Financial hardship among patients with lung cancer and their family caregivers: A comparative study of two institution-based samples from Hong Kong and Mainland China.

[OBJECTIVE] To investigate and compare the severity and prevalence of financial hardship among lung cancer patients and their caregivers in two institution-based samples from Hong Kong and Mainland China, emphasizing regional differences in healthcare systems and socioeconomic contexts.

[METHODS] A cross-sectional survey of 355 patient-caregiver pairs (Hong Kong: 50; Mainland China: 305) collected data on sociodemographic and clinical characteristics, financial hardship, quality of life (QoL), and distress. Comparisons were made using independent sample t-tests, Chi-square tests, and Ordinary Least Squares (OLS) regression.

[RESULTS] Financial hardship was prevalent and severe in both Hong Kong and Mainland China for both patients (52.0% vs. 42.3%, Mean COST score: 15.04 vs. 16.48) and Caregivers (28.0% vs. 25.2%; Mean COST score: 18.36 vs. 19.82). Patients' and caregivers' COST scores were strongly correlated ( < 0.05). Greater financial hardship was associated with higher psychological distress and poorer QoL. OLS analysis identified younger age, lower education, advanced cancer stage, and region × income interactions as significant determinants for both patients and caregivers. High-income participants (CNY 20,001-30,000 and > CNY 30,000) in Mainland China reported less hardship than their Hong Kong counterparts (≥ HKD 30,000), while low-income participants (< CNY 5000) experienced greater hardship ( < 0.05). Region × employment interactions indicated that caregivers in Mainland China faced elevated financial vulnerability across employment groups. Sensitivity analysis confirmed the robustness of these findings.

[CONCLUSIONS] Financial hardship is prevalent among lung cancer patients and caregivers across regions, shaped by the interplay of socioeconomic position and healthcare system design. Early screening, family-centered support, and policies addressing socioeconomic inequities are essential to mitigate financial hardship across diverse healthcare settings.