Prevalence and Factors Associated With Financial Toxicity Among Patients With GI Cancer in Pakistan

PURPOSE: Financial toxicity (FT) affects cancer care in low- and middle-income countries (LMICs), affecting treatment adherence and quality of life. This study assesses FT prevalence and associated factors among patients with gastrointestinal cancer across distinct health care systems in Pakistan. METHODS: A cross-sectional study was conducted across three tertiary care centers in Karachi: Aga Khan University Hospital (AKUH, private, fee-for-service), Jinnah Postgraduate Medical Centre (JPMC, public, free), and Cancer Foundation Hospital (CFH, private-philanthropy, subsidized). FT was assessed using the Urdu version of the Comprehensive Score for FT-Functional Assessment of Chronic Illness Therapy (COST-FACIT). Multivariable negative binomial regression identified factors linked to high FT. RESULTS: Of 375 patients, 44.5% were from AKUH, 33.6% from JPMC, and 21.9% from CFH. Mean age was 50.8 ± 14.4 years, with 62.4% males. Only 8.3% had health insurance, and median International Wealth Index was 79.9 (IQR, 57.1-95.1). Catastrophic health care expenditure affected 41.7%. Mean COST-FACIT score was 16.0 ± 7.4; 46.1% experienced mild FT (score: 14-26) and 41.9% moderate FT (score: ≤14). Delaying or forgoing care, borrowing money, selling assets, and cutting essentials were strongly associated with increased FT (P < .001). Patients at AKUH reported higher FT than JPMC (incidence rate ratio [IRR], 0.84 [95% CI, 0.74 to 0.97]). Younger patients (21-50 years; IRR, 0.66 [95% CI, 0.46 to 0.95]) and those receiving chemotherapy (IRR, 0.89 [95% CI, 0.81 to 0.98]) experienced higher FT. Females (IRR, 1.36 [95% CI, 1.17 to 1.58]) and higher socioeconomic status (IRR, 1.39 [95% CI, 1.06 to 1.83]) were associated with lower FT. CONCLUSION: Nearly 85% of patients with GI cancer faced FT. Younger age, male gender, lower socioeconomic status, and systemic therapy were associated with higher FT. Subsidized care, financial support, and institution-specific strategies are critical to mitigating FT in LMIC health care systems.