Aims: Advances in cancer treatment have extended survival for individuals diagnosed with advanced/metastatic cancer; however, living longer can result in substantial and ongoing costs. Financial toxicity within the advanced/metastatic cancer population is an emerging field of research; however, the qualitative evidence capturing lived experiences, as well as the perspectives of healthcare professionals, is not well understood. This review aimed to map qualitative studies exploring financial toxicity among adults with advanced/metastatic cancers, their caregivers and perspectives of healthcare professionals.
Methods: Using Arksey and O’Malley’s scoping review framework, we searched Medline, Embase, PsychINFO and Scopus (August 15, 2025). Eligible studies reported qualitative data on financial toxicity in advanced/metastatic adult patients. Three reviewers independently screened studies in Covidence. Conflicts were resolved through consensus, with a fourth reviewer consulted as necessary. One author extracted and synthesised the qualitative data.
Results: Of 2608 studies screened, 47 met the inclusion criteria with the majority from the United States. Most used semi-structured interviews and focused specifically on patient perspectives within a mixed cancer population. Twelve themes were identified: employment disruption; behavioural changes to mitigate financial toxicity; pre-existing financial strain; burden of indirect non-medical costs; access to financial support services; cost of cancer-related treatment; end-of-life, palliative care or future planning; effects of societal attitudes and self-image; financial barriers to treatment; administrative burden; costs for ongoing quality of life; COVID-19-related exacerbation.
Conclusions: This review highlights the multifaceted nature of financial toxicity in advanced/metastatic cancer, encompassing structural, psychosocial and behavioural dimensions. Financial toxicity profoundly affects quality of life and care decisions, prompting adaptive strategies among patients and families. Participants described adaptive strategies to manage financial strain. Future research requires longitudinal studies to assess the impact of financial toxicity over time, especially in the context of behavioural changes that people with advanced/metastatic cancer engage in.