Abstract: Objective: To explore the multiple mediating effects of self-efficacy and social support in the relationships of financial toxicity and quality of life among patients with esophageal cancer. Methods: A total of 452 patients with esophageal cancer from National Cancer Center were selected by convenience sampling. A self-designed sociodemographic questionnaire, the Comprehensive Scores for Financial Toxicity Based on the Patient-Reported Outcome Measures (COST-PORM), the Social Support Rating Scale (SSRS), the Strategies Used by People to Promote Health (SUPPH), and the Functional Assessment of Cancer Therapy-G (FACT-G) were utilized for survey. Results: The patients scored (20.68±7.06) on financial toxicity, (38.20±7.89) on social support, (85.01±14.78) on self-efficacy, and (52.08±11.34) on quality of life. The indirect effect of financial toxicity on quality of life was identified, and the total indirect effect value was 0.112 (χ2/df=1.988, CFI=0.928, IFI=0.914, RMSEA=0.038). Self-efficacy and social support accounted for 43.85% and 14.60% of the total indirect effect, respectively. The chain-mediating effect of self-efficacy and social support on the relationship between financial toxicity and quality of life accounted for 6.0% of the total indirect effect. Conclusion: Financial toxicity not only directly affected patients' quality of life, but also indirectly affected patients' quality of life through self-efficacy, social support, and its chain mediating effect.

Key words: esophageal cancer; financial toxicity; self-efficacy; social support; quality of life; mediating effect