Background: Financial toxicity (FT) is increasingly recognized as a clinically relevant consequence of cancer care, with important implications for quality of life and survival. Patients with head and neck cancer (HNC) may be particularly vulnerable due to intensive multimodal treatments, prolonged recovery, and impaired return to work. We conducted a systematic review and meta-analysis to quantify FT in HNC patients and to examine associated individual and contextual factors across healthcare settings.

Methods: A systematic review and meta-analysis were conducted in accordance with the PRISMA guidelines. Searches were performed in MEDLINE/PubMed, EMBASE, Cochrane Library, Web of Science, Scopus, and LILACS through June 4, 2025. Cross-sectional and cohort studies assessing financial toxicity in adult HNC patients using validated patient-reported outcome measures (FACIT-COST, FIT, or EORTC QLQ-C30) were included. Random-effects meta-analyses were conducted to estimate pooled FT levels, with subgroup analyses.

Results: Thirteen studies were included in the systematic review (Figure 1), of which nine were eligible for meta-analysis (Figure 2), comprising a total of 833 patients. FT was most commonly assessed using the FACIT-COST instrument and 10 out of 13 studies were from High income countries. The oropharynx was the most common subsite across studies. The pooled mean COST score was 21.12 (95% CI, 17.78 - 24.47), which, although mild, already indicates a clinically meaningful financial burden. FT varied across economic and demographic contexts. Patients aged 60 years or younger had worse toxicity (COST score 17.93) compared with older patients. Similarly, patients from upper-middle and low-income countries were more affected by FT (COST score 16.03) than those from high-income settings. In contrast, no consistent differences were observed by sex. Evidence from longitudinal studies suggested partial improvement in COST scores over time; however, a substantial financial burden persisted among socioeconomically vulnerable subgroups, including patients with lower income, limited social protection, or ongoing treatment-related morbidity.

Conclusions/Implications: FT in HNC is a dynamic and context-dependent phenomenon shaped by individual characteristics and structural conditions. Further studies are needed to clarify the role of gender in FT. Analyses stratified by tumor subsite and type of treatment would be particularly valuable, given the heterogeneity of treatment pathways and functional outcomes across HNC subsites. Longitudinal and context-sensitive FT assessment is essential to inform equitable cancer care and prevent financial burden from undermining treatment benefits.

Figure 1. PRISMA flow chart of the article selection process. Figure 2. Sankey diagram illustrating the studies included in the systematic review and meta-analysis.