Financial toxicity of surgical cancer treatment in LMICs: Implications for patients and health systems

Financial toxicity, the economic burden experienced by patients due to cancer treatment, has emerged as a critical concern, particularly in low- and middle-income countries (LMICs) where health systems are often under-resourced and out-of-pocket expenditure dominates healthcare financing. This narrative review explores the financial toxicity associated with surgical cancer treatment in LMICs, highlighting its multifaceted impact on patients and health systems. Drawing on current literature, we examined direct medical costs, non-medical expenses, income loss, and coping strategies such as debt and asset depletion. We also assessed how these financial pressures lead to delayed treatment, reduced adherence, poor clinical outcomes, and catastrophic health expenditure. At the health systems level, financial toxicity undermines cancer control efforts, exacerbates health inequities, and limits progress toward universal health coverage. The review further identified structural barriers, such as inadequate health insurance schemes, fragmented surgical services, and a lack of social safety nets, that intensify economic hardship for cancer patients. We concluded by recommending policy reforms, including the integration of financial risk protection mechanisms, investment in surgical oncology infrastructure, and the inclusion of cancer surgery in national cancer control plans. Addressing the financial toxicity of surgical cancer care is vital to improving cancer outcomes and advancing equitable, sustainable health systems in LMICs.