Financial Toxicity in Patients With Gynecological Cancers: A Literature Review

Abstract

Objective: This review aims to examine the nature of financial toxicity (FT) in patients with gynecologic cancers, including its occurrence, temporal trends, contributing factors, associated consequences, assessment methodologies, and coping strategies. Additionally, it discusses future directions for health policy and system-level interventions to address FT. Mechanism: FT primarily arises from the significant out-of-pocket expenses associated with cancer care, together with income loss due to medical leave. It is driven by multilevel systemic factors (policy, payer, provider levels), and it is further exacerbated by intervenable, patient-level factors within clinical care delivery process. Findings in brief: Approximately 50% of patients with gynecologic oncology (GO) experience FT. This is associated with reduced quality of life, impaired treatment adherence, and poorer overall survival outcomes. FT disproportionately affects socioeconomically disadvantaged populations and leads to poorer economic stability and adverse health outcomes. The literature addresses the prevalence, temporal trends, contributing factors, associated consequences, and available assessment methodologies for FT. Feasible strategies to mitigate FT include early screening, provision of financial assistance and counseling, consideration of the treatment cost and value in clinical decision-making, and improved access to resources. Conclusions: FT is a prevalent and serious concern in GO, with significant impacts on patient well-being and outcomes. Although systemic factors are the primary drivers, actionable patient-level interventions can mitigate FT within clinical settings. Future efforts should prioritize health insurance reforms to expand coverage and reduce under-insurance, as well as health system strategies that restrict and ineffective high-cost spending, while targeting services to high-risk GO populations.