The burden of cancer is a major global challenge, with approximately 20 million new cases and 9.7 million deaths in 2022. By 2040, cancer-related deaths could reach 15.3 million annually, and new cases may rise to nearly 30 million. High HDI countries will see the largest absolute increase, while low and medium HDI nations will face the highest proportional rises, with death rates expected to nearly double by 2050.

This issue is particularly severe in low- and middle-income regions, where inadequate data on cancer prevalence hampers effective intervention. Factors such as limited resources, poor health informatics, and cultural barriers contribute to this problem, perpetuating neglect and inadequate care.

Financial toxicity (FT)—the financial strain from cancer treatment—can lead to nonadherence, reduced quality of life, and increased mortality. Patients with comorbidities often experience heightened FT, especially in high out-of-pocket expense environments. Low-income patients are particularly vulnerable due to limited financial reserves and job instability.

Despite extensive research on cancer patients in high-income countries, there is a notable lack of studies in low- and middle-income countries (LMICs), limiting our understanding of FT's impact in these regions.

This multicenter study aims to explore FT and its effects on mental health among cancer patients in LMICs, including Egypt, Iraq, Armenia, and Georgia. The findings will highlight the connection between financial stress and psychological distress, identify specific risk factors, and inform targeted interventions to improve patient outcomes and support systems in cancer care.