Quality of Life and Symptoms Management in Cancer Patients with Financial Toxicity: A Systematic Review
Abstract
Cancer is a complex disease associated with a wide range of symptoms, declining quality of life, and financial toxicity (FT).To examine the quality of life and symptoms management in Cancer patients experiencing financial toxicity based on a review of published literature.A systematic review was conducted using five databases: Sage Journals, Science Direct, ProQuest, Clinical Key, and Oxford Academic from 2015-2025 years with keywords Quality of Life, Symptom Management and Cancer Patients. The quality of studies was assessed depending on the study design of the 1,050 articles found, only 11 were reviewed. Findings from 11 studies indicated that the quality of life in cancer patients is influenced by multiple factors. Financial toxicity showed a negative correlation with quality of life (r =0.23, p = 0.0057), indicating that higher levels of financial toxicity are associated with lower quality of life. Psychological symptoms such US anxiety and depression were positively associated with FT (r = 0.27, p = 0.0151; r = 0.18, p = 0.0336). High symptom burden, both physical and psychological, significantly reduced quality of life, while social support played a positive role in enhancing well-being (r = -0.17, p = 0.0412). Integrative therapies improved quality of life by 82%, and cost related health literacy was found to reduce financial toxicity (OR = 0.823, p= 0.039). Holistic interventions and attention to the financial challenges faced by cancer patients are essential for improving quality of life, particularly for those affected by financial toxicity. Effective symptom management involves the use of various tools (ESAS, HADS, FACT-G, SESI, EORTC QLQ-C30) and approaches such as palliative care, integrative therapies, symptom cluster management, acupuncture, financial support, social support, enhanced cost-related health literacy, improved psychological resilience, and identification of financial toxicity risks.The quality of life in Cancer patients is influenced by a complex interaction of factors, including financial condition, symptom management, social support, and multidisciplinary care. Enhancing health literacy—especially regarding financial aspects—with comprehensive, evidence-based, and accessible information such as insurance, medication coverage, and financial resources, is critically important.
References
Bao, T., Li, Q., DeRito, J.L., Seluzicki, C., Im, E.O., & Mao, J. (2018). Barriers to Acupuncture Use Among Breast Cancer Survivors: A Cross-Sectional Analysis. Integrative Cancer Therapies , 17 (3), 854–859. doi: 10.1177/1534735418754309
Barbarian, C., Delgado Guay, M. O., Sanchez, S., Bross, C., Ruer, M., Rhondali, W., Monsarrat, L., Michaud, P., Schott, A. M., Bruera, E., & Filbet, M. (2019). Inequalities in Financial Distress, Symptoms, and Quality of Life Among Patients with Advanced Cancer in France and the US The Oncologist , 24 (8), 1121–1127. doi: 10.1634/theoncologist.2018-0353
Baum, L.V., Koyama, T., Schremp, E.A., Zhang, K., Rodweller, C.A., Roth, M.C., Compas, B.E., & Friedman, D.L. (2022). Posttraumatic stress symptoms and financial toxicity among adolescents and young adult oncology patients and their caregiver at Cancer diagnosis. Cancer , 128 (10), 2005–2014. doi: 10.1002/cncr.34146
Bygrave, A., Whittaker, K., Paul, C., Fradgley, E. A., Varlow, M., & Aranda, S. (2021). Australian experiences of out-of-pocket costs and financial burden following a cancer diagnosis: A systematic review. In International Journal of Environmental Research and Public Health (Vol. 18, Issue 5, pp. 1–24). MDPI AG. doi: 10.3390/ijerph18052422
Chino, F., & Yousuf Zafar, S. (2019). Financial Toxicity and Equitable Access to Clinical Trials . doi: 10.1200/EDBK_
Delgado-Guay, M., Ferrer, J., Rieber, A.G., Rhondali, W., Tayjasanant, S., Ochoa, J., Cantu, H., Chisholm, G., Williams, J., Frisbee-Hume, S., & Bruera, E. (2015). Financial Distress and Its Associations With Physical and Emotional Symptoms and Quality of Life Among Advanced Cancer Patients. The Oncologist , 20 (9), 1092–1098. doi: 10.1634/theoncologist.2015-0026
Edward, J.S., Kay Rayens, M., Zheng, X., & Vanderpool, R.C. (2021). The association of health insurance literacy and numeracy with financial toxicity and hardship among colorectal cancer survivors . doi: 10.1007/s00520-021-06036-9/Published
Fabian, A., Rühle, A., Domschikowski, J., Trommer, M., Wegen, S., Becker, J.N., Wurschi, G., Boeke, S., Sonnhoff, M., Fink, C. A., Kasmann, L., Schneider, M., Bockelmann, E., Treppner, M., Krug, D., & Nicolay, N. H. (2023). Financial toxicity in cancer patients undergoing radiotherapy in a universal health care system – A prospective multicenter study of 1075 patients. Radiotherapy and Oncology , 183 . doi: 10.1016/j.radonc.2023.109604
Hack, C. C., Hackl, J., Hüttner, N. B. M., Langemann, H., Schwitulla, J., Dietzel-Drentwett, S., Fasching, P. A., Beckmann, M. W., & Theuser, A. K. (2018). Self-reported Improvement in Side Effects and Quality of Life With Integrative Medicine in Breast Cancer Patients. Integrative Cancer Therapies , 17 (3), 941–951. doi: 10.1177/1534735418777883
Han, X., Zhao, J., Zheng, Z., De Moor, J.S., Virgo, K.S., & Robin Yabroff, K. (2020). Medical financial hardship intensity and financial sacrifice associated with cancer in the United States.
Cancer Epidemiology Biomarkers and Prevention , 29 (2), 308–317. doi: 10.1158/1055- 9965.EPI-19-0460
IARC. (2022). graphic-absolute-numbers-inc-both-sexes-in-2022-all-cancer . Retrieved from International Agency for Research on Cancer (IARC). (2023). Cancer Today: Absolute numbers, Incidence, Both sexes, in 2022. Accessed November 21, 2024 at 15:55. https://gco.iarc.fr/today/en/dataviz/pie?mode=population&group_populations=0
Kim, Y. B., Lee, I. J., Byung-byung, H. K., Choi, Y. Y., Hong, B., & Lee, J. (2024). Symptoms network and quality of life of breast Cancer patients receiving multimodal Cancer treatment: Cross-sectional study. European Journal of Oncology Nursing , 71 . doi: 10.1016/j.ejon.2024.102661
Knight, T. G., Deal, A. M., Dusetzina, S. B., Muss, H. B., Choi, K., Bensen, J. T., & Williams, G.
R. (2018). Downloaded from ascopubs.org by 114.10.31.141 on November 17 . doi: 10.1200/JOP
Koskinen, J.P., Färkkilä, N., Sintonen, H., Saarto, T., Taari, K., & Roine, R.P. (2019). The association of financial difficulties and out-of-pocket payments with health-related quality of life among breast, prostate and colorectal Cancer patients. Act Oncology , 58 (7), 1062–1068. doi: 10.1080/0284186X.2019.1592218
Kuang, Y., Qiu, J., Liu, Y., Guo, S., Chen, T., Tang, L., So, W. K. W., & Xing, W. (2025).
Trajectories and predictors of financial toxicity in breast cancer patients: A multicenter longitudinal study in China. Breasts , 81 . doi: 10.1016/j.breast.2025.104441
Lentz, R., Benson, A. B., & Kircher, S. (2019). Financial toxicity in Cancer care: Prevalence, causes, consequences, and reduction strategies. In Journal of Surgical Oncology (Vol. 120, Issue 1, pp. 85–92). John Wiley and Sons Inc. doi: 10.1002/jso.25374
Nayak, M. G., George, A., Vidyasagar, M. S., Mathew, S., Nayak, S., Nayak, B. S., Shashidhara,
Y. N., & Kamath, A. (2017). Quality of life among Cancer patients. Indian Journal of Palliative Care , 23 (4), 445–450. doi: 10.4103/IJPC.IJPC_82_17
Nogueira, L. de A., Pimenta, A. M., Mantovani, M. de F., Cordeiro, H. K. O., Silva, L. D. S., & Kalinke, L. P. (2024). Financial Toxicity and Health-Related Quality of Life Among Cancer Patients: A Correlational Study*. Aquichan , 24 (1). doi: 10.5294/aqui.2024.24.1.6
Pearce, A., Tomalin, B., Kaambwa, B., Horevoorts, N., Duijts, S., Mols, F., van with Poll-Franse, L., & Koczwara, B. (2018). Financial toxicity is more than costs of care: the relationship between employment and financial toxicity in long-term cancer survivors. Journal of Cancer Survivorship , 13 (1), 10–20. doi: 10.1007/s11764-018-0723-7
Petruzzi, L.J., Prezio, E., Phillips, F., Smith, B., Currin-Mcculloch, J., Blevins, C., Gaddis, D., Eckhardt, S.G., Kvale, E., & Jones, B. (2022a). An exploration of financial toxicity among low-income patients with cancer in Central Texas: A mixed methods analysis. Palliative and Supportive Care . doi: 10.1017/S1478951522000256
Petruzzi, L.J., Prezio, E., Phillips, F., Smith, B., Currin-Mcculloch, J., Blevins, C., Gaddis, D., Eckhardt, S. G., Kvale, E., & Jones, B. (2022b). An exploration of financial toxicity among
low-income patients with cancer in Central Texas: A mixed methods analysis. Palliative and Supportive Care . doi: 10.1017/S1478951522000256
Prasetya, D., Layyinah, A., Maftuchan, A., Putri, S., Rosita, E., & Nurjanah, AI (2023). Consequence Financial Treatment Cancer in Indonesia: Studies Case Sufferer Cancer in Capital City of Jakarta 2023 .
Scheidegger, A., Bernhards grub, D., Cobbler, A., Muller, M., Nestor, K., Richle, E., & Baum,
E. (2023). Financial toxicity among Cancer survivors: a conceptual model based on a feedback perspective. Supportive Care in Cancer , 31 (10). doi: 10.1007/s00520-023-08066-x
So, W. KW, Oh, DW H., Chan, D. NS, Ng, M. S. N., Choi, KC, Xing, W., Chan, M., Mom,
SSS, Ho, P.S., Tong, M., Au, C., Ling, W.M., Chan, M., & Chan, R.J. (2023). Financial well-being US a mediator of the relationship between multimorbidity and health related quality of life in people with Cancer. Cancer Medicine , 12 (14), 15579–15587. him: 10.1002/cam4.6204
Susilowati, M., & Afiyanti, Y. (2021). The socio-demographic factors correlated with financial toxicity among patients with breast cancer in Indonesia. In Journal of Public Health Research (Vol. 10, Issue s1).
Witte, J., Mehlis, K., Surmann, B., Lingnau, R., Damm, O., Greiner, W., & Winkler, E.C. (2019). Methods for measuring financial toxicity after cancer diagnosis and treatment: a systematic review and its implications. In Annals of Oncology (Vol. 30, Issue 7, pp. 1061–1070). Oxford University Press. doi: 10.1093/annonc/mdz140
Yücel, KB, Özay, ZI, Sütcüoğlu, O., Yazıcı, O., Üner, A., Günel, N., Özet, A., Savaş, G., & Özdemir, N. (2023). Greater financial toxicity correlates with increased psychological distress and lower quality of life among Turkish Cancer patients. Supportive Care in Cancer , 31 (2). doi: 10.1007/s00520-023-07586-w
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