A Scoping Review of Interventions to Address Financial Toxicity in Pediatric and Adult Patients and Survivors of Cancer

Background: Financial toxicity (FT) is a common and significant challenge for people with cancer, impacting immediate clinical outcomes such as treatment adherence, as well as long-term outcomes such as quality of life and mortality. Multiple studies have tested interventions to address FT and develop recommendations for their implementation. Methods: In this scoping review, we analyzed thirty-six studies across 35,405 participants examining institution-based interventions for FT in both pediatric and adult patients and survivors of cancer in the U.S. Results: Common interventions included: financial navigation (n = 15), direct financial/medical assistance (n = 8), financial counseling or coaching (n = 5), and cost conversations prompters or encounter decision aids for treatment and cost (n = 5). Outcome measures varied widely, including the COmprehensive Score for financial Toxicity (COST), the Medical Expenditure Panel Survey (MEPS), total out-of-pocket costs or savings, and mental/psychological quality-of-life measured by the Patient-Reported Outcomes Measurement Information System (PROMIS). Many interventions showed promising results on improving FT, including financial assistance (e.g., free medication, copay assistance), treatment and insurance decision aids, and financial counseling. These strategies improved FT-related metrics, including patient out-of-pocket costs, care-related financial burden, health insurance knowledge, quality of life, and even overall survival. There was no dominant intervention method, with both low- and high-resource options proving effective. Discussion: Future research should seek to understand causal relationships between interventions and FT through robust study designs, such as randomized controlled trials with longitudinal follow-up, and evaluate interventions' implementation potential. There is also a need for standardized metrics for evaluating and reporting FT to better compare different interventions' success.