To assess the prevalence of financial hardship (FH) and examine its relationships with quality of life (QoL) and distress in newly diagnosed lung cancer patient–caregiver dyads.

This cross-sectional study included 218 lung cancer patient–caregiver dyads. FH outcomes were measured as general financial distress (Personal Financial Wellbeing Scale, PFW), material FH (MFH), psychological FH (PFH, Comprehensive Score for Financial Toxicity, COST), and behavioral FH (BFH). QoL was assessed using the 12-item Short Form Health Survey (SF-12) and distress using the NCCN Distress Thermometer (NCCN DT). Dyadic associations between FH, QoL, and distress were analyzed using Actor–Partner Interdependence Modeling (APIM).

Mean (SD) PFW scores for patients and caregivers were 4.63 (2.08) and 5.13 (1.97), respectively. 10.1% of patients and 16.5% of caregivers reported MFH, and 46.3% of patients and 81.7% of caregivers experienced work disruptions. Mean (SD) COST scores were 16.56 (10.18) for patients and 19.83 (9.14) for caregivers. Financial sacrifices were reported in 54.6% of patients and 61.0% of caregivers. Significant correlations existed between patients' and caregivers' FH outcomes, QoL, distress, and work-related variables. Actor effects indicated that each dyad member's FH was associated with their own QoL and distress, whereas partner effects revealed that patients’ FH was associated with caregivers’ distress.

FH is prevalent among newly diagnosed lung cancer families and linked to poorer QoL and greater distress within and across dyad members. Early financial screening and dyad or family-centered interventions are essential to mitigate FH and its psychosocial impact.

Oncology nurses should incorporate early FH screening into routine assessments for both patients and caregivers, recognizing the interconnected nature of their experiences. Dyad or family-focused interventions addressing work disruptions, financial sacrifices, and psychological burden may help mitigate FH's impact on psychological well-being and QoL.

Lung cancer

Family

Financial hardship

Quality of life

Distress

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