Financial toxicity in patients with head and neck cancer: a scoping review

Financial toxicity has emerged as an important outcome in oncology, particularly in head and neck cancer, due to therapeutic complexity and prolonged functional consequences. This study aimed to map and synthesize the available evidence on financial toxicity in patients with head and neck cancer. A scoping review was conducted in accordance with the Joanna Briggs Institute guidelines. Searches were performed in PubMed, Scopus, Embase, and Web of Science. After screening 1,466 studies, 29 met the eligibility criteria. Data were extracted by four reviewers, organized into a thematic matrix, and complemented by a bibliometric analysis using VOSviewer software. The studies, published between 2012 and 2025, showed that financial toxicity is frequent and multidimensional, involving direct costs (transportation, medications, food, and dental care related to oncological treatment) and indirect costs (loss of income and work absence). Factors such as low income, low educational level, informal employment, lack of insurance, and greater distance from treatment centers were associated with a higher risk of financial toxicity. This condition was associated with poorer quality of life, emotional distress, depressive symptoms, anxiety, treatment interruption or delay, and difficulties in returning to work. The most commonly used instrument was FACIT-COST, followed by FIT and author-developed questionnaires. Bibliometric analysis showed a concentration of studies in high-income countries and highlighted conceptual axes centered on “financial toxicity,” “quality of life,” and “treatment costs”. Financial toxicity represents a relevant and multidimensional outcome in the care of patients with head and neck cancer, with important psychosocial implications. Its impacts are significant along the therapeutic trajectory and on quality of life, making its systematic inclusion in clinical assessment essential. There is a need to strengthen support systems and health policies that integrate financial, social, and psychological support, aiming to reduce inequalities and promote equity in access to oncological care.