The Effect of Financial Toxicity on the Association Between Perceived Social Support and Negative Emotions in Post-Surgical Lung Cancer Patients: A Cross-Sectional Study From High-Middle Income Region in China

Abstract

Objective: To investigate the mediating role of financial toxicity in the relationship between perceived social support and negative emotions among post-surgical lung cancer patients in China.

Methods: A total of 447 lung cancer patients from China were recruited, participants completed the Comprehensive Scores for Financial Toxicity (COST), the Negative Emotion Screening Scale (NESS), and the Perceived Social Support Scale (PSSS). The hypothesized relations were explored using structural equation modeling via the bootstrapping approach. The study methods were compliant with the STROBE checklist.

Results: Nearly half (42.51%, n = 190) of the participants experienced financial toxicity. Negative emotions were negatively associated with perceived social support (r = -0.13) and negatively associated with financial toxicity scores (r = -0.50) (Note: COST is a reverse scoring scale, lower COST scores illustrate severe financial toxicity). Perceived social support was positively correlated with financial toxicity scores (r = 0.26). Financial toxicity scores negatively predicted negative emotions (β = -0.504). Social support and financial toxicity could explain 25.3% of the variance in patients' negative emotions. Social support positively predicted financial toxicity (β = 0.257) and explained 6.60% of the variance in financial toxicity. Furthermore, financial toxicity completely mediated the association between perceived social support and negative emotions (b = -0.124; 95% confidence interval: -0.182, -0.086).

Conclusion: The high prevalence of financial toxicity demonstrates its crucial role in patient outcomes. Our findings reveal that social support indirectly influences negative emotions through financial toxicity, establishing a clear pathway linking psychosocial and financial aspects of cancer care. These results suggest that integrated interventions targeting both financial burden and social support networks may be particularly effective in improving psychological outcomes among lung cancer patients in China's high-middle income regions. Future healthcare policies should prioritize comprehensive support systems that address this complex interplay of socioeconomic and psychological factors.

Keywords: financial toxicity; lung cancer; negative emotions; perceived social support; post‐surgical.

FIGURE 1

The mediating effect of social support affecting negative emotion through financial toxicity.