Financial toxicity, self-efficacy, self-care, and health-related quality of life in gastrointestinal cancer survivors in Taiwan.

Abstract

e23273 Background: Gastrointestinal cancer survivors frequently experience symptom burden, psychological adjustment demands, and financial strain that may compromise self-care behaviors and health-related quality of life (HRQoL). Although self-efficacy supports health-promoting behaviors and financial toxicity may impede effective self-care, integrated evidence linking these factors within Taiwan’s healthcare context remains limited. This study examined the associations among financial toxicity, cancer-related self-efficacy, self-care behaviors, and HRQoL in gastrointestinal cancer survivors in Taiwan. Methods: A cross-sectional, multicenter study was conducted between July 2025 and January 2026, enrolling 169 adult survivors with esophageal, gastric, hepatic, pancreatic, or colorectal cancer receiving treatment or routine follow-up. Structured questionnaires assessed demographic and socioeconomic characteristics, disease- and treatment-related factors, symptom severity, physical functioning, lifestyle factors, financial toxicity, cancer-related self-efficacy, and self-care ability. Multivariable linear regression analyses were performed with HRQoL as the outcome, adjusting for demographic, socioeconomic, and clinical covariates. Results: The regression model showed strong explanatory power (adjusted R ² = 0.795). Greater symptom severity was associated with poorer HRQoL ( β = −0.630, p = .001), whereas better physical functioning was positively associated with HRQoL ( β = 0.485, p = .002). Financial toxicity remained an independent negative predictor of HRQoL ( β = −0.716, p < .001). Self-care ability was the strongest positive predictor ( β = 0.907, p < .001), and cancer-related self-efficacy was also positively associated with HRQoL ( β = 0.340, p = .006). Conclusions: Among gastrointestinal cancer survivors in Taiwan, financial toxicity and self-care ability are key modifiable determinants of HRQoL, underscoring the importance of routine financial assessment and self-care–focused interventions in survivorship care.