The association between financial toxicity and mortality in hematologic malignancies: a systematic review and...

Hematologic malignancies impose substantial economic burdens, but the quantitative association between financial toxicity and overall survival remains poorly defined across diverse clinical settings and disease lineages.

Adhering to PRISMA and MOOSE guidelines, we searched electronic databases through January 2026 for studies reporting multivariable-adjusted hazard ratios (aHRs) for the association between financial toxicity and mortality in adults diagnosed with hematologic malignancies. A random-effects model with Hartung-Knapp adjustment was used for data synthesis. Small-study effects were addressed via the Duval and Tweedie trim-and-fill method.

Eleven cohorts involving 280 826 individuals were included. Meta-analysis identified a significant association between financial toxicity and inferior survival (pooled aHR: 1.57; 95% CI, 1.29-1.91; P < .001). High heterogeneity (I2 = 85.1%) and a wide 95% prediction interval (0.89-2.77) indicated substantial variability across settings. Subgroup analysis revealed that mortality risk was primarily linked to structural barriers, specifically lack of insurance (aHR: 1.66; 95% CI, 1.39-1.99), whereas this association was weaker in specialized transplant settings with integrated psychosocial support. Findings remained statistically significant after trim-and-fill adjustment for potential publication bias (adjusted aHR: 1.33; 95% CI, 1.05-1.69; P = .023).

Financial toxicity is a significant factor independently associated with mortality in hematologic malignancies. The strength of this association varies depending upon the care environment, with structural access barriers representing the highest risk. Integrating proactive financial navigation into standard clinical pathways is essential to alleviate socioeconomic disparities and may help improve survival outcomes.