Financial Toxicity and Healthcare Inequities among Oncology Patients in Low- and Middle-Income Countries: A Systematic Review

Abstract

Abstract Financial toxicity represents a major driver of healthcare inequities among oncology patients in low- and middle-income countries (LMICs). This systematic review found that high out-of-pocket healthcare expenditure frequently resulted in catastrophic financial burden, with prevalence estimates ranging from 48.0 to 96.9%, particularly in South Asia and Sub-Saharan Africa. Low household income, inadequate insurance coverage, rural residence, and reliance on private-sector healthcare were consistently associated with greater financial hardship. Beyond economic consequences, financial toxicity was strongly linked to treatment interruption, delayed healthcare utilization, psychological distress, food insecurity, reduced quality of life, and poorer clinical outcomes. Although public insurance schemes provided partial financial protection in certain settings, substantial out-of-pocket expenditure persisted across most healthcare systems. Overall, these findings underscore the urgent need for equitable health financing reforms, strengthened social protection mechanisms, and universal health coverage strategies to reduce financial toxicity and improve cancer care access in LMICs.