Cross-sectional study links endometriosis financial toxicity, acceptance and quality of life

Women with endometriosis who reported greater financial toxicity also reported lower health-related quality of life and greater difficulty accepting their condition in a cross-sectional study of 411 women recruited in Poland. Statistical mediation analysis indicated that disease acceptance accounted for part of the association between financial toxicity and quality of life, but the design cannot establish temporal order or causality. The findings link the burden of illness-related costs with psychological adaptation and patient-reported well-being, while showing that the direct association between financial toxicity and quality of life remained statistically significant after disease acceptance was included in the model.

Researchers recruited participants through online patient communities, social media channels, endometriosis-related networks and a collaborating Women’s Health Center. They assessed financial toxicity with the COST-FACIT, on which higher scores indicate lower financial toxicity; disease acceptance with the Acceptance of Illness Scale; and health-related quality of life with the Endometriosis Health Profile-30, or EHP-30. For the EHP-30, lower scores indicated better quality of life. The analysis used regression-based mediation with 5,000 bootstrap samples and adjusted for age, household income, previous surgical treatment and previous infertility treatment. Because all three main variables were measured cross-sectionally, the statistical model identified an indirect association consistent with a possible role for psychological adaptation, but it could not determine whether financial difficulties preceded changes in acceptance or whether acceptance influenced subsequent quality of life.

Higher COST-FACIT scores, indicating less financial toxicity, were associated with greater disease acceptance. The adjusted regression coefficient was 0.618, with a 95% confidence interval of 0.552 to 0.683. Less financial toxicity was also associated with better health-related quality of life, indicated by lower EHP-30 scores, with a coefficient of −0.537 and a 95% confidence interval of −0.711 to −0.362. Greater disease acceptance was independently associated with better quality of life, with a coefficient of −0.963 and a 95% confidence interval of −1.144 to −0.784. Each of these associations was statistically significant at p less than 0.001. Taken together, the results show that women facing greater strain from the financial consequences of endometriosis tended to report poorer quality of life and less acceptance of the condition.

The mediation estimate for the indirect association between financial toxicity and quality of life through disease acceptance was −0.595, with a 95% confidence interval of −0.731 to −0.472. The direct association between financial toxicity and quality of life remained statistically significant in the mediation model. This pattern is consistent with the possibility that psychological adaptation may constitute one component of the relationship between financial burden and health-related quality of life, rather than serving as a proven causal mechanism. The analysis also found that older age and previous infertility treatment were independently associated with better quality of life, measured by lower EHP-30 scores. Household income and previous surgical treatment were not independently associated with quality of life in the adjusted analysis.

The study provides an integrated view of several patient-reported features of endometriosis: the financial burden associated with the illness, how patients relate to their condition, and their health-related quality of life. It does not show that accepting endometriosis reduces financial toxicity, that financial hardship causes difficulty accepting the disease, or that improving either factor would improve quality of life. The cross-sectional design prevents assessment of temporal ordering, and the reliance on self-reported measures means the results concern participants’ reported experiences rather than independent clinical outcomes. Recruitment through online communities, social media, disease-related networks and one collaborating health center also limits how broadly the findings can be generalized to all women with endometriosis. Even with those constraints, the study identifies a statistically significant connection among financial toxicity, disease acceptance and quality of life and supports examining these factors together when describing the broader impact of endometriosis on patients’ lives.

Subject of Research: Associations among financial toxicity, disease acceptance and quality of life in women with endometriosis

Article Title: Financial toxicity, disease acceptance, and health-related quality of life in women with endometriosis: a cross-sectional mediation analysis

Article References: Pietrzak, K., Szablewska, A. W., Skrzypek-Czerko, M., Pryba, B., Tusiewicz, M., & Gaworska-Krzemińska, A. (2026). Financial toxicity, disease acceptance, and health-related quality of life in women with endometriosis: a cross-sectional mediation analysis. Frontiers in Medicine, 13, Article 1983927. https://doi.org/10.3389/fmed.2026.1983927

Image Credits: AI Generated

DOI: 10.3389/fmed.2026.1983927

Keywords: endometriosis, financial toxicity, disease acceptance, health-related quality of life, mediation analysis, patient-reported outcomes, cross-sectional study, women's health, psychological adaptation, Financial, toxicity, disease