Financial toxicity and head and neck cancer: A systematic review and meta-analysis.

Abstract

e13629 Background: Patients with head and neck cancer (HNC) may be particularly vulnerable to Financial Toxicity (FT) due to intensive multimodal treatments, new high cost technologies, prolonged recovery, and impaired return to work. We conducted a systematic review and meta-analysis to quantify FT in HNC patients and to examine associated factors across healthcare settings. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Searches were performed in MEDLINE/PubMed, EMBASE, Cochrane Library, Web of Science, Scopus, and LILACS through June 4, 2025. Eligible studies assessing FT in adult patients with HNC using validated patient-reported outcome measures were included. Random-effects meta-analyses were conducted using RStudio software to estimate pooled FT levels, with subgroup analyses. Results: Thirteen studies were included in the systematic review, of which nine were eligible for meta-analysis, comprising a total of 833 patients. Financial toxicity (FT) was most commonly assessed using the FACIT-COST instrument, and 10 of the 13 studies were conducted in High-income countries. The oropharynx was the most frequently reported subsite. The pooled mean COST score was 21.12 (95% CI, 17.78–24.47), which, although classified as mild, indicates a clinically meaningful financial burden. FT may show partial recovery over time and varied across economic and demographic contexts: patients aged < 60 years had worse toxicity (COST 17.93) than older patients, and those from upper-middle and low-income countries experienced greater toxicity (COST 16.03) compared with patients from high-income settings. No consistent differences were observed by sex. Conclusions: FT in HNC is a dynamic and context-dependent phenomenon shaped by individual characteristics and structural conditions. Further studies are needed to clarify the role of gender in FT. Analyses stratified by tumor subsite and type of treatment would be particularly valuable, given the heterogeneity of treatment pathways and functional outcomes across HNC subsites. Longitudinal and context-sensitive FT assessment is essential to inform equitable cancer care and prevent financial burden from undermining treatment benefits.