Financial Toxicity During Active Treatment for Head and Neck Cancer: Clinical Burden, Structural Determinants, and...

Head and neck cancer (HNC) is associated with substantial morbidity, functional impairment, and represents a substantial socioeconomic burden worldwide. Although advances in surgery, radiotherapy (RT), and systemic therapies have improved oncologic outcomes, treatment-related toxicities frequently overlap with profound economic consequences for patients and caregivers. Financial toxicity (FT), defined as the objective financial burden and subjective financial distress associated with cancer care, has emerged as a clinically relevant determinant of treatment adherence, quality of life (QoL), and survival. In HNC, FT appears particularly critical during active treatment, when multimodal therapies, nutritional compromise, work interruption, transportation costs, and supportive care needs converge.

This structured narrative review synthesizes current literature regarding FT during active treatment for HNC, focusing on conceptual definitions, measurement approaches, temporal dynamics, clinical and psychosocial consequences, and health system determinants. The review was conducted according to the Scale for the Assessment of Narrative Review Articles (SANRA) framework using searches of PubMed/MEDLINE, Scopus, Embase, and Google Scholar.

Available evidence suggests that FT may emerge early during treatment and evolve dynamically throughout the care trajectory. Lower socioeconomic status, treatment intensity, work interruption, and limited social support have been reported in association with increased FT. FT has also been linked to worse health-related QoL, higher symptom burden, treatment interruptions, hospitalization, and reduced survival, although the limited number of studies and methodological heterogeneity preclude definitive conclusions. Emerging evidence suggests that FT may be partially modifiable through interventions such as financial counseling and patient navigation.

Future research should prioritize prospective and interventional designs using standardized multidimensional instruments capable of capturing both objective and subjective domains of FT. Integrating routine FT assessment into supportive oncology workflows may help identify vulnerable patients and support more equitable, patient-centered HNC care.