{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T20:58:11Z","timestamp":1785358691883,"version":"3.55.0"},"reference-count":51,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"7","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO Glob Oncol"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>PURPOSE<\/jats:title>\n                    <jats:p>Lebanon's ongoing economic collapse has severely disrupted access to cancer care and increased out-of-pocket financial burden for patients. Financial toxicity and psychological distress are recognized barriers to treatment experience and adherence, yet little is known about how these factors interact within collapsing health systems. This study assessed whether psychological distress is indirectly associated between financial toxicity and treatment satisfaction among Lebanese adults with cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A cross-sectional survey was conducted among 308 adult patients with cancer receiving or recently completing treatment across Lebanon. Participants completed validated Arabic versions of the Comprehensive Score of Financial Toxicity Functional Assessment of Chronic Illness Therapy (COST-FACIT; financial toxicity; lower scores indicate greater toxicity), PHQ-4 (anxiety\/depression), FACIT-TS-G (treatment satisfaction), and Multidimensional Scale of Perceived Social Support (social support). Descriptive statistics, bivariate analyses, and multivariable linear regression were performed. Indirect associations were tested using Hayes' PROCESS Model 4 with 5,000 bias-corrected bootstrap samples, adjusting for relevant sociodemographic and clinical covariates including age, insurance status, and treatment variables.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      Participants had a mean age of 47.9 years; 58.4% was female. Lower COST scores (greater financial toxicity) were significantly associated with higher psychological distress (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001). Higher distress was significantly associated with lower treatment satisfaction (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001). In multivariable models, financial toxicity, psychological distress, social support, and insurance coverage were independent predictors of treatment satisfaction. Indirect analysis indicated a significant indirect association between financial toxicity and treatment satisfaction through psychological distress. The direct association remained significant, indicating mediation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Among patients with cancer living through Lebanon's economic crisis, greater financial toxicity was associated with higher psychological distress and lower treatment satisfaction. Psychological distress accounted for this relationship. These findings underscore the need for integrated psychosocial support and financial navigation within resource-constrained oncology settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1200\/go-25-00688","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T19:59:12Z","timestamp":1785355152000},"update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":0,"title":["Financial Toxicity and Treatment Satisfaction Among Lebanese Patients With Cancer: Indirect Associations Involving Psychological Distress"],"prefix":"10.1200","volume":"12","author":[{"given":"Pauline","family":"Jakal","sequence":"first","affiliation":[{"name":"School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirna","family":"Fawaz","sequence":"additional","affiliation":[{"name":"School of Nursing, Beirut Arab University, Beirut, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6918-5689","authenticated-orcid":true,"given":"Souheil","family":"Hallit","sequence":"additional","affiliation":[{"name":"School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon"},{"name":"Applied Science Research Center, Applied Science Private University, Amman, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clemence","family":"Matta","sequence":"additional","affiliation":[{"name":"School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon"},{"name":"Department of Oncology, Notre Dame des Secours University Hospital, Byblos, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0172-0538","authenticated-orcid":true,"given":"Ali","family":"Hemade","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Lebanese University, Hadat, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.2016.013573"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13045-024-01640-8"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31012-1"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccell.2023.02.016"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.3390\/jpm15040141"},{"key":"e_1_3_5_7_2","first-page":"3173","article-title":"Financial burden of cancer drug treatment in Lebanon","volume":"17","author":"Elias F","year":"2016","unstructured":"Elias F, Khuri FR, Adib SM, et al: Financial burden of cancer drug treatment in Lebanon. Asian Pac J Cancer Prev 17:3173-3177, 2016","journal-title":"Asian Pac J Cancer Prev"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0040-1721291"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2022-008722"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/10732748251359407"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-024-03560-3"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzt070"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.2147\/PPA.S24752"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2407-14-42"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-022-06952-4"},{"key":"e_1_3_5_16_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-022-00341-1"},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-022-07044-z"},{"key":"e_1_3_5_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2023.06.1195"},{"key":"e_1_3_5_19_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-023-07586-w"},{"key":"e_1_3_5_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsps.2022.01.020"},{"key":"e_1_3_5_21_2","doi-asserted-by":"publisher","DOI":"10.1002\/pon.3409"},{"key":"e_1_3_5_22_2","doi-asserted-by":"publisher","DOI":"10.3332\/ecancer.2024.1690"},{"key":"e_1_3_5_23_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.23149"},{"key":"e_1_3_5_24_2","doi-asserted-by":"publisher","DOI":"10.1002\/pon.70038"},{"key":"e_1_3_5_25_2","doi-asserted-by":"publisher","DOI":"10.1097\/00002820-200509000-00008"},{"key":"e_1_3_5_26_2","first-page":"204","article-title":"The impact and incidence of altered body image in patients with head and neck tumors: A systematic review","volume":"5","author":"Manier KK","year":"2018","unstructured":"Manier KK, Rowe LS, Welsh J, et al: The impact and incidence of altered body image in patients with head and neck tumors: A systematic review. Neurooncol Pract 5:204-213, 2018","journal-title":"Neurooncol Pract"},{"key":"e_1_3_5_27_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13561-023-00435-w"},{"key":"e_1_3_5_28_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-9280.2007.01882.x"},{"key":"e_1_3_5_29_2","doi-asserted-by":"publisher","DOI":"10.1186\/1477-7525-1-79"},{"key":"e_1_3_5_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2009.06.019"},{"key":"e_1_3_5_31_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-024-05978-8"},{"key":"e_1_3_5_32_2","first-page":"159","article-title":"Validation of the Arabic translation of the multidensional scale of social support (arabic MSPSS) in a Lebanese community sample","volume":"23","author":"R M","year":"2012","unstructured":"R M, Kazarian S: Validation of the Arabic translation of the multidensional scale of social support (arabic MSPSS) in a Lebanese community sample. Arab J Psychiatry 23:159-168, 2012","journal-title":"Arab J Psychiatry"},{"key":"e_1_3_5_33_2","doi-asserted-by":"publisher","DOI":"10.4103\/aca.ACA_157_18"},{"key":"e_1_3_5_34_2","first-page":"335","article-title":"Introduction to mediation, moderation, and conditional process analysis: A regression-based approach","volume":"51","author":"Hayes AF","year":"2013","unstructured":"Hayes AF: Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. J Educ Measure 51:335-337, 2013","journal-title":"J Educ Measure"},{"key":"e_1_3_5_35_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.28814"},{"key":"e_1_3_5_36_2","first-page":"101367","article-title":"Relationships between financial toxicity and symptom burden among cancer patients: A longitudinal study","volume":"55","author":"Kuang Y","year":"2025","unstructured":"Kuang Y, Qi X, Qiu J, et al: Relationships between financial toxicity and symptom burden among cancer patients: A longitudinal study. Lancet 55:101367, 2025","journal-title":"Lancet"},{"key":"e_1_3_5_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejon.2023.102489"},{"key":"e_1_3_5_38_2","doi-asserted-by":"publisher","DOI":"10.1200\/OP.24.00025"},{"key":"e_1_3_5_39_2","doi-asserted-by":"publisher","DOI":"10.1089\/jayao.2018.0143"},{"key":"e_1_3_5_40_2","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000038871"},{"key":"e_1_3_5_41_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10834-022-09820-9"},{"key":"e_1_3_5_42_2","doi-asserted-by":"publisher","DOI":"10.3390\/bs15070915"},{"key":"e_1_3_5_43_2","doi-asserted-by":"publisher","DOI":"10.1002\/pon.3055"},{"key":"e_1_3_5_44_2","doi-asserted-by":"publisher","DOI":"10.3747\/co.v16i6.432"},{"key":"e_1_3_5_45_2","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2012-0279"},{"key":"e_1_3_5_46_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.critrevonc.2009.06.003"},{"key":"e_1_3_5_47_2","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2015-0026"},{"key":"e_1_3_5_48_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2024-017557"},{"key":"e_1_3_5_49_2","doi-asserted-by":"publisher","DOI":"10.1200\/OP.22.00665"},{"key":"e_1_3_5_50_2","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.3979"},{"key":"e_1_3_5_51_2","doi-asserted-by":"publisher","DOI":"10.31661\/gmj.v13i.3327"},{"key":"e_1_3_5_52_2","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.18.00120"}],"container-title":["JCO Global Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ascopubs.org\/doi\/pdfdirect\/10.1200\/GO-25-00688","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T19:59:18Z","timestamp":1785355158000},"score":1,"resource":{"primary":{"URL":"https:\/\/ascopubs.org\/doi\/10.1200\/GO-25-00688"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":51,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1200\/GO-25-00688"],"URL":"https:\/\/doi.org\/10.1200\/go-25-00688","relation":{},"ISSN":["2687-8941"],"issn-type":[{"value":"2687-8941","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]},"assertion":[{"value":"2025-11-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-02","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-06","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-29","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e2500688"}}