Evidence map›Paper›PMID 42387329›Full record

SynthesisCancer medicine2026

Assessing Financial Toxicity in Cancer: A Global Systematic Review and Meta-Analysis Using an Asset Framework.

Seema Kacker, Wassim Najjar, Rachel Stemme, Nadia L Samaha, Gayane Yenokyan, Maria Armache, Madison Hearn, C Scott Dorris, Tobias Todsen, John De Almeida and 7 more

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Cancer medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Trial
  2. The Healer's Heartache: Reforming Medicine from the Rough Ground.Journal of general internal medicine · 2026
    Review
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors.

Seema KackerDepartment of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.ORCID https://orcid.org/0000-0001-6960-445X
Wassim NajjarDepartment of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Rachel StemmeDepartment of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Nadia L SamahaDepartment of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Gayane YenokyanDepartment of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Maria ArmacheDepartment of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Madison HearnDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.ORCID https://orcid.org/0000-0002-0632-4116
C Scott DorrisDahlgren Memorial Library, Georgetown University School of Medicine, Washington, DC, USA.ORCID https://orcid.org/0000-0002-4664-6793
Tobias TodsenDepartment of Otorhinolaryngology - Head and Neck Surgery and Audiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
John De AlmeidaDepartment of Otolaryngology - Head and Neck Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.ORCID https://orcid.org/0000-0002-1546-5033
Johannes FaganDepartment of Surgery, Division of Otorhinolaryngology, University of Cape Town, Cape Town, South Africa.ORCID https://orcid.org/0000-0001-7924-7265
Hisham MehannaInstitute of Head and Neck Studies and Education, University of Birmingham, Birmingham, UK.
Carole FakhryDepartment of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Laila A GharzaiDepartment of Radiation Oncology, Northwestern University, Chicago, Illinois, USA.ORCID https://orcid.org/0000-0001-6420-9274
Sudip GuptaJohns Hopkins Carey Business School, Baltimore, Maryland, USA.ORCID https://orcid.org/0000-0001-9076-4183
Catherine K EttmanHopkins Business of Health Initiative, Baltimore, Maryland, USA.
Leila J MadyDepartment of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.ORCID https://orcid.org/0000-0002-2682-3297

Funding

Hopkins Business of Health Initiative
6 · The paper itself

Abstract

backgroundFinancial toxicity (FT), encompassing objective and subjective impacts of cancer care costs, is linked to poorer quality of life, reduced treatment adherence, and higher mortality. While patient-level risk factors have been examined, a system-level perspective incorporating socioeconomic context is needed to understand global variation in FT.

methodsMEDLINE, CINAHL, Embase, and Web of Science were searched from inception to 06/27/2025 for peer-reviewed, English-language studies describing self-reported FT outcomes among adults with cancer. Reviewers extracted study characteristics, FT prevalence, predictors, and measurement tools. Financial, physical, and social asset measures from the World Bank were merged with FT data by study country and year of data collection. Focusing on studies reporting Comprehensive Score for Financial Toxicity (COST) scores, multilevel random effects meta-analysis was performed. Univariate and multivariate multilevel meta-regression evaluated relationships between country-level assets and COST.

resultsOne hundred thirty-two studies from 22 countries were included, with FT prevalence ranging from 4.0% to 100.0%. Three-level meta-analysis of 75 COST-based studies (15 countries; 83,623 patients) yielded a pooled mean COST score of 21.2 (95% CI: 19.1-23.3; 95% prediction interval: 13.3-32.4), though substantial heterogeneity (I

conclusionsFT among cancer patients is linked to structural conditions governing access to education, employment, and financial systems, although expanded research in low-resource settings is needed. These findings highlight the roles of economic development strategies and investment in human capital in helping to safeguard against population-level FT.

Indexed as

Cost of IllnessHealth Care CostsHealth ExpendituresNeoplasmsHumansQuality of LifeSocioeconomic Factorsasset‐based frameworkcancerfinancial toxicityglobal perspectivepopulation‐level

Identifiers

PMID42387329
PMCPMC13323185

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.