Over the past decade, the number of cancer cases has continued to rise, placing a heavy burden on patients' families and healthcare systems. Although innovative treatments and drugs have improved patient outcomes, the financial toxicity (FT) of treatment is a growing concern among oncologists. Previous research have examined the impacts of FT on the HRQOL of cancer patients. However, the extent of the association is unclear, given that previous studies vary in the enrolled population, adjustment of confounding factors, and usage of FT assessment tools. To address this gap, the main purpose of this systematic review is to examine the relationship between FT and HRQOL of cancer survivors, and explore any potential factors that may affect this relationship.

Objective Using the Comprehensive Score for Financial Toxicity (COST) tool to measure financial toxicity (FT) among nasopharyngeal cancer (NPC) patients in western China and investigate the association between FT and psychological distress.MethodsWe conducted a cross-sectional study of survivors with NPC in a tertiary oncology hospital in China. FT was assessed using the COST (Chinese version), a validated instrument widely used both at home and abroad. The NCCN Distress Thermometer (DT) was used to measure psychological distress. A multivariate logistic regression model was built to determine factors associated with FT, and the Pearson correlation was used to assess the correlation between COST and DT scores.ResultsOf 210 patients included in this study, the mean FT score was 16.3 (median: 22.5, SD: 9.7), and the prevalence of FT was 66.2% (mild FT: 37.1%, moderate FT: 50.5%, severe FT: 2.4%). Suggested by the logistic regression model, 5 variables were associated with increased FT: unemployed, no commercial insurance, receiving lower annual income, advanced cancer, and receiving targeted therapy. The Pearson correlation showed a significantly moderate correlation between financial toxicity and psychological distress (r= -0.587, P < 0.001).ConclusionPatients with nasopharyngeal carcinoma (NPC) in western China demonstrated higher self-reported financial toxicity (FT) associated with factors including unemployed, no commercial insurance, receiving lower annual income, advanced cancer, and receiving targeted therapy. These predictors will help clinicians identify potential patients with FT in advance and conduct effective psychological interventions.

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Background: Similar to the side effects of cancer treatment，financial toxicity can affect the quality of life of patients, which has attracted increasing attention in the field of oncology. Despite the fact that the estimated prevalence and risk factors of financial toxicity are widely reported, these results have not been synthesized.Objectives: This review aimed to systematically assess the prevalence and risk factors of self-reported financial toxicity.Design: Systematic review and meta-analysis.Data Sources: A computer search of English literature using the database of PubMed, EMBASE, Web of Science, PsycINFO, CHINAHL, and reference list of the included articles between 2010 and September 2021. The observational studies that reported the prevalence or risk factors of financial toxcity used subjective measures will be included.Methods: A systematic review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The risk of bias was assessed by the NIH observational cohort and cross-sectional study quality assessment tool. The data were extracted by two reviewers and listed in a descriptive table for meta-analysis.Results: In the 22 studies available for the meta-analysis, the pooled prevalence of financial toxicity was estimated to be 45% (95% CI: 38% to 53%, I2 = 97.3%, P < 0.001), which was based on a random-effects model. The pooled analysis identified 9 potential risk factors of financial toxicity(7 in β and 8 in OR) : low income (OR = 2.48, 95% CI: 1.72 to 3.24, I2 =3.1%, P < 0.001), greater annual OOP(β = -4.26, 95% CI: -6.95 to -1.57, I2 =0%, P=0.002), younger age(OR = 2.05, 95% CI: 1.56 to 2.54, I2 =0%, P < 0.001), no private insurance(OR = 1.69, 95% CI: 1.02 to 2.37, I2 =0%, P < 0.001), unmarried(OR = 1.10, 95% CI: 0.95 to 1.25, I2 =53,3%, P < 0.001), non-white(OR = 1.59, 95% CI: 1.33 to 1.85, I2 =0%, P < 0.001), advanced cancer(β = -4.74, 95% CI: -6.90 to -2.57, I2 =0%, P < 0.001), unemployed(β = -2.90, 95% CI: -5.71 to -0.63, I2 =75,7%, P < 0.001), more recent diagnosis(OR = 1.31, 95% CI: 1.04 to 1.57, I2 =0%, P < 0.001). Conclusion This systematic review found a pooled prevalence of self-reported financial toxicity of 45%. Low income, greater annual OOP, younger age, unmarried, unemployed, non-white, no private insurance, advanced cancer, and more recent diagnosis constituted risk factors for self-reported financial toxicity. The Research on risk factors for financial toxicity can provide a theoretical basis for nursing staff to evaluate and intervene in the financial toxicity among cancer survivors.