Financial toxicity among families of children with cancer: a qualitative systematic review and meta-aggregation.

OBJECTIVE

To synthesize qualitative evidence on how financial toxicity is experienced, sustained, and managed at the family level in pediatric cancer.

DESIGN

A qualitative systematic review using meta-aggregation.

DATA SOURCES: PubMed, Web of Science, Embase, PsycINFO, CINAHL, and three major Chinese databases (CNKI, WanFang, VIP) were searched up to May 2025.

METHODS

Two reviewers independently conducted study screening, data extraction, and quality appraisal following Joanna Briggs Institute (JBI) guidelines. Discrepancies were resolved through discussion and team consensus. Meta-aggregation was applied to synthesize findings.

RESULTS

Fourteen studies of moderate-to-high methodological quality, involving 524 participants (primarily parents of children with cancer) from seven countries, were included. Thirty-eight initial findings were aggregated into 10 categories and further synthesized into three final findings: (1) Financial toxicity arose from the accumulation of direct medical costs, indirect expenses, income loss due to employment disruption, and inadequate insurance or social support; (2) These financial pressures compromised family economic security and were associated with debt, reduced living standards, long-term financial vulnerability, and psychosocial impacts; (3) Families attempted to manage financial toxicity through external financial assistance and reorganization of life around the child's treatment, although such strategies often provided only partial relief.

CONCLUSIONS

Financial toxicity in pediatric oncology is a sustained and family-level burden that undermines household stability beyond clinical treatment phases. The limited effectiveness of existing coping strategies highlights structural gaps in supportive care. Early identification of financial risk, family-centered counseling, and coordinated system-level support may mitigate long-term consequences and promote more equitable survivorship outcomes.

PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

PROSPERO REGISTRATION: This review was prospectively registered with PROSPERO, the International Prospective Register of Systematic Reviews (CRD42024519179). Available from https://www.crd.york.ac.uk/PROSPERO/view/CRD42024519179 .