Mapping Disparities in the Measurement of Financial Toxicity in Cancer Care: A Scoping Review

Financial toxicity from cancer treatment is a significant barrier to equitable care and an important clinical and public health concern. This scoping review examines global patterns in the assessment of financial toxicity in cancer care and compiles an inventory of domains and subdomains used in existing assessment tools.

From 3,343 records screened, 454 studies were included. Most were conducted in high-income countries (81.7%, n = 371), with 93.8% focused on adult populations. Across 438 quantitative studies, 164 distinct financial toxicity questionnaires comprising 1,104 questions were identified. The COmprehensive Score for financial Toxicity (COST) was the most frequently used tool (40.4%). Only 48.2% of questionnaires had undergone validation in cancer populations. The majority of questions addressed material domains (51.3%), followed by behavioral (29.9%) and psychosocial (18.8%) aspects. The most common subdomains identified were health expenditure within the material domain (9.6%), delaying or forgoing healthcare services within the behavioral domain (12.6%), and perceived financial burden of healthcare costs within the psychosocial domain (12.8%). Findings from 32 qualitative studies aligned with these patterns, highlighting healthcare costs and employment loss as key concerns. Most studies of financial toxicity in cancer care are conducted among adults in high-income countries and measure material domains. Greater attention is needed to expand financial toxicity research in low- and middle-income countries and among pediatric, adolescent, and caregiver populations.