Financial toxicity and mental well-being of the oral cancer survivors residing in a developing country in the era of COVID 19 pandemic – A cross-sectional study

Abhinav Thaduri, Pankaj K. Garg, Manu Malhotra, Mahendra Pal Singh, Dharma Ram Poonia, Madhu Priya, Amit Tyagi, Amit Kumar, Abhishek Bhardwaj, Bhinyaram Jat, Achyuth Panuganti, Kinjal Majumdar, Shahab Usmani, S. Vikramjit

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Objectives: The primary outcome measures evaluated the financial toxicity and mental well-being of the oral cancer survivors. Methods: A cross-sectional study of oral cancer survivors who were disease-free for more than 6 months after treatment and visited the hospital for a routine follow-up is included in the study. Mental well-being and financial toxicity were evaluated using the Depression, Anxiety, and Stress Scale - 21 (DASS 21) and Comprehensive Score for financial Toxicity (COST- Functional Assessment of Chronic Illness Therapy) questionnaires. A literature review was done to compare the results with financial toxicity and mental health in cancer patients from the pre-pandemic era. Results: A total of 79 oral cancer survivors were included in the study, predominantly males (M: F = 10:1). The age ranged from 26 to 75 years (The median age is 49). The full-time employment dropped from 83.5% in the pre-treatment period to 21.5% post-treatment. Depression was observed in 58.2% and anxiety in 72.2%. Unemployed survivors were observed to have more depression (OR = 1.3, 95% confidence interval (CI) = 0.3–5.4, p = 0.6), anxiety (OR = 3.5, 95% CI = 0.3–21.2, p = 0.1) and stress (OR = 1.6, 95% CI = 0.3–6.6, p = 0.5) than rest of the cohort. On univariate analysis, unemployed survivors (M = 11.8 ± 3.8, p = 0.01) had significantly poorer financial toxicity scores. Survivors with depression (M = 16.4 ± 7.1, p = 0.06) and stress (M = 14.4 ± 6.8, p = 0.002) had poor financial toxicity scores. On multifactorial analysis of variance, current employment (p = 0.04) and treatment modality (p = 0.05) were significant factors impacting the financial toxicity. Conclusion: There is a trend towards increased incidence of depression, anxiety, and stress among oral cancer survivors compared to the literature from the pre-COVID era. There is significant financial toxicity among either unemployed or part-time workers. This calls for urgent public/government intervention to prevent the long-term impact of financial toxicity on survival and quality of life.

Original languageEnglish
Pages (from-to)58-67
Number of pages10
Issue number1
Publication statusPublished - 01-2023

All Science Journal Classification (ASJC) codes

  • Experimental and Cognitive Psychology
  • Oncology
  • Psychiatry and Mental health


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