Financial toxicity in patients suffering from oral squamous cell carcinoma in Germany - A single centre survey

Eugen Hecht; Thomas Rückschloss; Sonja Steen; Moritz Bleymehl; Michael Engel; Jürgen Hoffmann; Julius Moratin

doi:10.1016/j.jcms.2026.104448

Financial toxicity in patients suffering from oral squamous cell carcinoma in Germany - A single centre survey

J Craniomaxillofac Surg. 2026 Apr;54(4):104448. doi: 10.1016/j.jcms.2026.104448. Epub 2026 Feb 8.

Authors

Eugen Hecht¹, Thomas Rückschloss², Sonja Steen², Moritz Bleymehl², Michael Engel², Jürgen Hoffmann², Julius Moratin²

Affiliations

¹ University of Heidelberg, Department of Oral and Cranio-Maxillofacial Surgery, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany. Electronic address: Eugen.hecht@med.uni-heidelberg.de.
² University of Heidelberg, Department of Oral and Cranio-Maxillofacial Surgery, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany.

PMID: 41662794
DOI: 10.1016/j.jcms.2026.104448

Abstract

Objectives: Cancer-related financial toxicity has been recognized as a growing survivorship issue, even in high income countries with established social welfare systems. However, data on the financial impact of head and neck cancers, particularly oral cavity carcinoma (OSCC), remain scarce in Germany. This study aims to quantify the financial burden experienced by OSCC patients following surgical and/or multimodal treatment within the German healthcare system.

Materials and methods: We conducted a prospective, cross-sectional study at a single university hospital. Patients with OSCC undergoing oncological follow-up were included. Financial toxicity was measured using the Financial Index of Toxicity (FIT) questionnaire along with 11 additional items addressing changes in income, employment, rehabilitation, and social participation.

Results: 101 patients with OSCC were included. The mean overall FIT score was 23.8 (SD 15.9), indicating a moderate financial burden. Subscores revealed a financial stress score of 10.8 (SD 16.9), a financial strain score of 33.6 (SD 19.5), and a lost productivity score of 22.8 (SD 31.2). Patients with advanced tumor stages (UICC III/IV) showed higher financial toxicity, particularly in the domains of lost productivity and strain. Additional socioeconomic items revealed reduced household income and significant difficulties in returning to work or accessing rehabilitation.

Conclusion: Our study provides the first structured assessment of financial toxicity in OSCC patients within the German healthcare system. Even in a publicly funded health system, substantial financial distress occurs-particularly in patients with advanced-stage disease and impaired speech function.

Clinical relevance: These findings underscore the need for systematic financial risk screening and the development of German-specific assessment tools to address the socioeconomic burden in cancer care.

Keywords: Financial strain; Financial stress; HNSCC; Oral squamous cell carcinomas.

MeSH terms

Adult
Aged
Aged, 80 and over
Carcinoma, Squamous Cell* / economics
Carcinoma, Squamous Cell* / therapy
Cost of Illness*
Cross-Sectional Studies
Employment
Female
Financial Stress* / economics
Germany
Humans
Income
Male
Middle Aged
Mouth Neoplasms* / economics
Mouth Neoplasms* / therapy
Prospective Studies
Surveys and Questionnaires