considered for patients with greater financial toxicity, while psychosocial intervention strategies require prospective evaluation before their effectiveness can be inferred. The classes mainly reflected different levels of financial toxicity rather than distinct response patterns.
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BibTeX
@article{nie2026financial,
title = {{Financial toxicity profiles and associated factors among lung cancer patients receiving immunotherapy: a latent profile analysis}},
author = {Jing Nie and Peijuan Hu and Wei Qian and Xiaoyan Lu and Yulong Tan},
journal = {Frontiers in Public Health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1909233},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1909233/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Financial toxicity profiles and associated factors among lung cancer patients receiving immunotherapy: a latent profile analysis
AU - Jing Nie
AU - Peijuan Hu
AU - Wei Qian
AU - Xiaoyan Lu
AU - Yulong Tan
PY - 2026
DA - 2026/10/16
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1909233
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1909233/full
AB - Objectives: To identify latent profiles of patient-reported financial toxicity and factors associated with profile membership among lung cancer patients receiving immunotherapy. Methods: A total of 331 lung cancer patients receiving immunotherapy were recruited by convenience sampling. Financial toxicity, perceived social support, and psychological resilience were assessed using the Comprehensive Score for Financial Toxicity (COST-PROM), Perceived Social Support Scale (PSSS), and Connor-Davidson Resilience Scale (CD-RISC), respectively. Latent profile analysis (LPA) based on the 11 COST-PROM items was used to identify financial-toxicity profiles. Factors associated with profile membership were examined using the Mplus three-step R3STEP procedure, which accounts for classification uncertainty. A conventional multinomial logistic regression based on most-likely class assignment was used as a sensitivity analysis. Additional analyses examined the robustness of the LPA solution, an R3STEP model including all available covariates, collinearity, and possible nonlinear effects of PSSS and CD-RISC. Results: Three profiles were identified: Severe Financial Toxicity (28.7%), Moderate Financial Toxicity (39.9%), and Mild Financial Toxicity (31.4%). In R3STEP analyses, lower monthly income, out-of-pocket payment, and non-working status were associated with higher odds of Severe Financial Toxicity profile membership ( p < 0.05), whereas higher PSSS and CD-RISC scores were associated with lower odds ( p < 0.05). The modal-assignment sensitivity analysis yielded materially consistent findings. The three classes differed mainly in overall severity, with broadly parallel item profiles. Average posterior probabilities were 0.989, 0.982, and 0.992 for the Severe, Moderate, and Mild classes, respectively. Both alternative LPA models retained three classes, and the additional multivariable R3STEP model produced similar results. Conclusion: Patient-reported financial toxicity was heterogeneous among lung cancer patients receiving immunotherapy. Socioeconomic vulnerability and psychosocial characteristics were associated with profile membership. Routine financial-distress screening and financial navigation may be considered for patients with greater financial toxicity, while psychosocial intervention strategies require prospective evaluation before their effectiveness can be inferred. The classes mainly reflected different levels of financial toxicity rather than distinct response patterns.
SN - 2296-2565
ER -