Background: Financial toxicity is increasingly recognised as a significant adverse effect of cancer care, affecting treatment adherence, quality of life, and clinical outcomes. Women with breast cancer living in rural and regional Australia experience disproportionately higher financial burden than metropolitan patients because of travel requirements, accommodation costs, reduced service availability, and income disruption. Despite growing recognition of financial toxicity, there remains limited consensus regarding comprehensive methods to estimate diagnostic-related costs.
Methods: A narrative review of international and Australian literature was undertaken to synthesise evidence on financial toxicity among breast cancer patients, with particular emphasis on rural–metropolitan disparities, validated financial toxicity instruments, and approaches to healthcare cost estimation. Evidence from systematic reviews, validation studies, health economic analyses, and Australian cancer care research informed the development of a structured diagnostic cost methodology.
Results: The review demonstrates that catastrophic health expenditure affects more than half of cancer patients globally, with rural populations consistently experiencing greater out-of-pocket expenditure, travel costs, accommodation expenses, productivity losses, and financial distress. Validated assessment instruments, including the Comprehensive Score for Financial Toxicity (COST-FACIT), Subjective Financial Distress Questionnaire (SFDQ), and FinTox, provide reliable measures of patient-reported financial burden but do not sufficiently capture diagnostic-phase costs. A novel diagnostic cost framework is proposed that integrates direct diagnostic costs (consultations, imaging, pathology, biopsies), indirect costs (travel, accommodation, lost productivity, caregiver time), and psychosocial impacts to provide a more comprehensive assessment of the economic burden associated with breast cancer diagnosis.
Conclusions: Financial toxicity remains a major contributor to inequitable cancer outcomes, particularly for rural and regional patients. Standardising measurement through a comprehensive diagnostic cost methodology may improve economic evaluation, inform policy development, and support targeted interventions including financial navigation services, telehealth expansion, and enhanced rural travel assistance. Incorporating financial toxicity
assessment into routine oncology practice is essential to achieving equitable, patient-centred cancer care.