{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T16:47:56Z","timestamp":1791823676040,"version":"4.3.4"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T00:00:00Z","timestamp":1767744000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"\n Purpose<\/jats:title>\n To assess the level of financial toxicity (FT) experienced by carers of children with cancer in Western China, identify associated factors.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A cross-sectional survey was conducted at a large tertiary hospital (\n N<\/jats:italic>\n =\u202f304 carers). Data included sociodemographic, Comprehensive Score for Financial Toxicity \u2013 Patient-Reported Outcome Measure (COST-PROM), perceived social support (PSSS), and anxiety\/depression (HADS). Univariate analyses were employed to compare FT scores across groups, Pearson correlations to examine associations between continuous variables, and hierarchical multiple linear regression analysis to identify predictors of FT.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The mean COST-PROM score was 12.24 (SD\u202f=\u202f8.44), indicating moderate FT. Elevated FT demonstrated significant correlations with heightened anxiety (\n r<\/jats:italic>\n =\u202f\u22120.44), depression (\n r<\/jats:italic>\n =\u202f\u22120.47), and diminished total social support (\n r<\/jats:italic>\n =\u202f0.32) (all\n p<\/jats:italic>\n &lt;\u202f0.01). The final regression model (Adjusted R\n 2<\/jats:sup>\n =\u202f0.309,\n p<\/jats:italic>\n &lt;\u202f0.001) revealed that factors significantly associated with increased FT included: carers\u2019 employment change (\n \u03b2<\/jats:italic>\n =\u202f\u22120.113), out-of-pocket medical expenses exceeding 40% of annual household income (\n \u03b2<\/jats:italic>\n =\u202f\u22120.112), and the presence of loans (\n \u03b2<\/jats:italic>\n =\u202f\u22120.135). Conversely, the perception that family income was sufficient to cover treatment costs (\u03b2\u202f=\u202f0.257) and greater perceived support from friends (PSSS;\n \u03b2<\/jats:italic>\n =\u202f0.234) were significantly associated with decreased FT. In addition, both anxiety and depression scores were significantly correlated with higher FT.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Carers in this sample experience moderate FT, which is strongly linked to economic hardship, and diminished social support (particularly from friends). Interventions should address modifiable factors like social support, anxiety, depression, alongside financial navigation and psychological support services.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1677962","type":"journal-article","created":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T05:14:25Z","timestamp":1767762865000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Financial toxicity, social support, and negative emotions among caregivers of children with cancer: a cross-sectional study in Western China"],"prefix":"10.3389","volume":"13","author":[{"given":"Xuan","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Nursing, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Department of Hematology, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sufang","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Nursing, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Department of Hematology, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Nursing, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education","place":["Chengdu, China"]},{"name":"Department of Neonatology, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiurong","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Nursing, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Department of Hematology, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongju","family":"Dai","sequence":"additional","affiliation":[{"name":"Department of Nursing, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Department of Hematology, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,7]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e185","DOI":"10.1016\/s1470-2045(20)30022-x","article-title":"Sustainable care for children with cancer: a lancet oncology commission","volume":"21","author":"Atun","year":"2020","journal-title":"Lancet Oncol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1016\/s1470-2045(18)30909-4","article-title":"Estimating the total incidence of global childhood cancer: a simulation-based analysis","volume":"20","author":"Ward","year":"2019","journal-title":"Lancet Oncol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1020","DOI":"10.1016\/S0140-6736(22)01541-0","article-title":"Socioeconomic inequalities in cancer incidence and access to health services among children and adolescents in China: a cross-sectional study","volume":"400","author":"Ni","year":"2022","journal-title":"Lancet"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1663","DOI":"10.1200\/jco.2011.37.8018","article-title":"Improved survival for children and adolescents with acute lymphoblastic leukemia between 1990 and 2005: a report from the children's oncology group","volume":"30","author":"Hunger","year":"2012","journal-title":"J Clin Oncol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"117","DOI":"10.12104\/j.issn.1674-4748.2023.01.028","article-title":"Survey on the current status of economic toxicity in children with leukaemia and analysis of its influencing factors. 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