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. 2025 Jul 11;33(8):680.
doi: 10.1007/s00520-025-09718-w.

Financial toxicity and quality of life among older adults with cancer: a moderated mediation model of loneliness and social support

Qin Zhao  1   2 , Yi Kuang  3 , Xiaoyi Yuan  4 , Yanling Sun  5 , Zheng Zhu  2 , Jing Zhu  6 , Haiyan Gu  6 , Weijie Xing  7
Affiliations

Financial toxicity and quality of life among older adults with cancer: a moderated mediation model of loneliness and social support

Qin Zhao et al. Support Care Cancer. .

Abstract

Purpose: Financial toxicity (FT) is prevalent among older adults with cancer due to the expensive costs of cancer treatment and causes a decline in quality of life (QoL). This study aimed to get insights into the potential mechanisms of how FT impacts QoL through a moderated mediation model and explore the mediating role of loneliness and the moderating role of social support.

Methods: A cross-sectional survey from May to October 2021 was conducted to recruit older adults with cancer aged 60 years and above in Shanghai, China. A total of 832 participants were included and answered questionnaires. SPSS PROCESS macro 4.2 software was administered to perform moderated mediation analysis. In the conceptual model, FT serves as the independent variable, QoL as the outcome variable, and loneliness as the mediator. Social support is hypothesized as moderator, influencing all three paths in the mediation model.

Results: Loneliness partially mediated the relationship of FT on QoL (β = 0.129, P < 0.001, 95%CI: 0.093, 0.169), accounting for 30.71% of the total effect. Social support moderated the association between FT and loneliness (β = 0.154, P < 0.001, 95% CI: 0.090, 0.219), and the connection between loneliness and QoL (β = 0.048, P < 0.05, 95% CI: 0.004, 0.091). As social support decreased, the mediating effect of loneliness became stronger.

Conclusion: The study revealed that FT not only directly impacted QoL but also operated through the mediating mechanism of loneliness. These insights contribute to a better understanding of the psychosocial factors related to financial challenges among older adults with cancer and play an essential role in developing targeted interventions and support systems to improve the overall QoL of this vulnerable population. Future research may further explore the dynamic nature of these relationships and investigate effective strategies to alleviate financial burdens and enhance social support for older adults navigating cancer-related challenges.

Keywords: Cancer; Financial toxicity; Loneliness; Older adults; Quality of life; Social support.

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Conflict of interest statement

Declarations. Ethics statement: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of School of Nursing, Fudan University (IRB#TYSQ2020-04–09). Conflict of interest: The authors declare no competing interests.

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