{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T15:41:30Z","timestamp":1785426090507,"version":"3.56.0"},"reference-count":38,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,26]],"date-time":"2026-04-26T00:00:00Z","timestamp":1777161600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"FCT\u2014Funda\u00e7\u00e3o para a Ci\u00eancia e a Tecnologia, I.P.","award":["UID\/06397\/2025"],"award-info":[{"award-number":["UID\/06397\/2025"]}]},{"award":["UID\/06397\/2025"],"award-info":[{"award-number":["UID\/06397\/2025"]}],"id":[{"id":"https:\/\/ror.org\/00snfqn58","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: Financial toxicity (FT) is increasingly recognised as a critical dimension of the cancer care continuum, reflecting both objective financial burden and subjective financial distress arising from cancer-related care. Head and neck cancers (HNC) may be particularly vulnerable to FT because treatment often involves multimodal care, functional morbidity, prolonged rehabilitation, and disruption to employment. This scoping review mapped and synthesised the literature on FT in a focused subset of head and neck cancers (HNC), namely malignancies of the oral cavity, oropharynx, nasopharynx, sinonasal tract, and major and minor salivary glands. Methods: A scoping review was conducted in accordance with the methodological guidance of the Joanna Briggs Institute for scoping reviews to identify and synthesise studies addressing FT in the selected HNC subsites. Searches were undertaken in MEDLINE, Embase, Scopus, Web of Science, CINAHL, EconLit, and Global Index Medicus for English-language studies published between 1 January 2015 and 1 January 2025. The search window was restricted to this period to capture the more contemporary evolution of FT as a distinct research construct in oncology. Eligible studies included adult patients and reported patient-level FT outcomes, including direct costs, indirect costs, out-of-pocket expenditure, financial hardship, financial distress, employment disruption, or related economic strain. Findings were synthesised narratively and organised thematically. Results: Twenty-five studies published between 2015 and 2025 were included. The evidence base was dominated by cross-sectional and retrospective designs, with limited prospective follow-up and very little intervention-focused research. FT was conceptualised heterogeneously across studies, spanning direct expenditure, indirect and non-medical costs, subjective financial distress, and coping-related consequences. Questionnaire-based approaches were used in 13 studies, but only a smaller subset employed FT-specific instruments such as COST. Across the literature, FT was most commonly associated with lower income, weaker financial protection, employment disruption, rural residence in some settings, and more intensive treatment. Reported downstream associations included poorer quality of life, psychological distress, care alteration, and work-related burden, although evidence for treatment delay or survival effects was more limited and should be interpreted cautiously. Conclusions: In this focused HNC subset, FT appears multidimensional, socially patterned, and clinically relevant. However, the literature remains methodologically fragmented, with inconsistent measurement and sparse longitudinal evidence. Future work should prioritise validated and tumour-specific assessment strategies, prospective study designs, and evaluation of mitigation interventions that address both direct and indirect burden across the cancer continuum.<\/jats:p>","DOI":"10.3390\/cancers18091378","type":"journal-article","created":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T19:24:51Z","timestamp":1777317891000},"page":"1378","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Financial Toxicity in Selected Head and Neck Cancers: A Scoping Review of Measurement, Burden, and Outcomes"],"prefix":"10.3390","volume":"18","author":[{"given":"Madhuri","family":"Desai","sequence":"first","affiliation":[{"name":"HEADS Doctoral Programme, Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Rua Doutor Pl\u00e1cido da Costa, 4200-450 Porto, Portugal"},{"name":"RISE-Health, Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Alameda Prof. Hern\u00e2ni Monteiro, 4200-319 Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuel Fernandes","family":"Pinheiro","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Porto, Alameda Professor Hern\u00e2ni Monteiro, 4200-319 Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0740-9936","authenticated-orcid":false,"given":"Ekta","family":"Pandey","sequence":"additional","affiliation":[{"name":"RISE-Health, Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Alameda Prof. Hern\u00e2ni Monteiro, 4200-319 Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geetpriya","family":"Kaur","sequence":"additional","affiliation":[{"name":"RISE-Health, Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Alameda Prof. Hern\u00e2ni Monteiro, 4200-319 Porto, Portugal"},{"name":"PDICSS Doctoral Programme, Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Rua Doutor Pl\u00e1cido da Costa, 4200-450 Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neetu","family":"Sinha","sequence":"additional","affiliation":[{"name":"RISE-Health, Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Alameda Prof. Hern\u00e2ni Monteiro, 4200-319 Porto, Portugal"},{"name":"PDICSS Doctoral Programme, Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Rua Doutor Pl\u00e1cido da Costa, 4200-450 Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7628-8598","authenticated-orcid":false,"given":"Rui Amaral","family":"Mendes","sequence":"additional","affiliation":[{"name":"RISE-Health, Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Alameda Prof. Hern\u00e2ni Monteiro, 4200-319 Porto, Portugal"},{"name":"Department of Oral and Maxillofacial Medicine and Diagnostic Sciences, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106-7342, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1634\/theoncologist.2012-0279","article-title":"The financial toxicity of cancer treatment: A pilot study assessing out-of-pocket expenses and the insured cancer patient\u2019s experience","volume":"18","author":"Zafar","year":"2013","journal-title":"Oncologist"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1002\/jso.25374","article-title":"Financial toxicity in cancer care: Prevalence, causes, consequences, and reduction strategies","volume":"120","author":"Lentz","year":"2019","journal-title":"J. Surg. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"4922","DOI":"10.3390\/curroncol30050371","article-title":"Financial Toxicity and Out-of-Pocket Costs for Patients with Head and Neck Cancer","volume":"30","author":"Smith","year":"2023","journal-title":"Curr. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.14639\/0392-100X-N2762","article-title":"Measuring financial toxicity in head and neck cancer: A systematic review","volume":"44","author":"Raggini","year":"2024","journal-title":"Acta Otorhinolaryngol. Ital."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1007\/s40273-014-0169-3","article-title":"The economic burden of head and neck cancer: A systematic literature review","volume":"32","author":"Wissinger","year":"2014","journal-title":"Pharmacoeconomics"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e466","DOI":"10.3747\/co.24.3543","article-title":"Feasibility of assessing patient health benefits and incurred costs resulting from early dysphagia intervention during and immediately after chemoradiotherapy for head-and-neck cancer","volume":"24","author":"Martino","year":"2017","journal-title":"Curr. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.oraloncology.2018.04.024","article-title":"An assessment of patient burdens from head and neck cancer survivorship care","volume":"82","author":"Massa","year":"2018","journal-title":"Oral Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1002\/lio2.1038","article-title":"Financial toxicity among head and neck cancer patients and their caregivers: A cross-sectional pilot study","volume":"8","author":"Nguyen","year":"2023","journal-title":"Laryngoscope Investig. Otolaryngol."},{"key":"ref_9","first-page":"e1528","article-title":"Out-of-pocket costs associated with head and neck cancer treatment","volume":"5","author":"Khan","year":"2022","journal-title":"Cancer Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"105196","DOI":"10.1016\/j.oraloncology.2021.105196","article-title":"Association of significant financial burden with survival for head and neck cancer patients treated with radiation therapy","volume":"115","author":"Ma","year":"2021","journal-title":"Oral Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1001\/jamaoto.2022.3269","article-title":"Quantifying Total and Out-of-Pocket Costs Associated with Head and Neck Cancer Survivorship","volume":"148","author":"Massa","year":"2022","journal-title":"JAMA Otolaryngol. Head Neck Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3062","DOI":"10.1002\/hed.26801","article-title":"The cost of cure: Examining objective and subjective financial toxicity in head and neck cancer survivors","volume":"43","author":"Baddour","year":"2021","journal-title":"Head Neck"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1002\/pon.6030","article-title":"Financial toxicity and mental well-being of the oral cancer survivors residing in a developing country in the era of COVID 19 pandemic\u2014A cross-sectional study","volume":"32","author":"Thaduri","year":"2023","journal-title":"Psychooncology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"91","DOI":"10.4103\/jcrt.jcrt_709_24","article-title":"Long-term impact of financial distress and mental well-being in early vs advanced oral cancer patients on the quality of life of informal caregivers: An exploratory study of a real-world cohort from LMIC","volume":"21","author":"Thaduri","year":"2025","journal-title":"J. Cancer Res. Ther."},{"key":"ref_15","first-page":"201","article-title":"Financial toxicity-related factors in patients with nasopharyngeal carcinoma: A cross-sectional study","volume":"33","author":"Luo","year":"2025","journal-title":"Support. Care Cancer"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Jiang, H., Mou, W., Lyu, J., Jiang, L., Liu, Y., Zeng, Y., Hu, A., Zheng, W., Jiang, Q., and Yang, S. (2022). Assessment of self-reported financial toxicity among patients with nasopharyngeal carcinoma undergoing radiotherapy: A cross-sectional study in western China. Front. Oncol., 12.","DOI":"10.3389\/fonc.2022.1011052"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Rast, J., Zebralla, V., Wald, T., Dietz, A., Wichmann, G., and Wiegand, S. (2025). The impact of financial burden on quality of life among German head and neck cancer survivors. BMC Cancer, 25.","DOI":"10.1186\/s12885-025-13927-1"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.ijrobp.2022.08.065","article-title":"Patient-Reported Financial Toxicity in a Population-Based Cohort of Oropharynx Cancer Survivors","volume":"116","author":"Diao","year":"2023","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Rast, J., Zebralla, V., Dietz, A., Wichmann, G., and Wiegand, S. (2024). Cancer-associated financial burden in German head and neck cancer patients. Front. Oncol., 14.","DOI":"10.3389\/fonc.2024.1329242"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1002\/cncr.30369","article-title":"Measuring financial toxicity as a clinically relevant patient-reported outcome: The validation of the COmprehensive Score for financial Toxicity (COST)","volume":"123","author":"Yap","year":"2017","journal-title":"Cancer"},{"key":"ref_21","first-page":"403","article-title":"Measures of financial toxicity in cancer survivors: A systematic review","volume":"32","author":"Thomy","year":"2024","journal-title":"Support. Care Cancer"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2119","DOI":"10.11124\/JBIES-20-00167","article-title":"Updated methodological guidance for the conduct of scoping reviews","volume":"18","author":"Peters","year":"2020","journal-title":"JBI Evid. Synth."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"467","DOI":"10.7326\/M18-0850","article-title":"PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation","volume":"169","author":"Tricco","year":"2018","journal-title":"Ann. Intern. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1001\/jamaoto.2021.0835","article-title":"Costs Associated With Imaging Surveillance After Treatment for Head and Neck Cancer","volume":"147","author":"Nocon","year":"2021","journal-title":"JAMA Otolaryngol Head Neck Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1611","DOI":"10.31557\/APJCP.2022.23.5.1611","article-title":"Household Catastrophic Health Expenditure from Oral Potentially Malignant Disorders and Oral Cancer in Public Healthcare of Malaysia","volume":"23","author":"Raman","year":"2022","journal-title":"Asian Pac. J. Cancer Prev."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.jcpo.2015.12.007","article-title":"Financial barriers to oral cancer treatment in India","volume":"7","author":"Edwards","year":"2016","journal-title":"J. Cancer Policy"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1443","DOI":"10.1158\/1055-9965.EPI-17-0220","article-title":"Medical Care Cost of Oropharyngeal Cancer among Texas Patients","volume":"26","author":"Lairson","year":"2017","journal-title":"Cancer Epidemiol Biomarkers Prev."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"26","DOI":"10.5430\/rwe.v11n3p26","article-title":"Treatment Costs for Nasopharyngeal Cancer by Stages: Patients\u2019 Experience in Sarawak General Hospital","volume":"11","author":"Yeoh","year":"2020","journal-title":"Res. World Econ."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"103154","DOI":"10.1016\/j.amjoto.2021.103154","article-title":"Prevalence, trends, and demographic characteristics associated with self-reported financial stress among head and neck cancer patients in the United States of America","volume":"42","author":"Jella","year":"2021","journal-title":"Am. J. Otolaryngol."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Zhou, L.-F., Zeng, P.-P., Zhou, L.-H., Min, K., Wei, B., and Wang, Y.-S. (2022, January 18\u201321). Factors influencing out-of-pocket ratio to CPS among NPC patients in Guangxi: 2014\u20132020. Proceedings of the HPCC\/DSS\/SmartCity\/DependSys 2022, Chengdu, China.","DOI":"10.1109\/HPCC-DSS-SmartCity-DependSys57074.2022.00319"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Ehrsson, Y., Kisiel, M., Yang, Y., and Laurell, G. (2023). Predicting Return to Work after Head and Neck Cancer Treatment Is Challenging Due to Factors That Affect Work Ability. Cancers, 15.","DOI":"10.21203\/rs.3.rs-2774412\/v1"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1016\/j.ijrobp.2019.09.001","article-title":"Return to Work in Survivors of Human Papillomavirus-Associated Oropharyngeal Cancer: An Australian Experience","volume":"106","author":"Morales","year":"2020","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1001\/jamaoto.2018.3982","article-title":"Comparison of the Financial Burden of Survivors of Head and Neck Cancer With Other Cancer Survivors","volume":"145","author":"Massa","year":"2019","journal-title":"JAMA Otolaryngol. Head Neck Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e027661","DOI":"10.1136\/bmjopen-2018-027661","article-title":"Economic burden of managing oral cancer patients in Sri Lanka: A cross-sectional hospital -based costing study","volume":"9","author":"Amarasinghe","year":"2019","journal-title":"BMJ Open"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"379","DOI":"10.4103\/ijc.IJC_224_19","article-title":"Financial impact of oral cancer treatment on the households in rural India","volume":"60","author":"Goswami","year":"2023","journal-title":"Indian J. Cancer"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e70879","DOI":"10.1002\/cam4.70879","article-title":"A scoping review of interventions to address financial toxicity in pediatric and adult patients and survivors of cancer","volume":"14","author":"Ping","year":"2025","journal-title":"Cancer Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1200\/OP.24.00375","article-title":"Interventions to Address Cancer-Related Financial Hardship: A Scoping Review and Call to Action","volume":"21","author":"Wheeler","year":"2025","journal-title":"JCO Oncol. Pract."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1007\/s11764-022-01298-6","article-title":"Return to work in head and neck cancer survivors: A systematic review","volume":"17","author":"Morales","year":"2023","journal-title":"J. Cancer Surviv."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/9\/1378\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T19:40:34Z","timestamp":1777318834000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/9\/1378"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,26]]},"references-count":38,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["cancers18091378"],"URL":"https:\/\/doi.org\/10.3390\/cancers18091378","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,26]]}}}