OBJECTIVES: Financial toxicity is recognised as an important adverse consequence of cancer treatment that may be associated with impaired health-related quality of life (HRQOL). We aim to perform a systematic review and meta-analysis on studies investigating the relationship between HRQOL and subjective financial toxicity measured with the Comprehensive Score for Financial Toxicity (COST) instrument in cancer patients and survivors.

METHODS: Systematic literature search was performed in PubMed, Web of Science, CINAHL, and PsycInfo for articles published until April 2022. Methodological quality was assessed using Appraisal Tool for Cross-Sectional Studies and Critical Appraisal Skills Programme Cohort Study Checklist. Where applicable, outcomes were pooled using random-effects meta-analysis.

RESULTS: The included 31 studies had a combined sample of 13,481 patients and survivors with more than 25 types of cancer. The studies originated from nine countries, with the US (n=18), China (n=4), and Australia (n=3) being the most common. Nineteen different validated HRQOL measures were used in these studies: generic (n=9), cancer-specific (n=3), and condition-specific (n=7). The most frequently used scales were FACT-G (n=9), EORTC QLQ-C30 (n=5), and EQ-5D (n=5). Thirty studies concluded that higher financial toxicity was significantly related to worse HRQOL. Nine studies reported financial toxicity as a significant predictor of HRQOL using multiple regression models after adjusting for socio-demographic and clinical factors. Ten HRQOL domains were correlated with financial toxicity: mental health, daily functioning, social health, physical health, physical functioning, global health, pain, fatigue, cognitive functioning, and sleep. The meta-analysis indicated a moderate correlation between COST and overall HRQOL measured with FACT instruments (r=0.53, 95%CI: 0.46-0.60).

CONCLUSIONS: This is the first systematic review and meta-analysis to summarise the literature on the relationship between subjective financial toxicity and HRQOL in cancer patients and survivors. We confirm financial toxicity to be a relevant outcome of oncology care that is related to the decline of HRQOL in patients.