---
title: "Financial toxicity in families of children with cancer: qualitative systematic review and meta-agg"
id: "pubmed-42763337"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42763337"
content_type: "clinical_feed_article"
specialty: "Oncology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42763337/"
doi: "10.1007/s00520-026-11232-6"
published_at: "2026-09-20T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Financial toxicity in families of children with cancer: qualitative systematic review and meta-agg
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42763337
- **Specialty:** [Oncology](https://medichelpline.com/clinical-feed/oncology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42763337/)
- **DOI:** [10.1007/s00520-026-11232-6](https://doi.org/10.1007%2Fs00520-026-11232-6)
- **Published At:** 2026-09-20T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This qualitative systematic review synthesized evidence on how **financial toxicity** is experienced, sustained, and managed at the family level in **pediatric cancer**. - The authors performed a meta-aggregation of qualitative studies identified through searches of PubMed, Web of Science, Embase, PsycINFO, CINAHL, and three Chinese databases (CNKI, WanFang, VIP) through May 2025. - Two independent reviewers conducted study selection, data extraction, and quality appraisal using Joanna Briggs Institute (JBI) guidance; discrepancies were resolved by discussion and consensus. - Fourteen studies of moderate-to-high methodological quality were included, representing 524 participants (primarily parents) across seven countries. - Thirty-eight initial findings were aggregated into 10 categories and synthesized into three final findings describing origins, impacts, and coping strategies for financial toxicity. - Finding 1: Financial toxicity stems from accumulating **direct medical costs**, indirect expenses, income loss from disrupted employment, and gaps in insurance or social support. - Finding 2: Financial pressures impair family economic security and are linked to debt, lowered living standards, persistent vulnerability, and psychosocial harms. - Finding 3: Families manage financial toxicity through external assistance and reorganizing life around treatment, but these coping strategies often provide only partial or temporary relief. - The review concludes that financial toxicity is a sustained, family-level burden that extends beyond clinical care and undermines household stability. - Authors note limited effectiveness of coping strategies, implying structural gaps in supportive care and the need for early risk identification, family-centered counseling, and coordinated system-level supports to reduce long-term consequences. - The review was prospectively registered in PROSPERO (CRD42024519179). Authors declared no competing interests.
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Financial toxicity among families of children with cancer: a qualitative systematic review and meta-aggregation [Hui Yang](https://pubmed.ncbi.nlm.nih.gov/?term=Yang+H&cauthor_id=42763337)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42763337/#full-view-affiliation-1 "School of Nursing, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42763337/#full-view-affiliation-2 "Department of Breast Oncology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China."), [Chen Li](https://pubmed.ncbi.nlm.nih.gov/?term=Li+C&cauthor_id=42763337)[#](https://pubmed.ncbi.nlm.nih.gov/42763337/#full-view-equal-contrib-explanation "Contributed equally")[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42763337/#full-view-affiliation-1 "School of Nursing, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42763337/#full-view-affiliation-2 "Department of Breast Oncology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China."), [Qian Chen](https://pubmed.ncbi.nlm.nih.gov/?term=Chen+Q&cauthor_id=42763337)[#](https://pubmed.ncbi.nlm.nih.gov/42763337/#full-view-equal-contrib-explanation "Contributed equally")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42763337/#full-view-affiliation-2 "Department of Breast Oncology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China."), [Dan Shu](https://pubmed.ncbi.nlm.nih.gov/?term=Shu+D&cauthor_id=42763337)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42763337/#full-view-affiliation-3 "Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China."), [Tie Xia Lu](https://pubmed.ncbi.nlm.nih.gov/?term=Lu+TX&cauthor_id=42763337)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42763337/#full-view-affiliation-4 "Department of Oncology, General Hospital of Central Theater Command of Chinese People's Liberation Army, Wuhan, Hubei, China."), [Huijing Zou](https://pubmed.ncbi.nlm.nih.gov/?term=Zou+H&cauthor_id=42763337)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42763337/#full-view-affiliation-1 "School of Nursing, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China."), [Dan Luo](https://pubmed.ncbi.nlm.nih.gov/?term=Luo+D&cauthor_id=42763337)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42763337/#full-view-affiliation-1 "School of Nursing, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China."), [Bing Xiang Yang](https://pubmed.ncbi.nlm.nih.gov/?term=Yang+BX&cauthor_id=42763337)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42763337/#full-view-affiliation-1 "School of Nursing, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China."), [Xiao Qin Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+XQ&cauthor_id=42763337)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42763337/#full-view-affiliation-5 "School of Nursing, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China. xiaoqin_wang78@163.com."), [Qian Liu](https://pubmed.ncbi.nlm.nih.gov/?term=Liu+Q&cauthor_id=42763337)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42763337/#full-view-affiliation-6 "School of Nursing, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China. hopeliuqian@whu.edu.cn.") Affiliations Expand ### Affiliations * 1 School of Nursing, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China. * 2 Department of Breast Oncology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China. * 3 Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China. * 4 Department of Oncology, General Hospital of Central Theater Command of Chinese People's Liberation Army, Wuhan, Hubei, China. * 5 School of Nursing, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China. xiaoqin_wang78@163.com. * 6 School of Nursing, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China. hopeliuqian@whu.edu.cn. # Contributed equally. * PMID: **42763337** * DOI: [ 10.1007/s00520-026-11232-6 ](https://doi.org/10.1007/s00520-026-11232-6) Item in Clipboard Review # Financial toxicity among families of children with cancer: a qualitative systematic review and meta-aggregation Hui Yang et al. Support Care Cancer. 2026. Show details Display options Display options Format Abstract PubMed PMID Support Care Cancer Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Support+Care+Cancer%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Support+Care+Cancer%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42763337/) . 2026 Sep 20;34(10):991. doi: 10.1007/s00520-026-11232-6. ### Authors [Hui Yang](https://pubmed.ncbi.nlm.nih.gov/?term=Yang+H&cauthor_id=42763337)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42763337/#short-view-affiliation-1 "School of Nursing, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42763337/#short-view-affiliation-2 "Department of Breast Oncology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China."), [Chen Li](https://pubmed.ncbi.nlm.nih.gov/?term=Li+C&cauthor_id=42763337)[#](https://pubmed.ncbi.nlm.nih.gov/42763337/#short-view-equal-contrib-explanation "Contributed equally")[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42763337/#short-view-affiliation-1 "School of Nursing, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42763337/#short-view-affiliation-2 "Department of Breast Oncology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China."), [Qian Chen](https://pubmed.ncbi.nlm.nih.gov/?term=Chen+Q&cauthor_id=42763337)[#](https://pubmed.ncbi.nlm.nih.gov/42763337/#short-view-equal-contrib-explanation "Contributed equally")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42763337/#short-view-affiliation-2 "Department of Breast Oncology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China."), [Dan Shu](https://pubmed.ncbi.nlm.nih.gov/?term=Shu+D&cauthor_id=42763337)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42763337/#short-view-affiliation-3 "Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China."), [Tie Xia Lu](https://pubmed.ncbi.nlm.nih.gov/?term=Lu+TX&cauthor_id=42763337)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42763337/#short-view-affiliation-4 "Department of Oncology, General Hospital of Central Theater Command of Chinese People's Liberation Army, Wuhan, Hubei, China."), [Huijing Zou](https://pubmed.ncbi.nlm.nih.gov/?term=Zou+H&cauthor_id=42763337)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42763337/#short-view-affiliation-1 "School of Nursing, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China."), [Dan Luo](https://pubmed.ncbi.nlm.nih.gov/?term=Luo+D&cauthor_id=42763337)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42763337/#short-view-affiliation-1 "School of Nursing, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China."), [Bing Xiang Yang](https://pubmed.ncbi.nlm.nih.gov/?term=Yang+BX&cauthor_id=42763337)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42763337/#short-view-affiliation-1 "School of Nursing, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China."), [Xiao Qin Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+XQ&cauthor_id=42763337)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42763337/#short-view-affiliation-5 "School of Nursing, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China. xiaoqin_wang78@163.com."), [Qian Liu](https://pubmed.ncbi.nlm.nih.gov/?term=Liu+Q&cauthor_id=42763337)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42763337/#short-view-affiliation-6 "School of Nursing, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China. hopeliuqian@whu.edu.cn.") ### Affiliations * 1 School of Nursing, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China. * 2 Department of Breast Oncology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China. * 3 Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China. * 4 Department of Oncology, General Hospital of Central Theater Command of Chinese People's Liberation Army, Wuhan, Hubei, China. * 5 School of Nursing, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China. xiaoqin_wang78@163.com. * 6 School of Nursing, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China. hopeliuqian@whu.edu.cn. # Contributed equally. * PMID: **42763337** * DOI: [ 10.1007/s00520-026-11232-6 ](https://doi.org/10.1007/s00520-026-11232-6) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Objective:** To synthesize qualitative evidence on how financial toxicity is experienced, sustained, and managed at the family level in pediatric cancer. **Design:** A qualitative systematic review using meta-aggregation. **Data sources:** PubMed, Web of Science, Embase, PsycINFO, CINAHL, and three major Chinese databases (CNKI, WanFang, VIP) were searched up to May 2025. **Methods:** Two reviewers independently conducted study screening, data extraction, and quality appraisal following Joanna Briggs Institute (JBI) guidelines. Discrepancies were resolved through discussion and team consensus. Meta-aggregation was applied to synthesize findings. **Results:** Fourteen studies of moderate-to-high methodological quality, involving 524 participants (primarily parents of children with cancer) from seven countries, were included. Thirty-eight initial findings were aggregated into 10 categories and further synthesized into three final findings: (1) Financial toxicity arose from the accumulation of direct medical costs, indirect expenses, income loss due to employment disruption, and inadequate insurance or social support; (2) These financial pressures compromised family economic security and were associated with debt, reduced living standards, long-term financial vulnerability, and psychosocial impacts; (3) Families attempted to manage financial toxicity through external financial assistance and reorganization of life around the child's treatment, although such strategies often provided only partial relief. **Conclusions:** Financial toxicity in pediatric oncology is a sustained and family-level burden that undermines household stability beyond clinical treatment phases. The limited effectiveness of existing coping strategies highlights structural gaps in supportive care. Early identification of financial risk, family-centered counseling, and coordinated system-level support may mitigate long-term consequences and promote more equitable survivorship outcomes. **Patient or public contribution:** No patient or public contribution. **Prospero registration:** This review was prospectively registered with PROSPERO, the International Prospective Register of Systematic Reviews (CRD42024519179). Available from https://www.crd.york.ac.uk/PROSPERO/view/CRD42024519179 . **Keywords:** Family; Financial toxicity; Pediatric cancer; Qualitative synthesis; Supportive care. © 2026. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Declarations. Competing interests: The authors declare no competing interests. ## References 1. 1. Parsons SK, Castellino SM, Yabroff KR (2018) Cost, value, and financial hardship in cancer care: implications for pediatric oncology. Am Soc Clin Oncol Educ Book 38:850–860. - [DOI](https://doi.org/10.1200/edbk_200359) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/30231364/) 2. 1. Santacroce SJ, Kneipp SM (2019) A conceptual model of financial toxicity in pediatric oncology. J Pediatr Oncol Nurs 36:6–16. - [DOI](https://doi.org/10.1177/1043454218810137) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/30798687/) 3. 1. Ospelt M, Kälin S, Schifferli A et al (2025) Parental employment adjustment during and after childhood cancer treatment - a report from the Swiss Childhood Cancer Survivor Study-Parents. Support Care Cancer 33. - [DOI](https://doi.org/10.1007/s00520-025-09599-z) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/40481957/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/12145287/) 4. 1. Roser K, Erdmann F, Michel G et al (2019) The impact of childhood cancer on parents’ socio-economic situation—a systematic review. Psychooncology 28:1207–1226. - [DOI](https://doi.org/10.1002/pon.5088) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/30970149/) 5. 1. Warner EL, Kirchhoff AC, Nam GE, Fluchel M (2015) Financial burden of pediatric cancer for patients and their families. J Oncol Pract 11:12–18. - [DOI](https://doi.org/10.1200/jop.2014.001495) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/25316026/) Show all 49 references ## Publication types * Systematic Review Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Systematic+Review%22%5Bpt%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Systematic+Review) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42763337/) * Review Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Review%22%5Bpt%5D&sort=date&sort_order
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