Financial toxicity as a structural barrier to cervical cancer treatment in Sub-Saharan Africa.

Cervical cancer remains one of the most common and preventable cancers among women in sub-Saharan Africa. Despite established curative treatments, most women present with locally advanced disease and many fail to complete therapy. Financial toxicity encompassing, direct medical costs, non-medical expenditures, income loss, and psychological distress, is an underrecognized but potentially important contributor to this treatment gap. This narrative review examines evidence on the magnitude, structural drivers, and consequences of financial toxicity in cervical cancer care across sub-Saharan Africa, and proposes system-level mitigation strategies. Targeted searches of PubMed, Embase, and Google Scholar (January 2013-April 2026), were supplemented by gray literature and reports from international health agencies. Thematic synthesis was conducted along the cervical cancer care continuum within a universal health coverage financial risk protection framework. The reviewed evidence suggests that financial toxicity is multi-dimensional, cumulative, and largely shaped by health-system organization. Quantitative studies report substantial out-of-pocket expenditure and catastrophic health spending, while qualitative studies consistently describe severe financial hardship, although definitions and measurement approaches vary across studies. Centralized radiotherapy services, requiring repeated long-distance travel over 5 to 6 weeks, appear to be an important structural contributor through transport, accommodation, and income-related costs. Available evidence further suggests that financial toxicity may contribute to delayed treatment initiation, missed radiotherapy sessions, incomplete chemoradiation, and treatment abandonment. This review also raises the hypothesis that, in radiotherapy-constrained settings, treatment pathway adaptation such as neoadjuvant chemotherapy followed by surgery may have financial as well as oncologic implications that warrant prospective evaluation. Direct evidence linking financial toxicity to survival outcomes remains limited. Reducing financial barriers will likely require health-system reforms, including decentralized service delivery where feasible, integration of financial navigation into oncology services, universal health coverage benefit packages covering the full cervical cancer care continuum, and treatment protocols that account for patients' financial burden.