Financial Toxicity Among Breast Cancer Patients

Background Breast cancer has become the leading cause of global cancer incidence. With the improvement of treatment methods, financial toxicity among breast cancer patients has been widely studied.The aims of this study were to summarize the risk factors for and outcomes of financial toxicity among breast cancer patients, to identify populations at risk for financial toxicity, to identify the consequent health impacts, and to provide evidence for subsequent intervention programs.We searched the PubMed/MEDLINE, Web of Science, MEDLINE (Ovid), CINAHL (EBSCO), EMBASE (Ovid), ProQuest, and China National Knowledge Infrastructure databases from inception to July 21, 2022. We followed the updated framework for scoping reviews proposed by the Joanna Briggs Institute.A total of 31 studies were included. Risk factors and outcomes of financial toxicity among breast cancer patients were identified and extracted. The risk factors included socioeconomic, demographic, disease and treatment, and psychological and cognitive factors, whereas financial toxicity affected the physical, behavioral, and psychological domains of breast cancer patients, resulting in material loss, coping behaviors, and impaired health-related quality of life.Financial toxicity among breast cancer patients depends on multiple factors and has profound effects. The findings will be helpful for identifying breast cancer patients at a high risk of financial toxicity and developing intervention programs to reduce financial toxicity and outcomes.More high-quality prospective, multicenter studies should be conducted in the future to better understand the trajectory of and risk factors for financial toxicity. Further studies should merge symptom management and psychosocial support into intervention programs.According to the global cancer statistics released by the International Agency for Research on Cancer in 2020, there were an estimated 2.3 million new cases of breast cancer in 2020; therefore, breast cancer surpassed lung cancer as the leading cause of global cancer incidence, and its incidence is increasing rapidly every year.1 In Europe and China, there were estimated to be more than 530 000 new cases and 420 000 new cases, respectively, in 2020; furthermore, it is estimated that approximately 287 850 new cases of breast cancer were diagnosed in the United States in 2022.1-3 Breast cancer has become the most common type of cancer and the leading cause of cancer-related death among women, and it seriously threatens women's physical and mental health.1 With the development of advanced diagnostic techniques and treatment methods, breast cancer patients face an overwhelming medical financial burden while experiencing improved life expectancy and clinical outcomes.4,5 Generally, healthcare expenditure was considered "catastrophic" when the out-of-pocket (OOP) healthcare spending greatly exceeded a certain proportion of household income or capacity to pay.6 Research showed that the mean OOP expenditure for breast cancer patients in China in 2019 accounted for 55.20% of the mean household nonfood expenditures, whereas the overall incidence of catastrophic health expenditures reached 66.28%.6 Therefore, breast cancer still had a significant catastrophic economic impact on patients and families.To describe the adverse impacts of OOP healthcare costs for cancer patients, Zafar et al7,8 proposed the term financial toxicity, which covers both objective financial burden and subjective financial distress. A review by Smith et al9 revealed that the concept of financial toxicity included material hardships (eg, OOP medical expenditures), psychological burden (eg, financial worry), and adverse coping behaviors (eg, reduction in spending on food and necessary medications). Financial toxicity is mainly caused by high OOP costs after cancer diagnosis (direct and indirect) and the reduction in income during treatment and rehabilitation.10,11 The consequences of financial toxicity range from bankruptcy and poor health-related quality of life to worse disease outcomes.12Studies have shown that between 5% and 41% of breast cancer patients experience different degrees of financial toxicity.13-16 The occurrence of financial toxicity can lead to depression, anxiety, worse physical symptom burden, and worse quality of life.16,17 Systematically summarizing the risk factors and adverse outcomes of financial toxicity can help clinicians identify groups at a high risk of financial toxicity and develop relevant interventions to reduce financial toxicity and the incidence of adverse outcomes. The incidence of financial toxicity is related to demographic risk factors, clinical risk factors, and medical insurance status. The most commonly reported factors were female sex, younger age, non-White race, longer distance from treatment centers, unemployment, low income at baseline, adjuvant therapies, and a more recent diagnosis.9,11,12,18 However, previous systematic reviews of financial toxicity have included a wide range of cancer categories. Xu et al19 summarized existing data on the measures, prevalence, risk factors, and health-related consequences associated with financial toxicity in Chinese cancer patients in their systematic review, but only quantitative studies were included. However, some qualitative studies related to financial toxicity have emerged in recent years, providing a deeper perspective and understanding of financial toxicity.20 Moreover, only 3 of the included studies focused on breast cancer patients.19 Considering that female sex is a risk factor for financial toxicity and that the treatment methods for breast cancer are different from those of other cancers,11,12,21 previous integrated results on the financial toxicity of a wide range of cancer patients cannot fully provide a reference for breast cancer patients.Factors related to financial toxicity and the impacts of financial toxicity on patients in the field of breast cancer are still not well reported in the literature, and existing studies are heterogeneous in terms of study design, outcomes, and means of outcome assessment. A scoping review provides an overview by mapping evidence from a variety of studies using different research methodologies and representing this evidence by graphing or charting the data, which is difficult to do when performing a systematic review.22,23 Thus, we conducted this scoping review to map and summarize the evidence in this rapidly growing field of financial toxicity in breast cancer patients, focusing on the risk factors and outcomes for financial toxicity in breast cancer and to guide future research directions.Background Breast cancer has become the leading cause of global cancer incidence. With the improvement of treatment methods, financial toxicity among breast cancer patients has been widely studied. The aims of this study were to summarize the risk factors for and outcomes of financial toxicity among breast cancer patients, to identify populations at risk for financial toxicity, to identify the consequent health impacts, and to provide evidence for subsequent intervention programs.We searched the PubMed/MEDLINE, Web of Science, MEDLINE (Ovid), CINAHL (EBSCO), EMBASE (Ovid), ProQuest, and China National Knowledge Infrastructure databases from inception to July 21, 2022. We followed the updated framework for scoping reviews proposed by the Joanna Briggs Institute.A total of 31 studies were included. Risk factors and outcomes of financial toxicity among breast cancer patients were identified and extracted. The risk factors included socioeconomic, demographic, disease and treatment, and psychological and cognitive factors, whereas financial toxicity affected the physical, behavioral, and psychological domains of breast cancer patients, resulting in material loss, coping behaviors, and impaired health-related quality of life.Financial toxicity among breast cancer patients depends on multiple factors and has profound effects. The findings will be helpful for identifying breast cancer patients at a high risk of financial toxicity and developing intervention programs to reduce financial toxicity and outcomes.More high-quality prospective, multicenter studies should be conducted in the future to better understand the trajectory of and risk factors for financial toxicity. Further studies should merge symptom management and psychosocial support into intervention programs.According to the global cancer statistics released by the International Agency for Research on Cancer in 2020, there were an estimated 2.3 million new cases of breast cancer in 2020; therefore, breast cancer surpassed lung cancer as the leading cause of global cancer incidence, and its incidence is increasing rapidly every year.1 In Europe and China, there were estimated to be more than 530 000 new cases and 420 000 new cases, respectively, in 2020; furthermore, it is estimated that approximately 287 850 new cases of breast cancer were diagnosed in the United States in 2022.1-3 Breast cancer has become the most common type of cancer and the leading cause of cancer-related death among women, and it seriously threatens women's physical and mental health.1 With the development of advanced diagnostic techniques and treatment methods, breast cancer patients face an overwhelming medical financial burden while experiencing improved life expectancy and clinical outcomes.4,5 Generally, healthcare expenditure was considered "catastrophic" when the out-of-pocket (OOP) healthcare spending greatly exceeded a certain proportion of household income or capacity to pay.6 Research showed that the mean OOP expenditure for breast cancer patients in China in 2019 accounted for 55.20% of the mean household nonfood expenditures, whereas the overall incidence of catastrophic health expenditures reached 66.28%.6 Therefore, breast cancer still had a significant catastrophic economic impact on patients and families.To describe the adverse impacts of OOP healthcare costs for cancer patients, Zafar et al7,8 proposed the term financial toxicity, which covers both objective financial burden and subjective financial distress. A review by Smith et al9 revealed that the concept of financial toxicity included material hardships (eg, OOP medical expenditures), psychological burden (eg, financial worry), and adverse coping behaviors (eg, reduction in spending on food and necessary medications). Financial toxicity is mainly caused by high OOP costs after cancer diagnosis (direct and indirect) and the reduction in income during treatment and rehabilitation.10,11 The consequences of financial toxicity range from bankruptcy and poor health-related quality of life to worse disease outcomes.12Studies have shown that between 5% and 41% of breast cancer patients experience different degrees of financial toxicity.13-16 The occurrence of financial toxicity can lead to depression, anxiety, worse physical symptom burden, and worse quality of life.16,17 Systematically summarizing the risk factors and adverse outcomes of financial toxicity can help clinicians identify groups at a high risk of financial toxicity and develop relevant interventions to reduce financial toxicity and the incidence of adverse outcomes. The incidence of financial toxicity is related to demographic risk factors, clinical risk factors, and medical insurance status. The most commonly reported factors were female sex, younger age, non-White race, longer distance from treatment centers, unemployment, low income at baseline, adjuvant therapies, and a more recent diagnosis.9,11,12,18 However, previous systematic reviews of financial toxicity have included a wide range of cancer categories. Xu et al19 summarized existing data on the measures, prevalence, risk factors, and health-related consequences associated with financial toxicity in Chinese cancer patients in their systematic review, but only quantitative studies were included. However, some qualitative studies related to financial toxicity have emerged in recent years, providing a deeper perspective and understanding of financial toxicity.20 Moreover, only 3 of the included studies focused on breast cancer patients.19 Considering that female sex is a risk factor for financial toxicity and that the treatment methods for breast cancer are different from those of other cancers,11,12,21 previous integrated results on the financial toxicity of a wide range of cancer patients cannot fully provide a reference for breast cancer patients.Factors related to financial toxicity and the impacts of financial toxicity on patients in the field of breast cancer are still not well reported in the literature, and existing studies are heterogeneous in terms of study design, outcomes, and means of outcome assessment. A scoping review provides an overview by mapping evidence from a variety of studies using different research methodologies and representing this evidence by graphing or charting the data, which is difficult to do when performing a systematic review.22,23 Thus, we conducted this scoping review to map and summarize the evidence in this rapidly growing field of financial toxicity in breast cancer patients, focusing on the risk factors and outcomes for financial toxicity in breast cancer and to guide future research directions.Background Breast cancer has become the leading cause of global cancer incidence. With the improvement of treatment methods, financial toxicity among breast cancer patients has been widely studied.The aims of this study were to summarize the risk factors for and outcomes of financial toxicity among breast cancer patients, to identify populations at risk for financial toxicity, to identify the consequent health impacts, and to provide evidence for subsequent intervention programs.We searched the PubMed/MEDLINE, Web of Science, MEDLINE (Ovid), CINAHL (EBSCO), EMBASE (Ovid), ProQuest, and China National Knowledge Infrastructure databases from inception to July 21, 2022. We followed the updated framework for scoping reviews proposed by the Joanna Briggs Institute.A total of 31 studies were included. Risk factors and outcomes of financial toxicity among breast cancer patients were identified and extracted. The risk factors included socioeconomic, demographic, disease and treatment, and psychological and cognitive factors, whereas financial toxicity affected the physical, behavioral, and psychological domains of breast cancer patients, resulting in material loss, coping behaviors, and impaired health-related quality of life.Financial toxicity among breast cancer patients depends on multiple factors and has profound effects. The findings will be helpful for identifying breast cancer patients at a high risk of financial toxicity and developing intervention programs to reduce financial toxicity and outcomes.More high-quality prospective, multicenter studies should be conducted in the future to better understand the trajectory of and risk factors for financial toxicity. Further studies should merge symptom management and psychosocial support into intervention programs.According to the global cancer statistics released by the International Agency for Research on Cancer in 2020, there were an estimated 2.3 million new cases of breast cancer in 2020; therefore, breast cancer surpassed lung cancer as the leading cause of global cancer incidence, and its incidence is increasing rapidly every year.1 In Europe and China, there were estimated to be more than 530 000 new cases and 420 000 new cases, respectively, in 2020; furthermore, it is estimated that approximately 287 850 new cases of breast cancer were diagnosed in the United States in 2022.1-3 Breast cancer has become the most common type of cancer and the leading cause of cancer-related death among women, and it seriously threatens women's physical and mental health.1 With the development of advanced diagnostic techniques and treatment methods, breast cancer patients face an overwhelming medical financial burden while experiencing improved life expectancy and clinical outcomes.4,5 Generally, healthcare expenditure was considered "catastrophic" when the out-of-pocket (OOP) healthcare spending greatly exceeded a certain proportion of household income or capacity to pay.6 Research showed that the mean OOP expenditure for breast cancer patients in China in 2019 accounted for 55.20% of the mean household nonfood expenditures, whereas the overall incidence of catastrophic health expenditures reached 66.28%.6 Therefore, breast cancer still had a significant catastrophic economic impact on patients and families.To describe the adverse impacts of OOP healthcare costs for cancer patients, Zafar et al7,8 proposed the term financial toxicity, which covers both objective financial burden and subjective financial distress. A review by Smith et al9 revealed that the concept of financial toxicity included material hardships (eg, OOP medical expenditures), psychological burden (eg, financial worry), and adverse coping behaviors (eg, reduction in spending on food and necessary medications). Financial toxicity is mainly caused by high OOP costs after cancer diagnosis (direct and indirect) and the reduction in income during treatment and rehabilitation.10,11 The consequences of financial toxicity range from bankruptcy and poor health-related quality of life to worse disease outcomes.12Studies have shown that between 5% and 41% of breast cancer patients experience different degrees of financial toxicity. 13-16 The occurrence of financial toxicity can lead to depression, anxiety, worse physical symptom burden, and worse quality of life.16,17 Systematically summarizing the risk factors and adverse outcomes of financial toxicity can help clinicians identify groups at a high risk of financial toxicity and develop relevant interventions to reduce financial toxicity and the incidence of adverse outcomes. The incidence of financial toxicity is related to demographic risk factors, clinical risk factors, and medical insurance status. The most commonly reported factors were female sex, younger age, non-White race, longer distance from treatment centers, unemployment, low income at baseline, adjuvant therapies, and a more recent diagnosis.9,11,12,18 However, previous systematic reviews of financial toxicity have included a wide range of cancer categories. Xu et al19 summarized existing data on the measures, prevalence, risk factors, and health-related consequences associated with financial toxicity in Chinese cancer patients in their systematic review, but only quantitative studies were included. However, some qualitative studies related to financial toxicity have emerged in recent years, providing a deeper perspective and understanding of financial toxicity.20 Moreover, only 3 of the included studies focused on breast cancer patients.19 Considering that female sex is a risk factor for financial toxicity and that the treatment methods for breast cancer are different from those of other cancers,11,12,21 previous integrated results on the financial toxicity of a wide range of cancer patients cannot fully provide a reference for breast cancer patients.Factors related to financial toxicity and the impacts of financial toxicity on patients in the field of breast cancer are still not well reported in the literature, and existing studies are heterogeneous in terms of study design, outcomes, and means of outcome assessment. A scoping review provides an overview by mapping evidence from a variety of studies using different research methodologies and representing this evidence by graphing or charting the data, which is difficult to do when performing a systematic review.22,23 Thus, we conducted this scoping review to map and summarize the evidence in this rapidly growing field of financial toxicity in breast cancer patients, focusing on the risk factors and outcomes for financial toxicity in breast cancer and to guide future research directions.Background Breast cancer has become the leading cause of global cancer incidence. With the improvement of treatment methods, financial toxicity among breast cancer patients has been widely studied.The aims of this study were to summarize the risk factors for and outcomes of financial toxicity among breast cancer patients, to identify populations at risk for financial toxicity, to identify the consequent health impacts, and to provide evidence for subsequent intervention programs.We searched the PubMed/MEDLINE, Web of Science, MEDLINE (Ovid), CINAHL (EBSCO), EMBASE (Ovid), ProQuest, and China National Knowledge Infrastructure databases from inception to July 21, 2022. We followed the updated framework for scoping reviews proposed by the Joanna Briggs Institute.A total of 31 studies were included. Risk factors and outcomes of financial toxicity among breast cancer patients were identified and extracted. The risk factors included socioeconomic, demographic, disease and treatment, and psychological and cognitive factors, whereas financial toxicity affected the physical, behavioral, and psychological domains of breast cancer patients, resulting in material loss, coping behaviors, and impaired health-related quality of life.Financial toxicity among breast cancer patients depends on multiple factors and has profound effects. The findings will be helpful for identifying breast cancer patients at a high risk of financial toxicity and developing intervention programs to reduce financial toxicity and outcomes.More high-quality prospective, multicenter studies should be conducted in the future to better understand the trajectory of and risk factors for financial toxicity. Further studies should merge symptom management and psychosocial support into intervention programs.According to the global cancer statistics released by the International Agency for Research on Cancer in 2020, there were an estimated 2.3 million new cases of breast cancer in 2020; therefore, breast cancer surpassed lung cancer as the leading cause of global cancer incidence, and its incidence is increasing rapidly every year.1 In Europe and China, there were estimated to be more than 530 000 new cases and 420 000 new cases, respectively, in 2020; furthermore, it is estimated that approximately 287 850 new cases of breast cancer were diagnosed in the United States in 2022.1-3 Breast cancer has become the most common type of cancer and the leading cause of cancer-related death among women, and it seriously threatens women's physical and mental health.1 With the development of advanced diagnostic techniques and treatment methods, breast cancer patients face an overwhelming medical financial burden while experiencing improved life expectancy and clinical outcomes.4,5 Generally, healthcare expenditure was considered "catastrophic" when the out-of-pocket (OOP) healthcare spending greatly exceeded a certain proportion of household income or capacity to pay.6 Research showed that the mean OOP expenditure for breast cancer patients in China in 2019 accounted for 55.20% of the mean household nonfood expenditures, whereas the overall incidence of catastrophic health expenditures reached 66.28%.6 Therefore, breast cancer still had a significant catastrophic economic impact on patients and families.To describe the adverse impacts of OOP healthcare costs for cancer patients, Zafar et al7,8 proposed the term financial toxicity, which covers both objective financial burden and subjective financial distress. A review by Smith et al9 revealed that the concept of financial toxicity included material hardships (eg, OOP medical expenditures), psychological burden (eg, financial worry), and adverse coping behaviors (eg, reduction in spending on food and necessary medications). Financial toxicity is mainly caused by high OOP costs after cancer diagnosis (direct and indirect) and the reduction in income during treatment and rehabilitation.10,11 The consequences of financial toxicity range from bankruptcy and poor health-related quality of life to worse disease outcomes.12Studies have shown that between 5% and 41% of breast cancer patients experience different degrees of financial toxicity.13-16 The occurrence of financial toxicity can lead to depression, anxiety, worse physical symptom burden, and worse quality of life. 16,17 Systematically summarizing the risk factors and adverse outcomes of financial toxicity can help clinicians identify groups at a high risk of financial toxicity and develop relevant interventions to reduce financial toxicity and the incidence of adverse outcomes. The incidence of financial toxicity is related to demographic risk factors, clinical risk factors, and medical insurance status. The most commonly reported factors were female sex, younger age, non-White race, longer distance from treatment centers, unemployment, low income at baseline, adjuvant therapies, and a more recent diagnosis.9,11,12,18 However, previous systematic reviews of financial toxicity have included a wide range of cancer categories. Xu et al19 summarized existing data on the measures, prevalence, risk factors, and health-related consequences associated with financial toxicity in Chinese cancer patients in their systematic review, but only quantitative studies were included. However, some qualitative studies related to financial toxicity have emerged in recent years, providing a deeper perspective and understanding of financial toxicity.20 Moreover, only 3 of the included studies focused on breast cancer patients.19 Considering that female sex is a risk factor for financial toxicity and that the treatment methods for breast cancer are different from those of other cancers,11,12,21 previous integrated results on the financial toxicity of a wide range of cancer patients cannot fully provide a reference for breast cancer patients.Factors related to financial toxicity and the impacts of financial toxicity on patients in the field of breast cancer are still not well reported in the literature, and existing studies are heterogeneous in terms of study design, outcomes, and means of outcome assessment. A scoping review provides an overview by mapping evidence from a variety of studies using different research methodologies and representing this evidence by graphing or charting the data, which is difficult to do when performing a systematic review.22,23 Thus, we conducted this scoping review to map and summarize the evidence in this rapidly growing field of financial toxicity in breast cancer patients, focusing on the risk factors and outcomes for financial toxicity in breast cancer and to guide future research directions.Background Breast cancer has become the leading cause of global cancer incidence. With the improvement of treatment methods, financial toxicity among breast cancer patients has been widely studied.The aims of this study were to summarize the risk factors for and outcomes of financial toxicity among breast cancer patients, to identify populations at risk for financial toxicity, to identify the consequent health impacts, and to provide evidence for subsequent intervention programs.We searched the PubMed/MEDLINE, Web of Science, MEDLINE (Ovid), CINAHL (EBSCO), EMBASE (Ovid), ProQuest, and China National Knowledge Infrastructure databases from inception to July 21, 2022. We followed the updated framework for scoping reviews proposed by the Joanna Briggs Institute.A total of 31 studies were included. Risk factors and outcomes of financial toxicity among breast cancer patients were identified and extracted. The risk factors included socioeconomic, demographic, disease and treatment, and psychological and cognitive factors, whereas financial toxicity affected the physical, behavioral, and psychological domains of breast cancer patients, resulting in material loss, coping behaviors, and impaired health-related quality of life. Financial toxicity among breast cancer patients depends on multiple factors and has profound effects. The findings will be helpful for identifying breast cancer patients at a high risk of financial toxicity and developing intervention programs to reduce financial toxicity and outcomes.More high-quality prospective, multicenter studies should be conducted in the future to better understand the trajectory of and risk factors for financial toxicity. Further studies should merge symptom management and psychosocial support into intervention programs.According to the global cancer statistics released by the International Agency for Research on Cancer in 2020, there were an estimated 2.3 million new cases of breast cancer in 2020; therefore, breast cancer surpassed lung cancer as the leading cause of global cancer incidence, and its incidence is increasing rapidly every year.1 In Europe and China, there were estimated to be more than 530 000 new cases and 420 000 new cases, respectively, in 2020; furthermore, it is estimated that approximately 287 850 new cases of breast cancer were diagnosed in the United States in 2022.1-3 Breast cancer has become the most common type of cancer and the leading cause of cancer-related death among women, and it seriously threatens women's physical and mental health.1 With the development of advanced diagnostic techniques and treatment methods, breast cancer patients face an overwhelming medical financial burden while experiencing improved life expectancy and clinical outcomes.4,5 Generally, healthcare expenditure was considered "catastrophic" when the out-of-pocket (OOP) healthcare spending greatly exceeded a certain proportion of household income or capacity to pay.6 Research showed that the mean OOP expenditure for breast cancer patients in China in 2019 accounted for 55.20% of the mean household nonfood expenditures, whereas the overall incidence of catastrophic health expenditures reached 66.28%.6 Therefore, breast cancer still had a significant catastrophic economic impact on patients and families.To describe the adverse impacts of OOP healthcare costs for cancer patients, Zafar et al7,8 proposed the term financial toxicity, which covers both objective financial burden and subjective financial distress. A review by Smith et al9 revealed that the concept of financial toxicity included material hardships (eg, OOP medical expenditures), psychological burden (eg, financial worry), and adverse coping behaviors (eg, reduction in spending on food and necessary medications). Financial toxicity is mainly caused by high OOP costs after cancer diagnosis (direct and indirect) and the reduction in income during treatment and rehabilitation.10,11 The consequences of financial toxicity range from bankruptcy and poor health-related quality of life to worse disease outcomes.12Studies have shown that between 5% and 41% of breast cancer patients experience different degrees of financial toxicity.13-16 The occurrence of financial toxicity can lead to depression, anxiety, worse physical symptom burden, and worse quality of life.16,17 Systematically summarizing the risk factors and adverse outcomes of financial toxicity can help clinicians identify groups at a high risk of financial toxicity and develop relevant interventions to reduce financial toxicity and the incidence of adverse outcomes. The incidence of financial toxicity is related to demographic risk factors, clinical risk factors, and medical insurance status. The most commonly reported factors were female sex, younger age, non-White race, longer distance from treatment centers, unemployment, low income at baseline, adjuvant therapies, and a more recent diagnosis.9,11,12,18 However, previous systematic reviews of financial toxicity have included a wide range of cancer categories. Xu et al19 summarized existing data on the measures, prevalence, risk factors, and health-related consequences associated with financial toxicity in Chinese cancer patients in their systematic review, but only quantitative studies were included. However, some qualitative studies related to financial toxicity have emerged in recent years, providing a deeper perspective and understanding of financial toxicity.20 Moreover, only 3 of the included studies focused on breast cancer patients.19 Considering that female sex is a risk factor for financial toxicity and that the treatment methods for breast cancer are different from those of other cancers,11,12,21 previous integrated results on the financial toxicity of a wide range of cancer patients cannot fully provide a reference for breast cancer patients.Factors related to financial toxicity and the impacts of financial toxicity on patients in the field of breast cancer are still not well reported in the literature, and existing studies are heterogeneous in terms of study design, outcomes, and means of outcome assessment. A scoping review provides an overview by mapping evidence from a variety of studies using different research methodologies and representing this evidence by graphing or charting the data, which is difficult to do when performing a systematic review.22,23 Thus, we conducted this scoping review to map and summarize the evidence in this rapidly growing field of financial toxicity in breast cancer patients, focusing on the risk factors and outcomes for financial toxicity in breast cancer and to guide future research directions.Background Breast cancer has become the leading cause of global cancer incidence. With the improvement of treatment methods, financial toxicity among breast cancer patients has been widely studied.The aims of this study were to summarize the risk factors for and outcomes of financial toxicity among breast cancer patients, to identify populations at risk for financial toxicity, to identify the consequent health impacts, and to provide evidence for subsequent intervention programs.We searched the PubMed/MEDLINE, Web of Science, MEDLINE (Ovid), CINAHL (EBSCO), EMBASE (Ovid), ProQuest, and China National Knowledge Infrastructure databases from inception to July 21, 2022. We followed the updated framework for scoping reviews proposed by the Joanna Briggs Institute.A total of 31 studies were included. Risk factors and outcomes of financial toxicity among breast cancer patients were identified and extracted. The risk factors included socioeconomic, demographic, disease and treatment, and psychological and cognitive factors, whereas financial toxicity affected the physical, behavioral, and psychological domains of breast cancer patients, resulting in material loss, coping behaviors, and impaired health-related quality of life.Financial toxicity among breast cancer patients depends on multiple factors and has profound effects. The findings will be helpful for identifying breast cancer patients at a high risk of financial toxicity and developing intervention programs to reduce financial toxicity and outcomes. More high-quality prospective, multicenter studies should be conducted in the future to better understand the trajectory of and risk factors for financial toxicity. Further studies should merge symptom management and psychosocial support into intervention programs.According to the global cancer statistics released by the International Agency for Research on Cancer in 2020, there were an estimated 2.3 million new cases of breast cancer in 2020; therefore, breast cancer surpassed lung cancer as the leading cause of global cancer incidence, and its incidence is increasing rapidly every year.1 In Europe and China, there were estimated to be more than 530 000 new cases and 420 000 new cases, respectively, in 2020; furthermore, it is estimated that approximately 287 850 new cases of breast cancer were diagnosed in the United States in 2022.1-3 Breast cancer has become the most common type of cancer and the leading cause of cancer-related death among women, and it seriously threatens women's physical and mental health.1 With the development of advanced diagnostic techniques and treatment methods, breast cancer patients face an overwhelming medical financial burden while experiencing improved life expectancy and clinical outcomes.4,5 Generally, healthcare expenditure was considered "catastrophic" when the out-of-pocket (OOP) healthcare spending greatly exceeded a certain proportion of household income or capacity to pay.6 Research showed that the mean OOP expenditure for breast cancer patients in China in 2019 accounted for 55.20% of the mean household nonfood expenditures, whereas the overall incidence of catastrophic health expenditures reached 66.28%.6 Therefore, breast cancer still had a significant catastrophic economic impact on patients and families.To describe the adverse impacts of OOP healthcare costs for cancer patients, Zafar et al7,8 proposed the term financial toxicity, which covers both objective financial burden and subjective financial distress. A review by Smith et al9 revealed that the concept of financial toxicity included material hardships (eg, OOP medical expenditures), psychological burden (eg, financial worry), and adverse coping behaviors (eg, reduction in spending on food and necessary medications). Financial toxicity is mainly caused by high OOP costs after cancer diagnosis (direct and indirect) and the reduction in income during treatment and rehabilitation.10,11 The consequences of financial toxicity range from bankruptcy and poor health-related quality of life to worse disease outcomes.12Studies have shown that between 5% and 41% of breast cancer patients experience different degrees of financial toxicity.13-16 The occurrence of financial toxicity can lead to depression, anxiety, worse physical symptom burden, and worse quality of life.16,17 Systematically summarizing the risk factors and adverse outcomes of financial toxicity can help clinicians identify groups at a high risk of financial toxicity and develop relevant interventions to reduce financial toxicity and the incidence of adverse outcomes. The incidence of financial toxicity is related to demographic risk factors, clinical risk factors, and medical insurance status. The most commonly reported factors were female sex, younger age, non-White race, longer distance from treatment centers, unemployment, low income at baseline, adjuvant therapies, and a more recent diagnosis.9,11,12,18 However, previous systematic reviews of financial toxicity have included a wide range of cancer categories. Xu et al19 summarized existing data on the measures, prevalence, risk factors, and health-related consequences associated with financial toxicity in Chinese cancer patients in their systematic review, but only quantitative studies were included. However, some qualitative studies related to financial toxicity have emerged in recent years, providing a deeper perspective and understanding of financial toxicity.20 Moreover, only 3 of the included studies focused on breast cancer patients.19 Considering that female sex is a risk factor for financial toxicity and that the treatment methods for breast cancer are different from those of other cancers,11,12,21 previous integrated results on the financial toxicity of a wide range of cancer patients cannot fully provide a reference for breast cancer patients.Factors related to financial toxicity and the impacts of financial toxicity on patients in the field of breast cancer are still not well reported in the literature, and existing studies are heterogeneous in terms of study design, outcomes, and means of outcome assessment. A scoping review provides an overview by mapping evidence from a variety of studies using different research methodologies and representing this evidence by graphing or charting the data, which is difficult to do when performing a systematic review.22,23 Thus, we conducted this scoping review to map and summarize the evidence in this rapidly growing field of financial toxicity in breast cancer patients, focusing on the risk factors and outcomes for financial toxicity in breast cancer and to guide future research directions.Background Breast cancer has become the leading cause of global cancer incidence. With the improvement of treatment methods, financial toxicity among breast cancer patients has been widely studied.The aims of this study were to summarize the risk factors for and outcomes of financial toxicity among breast cancer patients, to identify populations at risk for financial toxicity, to identify the consequent health impacts, and to provide evidence for subsequent intervention programs.We searched the PubMed/MEDLINE, Web of Science, MEDLINE (Ovid), CINAHL (EBSCO), EMBASE (Ovid), ProQuest, and China National Knowledge Infrastructure databases from inception to July 21, 2022. We followed the updated framework for scoping reviews proposed by the Joanna Briggs Institute.A total of 31 studies were included. Risk factors and outcomes of financial toxicity among breast cancer patients were identified and extracted. The risk factors included socioeconomic, demographic, disease and treatment, and psychological and cognitive factors, whereas financial toxicity affected the physical, behavioral, and psychological domains of breast cancer patients, resulting in material loss, coping behaviors, and impaired health-related quality of life.Financial toxicity among breast cancer patients depends on multiple factors and has profound effects. The findings will be helpful for identifying breast cancer patients at a high risk of financial toxicity and developing intervention programs to reduce financial toxicity and outcomes.More high-quality prospective, multicenter studies should be conducted in the future to better understand the trajectory of and risk factors for financial toxicity. Further studies should merge symptom management and psychosocial support into intervention programs.According to the global cancer statistics released by the International Agency for Research on Cancer in 2020, there were an estimated 2. 3 million new cases of breast cancer in 2020; therefore, breast cancer surpassed lung cancer as the leading cause of global cancer incidence, and its incidence is increasing rapidly every year.1 In Europe and China, there were estimated to be more than 530 000 new cases and 420 000 new cases, respectively, in 2020; furthermore, it is estimated that approximately 287 850 new cases of breast cancer were diagnosed in the United States in 2022.1-3 Breast cancer has become the most common type of cancer and the leading cause of cancer-related death among women, and it seriously threatens women's physical and mental health.1 With the development of advanced diagnostic techniques and treatment methods, breast cancer patients face an overwhelming medical financial burden while experiencing improved life expectancy and clinical outcomes.4,5 Generally, healthcare expenditure was considered "catastrophic" when the out-of-pocket (OOP) healthcare spending greatly exceeded a certain proportion of household income or capacity to pay.6 Research showed that the mean OOP expenditure for breast cancer patients in China in 2019 accounted for 55.20% of the mean household nonfood expenditures, whereas the overall incidence of catastrophic health expenditures reached 66.28%.6 Therefore, breast cancer still had a significant catastrophic economic impact on patients and families.To describe the adverse impacts of OOP healthcare costs for cancer patients, Zafar et al7,8 proposed the term financial toxicity, which covers both objective financial burden and subjective financial distress. A review by Smith et al9 revealed that the concept of financial toxicity included material hardships (eg, OOP medical expenditures), psychological burden (eg, financial worry), and adverse coping behaviors (eg, reduction in spending on food and necessary medications). Financial toxicity is mainly caused by high OOP costs after cancer diagnosis (direct and indirect) and the reduction in income during treatment and rehabilitation.10,11 The consequences of financial toxicity range from bankruptcy and poor health-related quality of life to worse disease outcomes.12Studies have shown that between 5% and 41% of breast cancer patients experience different degrees of financial toxicity.13-16 The occurrence of financial toxicity can lead to depression, anxiety, worse physical symptom burden, and worse quality of life.16,17 Systematically summarizing the risk factors and adverse outcomes of financial toxicity can help clinicians identify groups at a high risk of financial toxicity and develop relevant interventions to reduce financial toxicity and the incidence of adverse outcomes. The incidence of financial toxicity is related to demographic risk factors, clinical risk factors, and medical insurance status. The most commonly reported factors were female sex, younger age, non-White race, longer distance from treatment centers, unemployment, low income at baseline, adjuvant therapies, and a more recent diagnosis.9,11,12,18 However, previous systematic reviews of financial toxicity have included a wide range of cancer categories. Xu et al19 summarized existing data on the measures, prevalence, risk factors, and health-related consequences associated with financial toxicity in Chinese cancer patients in their systematic review, but only quantitative studies were included. However, some qualitative studies related to financial toxicity have emerged in recent years, providing a deeper perspective and understanding of financial toxicity. 20 Moreover, only 3 of the included studies focused on breast cancer patients.19 Considering that female sex is a risk factor for financial toxicity and that the treatment methods for breast cancer are different from those of other cancers,11,12,21 previous integrated results on the financial toxicity of a wide range of cancer patients cannot fully provide a reference for breast cancer patients.Factors related to financial toxicity and the impacts of financial toxicity on patients in the field of breast cancer are still not well reported in the literature, and existing studies are heterogeneous in terms of study design, outcomes, and means of outcome assessment. A scoping review provides an overview by mapping evidence from a variety of studies using different research methodologies and representing this evidence by graphing or charting the data, which is difficult to do when performing a systematic review.22,23 Thus, we conducted this scoping review to map and summarize the evidence in this rapidly growing field of financial toxicity in breast cancer patients, focusing on the risk factors and outcomes for financial toxicity in breast cancer and to guide future research directions.Background Breast cancer has become the leading cause of global cancer incidence. With the improvement of treatment methods, financial toxicity among breast cancer patients has been widely studied.The aims of this study were to summarize the risk factors for and outcomes of financial toxicity among breast cancer patients, to identify populations at risk for financial toxicity, to identify the consequent health impacts, and to provide evidence for subsequent intervention programs.We searched the PubMed/MEDLINE, Web of Science, MEDLINE (Ovid), CINAHL (EBSCO), EMBASE (Ovid), ProQuest, and China National Knowledge Infrastructure databases from inception to July 21, 2022. We followed the updated framework for scoping reviews proposed by the Joanna Briggs Institute.A total of 31 studies were included. Risk factors and outcomes of financial toxicity among breast cancer patients were identified and extracted. The risk factors included socioeconomic, demographic, disease and treatment, and psychological and cognitive factors, whereas financial toxicity affected the physical, behavioral, and psychological domains of breast cancer patients, resulting in material loss, coping behaviors, and impaired health-related quality of life.Financial toxicity among breast cancer patients depends on multiple factors and has profound effects. The findings will be helpful for identifying breast cancer patients at a high risk of financial toxicity and developing intervention programs to reduce financial toxicity and outcomes.More high-quality prospective, multicenter studies should be conducted in the future to better understand the trajectory of and risk factors for financial toxicity. Further studies should merge symptom management and psychosocial support into intervention programs.According to the global cancer statistics released by the International Agency for Research on Cancer in 2020, there were an estimated 2.3 million new cases of breast cancer in 2020; therefore, breast cancer surpassed lung cancer as the leading cause of global cancer incidence, and its incidence is increasing rapidly every year.1 In Europe and China, there were estimated to be more than 530 000 new cases and 420 000 new cases, respectively, in 2020; furthermore, it is estimated that approximately 287 850 new cases of breast cancer were diagnosed in the United States in 2022. 1-3 Breast cancer has become the most common type of cancer and the leading cause of cancer-related death among women, and it seriously threatens women's physical and mental health.1 With the development of advanced diagnostic techniques and treatment methods, breast cancer patients face an overwhelming medical financial burden while experiencing improved life expectancy and clinical outcomes.4,5 Generally, healthcare expenditure was considered "catastrophic" when the out-of-pocket (OOP) healthcare spending greatly exceeded a certain proportion of household income or capacity to pay.6 Research showed that the mean OOP expenditure for breast cancer patients in China in 2019 accounted for 55.20% of the mean household nonfood expenditures, whereas the overall incidence of catastrophic health expenditures reached 66.28%.6 Therefore, breast cancer still had a significant catastrophic economic impact on patients and families.To describe the adverse impacts of OOP healthcare costs for cancer patients, Zafar et al7,8 proposed the term financial toxicity, which covers both objective financial burden and subjective financial distress. A review by Smith et al9 revealed that the concept of financial toxicity included material hardships (eg, OOP medical expenditures), psychological burden (eg, financial worry), and adverse coping behaviors (eg, reduction in spending on food and necessary medications). Financial toxicity is mainly caused by high OOP costs after cancer diagnosis (direct and indirect) and the reduction in income during treatment and rehabilitation.10,11 The consequences of financial toxicity range from bankruptcy and poor health-related quality of life to worse disease outcomes.12Studies have shown that between 5% and 41% of breast cancer patients experience different degrees of financial toxicity.13-16 The occurrence of financial toxicity can lead to depression, anxiety, worse physical symptom burden, and worse quality of life.16,17 Systematically summarizing the risk factors and adverse outcomes of financial toxicity can help clinicians identify groups at a high risk of financial toxicity and develop relevant interventions to reduce financial toxicity and the incidence of adverse outcomes. The incidence of financial toxicity is related to demographic risk factors, clinical risk factors, and medical insurance status. The most commonly reported factors were female sex, younger age, non-White race, longer distance from treatment centers, unemployment, low income at baseline, adjuvant therapies, and a more recent diagnosis.9,11,12,18 However, previous systematic reviews of financial toxicity have included a wide range of cancer categories. Xu et al19 summarized existing data on the measures, prevalence, risk factors, and health-related consequences associated with financial toxicity in Chinese cancer patients in their systematic review, but only quantitative studies were included. However, some qualitative studies related to financial toxicity have emerged in recent years, providing a deeper perspective and understanding of financial toxicity.20 Moreover, only 3 of the included studies focused on breast cancer patients.19 Considering that female sex is a risk factor for financial toxicity and that the treatment methods for breast cancer are different from those of other cancers,11,12,21 previous integrated results on the financial toxicity of a wide range of cancer patients cannot fully provide a reference for breast cancer patients. Factors related to financial toxicity and the impacts of financial toxicity on patients in the field of breast cancer are still not well reported in the literature, and existing studies are heterogeneous in terms of study design, outcomes, and means of outcome assessment. A scoping review provides an overview by mapping evidence from a variety of studies using different research methodologies and representing this evidence by graphing or charting the data, which is difficult to do when performing a systematic review.22,23 Thus, we conducted this scoping review to map and summarize the evidence in this rapidly growing field of financial toxicity in breast cancer patients, focusing on the risk factors and outcomes for financial toxicity in breast cancer and to guide future research directions.Background Breast cancer has become the leading cause of global cancer incidence. With the improvement of treatment methods, financial toxicity among breast cancer patients has been widely studied.The aims of this study were to summarize the risk factors for and outcomes of financial toxicity among breast cancer patients, to identify populations at risk for financial toxicity, to identify the consequent health impacts, and to provide evidence for subsequent intervention programs.We searched the PubMed/MEDLINE, Web of Science, MEDLINE (Ovid), CINAHL (EBSCO), EMBASE (Ovid), ProQuest, and China National Knowledge Infrastructure databases from inception to July 21, 2022. We followed the updated framework for scoping reviews proposed by the Joanna Briggs Institute.A total of 31 studies were included. Risk factors and outcomes of financial toxicity among breast cancer patients were identified and extracted. The risk factors included socioeconomic, demographic, disease and treatment, and psychological and cognitive factors, whereas financial toxicity affected the physical, behavioral, and psychological domains of breast cancer patients, resulting in material loss, coping behaviors, and impaired health-related quality of life.Financial toxicity among breast cancer patients depends on multiple factors and has profound effects. The findings will be helpful for identifying breast cancer patients at a high risk of financial toxicity and developing intervention programs to reduce financial toxicity and outcomes.More high-quality prospective, multicenter studies should be conducted in the future to better understand the trajectory of and risk factors for financial toxicity. Further studies should merge symptom management and psychosocial support into intervention programs.According to the global cancer statistics released by the International Agency for Research on Cancer in 2020, there were an estimated 2.3 million new cases of breast cancer in 2020; therefore, breast cancer surpassed lung cancer as the leading cause of global cancer incidence, and its incidence is increasing rapidly every year.1 In Europe and China, there were estimated to be more than 530 000 new cases and 420 000 new cases, respectively, in 2020; furthermore, it is estimated that approximately 287 850 new cases of breast cancer were diagnosed in the United States in 2022.1-3 Breast cancer has become the most common type of cancer and the leading cause of cancer-related death among women, and it seriously threatens women's physical and mental health.1 With the development of advanced diagnostic techniques and treatment methods, breast cancer patients face an overwhelming medical financial burden while experiencing improved life expectancy and clinical outcomes. 4,5 Generally, healthcare expenditure was considered "catastrophic" when the out-of-pocket (OOP) healthcare spending greatly exceeded a certain proportion of household income or capacity to pay.6 Research showed that the mean OOP expenditure for breast cancer patients in China in 2019 accounted for 55.20% of the mean household nonfood expenditures, whereas the overall incidence of catastrophic health expenditures reached 66.28%.6 Therefore, breast cancer still had a significant catastrophic economic impact on patients and families.To describe the adverse impacts of OOP healthcare costs for cancer patients, Zafar et al7,8 proposed the term financial toxicity, which covers both objective financial burden and subjective financial distress. A review by Smith et al9 revealed that the concept of financial toxicity included material hardships (eg, OOP medical expenditures), psychological burden (eg, financial worry), and adverse coping behaviors (eg, reduction in spending on food and necessary medications). Financial toxicity is mainly caused by high OOP costs after cancer diagnosis (direct and indirect) and the reduction in income during treatment and rehabilitation.10,11 The consequences of financial toxicity range from bankruptcy and poor health-related quality of life to worse disease outcomes.12Studies have shown that between 5% and 41% of breast cancer patients experience different degrees of financial toxicity.13-16 The occurrence of financial toxicity can lead to depression, anxiety, worse physical symptom burden, and worse quality of life.16,17 Systematically summarizing the risk factors and adverse outcomes of financial toxicity can help clinicians identify groups at a high risk of financial toxicity and develop relevant interventions to reduce financial toxicity and the incidence of adverse outcomes. The incidence of financial toxicity is related to demographic risk factors, clinical risk factors, and medical insurance status. The most commonly reported factors were female sex, younger age, non-White race, longer distance from treatment centers, unemployment, low income at baseline, adjuvant therapies, and a more recent diagnosis.9,11,12,18 However, previous systematic reviews of financial toxicity have included a wide range of cancer categories. Xu et al19 summarized existing data on the measures, prevalence, risk factors, and health-related consequences associated with financial toxicity in Chinese cancer patients in their systematic review, but only quantitative studies were included. However, some qualitative studies related to financial toxicity have emerged in recent years, providing a deeper perspective and understanding of financial toxicity.20 Moreover, only 3 of the included studies focused on breast cancer patients.19 Considering that female sex is a risk factor for financial toxicity and that the treatment methods for breast cancer are different from those of other cancers,11,12,21 previous integrated results on the financial toxicity of a wide range of cancer patients cannot fully provide a reference for breast cancer patients.Factors related to financial toxicity and the impacts of financial toxicity on patients in the field of breast cancer are still not well reported in the literature, and existing studies are heterogeneous in terms of study design, outcomes, and means of outcome assessment. A scoping review provides an overview by mapping evidence from a variety of studies using different research methodologies and representing this evidence by graphing or charting the data, which is difficult to do when performing a systematic review.22,23 Thus, we conducted this scoping review to map and summarize the evidence in this rapidly growing field of financial toxicity in breast cancer patients, focusing on the risk factors and outcomes for financial toxicity in breast cancer and to guide future research directions.Background Breast cancer has become the leading cause of global cancer incidence. With the improvement of treatment methods, financial toxicity among breast cancer patients has been widely studied.The aims of this study were to summarize the risk factors for and outcomes of financial toxicity among breast cancer patients, to identify populations at risk for financial toxicity, to identify the consequent health impacts, and to provide evidence for subsequent intervention programs.We searched the PubMed/MEDLINE, Web of Science, MEDLINE (Ovid), CINAHL (EBSCO), EMBASE (Ovid), ProQuest, and China National Knowledge Infrastructure databases from inception to July 21, 2022. We followed the updated framework for scoping reviews proposed by the Joanna Briggs Institute.A total of 31 studies were included. Risk factors and outcomes of financial toxicity among breast cancer patients were identified and extracted. The risk factors included socioeconomic, demographic, disease and treatment, and psychological and cognitive factors, whereas financial toxicity affected the physical, behavioral, and psychological domains of breast cancer patients, resulting in material loss, coping behaviors, and impaired health-related quality of life.Financial toxicity among breast cancer patients depends on multiple factors and has profound effects. The findings will be helpful for identifying breast cancer patients at a high risk of financial toxicity and developing intervention programs to reduce financial toxicity and outcomes.More high-quality prospective, multicenter studies should be conducted in the future to better understand the trajectory of and risk factors for financial toxicity. Further studies should merge symptom management and psychosocial support into intervention programs.According to the global cancer statistics released by the International Agency for Research on Cancer in 2020, there were an estimated 2.3 million new cases of breast cancer in 2020; therefore, breast cancer surpassed lung cancer as the leading cause of global cancer incidence, and its incidence is increasing rapidly every year.1 In Europe and China, there were estimated to be more than 530 000 new cases and 420 000 new cases, respectively, in 2020; furthermore, it is estimated that approximately 287 850 new cases of breast cancer were diagnosed in the United States in 2022.1-3 Breast cancer has become the most common type of cancer and the leading cause of cancer-related death among women, and it seriously threatens women's physical and mental health.1 With the development of advanced diagnostic techniques and treatment methods, breast cancer patients face an overwhelming medical financial burden while experiencing improved life expectancy and clinical outcomes.4,5 Generally, healthcare expenditure was considered "catastrophic" when the out-of-pocket (OOP) healthcare spending greatly exceeded a certain proportion of household income or capacity to pay.6 Research showed that the mean OOP expenditure for breast cancer patients in China in 2019 accounted for 55. 20% of the mean household nonfood expenditures, whereas the overall incidence of catastrophic health expenditures reached 66.28%.6 Therefore, breast cancer still had a significant catastrophic economic impact on patients and families.To describe the adverse impacts of OOP healthcare costs for cancer patients, Zafar et al7,8 proposed the term financial toxicity, which covers both objective financial burden and subjective financial distress. A review by Smith et al9 revealed that the concept of financial toxicity included material hardships (eg, OOP medical expenditures), psychological burden (eg, financial worry), and adverse coping behaviors (eg, reduction in spending on food and necessary medications). Financial toxicity is mainly caused by high OOP costs after cancer diagnosis (direct and indirect) and the reduction in income during treatment and rehabilitation.10,11 The consequences of financial toxicity range from bankruptcy and poor health-related quality of life to worse disease outcomes.12Studies have shown that between 5% and 41% of breast cancer patients experience different degrees of financial toxicity.13-16 The occurrence of financial toxicity can lead to depression, anxiety, worse physical symptom burden, and worse quality of life.16,17 Systematically summarizing the risk factors and adverse outcomes of financial toxicity can help clinicians identify groups at a high risk of financial toxicity and develop relevant interventions to reduce financial toxicity and the incidence of adverse outcomes. The incidence of financial toxicity is related to demographic risk factors, clinical risk factors, and medical insurance status. The most commonly reported factors were female sex, younger age, non-White race, longer distance from treatment centers, unemployment, low income at baseline, adjuvant therapies, and a more recent diagnosis.9,11,12,18 However, previous systematic reviews of financial toxicity have included a wide range of cancer categories. Xu et al19 summarized existing data on the measures, prevalence, risk factors, and health-related consequences associated with financial toxicity in Chinese cancer patients in their systematic review, but only quantitative studies were included. However, some qualitative studies related to financial toxicity have emerged in recent years, providing a deeper perspective and understanding of financial toxicity.20 Moreover, only 3 of the included studies focused on breast cancer patients.19 Considering that female sex is a risk factor for financial toxicity and that the treatment methods for breast cancer are different from those of other cancers,11,12,21 previous integrated results on the financial toxicity of a wide range of cancer patients cannot fully provide a reference for breast cancer patients.Factors related to financial toxicity and the impacts of financial toxicity on patients in the field of breast cancer are still not well reported in the literature, and existing studies are heterogeneous in terms of study design, outcomes, and means of outcome assessment. A scoping review provides an overview by mapping evidence from a variety of studies using different research methodologies and representing this evidence by graphing or charting the data, which is difficult to do when performing a systematic review.22,23 Thus, we conducted this scoping review to map and summarize the evidence in this rapidly growing field of financial toxicity in breast cancer patients, focusing on the risk factors and outcomes for financial toxicity in breast cancer and to guide future research directions.