This meta-aggregation examined qualitative evidence on how financial toxicity develops at the family level in pediatric oncology. Across the included studies, families reported that financial strain emerged from multiple, cumulative sources: rising direct medical costs, ancillary and indirect expenses (for example travel, accommodation, and caregiving-related costs), loss of household income due to employment disruption, and inadequate coverage by insurance or social support systems. The synthesis emphasizes that financial toxicity is not a single expense event but an accumulation of ongoing costs combined with reduced earning capacity and gaps in financial protection.
The review found that sustained financial pressures jeopardized household economic security. Families described experiences of accumulating debt, reductions in living standards, and enduring financial vulnerability that extended beyond active treatment phases. These economic consequences were accompanied by psychosocial impacts for parents and families, including stress and emotional burden related to economic uncertainty. The aggregated findings portray financial toxicity as undermining both material and psychosocial stability within affected households.
Families deployed a range of coping strategies to manage financial strain. Common responses included seeking external financial assistance (charitable support, community resources, or ad hoc aid) and reorganizing daily life around the child’s treatment needs (adjusting work arrangements, reallocating resources, and prioritizing expenditures). The synthesis reports that these strategies often provided only partial or temporary relief. In many cases, assistance and reorganizational approaches did not fully address underlying income loss or long-term vulnerability, highlighting limits of available supports at the household level.
The authors conducted a qualitative systematic review using a meta-aggregation approach. Databases searched included PubMed, Web of Science, Embase, PsycINFO, CINAHL, and three major Chinese databases (CNKI, WanFang, VIP) with searches conducted up to May 2025. Two reviewers independently carried out study screening, data extraction, and methodological quality appraisal according to Joanna Briggs Institute (JBI) guidelines. Discrepancies between reviewers were resolved through discussion and team consensus. Meta-aggregation was applied to synthesize study findings into categories and final synthesized statements.
Fourteen qualitative studies met inclusion criteria and were appraised as having moderate-to-high methodological quality. The combined sample included 524 participants, primarily parents of children with cancer, across seven different countries. From the primary studies the reviewers extracted thirty-eight initial findings, which they grouped into ten categories and then distilled into three overarching synthesized findings describing the causes, consequences, and coping behaviors related to financial toxicity in families.
The review concludes that financial toxicity in pediatric oncology is a persistent, family-level burden that undermines household stability beyond the clinical treatment period. The limited effectiveness of household coping strategies suggests gaps in structural supports. The authors propose that early identification of families at financial risk, provision of family-centered counseling about financial and practical needs, and coordinated system-level supportive measures may help mitigate long-term economic and psychosocial consequences and promote more equitable survivorship outcomes. These implications point toward integrated approaches linking clinical teams with social, financial, and policy resources; however, specific interventions and their effectiveness were not described in detail in the primary studies synthesized.
The review reports prospective registration with PROSPERO (CRD42024519179). The authors declared no competing interests. The synthesis is based on the available qualitative literature up to May 2025; details such as country-specific policy contexts, exact types of assistance accessed by families, and quantitative magnitude of economic losses were not quantified in this qualitative meta-aggregation. The review highlights the need for further work to test targeted interventions and to evaluate system-level solutions addressing the structural drivers of financial toxicity.