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Peer-reviewedCC BYBMJ Open

Financial toxicity burden among patients with cancer and cancer survivors in the UK: a cross-sectional study of prevalence and variation across recruitment pathways

  • Tran Thu Ngan1
  • Michael Donnelly1
  • Damien Bennett2
  • Ciaran O’Neill1
  1. 1Centre for Public Health, Queen’s University Belfast, Belfast, UK
  2. 2Northern Ireland Cancer Registry, Belfast, UK
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Abstract

Objectives To examine variation in financial toxicity (FT) according to recruitment pathway among patients with cancer and cancer survivors in the UK and identify sociodemographic and clinical factors associated with FT.Design Cross-sectional online survey.Setting Participants were recruited across the UK through an online research panel (Prolific) and community-oriented and support-oriented pathways, including cancer charities, patient support groups and social media.Participants A total of 671 adults with a current or previous cancer diagnosis participated (497 recruited through the online research panel and 174 through community-oriented and support-oriented pathways).Primary and secondary outcome measures FT was measured using the validated Comprehensive Score for Financial Toxicity (COST). FT was defined as a COST score <26, encompassing mild (14–25) and moderate/severe (0–13). Multivariable logistic regression was used to examine the association between recruitment pathway and FT after adjusting for age group, sex, occupation, personal income, cancer stage at diagnosis and treatment status.Results In the study sample, 46.4% of participants experienced FT. FT prevalence was higher among participants recruited through community-oriented and support-oriented pathways than through the online research panel pathway (71.3% vs 37.6%, p<0.001). After adjustment for sociodemographic and clinical characteristics, participants recruited through community-oriented and support-oriented pathways had higher odds of FT (OR=2.83, 95% CI 1.69 to 4.75). Younger age, being unable to work due to illness and undergoing treatment were also independently associated with FT.Conclusions In this cross-sectional study, observed FT burden differed substantially according to recruitment pathway. Participants recruited through community-oriented and support-oriented pathways had higher odds of FT than those recruited through an online research panel. These findings suggest that recruitment source should be considered when interpreting FT estimates and designing future studies, particularly where the aim is to understand financial vulnerability among people affected by cancer.

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Cite

BibTeXRIS
BibTeX
@article{ngan2026financial,
  title = {{Financial toxicity burden among patients with cancer and cancer survivors in the UK: a cross-sectional study of prevalence and variation across recruitment pathways}},
  author = {Tran Thu Ngan and Michael Donnelly and Damien Bennett and Ciaran O’Neill},
  journal = {BMJ Open},
  year = {2026},
  month = nov,
  doi = {10.1136/bmjopen-2026-126799},
  url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-126799},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Financial toxicity burden among patients with cancer and cancer survivors in the UK: a cross-sectional study of prevalence and variation across recruitment pathways
AU  - Tran Thu Ngan
AU  - Michael Donnelly
AU  - Damien Bennett
AU  - Ciaran O’Neill
PY  - 2026
DA  - 2026/11/06
JO  - BMJ Open
DO  - 10.1136/bmjopen-2026-126799
UR  - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-126799
AB  - Objectives To examine variation in financial toxicity (FT) according to recruitment pathway among patients with cancer and cancer survivors in the UK and identify sociodemographic and clinical factors associated with FT.Design Cross-sectional online survey.Setting Participants were recruited across the UK through an online research panel (Prolific) and community-oriented and support-oriented pathways, including cancer charities, patient support groups and social media.Participants A total of 671 adults with a current or previous cancer diagnosis participated (497 recruited through the online research panel and 174 through community-oriented and support-oriented pathways).Primary and secondary outcome measures FT was measured using the validated Comprehensive Score for Financial Toxicity (COST). FT was defined as a COST score <26, encompassing mild (14–25) and moderate/severe (0–13). Multivariable logistic regression was used to examine the association between recruitment pathway and FT after adjusting for age group, sex, occupation, personal income, cancer stage at diagnosis and treatment status.Results In the study sample, 46.4% of participants experienced FT. FT prevalence was higher among participants recruited through community-oriented and support-oriented pathways than through the online research panel pathway (71.3% vs 37.6%, p<0.001). After adjustment for sociodemographic and clinical characteristics, participants recruited through community-oriented and support-oriented pathways had higher odds of FT (OR=2.83, 95% CI 1.69 to 4.75). Younger age, being unable to work due to illness and undergoing treatment were also independently associated with FT.Conclusions In this cross-sectional study, observed FT burden differed substantially according to recruitment pathway. Participants recruited through community-oriented and support-oriented pathways had higher odds of FT than those recruited through an online research panel. These findings suggest that recruitment source should be considered when interpreting FT estimates and designing future studies, particularly where the aim is to understand financial vulnerability among people affected by cancer.
SN  - 2044-6055
SN  - 2044-6055
ER  -