Introduction to Financial Toxicity in Cancer Patients

Financial toxicity is an emerging concern for cancer patients and their families, reflecting the multifaceted economic burdens associated with the disease and its treatment. It encompasses both direct costs, such as medical bills, and indirect costs, such as lost wages and transportation expenses (1). Financial toxicity has been shown to negatively impact treatment adherence, quality of life (QoL), and overall survival (2). Recent studies indicate that approximately 22%–64% of cancer patients experience significant financial distress, highlighting the urgent need for effective management strategies in this domain (3, 4).

In Slovenia, the economic burden of cancer is particularly pressing, with the number of newly diagnosed cases rising from 13,700 in 2013 to over 17,000 in 2021 (5). Given the country’s public healthcare system, which covers a wide range of services, it is essential to understand how financial toxicity manifests in this context and its implications for patient care. The recent reforms in health insurance coverage that aim to eliminate co-payments may alleviate some financial burdens; however, out-of-pocket expenses for non-covered services remain a significant issue (6).

The Comprehensive Score for Financial Toxicity (COST-FACIT) instrument has been validated in various healthcare settings and can provide insights into the financial burdens faced by cancer patients. By examining the prevalence of financial toxicity in Slovenia using this tool, we can better understand its relationship with QoL and inform future patient-centered interventions (7).

Impact of Hepatocellular Carcinoma on Elderly Populations

Hepatocellular carcinoma (HCC) represents a unique challenge in elderly populations, where the incidence is rising significantly. Elderly patients with HCC often present with distinct clinical features, including well-differentiated tumors and multiple comorbidities (8). Recent epidemiological studies show that the proportion of elderly patients among those diagnosed with HCC has steadily increased, highlighting the need for tailored management strategies (9).

The treatment of HCC in older adults requires careful consideration of physiological reserves and comprehensive geriatric assessments to mitigate potential complications arising from coexisting medical conditions (10). Notably, studies have demonstrated that when selected appropriately, elderly patients can achieve comparable outcomes to their younger counterparts across various treatment modalities (11). However, less invasive options, such as radiofrequency ablation or transarterial therapies, may be more suitable for some elderly patients, emphasizing the importance of individualized treatment plans (12).

Understanding the distinct epidemiological and clinical features of HCC in elderly populations is crucial for optimizing patient outcomes and ensuring that treatment strategies align with the unique needs of this age group.

Unique Challenges in Managing Young Adult Cancer Patients

Adolescent and young adult (AYA) patients, typically aged 15 to 39 years, face unique challenges in the management of cancer, including hepatocellular carcinoma. These patients often present with more aggressive tumor characteristics and specific etiological factors, such as early-onset chronic viral hepatitis (13). The treatment of HCC in this demographic emphasizes curative intent while addressing their psychosocial needs, including fertility preservation and long-term health maintenance (14).

Despite the aggressive nature of HCC in AYA patients, studies suggest they have relatively favorable prognoses when compared to older adults with similar disease characteristics (15). However, there is a notable lack of data regarding treatment outcomes in this population, highlighting the need for further research to develop effective and age-appropriate treatment strategies (16).

Moreover, the management of cancer in AYA patients requires a multidisciplinary approach that considers their developmental and life stage, as well as the long-term implications of treatment on their overall quality of life (17).

Role of Lipid Metabolism in Cancer Treatment Outcomes

Recent research has unveiled the critical role of lipid metabolism in cancer treatment outcomes, particularly in relation to the synthesis of acetyl-CoA in tissues such as the skin. Acetyl-CoA is a vital building block for lipid synthesis and has been implicated in various metabolic disorders and cancer (18). Inhibition of acetyl-CoA synthesis may disrupt lipid homeostasis, leading to alterations in cancer cell behavior and treatment efficacy (19).

Studies utilizing mouse models have shown that loss of acetyl-CoA synthesis in the skin depletes key epidermal barrier lipids, disrupting the skin barrier and causing rapid fat loss (20). This disruption in lipid metabolism highlights the importance of systemic lipid homeostasis in cancer progression and response to treatment.

Furthermore, understanding the interplay between lipid metabolism and cancer biology could pave the way for novel therapeutic strategies that target metabolic pathways to improve treatment outcomes (21).

Strategies for Personalized Cancer Care Across Age Groups

Personalized cancer care is critical to optimizing treatment outcomes across different age groups, particularly for elderly and AYA populations. Tailoring treatment strategies to individual patient needs involves considering factors such as age, comorbidities, tumor characteristics, and psychosocial factors (22).

For elderly patients, comprehensive geriatric assessments can aid in identifying physiological reserves and guiding treatment decisions that minimize complications (23). In contrast, AYA patients require special attention to their developmental stage and the long-term impacts of treatment, including fertility preservation and psychosocial support (24).

A multidisciplinary approach that integrates oncologists, geriatricians, and psychosocial support teams can enhance the overall quality of care and address the unique challenges faced by these populations. Additionally, leveraging advancements in precision medicine and understanding the role of lipid metabolism in cancer could further inform personalized treatment strategies that optimize outcomes for patients of all ages (25).

Conclusion

Enhancing cancer treatment and management for all ages necessitates a comprehensive understanding of the unique challenges faced by different patient populations. By addressing financial toxicity, tailoring treatment strategies to the needs of elderly and AYA patients, and recognizing the role of lipid metabolism in cancer outcomes, we can work towards improving the quality of care and patient outcomes. The ongoing research in these areas will be pivotal in shaping future cancer care practices, ensuring that all patients receive the best possible treatment tailored to their individual circumstances.

References

Financial Toxicity Among Cancer Patients in Slovenia. Retrieved from https://pubmed.ncbi.nlm.nih.gov/12010762/
Management of hepatocellular carcinoma in elderly and adolescent/young adult populations
Personalized Tumor-Specific Amplified DNA Junctions in Peripheral Blood of Patients with High-Grade Gliomas. Retrieved from https://pubmed.ncbi.nlm.nih.gov/12010965/
Acetyl-CoA synthesis in the skin is a key determinant of systemic lipid homeostasis. Retrieved from https://doi.org/10.1016/j.celrep.2025.115284
Paging Dr. Google: Characterizing Direct-to-Consumer Digital Advertisements From Oncology Treatment Centers. Retrieved from https://doi.org/10.7759/cureus.80994
Annual Report to the Nation on the Status of Cancer, featuring state‐level statistics after the onset of the COVID‐19 pandemic
Prevalence of medication related osteonecrosis of the jaw in patients treated with sequential antiresorptive drugs: systematic review and meta-analysis
Hounsfield units predict vertebral compression fractures in gastric cancer survivors after adjuvant irradiation. Retrieved from https://pubmed.ncbi.nlm.nih.gov/12010886/
Planning evaluation of stereotactic magnetic resonance–guided online adaptive radiosurgery for kidney tumors close to the organ at risk: is it valuable to wait for good timing to perform stereotactic radiosurgery? Retrieved from https://pubmed.ncbi.nlm.nih.gov/12010889/