Patient-reported financial toxicity among patients with liver cancer: a systematic review and meta-analysis

Abstract

Objective Financial toxicity (FT) refers to the negative impact of medical financial burden on patients’ overall health. The study aimed to quantify the prevalence and severity of patient-reported FT, identify the factors associated with FT in liver cancer patients, and thereby provide evidence to guide effective interventions to reduce the negative impacts of FT. Methods In this study the following peer-reviewed databases were systematically searched: PubMed, Web of Science, Embase, the Cochrane Library, CINAHL, China National Knowledge Infrastructure, Wanfang Data, VIP, and Sinomed. The search was conducted from the inception of each database to March 2, 2026. Two independent authors extracted data using a standardized data extraction tool and assessed the methodological quality of included studies using the Joanna Briggs Institute Critical Appraisal Tools. A random-effects model was applied to generate pooled estimates of FT rates and severity. Results Of the 13,412 articles, 39 were included in the study. Most studies were conducted in China (26/39, 66.67%). There was significant heterogeneity in the definition and measurement of FT. The pooled FT rate was 74% (95% CI: 61–85%), indicating high prevalence. The pooled FT score was 20.80 (95% CI: 19.70–21.92) for the COST (range 0–44) and 40.18 (95% CI: 27.12–53.24) for the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 Items (range 0–100), reflecting a moderate level of FT. These findings suggest that liver cancer patients present a high prevalence of FT, yet the overall severity remains moderately low. Conclusion The findings of this study indicate that FT is a common but moderate issue in liver cancer care. However, the lack of standardized measurement tools and inconsistent reporting methods have impaired the comparability of available evidence. Therefore, future research should develop a validated FT assessment for liver cancer and test targeted interventions to improve care and policy. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261345754, identifier: CRD420261345754.