Step forward: how health insurance mitigates financial toxicity in cancer care in Pakistan

Support Care Cancer. 2025 Oct 16;33(11):956. doi: 10.1007/s00520-025-10004-y.

ABSTRACT

AIM: Cancer imposes a significant financial burden on patients. This study evaluates the role of health cards in reducing financial toxicity (FT) and improving health-related quality of life (HRQOL) and psychological distress among cancer patients in Pakistan.

METHODS: This cross-sectional study was conducted in Bahawalpur, Pakistan, between March and June 2024. A total of 672 cancer patients (336 with and 336 without health cards) were recruited using non-probability purposive sampling. FT was assessed using the Comprehensive Score for Financial Toxicity (COST), while HRQOL was measured using the Functional Assessment of Cancer Therapy-General (FACT-G). The Depression, Anxiety, and Stress Scale-21 (DASS-21) evaluated psychological distress.

RESULTS: Independent t-tests showed significant differences between patients with and without health card coverage: FT significantly decrease from 7.21 to 13.24, HRQOL improve from 28.60 to 47.56, and psychological distress declined, all p < 0.001. FT correlated positively with HRQOL (r = 0.814) and negatively with depression (r = -0.222), anxiety (r = -0.475), and stress (r = -0.675), indicating strong links between financial relief and well-being (p < 0.001). MANOVA results indicated that health cards had a strong multivariate effect across all outcomes (Wilks’ Lambda = 0.060, F(5,666) = 2071.97, p < 0.001, η² = 0.940).

CONCLUSION: Health cards play a crucial role in reducing FT while improving HRQOL and psychological well-being among cancer patients in Pakistan. The findings underscore the need to expand health coverage to ensure financial protection and enhance successful treatment outcomes for vulnerable populations.

PMID:41102586 | DOI:10.1007/s00520-025-10004-y