Evidence on the influence of economic variables on breast and cervical cancer treatment in South Asia: Implications for healthcare strengthening - A scoping review

Background Cancer, particularly breast and cervical cancers, is a global health concern, mainly affecting Low- and Middle-Income Countries (LMICs). This highlights a rising burden on people, families, and healthcare systems. This scoping review aims to identify both the direct costs and the indirect costs associated with cervical and breast cancer treatment. Additionally, it seeks financial barriers and enablers to access breast and cervical cancer treatment in South Asia. Using the methodology developed by "Arksey and O'Malley" and "Levac et al.", we searched multiple electronic databases to identify relevant records. We then synthesised and discussed the results, using the Financial Framework model, adopted by Carrera PM, to examine financial toxicity in the treatment of cancer patients. Of the 192 records identified, 76 duplicates were removed and 116 screened, resulting in 12 included studies. The included studies reported substantial variation in the economic burden of breast and cervical cancer across India, Pakistan, Nepal and Afghanistan. Reported estimates included treatment-modality-specific costs, monthly expenditures, patient-level costs during diagnosis and treatment, and aggregate institutional costs. In India, cervical cancer treatment-modality costs ranged from USD 291 to USD 617, while one government-sponsored treatment study reported the most frequent breast-cancer claim category as INR 10,000–49,999 (USD 154.98–774.88), accounting for 87 of 181 cases (48.1%); the source-reported mean claim amount was INR 48,477 (USD 748.97). In Pakistan, the mean direct medical, direct non-medical and indirect costs for breast cancer were USD 1262.18, USD 310.88 and USD 273.38, respectively. In Afghanistan, one study reported an aggregate institutional treatment cost of USD 212,848.38 for breast cancer at Jamhuriyat Hospital in 2020.