Prevalence and Determinants of Financial Toxicity Among Patients with Breast Cancer: A Systematic Review and Meta-Analysis
| Author | Mohammad Akbari | en |
| Author | Maryam Seyed-Nezhad | en |
| Author | Hassan Karami | en |
| Author | Maryam Shirvani-Shiri | en |
| Author | Mohammad Moradi-Joo | en |
| Orcid | Hassan Karami [0000-0002-8612-5204] | en |
| Orcid | Maryam Shirvani-Shiri [0000-0002-8612-5204] | en |
| Orcid | Mohammad Moradi-Joo [0000-0002-9190-3429] | en |
| Issued Date | 2026-12-31 | en |
| Abstract | Context: Breast cancer is the most common malignancy among women worldwide and imposes substantial clinical and economic burdens. Financial toxicity, encompassing both objective financial strain and subjective distress related to cancer care and its management, adversely affects treatment adherence, quality of life, and survival. This systematic review and meta-analysis aimed to estimate the global pooled prevalence of financial toxicity among patients with breast cancer and to summarize its key determinants. Evidence Acquisition: We conducted a systematic review and meta-analysis using the Comprehensive Score for Financial Toxicity (COST) instrument as the primary measure of financial toxicity. We performed a comprehensive search of PubMed/MEDLINE, Scopus, Web of Science, Embase, the Cochrane Library, CINAHL, and gray literature from inception through October 2025, limited to English-language studies. Two reviewers independently screened and extracted data from eligible observational and interventional studies. Study quality was assessed using the JBI, NOS, or RoB-2 tools. Meta-analysis was conducted using a random-effects model in Stata 17, and determinants were synthesized through thematic categorization. Results: Twelve studies comprising 9,376 patients with breast cancer were included in the meta-analysis, yielding a pooled prevalence of financial toxicity of 48% (95% CI: 40 - 55%), with substantial heterogeneity (I2 = 97.3%, P < 0.001). Determinants of financial toxicity spanned multiple domains, including younger age, lower income, unemployment, advanced cancer stage, prior chemotherapy, high out-of-pocket costs, low social support, and limited health literacy. Seven overarching themes were identified, including sociodemographic, clinical, economic, psychosocial, health literacy and support, coping behaviors, and decision-making preferences, highlighting the multidimensional nature of financial toxicity among patients with breast cancer. | en |
| DOI | https://doi.org/10.5812/ijcm-169871 | en |
| URI | https://brieflands.com/journals/ijcm/articles/169871 | en |
| Keyword | Financial Toxicity | en |
| Keyword | Comprehensive Score For Financial Toxicity (COST) | en |
| Keyword | Breast Cancer | en |
| Keyword | Systematic Review | en |
| Keyword | Meta-analysis | en |
| Publisher | Brieflands | en |
| Title | Prevalence and Determinants of Financial Toxicity Among Patients with Breast Cancer: A Systematic Review and Meta-Analysis | en |
| Type | Systematic Review | en |
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