Financial Toxicity During Active Treatment for Head and Neck Cancer: Clinical Burden, Structural Determinants, and Supportive Care Perspectives
by
Ana Carolina Prado-Ribeiro
1,2,3,4,*, 
Luciana Estevam Simonato
3,4,5,
Manoela Carrera
6,7,
Thaís Bianca Brandão
1,2,3,
Manoela Domingues Martins
2,3,8 and
Thomas P. Sollecito
9 1
Instituto do Cancer do Estado de São Paulo (ICESP), University of São Paulo, São Paulo 01246-000, SP, Brazil
2
Piracicaba Dental School, State University of Campinas (UNICAMP), Piracicaba 13414-903, SP, Brazil
3
National Institute of Science and Technology in Translational Biophotonics in Dentistry (INCT-BIOFOTO BUCAL), Porto Alegre 90010-150, RS, Brazil
4
Bioengineering Graduate Program, Scientific and Technological Institute, Brazil University, São Paulo 08230-030, SP, Brazil
5
Environmental Sciences Graduate Program, Institute of Science and Technology, Brazil University, Fernandópolis 15600-000, SP, Brazil
6
Department of Life Sciences, State University of Bahia, Salvador 41150-000, BA, Brazil
7
School of Dentistry, Federal University of Bahia, Salvador 40100-150, BA, Brazil
8
Department of Oral Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre 90010-150, RS, Brazil
9
Department of Oral Medicine, Penn Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
*
Author to whom correspondence should be addressed.
Cancers 2026, 18(14), 2248; https://doi.org/10.3390/cancers18142248
Submission received: 25 May 2026
/
Revised: 6 July 2026
/
Accepted: 10 July 2026
/
Published: 14 July 2026
(This article belongs to the Special Issue Primary, Secondary, and Tertiary Prevention Strategies in Head and Neck Cancer)
Simple Summary
Head and neck cancer (HNC) is associated with substantial morbidity, functional impairment, and socioeconomic burden. During active treatment, patients may experience treatment-related toxicities, nutritional compromise, work interruption, transportation costs, and increased supportive care needs, all of which can contribute to financial toxicity (FT). This structured narrative review summarizes current evidence on FT during active treatment for HNC, focusing on definitions, measurement approaches, temporal patterns, clinical and psychosocial consequences, and health system determinants. Available evidence suggests that FT may emerge early, evolve throughout treatment, and be associated with poorer quality of life, higher symptom burden, treatment interruptions, hospitalization, and adverse clinical outcomes. Routine assessment of FT may help identify vulnerable patients and support earlier counseling, patient navigation, and more equitable, patient-centered cancer care.
Abstract
Background/Objectives: Head and neck cancer (HNC) is associated with substantial morbidity, functional impairment, and represents a substantial socioeconomic burden worldwide. Although advances in surgery, radiotherapy (RT), and systemic therapies have improved oncologic outcomes, treatment-related toxicities frequently overlap with profound economic consequences for patients and caregivers. Financial toxicity (FT), defined as the objective financial burden and subjective financial distress associated with cancer care, has emerged as a clinically relevant determinant of treatment adherence, quality of life (QoL), and survival. In HNC, FT appears particularly critical during active treatment, when multimodal therapies, nutritional compromise, work interruption, transportation costs, and supportive care needs converge. Methods: This structured narrative review synthesizes current literature regarding FT during active treatment for HNC, focusing on conceptual definitions, measurement approaches, temporal dynamics, clinical and psychosocial consequences, and health system determinants. The review was conducted according to the Scale for the Assessment of Narrative Review Articles (SANRA) framework using searches of PubMed/MEDLINE, Scopus, Embase, and Google Scholar. Results: Available evidence suggests that FT may emerge early during treatment and evolve dynamically throughout the care trajectory. Lower socioeconomic status, treatment intensity, work interruption, and limited social support have been reported in association with increased FT. FT has also been linked to worse health-related QoL, higher symptom burden, treatment interruptions, hospitalization, and reduced survival, although the limited number of studies and methodological heterogeneity preclude definitive conclusions. Emerging evidence suggests that FT may be partially modifiable through interventions such as financial counseling and patient navigation. Conclusions: Future research should prioritize prospective and interventional designs using standardized multidimensional instruments capable of capturing both objective and subjective domains of FT. Integrating routine FT assessment into supportive oncology workflows may help identify vulnerable patients and support more equitable, patient-centered HNC care.
