This systematic review and meta-analysis aimed to assess the global prevalence and determinants of financial toxicity in colorectal cancer (CRC) patients. PubMed, Embase, Web of Science, Scopus, PsycINFO, Cochrane, CINAHL, CNKI were searched through January 2025. Studies reporting financial toxicity scores, prevalence, or determinants were selected. The Agency for Healthcare Research and Quality Methodological Checklist and the Newcastle-Ottawa Scale were used to assess the article quality. Meta analyses were performed in R 4.2.5, with heterogeneity assessed by I2 test and subgroup analyses. Publication bias evaluated using funnel plots, Egger’s test and Luis Furuya-Kanamori index. 65 studies met inclusion criteria. The pooled prevalence of objective financial toxicity (catastrophic health expenditure) was 0.69 (95% CI: 0.45–0.94). For COST-PROM scale studies, prevalence was 0.74 (95% CI: 0.58–0.90); for self-developed scales, prevalence was 0.31 (95% CI: 0.24–0.40). Female patients had a higher risk of financial toxicity (OR = 1.37) compared with male patients (OR = 0.73, 95% CI: 0.53–0.99 for males). Younger patients (< 60 years) had a higher risk (OR = 2.13) compared with those aged ≥ 60 (OR = 0.47, 95% CI: 0.32–0.69 for ≥ 60 years). Insured patients had a higher risk compared with uninsured patients (OR = 1.88, 95% CI: 1.05–3.37). Unmarried patients had a higher risk (OR = 1.49) compared with married patients (OR = 0.67, 95% CI: 0.48–0.93 for married). Patients with lower educational attainment had a higher risk (OR = 2.27) compared with those with high school education or above (OR = 0.44, 95% CI: 0.37–0.53 for high education). Patients with stage IV cancer had a higher risk compared with stages I–III (OR = 1.32, 95% CI: 1.11–1.57). Only employment status and education level showed publication bias, and correction by trimming and filling did not change the conclusions. Financial toxicity is common among CRC patients. Higher risk was observed in females, younger patients, those with lower education, insured individuals, and patients with stage IV CRC. Interventions should target these vulnerable groups, highlighting that insurance alone may not fully protect against financial toxicity, and should strengthen financial support and social resources. • Colorectal cancer (CRC) is the second most common cancer globally, and while advances in treatment have improved survival rates, patients often face significant financial burdens. • Financial toxicity in cancer care is a recognized concern, adversely affecting treatment adherence and overall quality of life. • Previous research has identified various factors linked to financial toxicity among cancer patients; however, variability in measurement methods has led to inconsistent estimates of its prevalence and risk factors across studies. • This study provides a comprehensive global meta-analysis that integrates data on financial toxicity in CRC patients using multiple measurement approaches, including objective indicators (catastrophic health expenditure) and subjective evaluations (COST-PROM and self-developed scales). • It offers pooled prevalence estimates of financial toxicity across different assessment methods, highlighting significant differences among them, which helps clarify the heterogeneity in previously reported findings. • The analysis identifies critical determinants of financial toxicity in CRC patients, showing that gender, age, insurance status, marital status, education, and cancer stage are significantly associated with the risk of developing financial toxicity.
Shao et al. (Fri,) studied this question.