Journal of Preventive Medicine and Public Health

Volume 57(4); July 2024

Scoping Review

Assessment of Epidemiological Data and Surveillance in Korea Substance Use Research: Insights and Future Directions: Meekang Sung, Vaughan W. Rees, Hannah Lee, Mohammad S. Jalali; J Prev Med Public Health. 2024;57(4):307-318. Published online June 24, 2024; DOI: https://doi.org/10.3961/jpmph.24.171

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Abstract Summary PDF Supplementary Material: Objectives
Effective data collection and surveillance of epidemiological trends are essential in confronting the growing challenges associated with substance use (SU), especially in light of emerging trends and underreporting of cases. However, research and data are scarce regarding SU and substance use disorder (SUD) in Korea.
Methods
We conducted a scoping review to identify data sources and surveillance methods used in SU research in Korea up to December 2023. This review was complemented by semi-structured consultations with experts in this area in Korea, whose feedback led to revisions of previously identified data sources and assessments.
Results
Our review identified 32 publications conducting secondary analyses on existing data to examine the epidemiology of SU and SUD in Korea. Of these, 14 studies utilized clinical databases to explore the prescription patterns of addictive substances, particularly opioids. Eleven data sources showed promise for advancing SU research; however, they face substantial limitations, including a lack of available data, missing data, the absence of key variables, the exclusion of marginalized populations not captured within the clinical system, and complexities in matching individual-level data across time points and datasets.
Conclusions
Current surveillance methods for SU in Korea face considerable challenges in accessibility, usability, and standardization. Moreover, existing data repositories may fail to capture information on populations not served by clinical or judicial systems. To systematically improve surveillance approaches, it is necessary to develop a robust and nationally representative survey, refine the use of existing clinical data, and ensure the availability of data on treatment facilities.; Summary

Key Message
- A scoping review identified eleven promising data sources for substance use research in Korea but noted substantial challenges in current surveillance methods, particularly regarding accessibility, usability, and standardization.
- Existing data repositories often miss information on marginalized populations not served by clinical or judicial systems, and suffer from data gaps, missing key variables, and complexities in matching individual-level data over time.
- To address these issues, developing a robust, nationally representative survey, refining the use of existing clinical data, and ensuring data availability from treatment facilities are essential.

Original Articles

Psychometric Characteristics of the Fear of Cancer Recurrence Inventory-Severity Subscale Among Korean Cancer Survivors: So-Young Park; J Prev Med Public Health. 2024;57(4):319-326. Published online May 16, 2024; DOI: https://doi.org/10.3961/jpmph.24.096

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Abstract Summary PDF: Objectives
Despite the importance of choosing and using a valid assessment tool for fear of cancer recurrence (FCR) for early detection and interventions, the validity of the FCR inventory has yet to be thoroughly investigated in Korea. This study explored the psychometric properties of the Fear of Cancer Recurrence Inventory-Severity (FCRI-S) subscale and assessed its applicability to cancer survivors in Korea.
Methods
The survey involved 93 Korean individuals who had survived cancer. The reliability of the FCRI-S subscale was assessed using Cronbach’s α and composite reliability (CR). Confirmatory factor analysis (CFA), along with tests for discriminant and convergent validity, was conducted to evaluate the construct validity of the FCRI-S subscale.
Results
The FCRI-S subscale showed excellent internal consistency (Cronbach’s α=0.88; CR=0.89). CFA showed a good factor structure for the FCRI-S subscale, and the correlations of the FCRI-S subscale with FCR-related measures (r=0.69 to 0.80) and other psychosocial measures (r=-0.23 to 0.37) confirmed both the convergent and discriminant validity of the FCRI-S subscale.
Conclusions
This study confirmed the robust psychometric characteristics of the FCRI-S subscale among cancer survivors in Korea. The use of the FCRI-S subscale would be helpful for health professionals to rapidly screen FCR levels in clinical settings.; Summary

Korean summary
암 재발 두려움은 암 생존자들이 흔히 호소하는 심리사회적 어려움 중의 하나이다. 한국 성인 암 생존자들을 대상으로 암 재발 두려움-심각성 하위척도의 심리계량적 속성을 평가한 결과, 해당 하위척도가 좋은 타당도와 신뢰도를 보인 것으로 나타났다. 본 연구 결과는 임상 현장에서 암 재발 두려움에 대한 조기 발견과 적극적인 개입의 중요성을 강조한다.

Key Message
Fear of cancer recurrence (FCR) has emerged as a significant and common concern among cancer survivors. This study evaluated the psychometric properties of FCRI-S subscale among Korean adult cancer survivors and confirmed its good validity and reliability. Findings of this research emphasize the importance of early detection and active interventions for FCR in clinical settings.

Smoking-attributable Mortality in Korea, 2020: A Meta-analysis of 4 Databases: Eunsil Cheon, Yeun Soo Yang, Suyoung Jo, Jieun Hwang, Keum Ji Jung, Sunmi Lee, Seong Yong Park, Kyoungin Na, Soyeon Kim, Sun Ha Jee, Sung-il Cho; J Prev Med Public Health. 2024;57(4):327-338. Published online July 3, 2024; DOI: https://doi.org/10.3961/jpmph.23.471

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Abstract Summary PDF Supplementary Material

Objectives
Estimating the number of deaths caused by smoking is crucial for developing and evaluating tobacco control and smoking cessation policies. This study aimed to determine smoking-attributable mortality (SAM) in Korea in 2020.
Methods
Four large-scale cohorts from Korea were analyzed. A Cox proportional-hazards model was used to determine the hazard ratios (HRs) of smoking-related death. By conducting a meta-analysis of these HRs, the pooled HRs of smoking-related death for 41 diseases were estimated. Population-attributable fractions (PAFs) were calculated based on the smoking prevalence for 1995 in conjunction with the pooled HRs. Subsequently, SAM was derived using the PAF and the number of deaths recorded for each disease in 2020.
Results
The pooled HR for all-cause mortality attributable to smoking was 1.73 for current men smokers (95% confidence interval [CI], 1.53 to 1.95) and 1.63 for current women smokers (95% CI, 1.37 to 1.94). Smoking accounted for 33.2% of all-cause deaths in men and 4.6% in women. Additionally, it was a factor in 71.8% of men lung cancer deaths and 11.9% of women lung cancer deaths. In 2020, smoking was responsible for 53 930 men deaths and 6283 women deaths, totaling 60 213 deaths.
Conclusions
Cigarette smoking was responsible for a significant number of deaths in Korea in 2020. Monitoring the impact and societal burden of smoking is essential for effective tobacco control and harm prevention policies.

Summary

Korean summary
한국의 흡연율은 상당 수준 감소하였지만 흡연의 장기적인 건강영향은 지속적으로 나타나고 있다. 4개의 대규모 코호트와 1995년 흡연율을 사용하여 2020년 한국의 흡연기인 사망자수를 산출한 결과 남성 53,930명, 여성 6283명으로 총 60,213명이였다. 효과적인 담배규제와 금연 정책을 위하여 장기적인 사망자수 모니터링이 필요할 것이다.

Key Message
Despite the significant decrease in smoking rates in South Korea, the long-term health effects of smoking continue to manifest. Our analysis using four large-scale cohorts and 1995 smoking prevalence revealed that in 2020, the number of smoking-attributable death in South Korea was 53,930 for men and 6,283 for women, totaling 60,213. Long-term monitoring is necessary for effective tobacco control and smoking cessation policies.

Citations

Citations to this article as recorded by

The economic cost of direct smoking in South Korea
Kristine Namhee Kwon, Kangyeon Lee, Wankyo Chung
Preventive Medicine Reports.2024; 46: 102865. CrossRef

Modern Contraception and Anaemia Among Reproductive-age Women in India: Results From a Household Survey: Mihir Adhikary, Poulami Barman, Bharti Singh, Abhishek Anand; J Prev Med Public Health. 2024;57(4):339-346. Published online June 19, 2024; DOI: https://doi.org/10.3961/jpmph.23.504

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Abstract Summary PDF Supplementary Material: Objectives
Chronic anaemia is a significant health concern, particularly among women of childbearing age. Factors such as menstrual blood loss, childbirth, inadequate nutrition, closely spaced pregnancies, and recurrent gastrointestinal bleeding increase the risk of anaemia. This study investigated whether current contraceptive methods are associated with anaemia in Indian women of reproductive age.
Methods
Cross-sectional data from the fifth round of the National Family Health Survey, conducted in 2019-2021, were used for this investigation. We included only non-pregnant and non-amenorrhoeic women in our analysis, resulting in a final analytical sample of 673 094 women aged 15-49. Bivariate cross-tabulations and multivariable logistic regression were employed to analyse the data.
Results
The prevalence of anaemia was 57%, and the adjusted regression models found no significant association between the use of any contraceptive methods and women’s haemoglobin status. Women using traditional contraceptive methods had 1.08 (95% confidence interval, 1.05 to 1.11) times higher odds of having anaemia. Among the modern methods, other than injectables, all other methods—such as an intrauterine device, barrier use, and sterilisation—were associated with higher odds of anaemia compared to women who used contraceptive pills.
Conclusions
This study explored the relationship between modern contraceptives and haemoglobin levels in India, revealing that injectables were associated with a notable reduction in the odds of anaemia, whereas traditional contraceptives and other modern methods exhibited positive associations with anaemia. These findings prompt policymakers to focus on anaemia reduction and safe contraceptives. More research is needed to inform decisions, given the scant literature.; Summary

Key Message
This study investigated the association between contraceptive methods and anaemia in Indian women of reproductive age using data from the 2019-2021 National Family Health Survey. Results indicated that traditional contraceptives and several modern methods, except injectables, were associated with higher odds of anaemia. These findings suggest the need for policymakers to focus on anaemia reduction and the promotion of safer contraceptive options.

Mental Health of Medical Students After Combating the COVID-19 Epidemic: A Cross-sectional Study in Vietnam: Duc Minh Cap, Anh Quang Nguyen, Tham Thi Nguyen; J Prev Med Public Health. 2024;57(4):347-355. Published online May 22, 2024; DOI: https://doi.org/10.3961/jpmph.24.108

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Abstract Summary PDF: Objectives
This study was conducted to investigate the prevalence of mental health (MH) symptoms and associated factors among medical students who were engaged in combating the coronavirus disease 2019 (COVID-19) epidemic in 4 provinces/cities of Vietnam.
Methods
A cross-sectional study with 580 participants was conducted at a medical university in Northern Vietnam. MH was assessed using the 21-item Depression, Anxiety, and Stress Scale, which was previously standardized in Vietnam. Data were collected through a structured self-administered questionnaire. Multivariate logistic regression was employed to examine the association between MH symptoms and relevant factors.
Results
Out of a total of 2703 medical students, 21.5% responded to the questionnaire. Among the 580 respondents, the prevalence rates of depression, anxiety, and stress were 43.3%, 44.0%, and 24.7%, respectively. Factors significantly associated with self-reported depression included being female and having a COVID-19 infection. Similarly, being female and having a COVID-19 infection were significantly associated with self-reported anxiety. Factors associated with self-reported stress included being female, having a personal or family history of MH symptoms, working more than 8 hr/day, and having a COVID-19 infection.
Conclusions
COVID-19 has adversely impacted the MH of medical students. Our findings are valuable in their potential to motivate universities, MH professionals, and authorities to offer mental healthcare services to this group. Furthermore, there is a pressing need for training courses designed to equip future healthcare workers with the skills to manage crises effectively.; Summary

Key Message
This study investigated mental health symptoms among medical students after being involved in combating COVID-19 in Vietnam. Out of 580 participants, depression, anxiety, and stress rates were 43.3%, 44.0%, and 24.7%, respectively. Factors significantly associated with self-reported depression and anxiety were being female and having a COVID-19 infection. Factors associated with self-reported stress included being female, having a personal or family history of mental health symptoms, working more than 8 hours per day, and having a COVID-19 infection. The study emphasizes the importance of providing psychological support for medical students and the necessity for training programs to enhance crisis management skills.

The Impact of COVID-19 on Healthcare Services in Bangladesh: A Qualitative Study on Healthcare Providers’ Perspectives: Sharmin Parveen, Md. Shahriar Mahbub, Nasreen Nahar, K. A. M. Morshed, Nourin Rahman, Ezzat Tanzila Evana, Nazia Islam, Abu Said Md. Juel Miah; J Prev Med Public Health. 2024;57(4):356-369. Published online June 9, 2024; DOI: https://doi.org/10.3961/jpmph.24.081

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Abstract Summary PDF: Objectives
The objective of this study was to explore healthcare providers’ experiences in managing the coronavirus disease 2019 (COVID-19) pandemic and its impact on healthcare services.
Methods
A qualitative study was conducted with 34 healthcare professionals across 15 districts in Bangladesh. Among the participants, 24 were health managers or administrators stationed at the district or upazila (sub-district) level, and 10 were clinicians providing care to patients with COVID-19. The telephone interviews were conducted in Bangla, audio-recorded, transcribed, and then translated into English. Data were analyzed thematically.
Results
Most interviewees identified a range of issues within the health system. These included unpreparedness, challenges in segregating COVID-19 patients, maintaining isolation and home quarantine, a scarcity of intensive care unit beds, and ensuring continuity of service for non-COVID-19 patients. The limited availability of personal protective equipment, a shortage of human resources, and logistical challenges, such as obtaining COVID-19 tests, were frequently cited as barriers to managing the pandemic. Additionally, changes in the behavior of health service seekers, particularly increased aggression, were reported. The primary motivating factor for healthcare providers was the willingness to continue providing health services, rather than financial incentives.
Conclusions
The COVID-19 pandemic presented a unique set of challenges for health systems, while also providing valuable lessons in managing a public health crisis. To effectively address future health crises, it is crucial to resolve a myriad of issues within the health system, including the inequitable distribution of human resources and logistical challenges.; Summary

Key Message
This qualitative study explored healthcare providers' perspectives on the impact of the COVID-19 pandemic on healthcare services. Issues within the health system, such as a lack of skilled human resources, insufficient critical care facilities, low coverage of COVID-19 tests, inadequate logistical support, poor health behaviors and practices among health service seekers posed barriers to managing the pandemic at different healthcare levels. Ensuring personal protection for health professionals in the face of a novel disease presented a significant challenge. Increasing resource allocation and developing the capacity of healthcare providers were identified as potential solutions.

Assessing COVID-19 Vulnerability Among HIV-positive Men Who Have Sex With Men in Korea: The Role of Vaccination and Sexual Behaviors: Minsoo Jung; J Prev Med Public Health. 2024;57(4):370-378. Published online June 24, 2024; DOI: https://doi.org/10.3961/jpmph.24.196

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Abstract Summary PDF: Objectives
Comorbidities increase susceptibility to severe coronavirus disease 2019 (COVID-19) infections, but limited information has been published regarding human immunodeficiency virus (HIV) and COVID-19 co-infections. This study explored the relationships among socioeconomic characteristics, sexual behaviors, and COVID-19 infection rates among Korean men who have sex with men (MSM) who are also living with HIV.
Methods
Data were collected through a web survey aimed at members of the largest gay portal site in Korea, supported by the National Research Foundation of Korea (n=1005). The primary independent variables included COVID-19-related vaccinations and sexual behaviors. The dependent variable was the incidence of COVID-19 infection among respondents during the pandemic. For statistical analysis, hierarchical multiple logistic regression was performed, controlling for potential confounding variables.
Results
Model I indicated that older MSM were less likely to contract COVID-19 (adjusted odds ratio [aOR], 0.98; 95% confidence interval [CI], 0.96 to 0.99). Model II demonstrated that HIV-positive MSM were nearly twice as likely to be infected with COVID-19 compared to their HIV-negative counterparts (aOR, 1.97; 95% CI, 1.14 to 3.41). Furthermore, even after accounting for COVID-19 vaccination status in model III, HIV-positive MSM continued to show a higher risk of infection (aOR, 1.93; 95% CI, 1.12 to 3.35).
Conclusions
The findings of this study indicate that HIV-positive MSM are at an increased risk of contracting COVID-19, even when their vaccination status is considered. Therefore, it is essential to prioritize the prevention of COVID-19 infections in HIV-positive individuals by administering appropriate antiretroviral therapy and ensuring adherence to public health guidelines.; Summary

Korean summary
이 연구는 한국의 HIV 양성인 남성 동성애자(MSM)가 코로나-19 백신접종을 했어도 HIV 음성인 MSM에 비하여 COVID-19에 감염될 위험이 더 높다는 것을 보여주었다. 이러한 결과는 항레트로바이러스 요법의 준수나 촉진과 더불어 이들 취약 계층을 위한 COVID-19 예방조치 강화와 맞춤형 공중보건 전략의 필요성을 강조한다.

Key Message
This study found that HIV-positive men who have sex with men (MSM) in Korea are at a heightened risk of contracting COVID-19 compared to HIV-negative individuals, even when vaccination status is accounted for. This finding underscore the necessity of targeted public health strategies, including the promotion of adherence to antiretroviral therapy and the reinforcement of COVID-19 prevention measures for this vulnerable population.

The Associations Between Physical Activity and Mental Health Problems in Middle-aged Indonesians: Sri Handayani, Siti Isfandari, Diyan Ermawan Effendi, Rozana Ika Agustiya, Irfan Ardani, Arief Priyo Nugroho, Yunita Fitrianti; J Prev Med Public Health. 2024;57(4):379-387. Published online July 12, 2024; DOI: https://doi.org/10.3961/jpmph.24.003

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Abstract Summary PDF: Objectives
Mental health issues have become a growing concern worldwide. Research has shown that regular physical activity (PA) can positively affect mental health. This study investigated the associations between PA and mental health problems (MHPs) in middle-aged Indonesians.
Methods
The study utilized data from the 2018 Indonesian Basic Health Research Survey and used a cross-sectional approach. The participants included individuals aged 40-60 years who completed the 20-question Self-Reporting Questionnaire. A logistic regression was performed to analyze a sample of 263 930 data points.
Results
Nearly 10.4% of the participants suffered from mental health issues. Notably, among those who did not engage in moderate and vigorous PA, a sign of MHPs was found in 12.5% of participants. Those who met World Health Organization standards for PA were less likely to experience MHPs (10.1%). This study found a significant association between PA and mental health. After adjusting for smoking, alcohol consumption, non-communicable diseases, and socio-demographic variables like age, sex, education, occupation, marital status, and residence, the connection between PA and mental health became even stronger (adjusted odds ratio, 0.81; 95% confidence interval, 0.78 to 0.85; p<0.001).
Conclusions
Regular PA has been shown to affect mental health positively. Therefore, it is important to improve health education and efforts to raise awareness among middle-aged Indonesians about the importance of PA in maintaining good mental health.; Summary

Key Message
This study revealed a significant association between physical activity (PA) and mental problems (MHPs) among middle-aged Indonesians. Individuals who engaged in moderate to vigorous PA were less likely to experience MHPs compared to those who did not meet recommended PA levels. This association remained strong after adjusting confounding variables such as smoking, alcohol consumption, non-communicable diseases, and socio- demographic factors. Therefore, promoting regular physical activity could be a beneficial strategy for improving mental health status in this population.

Common Mental Disorders and Associated Factors During Pregnancy and the Postpartum Period in Indonesia: An Analysis of Data From the 2018 Basic Health Research: Arum Ariasih, Besral , Meiwita Budiharsana, Sudarto Ronoatmodjo; J Prev Med Public Health. 2024;57(4):388-398. Published online June 19, 2024; DOI: https://doi.org/10.3961/jpmph.24.082

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Abstract Summary PDF: Objectives
A substantial proportion of women experience mental health challenges during pregnancy or the postpartum period. Common mental disorders (CMDs), including depression, anxiety, and obsessive-compulsive disorder, are prevalent. Identifying causes and associated risk factors is imperative for early intervention and the prevention of mental health issues.
Methods
This study utilized data from the 2018 Basic Health Research, which was conducted nationwide in Indonesia, using a crosssectional approach. We focused on women aged 13-49 years who were currently or previously married, and had experienced pregnancy, including 8889 pregnant women and 77 012 women who had delivered between January 1, 2013 and August 31, 2018. The Self-Reporting Questionnaire-20 was employed to assess CMDs. Multivariate logistic regression was performed.
Results
The prevalence of CMDs in pregnant women was 12.6%, while postpartum mothers exhibited a prevalence of 10.1%. Poor health status displayed the strongest impact on CMDs during both pregnancy (adjusted odds ratio [aOR], 12.23; 95% confidence interval [CI], 9.01 to 16.60) and the postpartum period (aOR, 16.72; 95% CI, 14.85 to 18.82). Additional significant factors for both group include young maternal age, lack of education, unemployment, history of hypertension, and smoking status. Among pregnant women, CMDs was also associated with first-trimester pregnancy, previous pregnancy complications, and small upper arm circumference. For postpartum mothers, significant factors include living in rural areas, history of abortion, unwanted pregnancy, pregnancy complications, lack of antenatal care, spontaneous delivery, postpartum complications and contraceptive use.
Conclusions
CMDs can impact in pregnant and postpartum women. Early diagnosis and management must be seamlessly integrated into primary healthcare practices.; Summary

Key Message
A significant proportion of women experience common mental disorders (CMDs) during pregnancy (12.6%) and postpartum (10.1%) in Indonesia. Poor health status is the strongest predictor of CMDs in both periods. Other significant factors include young maternal age, lack of education, unemployment, hypertension history, and smoking. Additional pregnancy-specific factors are first-trimester pregnancy, previous complications, and small upper arm circumference. In contrast, postpartum factors include rural living, abortion history, unwanted pregnancy, pregnancy complications, lack of antenatal care, spontaneous delivery, postpartum complications, and contraceptive use. Integrating early diagnosis and management of CMDs into primary healthcare is essential.

Causal Model of Herb Use Behavior Among Working-age Adults in Thailand: Pitchada Prasittichok, Patcharee Duangchan, Sattawat Prapasiri, Ungsinun Intarakamhang; J Prev Med Public Health. 2024;57(4):399-406. Published online June 21, 2024; DOI: https://doi.org/10.3961/jpmph.23.554

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Abstract Summary PDF: Objectives
This study developed a causal relationship model of herb use from observational data and analyzed the direct and indirect effects of herb use on health according to the model.
Methods
A cross-sectional study was conducted with 400 participants aged 26-59 years, selected through multistage random sampling. The instruments used for data collection included demographic information, herb use, health literacy (HL), perceived social support, societal values, and attitudes toward herb use. The conceptual model, hypothesized based on prior evidence, was tested using confirmatory factor analysis through structural equation modeling. Path coefficients were estimated using the maximum likelihood method.
Results
The final model utilized empirical data, which showed that perceived social support had the most significant impact on herb use. This was followed by HL, positive attitudes toward herbal remedies, and societal values, with coefficients of 0.31, 0.18, and 0.16, respectively. When analyzing variables that indirectly affected herb use, it was clear that positive attitudes, perceived social support, and societal values significantly influenced herb use through HL, with influence coefficients of 0.08, 0.16, and 0.04, respectively. Together, these variables accounted for 68% of the variance in herb use.
Conclusions
The findings from this study can be utilized to develop and implement strategies that guide the use of herbal products, ultimately aiming to improve human health.; Summary

Key Message
A causal relationship model of herb use was created from observational data in this research, and the direct and indirect impacts of herb use on health were examined based on the model. The most vital factor influencing the use of herbal remedies is the level of social support perceived by an individual. Significant roles are also played by health literacy, positive attitudes toward herbal remedies, and societal values. Positive outlooks, community backing, and cultural principles indirectly influence the utilization of herbal remedies through health literacy. The research results can help develop approaches to encourage the correct usage of herbal items, ultimately improving public health.

Beyond Medical Bills: High Prevalence of Financial Toxicity and Diverse Management Strategies Among Vietnamese Patients With Cancer: Binh Thang Tran, Thanh Gia Nguyen, Dinh Duong Le, Minh Tu Nguyen, Nhan P. T. Nguyen, Minh Hanh Nguyen, The Due Ong; J Prev Med Public Health. 2024;57(4):407-419. Published online June 24, 2024; DOI: https://doi.org/10.3961/jpmph.24.090

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Abstract Summary PDF Supplementary Material: Objectives
This study was conducted to measure financial toxicity (FT) among patients with cancer in Vietnam using the COmprehensive Score for financial Toxicity (COST) and to describe the cost management strategies employed by these patients.
Methods
This comprehensive cross-sectional study enrolled 634 patients from 2 specialized oncology hospitals in Vietnam. Using COST cut-off scores, FT was classified as none/mild (≥26), moderate (14-25), or severe (≤13). Cost management strategies, or coping mechanisms, were classified into 4 groups: lifestyle changes, financial resource strategies, treatment modifications, and support seeking.
Results
The prevalence of FT was 91.8%, with 51.7% of participants demonstrating severe and 40.1% exhibiting moderate FT. Severe FT was significantly associated with female, low education level, unstable employment, low household economic status, and advanced cancer stage. The most common coping strategies were as follows: among lifestyle changes, reducing spending on basic items and leisure activities (78.7%) and cutting back on essential household expenses (66.4%); among financial resource strategies, borrowing money from relatives or friends (49.1%) and withdrawing funds from retirement or savings accounts (34.1%); within treatment modifications, switching treatment facilities or doctors due to cost concerns (9.3%); and within support seeking, obtaining help from welfare or community organizations (18.8%). All strategies were significantly more likely to be used by patients with severe FT.
Conclusions
FT was highly prevalent among patients with cancer. Most patients relied on lifestyle adjustments and coping strategies, underscoring the need for improved financial support systems to alleviate the economic burden associated with cancer care.; Summary

Key Message
- This first large-scale analysis looks into the financial toxicity faced by patients with cancer in Vietnam, as an example of low- and middle-income countries.
- Financial toxicity was remarkably high prevalent and strongly associated with patient- level factors.
- Patients experiencing financial toxicity tend to use various cost-coping strategies.
- These findings underscore the need for routine screening for financial toxicity risk and interventions.

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