Mapping the Landscape of Financial Toxicity Assessment in Cancer: A Scoping Review

Introduction Financial toxicity from cancer treatment is a significant barrier to equitable care and an important clinical and public health concern. This scoping review systematically review the financial toxicity assessment pattern in cancer care across global settings and generate an inventory of domains and sub-domains of questions used to assess financial toxicity. Methods A comprehensive search of six databases was conducted, without language or date restrictions. Eligible studies reported on the development, validation, or application of financial toxicity assessment tools, with ≥50% inclusion of patients with cancer or caregivers. Questions evaluating financial toxicity were extracted and classified into three domains: material, behavioral, and psychosocial, with further categorization into subdomains. Results Of the 3,343 records screened, 454 studies met the inclusion criteria. The majority were conducted in high-income countries (81.7%, n = 371), and 93.8% focused on adults. Across 438 quantitative studies, 164 unique financial toxicity questionnaires containing 1,104 questions were identified. The COmprehensive Score for financial Toxicity (COST) was the most used (40.4%). Only 48.2% of questionnaires had been validated among patients with cancer. Most questions assessed material domains (51.3%), followed by behavioral (29.9%) and psychosocial (18.8%). Themes from 32 qualitative studies echoed these distributions, highlighting healthcare expenditure and job loss as prominent concerns. Conclusions Most studies of financial toxicity in cancer care are conducted among adults in high-income countries, and measure material domains. There is a need to increase financial toxicity research in low- and middle-income countries, and among pediatric and adolescent patients and caregivers of people with cancer.