Prevalence and determinants of financial toxicity in patients with colorectal cancer: a systematic review and meta-analysis

This systematic review and meta-analysis aimed to assess the global prevalence and determinants of financial toxicity in colorectal cancer (CRC) patients. 65 studies met inclusion criteria. The pooled prevalence of objective financial toxicity (catastrophic health expenditure) was 0.69. Female patients had a higher risk of financial toxicity (OR = 1.37) compared with male patients. Younger patients (< 60 years) had a higher risk (OR = 2.13) compared with those aged ≥ 60 (OR = 0.47). Insured patients had a higher risk compared with uninsured patients (OR = 1.88). Patients with lower educational attainment had a higher risk (OR = 2.27) compared with those with high school education or above (OR = 0.44). Patients with stage IV cancer had a higher risk compared with stages I–III (OR = 1.32). 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.