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The financial toxicity of cancer: unveiling global burden and risk factors – a systematic review and meta-analysis

T. A. Kitaw, Befkad Deresse Tilahun, Alemu Birara Zemariam, A. Getie, Molla Azmeraw Bizuayehu, Ribka Nigatu Haile

BMJ Global Health, 2025

428 participants · 83 citations

Abstract

Background Cancer, a major global health challenge, not only threatens lives but also imposes severe financial burdens, known as ‘financial toxicity’. This strain extends beyond treatment costs to include indirect expenses like lost income and out-of-pocket payments. Despite its urgency, global insights remain fragmented, often limited to specific regions with inconsistent findings. This systematic review and meta-analysis aims to provide a comprehensive overview of cancer-related financial toxicity and identify key risk factors contributing to this burden. Methods We conducted a systematic review and meta-analysis, searching databases like Medline, Web of Science, PubMed, Scopus, International Scientific Indexing and Google Scholar for peer-reviewed observational studies. Data were extracted into Microsoft Excel 2021, and study quality was assessed using the Joanna Briggs Institute critical appraisal tool. Statistical analysis was performed using STATA V.17, with catastrophic health expenditures (CHEs) pooled via a random-effects model. Heterogeneity was explored to understand variations in study outcomes. Subgroup and sensitivity analyses were conducted to assess individual study impacts, while publication bias was evaluated using Begger and Egger’s tests. Univariate meta-regression analysis determined the impact of study-level covariates on CHE estimates. Results This analysis included 35 observational studies, covering 428 373 patients with cancer. The pooled prevalence…

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Evidence Hub reads this as a meta-analysis. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 428 participants or records.

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