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Objectives <p>This systematic review and meta-analysis aimed to assess the global prevalence and determinants of financial toxicity in colorectal cancer (CRC) patients.</p> Methods <p>PubMed, Embase, Web of Science, Scopus, PsycINFO, Cochrane, CINAHL, CNKI were searched through January 2025. Studies reporting financial toxicity scores, prevalence, or determinants were selected. The Agency for Healthcare Research and Quality Methodological Checklist and the Newcastle-Ottawa Scale were used to assess the article quality. Meta analyses were performed in R 4.2.5, with heterogeneity assessed by I<sup>2</sup> test and subgroup analyses. Publication bias evaluated using funnel plots, Egger’s test and Luis Furuya-Kanamori index.</p> Results <p>65 studies met inclusion criteria. The pooled prevalence of objective financial toxicity (catastrophic health expenditure) was 0.69 (95% CI: 0.45–0.94). For COST-PROM scale studies, prevalence was 0.74 (95% CI: 0.58–0.90); for self-developed scales, prevalence was 0.31 (95% CI: 0.24–0.40). Female patients had a higher risk of financial toxicity (OR = 1.37) compared with male patients (OR = 0.73, 95% CI: 0.53–0.99 for males). Younger patients (&lt; 60 years) had a higher risk (OR = 2.13) compared with those aged ≥ 60 (OR = 0.47, 95% CI: 0.32–0.69 for ≥ 60 years). Insured patients had a higher risk compared with uninsured patients (OR = 1.88, 95% CI: 1.05–3.37). Unmarried patients had a higher risk (OR = 1.49) compared with married patients (OR = 0.67, 95% CI: 0.48–0.93 for married). Patients with lower educational attainment had a higher risk (OR = 2.27) compared with those with high school education or above (OR = 0.44, 95% CI: 0.37–0.53 for high education). Patients with stage IV cancer had a higher risk compared with stages I–III (OR = 1.32, 95% CI: 1.11–1.57). Only employment status and education level showed publication bias, and correction by trimming and filling did not change the conclusions.</p> Conclusion <p>Financial toxicity is common among CRC patients. Higher risk was observed in females, younger patients, those with lower education, insured individuals, and patients with stage IV CRC. Interventions should target these vulnerable groups, highlighting that insurance alone may not fully protect against financial toxicity, and should strengthen financial support and social resources.</p>

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Prevalence and determinants of financial toxicity in patients with colorectal cancer: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月20日

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  • Xinye Shao,
  • Yue Ma,
  • Yikun Wang,
  • Xuejun Lin,
  • Xin Wang,
  • Ang Zheng

摘要

Objectives

This systematic review and meta-analysis aimed to assess the global prevalence and determinants of financial toxicity in colorectal cancer (CRC) patients.

Methods

PubMed, Embase, Web of Science, Scopus, PsycINFO, Cochrane, CINAHL, CNKI were searched through January 2025. Studies reporting financial toxicity scores, prevalence, or determinants were selected. The Agency for Healthcare Research and Quality Methodological Checklist and the Newcastle-Ottawa Scale were used to assess the article quality. Meta analyses were performed in R 4.2.5, with heterogeneity assessed by I2 test and subgroup analyses. Publication bias evaluated using funnel plots, Egger’s test and Luis Furuya-Kanamori index.

Results

65 studies met inclusion criteria. The pooled prevalence of objective financial toxicity (catastrophic health expenditure) was 0.69 (95% CI: 0.45–0.94). For COST-PROM scale studies, prevalence was 0.74 (95% CI: 0.58–0.90); for self-developed scales, prevalence was 0.31 (95% CI: 0.24–0.40). Female patients had a higher risk of financial toxicity (OR = 1.37) compared with male patients (OR = 0.73, 95% CI: 0.53–0.99 for males). Younger patients (< 60 years) had a higher risk (OR = 2.13) compared with those aged ≥ 60 (OR = 0.47, 95% CI: 0.32–0.69 for ≥ 60 years). Insured patients had a higher risk compared with uninsured patients (OR = 1.88, 95% CI: 1.05–3.37). Unmarried patients had a higher risk (OR = 1.49) compared with married patients (OR = 0.67, 95% CI: 0.48–0.93 for married). Patients with lower educational attainment had a higher risk (OR = 2.27) compared with those with high school education or above (OR = 0.44, 95% CI: 0.37–0.53 for high education). Patients with stage IV cancer had a higher risk compared with stages I–III (OR = 1.32, 95% CI: 1.11–1.57). Only employment status and education level showed publication bias, and correction by trimming and filling did not change the conclusions.

Conclusion

Financial toxicity is common among CRC patients. Higher risk was observed in females, younger patients, those with lower education, insured individuals, and patients with stage IV CRC. Interventions should target these vulnerable groups, highlighting that insurance alone may not fully protect against financial toxicity, and should strengthen financial support and social resources.