Financial toxicity of patients with cancer enrolled in clinical trials: a systematic review
Ronald Chow, James H B Im, Georgia C Richards, Camilla Zimmermann, Carl HeneghanPurpose
Financial toxicity is increasingly recognised as a significant consequence of cancer treatment yet little is known about its impact on patients with cancer enrolled in pharmacological clinical trials. This review aimed to quantify direct medical and indirect non-medical financial toxicities experienced by these patients, and assess how they are measured and reported.
Design
We conducted a systematic review of Ovid Medline, Ovid Embase and the Cochrane Central Register of Controlled Trials from inception to 30 April 2025. Studies were included if they reported on direct or indirect financial toxicity among patients with cancer enrolled in pharmacological clinical trials. Cost data were extracted and adjusted to 2025 US dollars. Study methodology and outcomes were noted. Study quality was assessed using the AXIS tool.
Results
Three studies, all conducted in the USA, were included. Two reported direct financial toxicity of US$250–US$300 a month and two reported indirect toxicity exceeding US$800/month. Key cost drivers for indirect toxicity included housing and travel-related expenses. All studies had methodological concerns, including the use of unvalidated self-developed surveys and omission of key cost domains, such as lost income and caregiver burden.
Conclusions
There is sparse evidence, but this review suggests that financial toxicity among trial participants is substantial, and may exceed that of the general cancer population. Further research using standardised, validated methods across diverse contexts is needed.