South Africa's speech-language therapy (SLT) and audiology professions face challenges in achieving linguistic and cultural integration (i.e., the meaningful incorporation of diverse linguistic and cultural perspectives into training and practice), a critical aspect for effectively serving the country's diverse population. Limited curriculum content on indigenous languages and cultural competence, along with low diversity of academic and clinical training staff (staff), may hinder students' preparedness for multilingual and multicultural clinical practice. This study explored undergraduate students' views and self-reported practices regarding linguistic and cultural integration during their professional training. To explore the views and practices of South African SLT and audiology undergraduate students concerning linguistic and cultural integration in their training. A cross-sectional convergent mixed-methods survey design was used to gather quantitative and qualitative data from a purposive sample of 48 third- and fourth-year SLT and audiology students across four South African universities. Data were collected using a structured online questionnaire, including Likert-scale items and open-ended questions. Quantitative data were analysed using descriptive and inferential statistics, while thematic analysis was applied to qualitative responses. Within this sample, participants recognised the importance of linguistic and cultural competence but report feeling inadequately prepared to implement these skills in clinical settings. Key barriers included insufficient curriculum coverage of cultural topics, reliance on untrained interpreters, and a lack of bilingual resources. Students from indigenous language backgrounds reported higher ratings of the importance of linguistic integration than their English-speaking peers (p < .05). Qualitative themes suggested a perceived need for greater curriculum responsiveness, increased staff diversity, and enhanced institutional support to facilitate culturally competent practice. These exploratory findings suggest that curriculum responsiveness, institutional support, and staff diversity may warrant further consideration within ongoing efforts aimed at improving student preparedness for practice in South Africa's multilingual and multicultural healthcare environment. These findings point to the need for ongoing educational transformation efforts to better serve the diverse needs of the South African population.
Work time management is an important aspect in organizing medical care. Current regulations do not establish recommended time limits for audiologists. To determine the time spent on audiologist's appointments and performing various diagnostic and rehabilitation procedures. At the City Audiology Center for Adults (St Petersburg), a time estimate was conducted for 10 audiologists who performed various medical diagnostic and rehabilitation audiology services. The advisability of standardizing audiologist's appointment duration to 30 minutes was established (for adult patients, without an instrumental audiological assessment or 60 minutes if an assessment (pure tone audiometry, acoustic impedance, otoacoustic emissions) is included). The results of medical appointments for diagnostic tests (acoustic impedance, speech audiometry, nasopharyngeal endoscopy, otoacoustic emissions, auditory brainstem response (ABR), ASSR, central auditory processing disorders tests, and vestibular tests) and rehabilitation interventions (hearing aid issuance, selection, or fitting of hearing aids) are determined. The obtained data can be used for inclusion in specialized regulatory documents governing the activities of audiologists and otolaryngologists. Нормирование труда является важным аспектом при организации оказания медицинской помощи. Действующими нормативно-правовыми актами не установлены рекомендованные нормы приема врача — сурдолога-оториноларинголога. Определить временные затраты на прием врача — сурдолога-оториноларинголога и выполнение различных диагностических и реабилитационных мероприятий. На базе Городского сурдологического центра для взрослых СПб ГБУЗ «Городской гериатрический медико-социальный центр» проведен хронометраж рабочего времени 10 врачей — сурдологов-оториноларингологов, которые оказывали различные медицинские диагностические и реабилитационные услуги сурдологического профиля. Целесообразно установить нормированное время базового приема врачом — сурдологом-оториноларингологом взрослого пациента без проведения инструментального аудиологического обследования в объеме 30 мин, а с проведением обследования (тональная пороговая аудиометрия, акустическая импедансометрия и регистрация отоакустической эмиссии) — 60 мин. Представлены результаты хронометража врачебных приемов по проведению диагностических исследований (акустической импедансометрии, речевой аудиометрии, эндоскопии носоглотки, регистрации отоакустической эмиссии и коротколатентных слуховых вызванных потенциалов (КСВП, ASSR-тест), проведения тестов для диагностики центральных слуховых расстройств, исследования вестибулярного анализатора) и реабилитационных мероприятий (выдача слуховых аппаратов, подбор или настройка имеющихся слуховых аппаратов). Полученные данные могут быть использованы для включения в профильные нормативные документы, регулирующие деятельность врача — сурдолога-оториноларинголога.
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Clinical care for patients who report substantial hearing difficulties despite having little or no hearing loss is a topic of great debate within and beyond audiology. Building on our previous retrospective review of veterans evaluated for auditory processing disorders across the Veterans Health Administration (VHA), the current work presents five such case studies. The goal is to work toward improved patient care by providing a more in-depth view highlighting both strengths and weaknesses of approaches to care for veterans whose hearing difficulties are not explained by hearing loss. Five case studies were selected for review with the goal of identifying individuals with a wide range of etiologies and experiences receiving care for auditory complaints across the VHA. All information provided is taken directly from chart notes available from VHA and Defense Health Agency sources. Etiologies included traumatic brain injury, jet fuel exposure, and nonspecific origins. Some patients experienced well-coordinated care across medical departments, while others experienced repeated barriers and high burdens of self-advocacy while trying to navigate the health care system. Furthermore, differences in the approach of audiologists and speech-language pathologists are highlighted, including differing emphasis on diagnostic tests versus self-report measures and use of top-down versus bottom-up rehabilitation tools. This work highlights several options likely to improve care for veterans with auditory processing deficits, including greater emphasis on addressing patient-specific needs and goals, improved communication and collaboration between audiology and other medical disciplines, and the potential role for auditory device-based rehabilitation options, even among patients with minimal hearing loss.
Rural populations face distinctive challenges that may hinder their ability to access health services, including speech-language pathology and audiology. To address this, our speech-language pathology program partnered with local agencies and traveled to neighboring rural communities to provide speech and hearing services in central Pennsylvania for a minimal investment.
Benign paroxysmal positional vertigo (BPPV) is the most prevalent vestibular disorder in clinical practice, yet its diagnosis and management remain challenging for trainees due to their procedural and interpretation-dependent nature. Existing teaching approaches are often variable, lack standardisation, and provide limited support for skill acquisition. While multimedia learning is increasingly adopted in medical education, few resources are systematically developed and rigorously validated, particularly in vestibular training. This study aimed to develop and validate the content and face validity of the SMART-BPPV multimedia learning tool for BPPV education. This methodological study followed the ADDIE instructional design framework. After completion of the analysis, design, and development phases, the module underwent structured content and face validation. Seven experts in otorhinolaryngology and audiology assessed content relevance and clarity using a 4-point scale. Item- and scale-level Content Validity Indices (I-CVI, S-CVI/Ave) and chance-corrected agreement statistics were calculated. Face validity was evaluated by 30 medical officers assessing clarity, usability, and relevance. The module demonstrated excellent content validity (S-CVI/Ave = 0.987; I-CVI = 0.857-1.000; k* = 0.848-1.000). Interrater agreement using Gwet's AC1 was near-perfect (0.976), while Fleiss' κ (- 0.01) reflected the known paradox associated with highly uniform ratings. Face validity was similarly high (S-FVI/Ave = 0.999; I-FVI = 0.967-1.000). Qualitative feedback consistently highlighted clarity, logical organisation, and effective visual design, with minor refinements incorporated. SMART-BPPV demonstrated excellent content and face validity, supporting its suitability as a structured educational resource for introductory BPPV education. Future studies should evaluate its impact on knowledge acquisition and procedural performance.
Sodium thiosulfate (STS) has recently been approved as an otoprotectant for systemic use in pediatric cancer patients receiving cisplatin treatment for localized, nonmetastatic solid tumors by the Food and Drug Administration, European Medicines Agency, and Medicines and Healthcare Products Regulatory Agency. While incorporating STS into the current standard of care pediatric practice, questions about uniform, timely, and safe administration are raised that may benefit from additional guidance. Recognizing that advancing clinical practice presents multiple challenges, an international onco-ototoxicity prevention task force, including experts in pediatric oncology, audiology, and pharmacology, was established to identify potential barriers to the implementation of otoprotection and to offer practical solutions for clinical services for children exposed to cisplatin, based on available evidence, as well as consensus where data are less robust. This task force held several online meetings and a working group session at the annual SIOPE meeting in Milan in May 2024, where the challenges for implementing STS were outlined and addressed. Nine key challenges were identified, including, for example, the timing of both cisplatin infusion and STS administration, the optimal integration of STS into existing treatment protocols, potential drug interactions, and relevant economic considerations. In this article, we propose practical steps to address these challenges, informed by the existing literature and expert opinion, incorporating recommendation statements from the international onco-ototoxicity prevention task force on behalf of the SIOP Supportive Care Network, to facilitate the implementation of STS in children with localized, nonmetastatic disease.
In addition to a gap detection threshold, an auditory gap detection task also provides information on response time. This study investigated the association of response time from an adaptive gap detection task with two validated measures of cognitive processing speed as well as scores from a cognitive screener, while accounting for the effects of age, peripheral hearing ability, and HIV status. Participants (age 17-45 years) were from a prospective cohort study in Dar es Salaam, Tanzania with normal hearing ability and no reported neurological diseases. The final sample included 283 unique subjects (158 living with HIV, 125 without HIV) matched on age and sex. Multiple linear regression models were employed to assess the relationship between gap response time and cognitive processing speed scores from the Tests of Variables of Attention, Cogstate test battery, and Montreal Cognitive Assessment. Regression analysis showed significant relationships between gap response time and all processing speed scores, except one. Age showed varying degrees of association with different processing speed measures, but peripheral hearing ability did not show any significant relationship with speed measures. This study identifies a link between cognitive processing speed and gap detection response times. With further validation, gap detection response times could emerge as a straightforward yet informative measure of cognitive processing speed and would expand the clinical usefulness of the gap test. In the audiology clinic, this measure may hold promise as a tool for detecting and monitoring cognitive decline.
The problem of hearing impairment in children remains of high medical and social significance, as it negatively affects speech development, social adaptation, and quality of life. Early rehabilitation plays a crucial role, and parental involvement is a key factor in success. In the Russian Federation, ear diseases account for 5% of the structure of childhood disability, necessitating the development of accessible regional rehabilitation programs with active family involvement. To present a comprehensive regional rehabilitation program for children with hearing impairments in the Ivanovo region, developed with the support of the National Medical Research Center for Otorhinolaryngology of the FMBA of Russia, and to describe its main modules aimed at actively involving parents in the process of hearing restoration, speech development, and social adaptation of the child. This work is based on an analysis of the experience of implementing the regional program at the audiology department of the Ivanovo Regional Clinical Hospital with the participation of the Department of Otorhinolaryngology of Ivanovo State Medical University. The description is based on program documentation, session protocols, and interviews with participants (specialists and parents). A qualitative and descriptive analysis was conducted, identifying key modules, rehabilitation stages, and the roles of specialists. The program includes comprehensive diagnostics (audiological, speech therapy, psychological), an individualized rehabilitation plan, and a differentiated approach for users of hearing aids and cochlear implants. Educational modules for parents have been developed: psychological education, training in device handling, communication strategies, parental coaching, psychological support, social navigation, monitoring, and supervision. Innovative components include theater therapy and vocal lessons, which contribute to the development of prosody and strengthen parent-child relationships. The program is implemented by a multidisciplinary team (audiologist, ENT physician, speech-language pathologist, psychologist, social worker, coordinator) in accordance with a calendar model (0-1 month, 1-6 months, 6-24 months, preschool and school stages). Distance learning formats are provided for families from remote areas. The regional program of the Ivanovo region represents an example of a comprehensive family-centered approach that integrates modern evidence-based rehabilitation methods. This experience can serve as a model for the development of similar programs in other regions. Further research will be aimed at quantitative evaluation of the effectiveness of the described modules. Нарушения слуха у детей имеют большое социально-медицинское значение, поскольку негативно влияют на речевое развитие, социальную адаптацию и качество жизни. Ранняя реабилитация играет решающую роль, а участие родителей является ключевым фактором успеха. В Российской Федерации заболевания уха составляют 5% в структуре детской инвалидности, что обусловливает необходимость создания доступных региональных программ реабилитации с активным вовлечением семьи. Представить комплексную региональную программу реабилитации детей с нарушениями слуха в Ивановской области, разработанную при поддержке НМИЦО ФМБА России, и описать ее основные модули, направленные на активное вовлечение родителей в процесс восстановления слуха, развития речи и социальной адаптации ребенка. В основу работы положен анализ опыта реализации региональной программы на базе сурдологического кабинета Ивановской областной клинической больницы при участии кафедры оториноларингологии ФГБОУ ВО «Ивановский ГМУ» Минздрава России. Описание основано на документации программы, протоколах занятий и интервью с участниками (специалистами и родителями). Проведен качественный и описательный анализ с выделением ключевых модулей, этапов реабилитации и роли специалистов. Программа включает комплексную диагностику (аудиологическую, логопедическую, психологическую), индивидуальный план реабилитации и дифференцированный подход для пользователей слуховых аппаратов и кохлеарных имплантов. Разработаны образовательные модули для родителей: психологическое образование, обучение обращению с техникой, коммуникативные стратегии, родительский коучинг, психологическая поддержка, социальная навигация, мониторинг и супервизия. Инновационными компонентами выступают театральная терапия и вокальные занятия, способствующие развитию просодики и укреплению детско-родительских отношений. Программа реализуется мультидисциплинарной командой (аудиолог, врач-оториноларинголог, логопед-дефектолог, психолог, социальный работник, координатор) в соответствии с календарной моделью (0—1 мес, 1—6 мес, 6—24 мес, дошкольный и школьный этапы). Предусмотрены дистанционные формы работы для семей из отдаленных районов. Региональная программа Ивановской области представляет собой пример комплексного семейно-центрированного подхода, интегрирующего современные научно обоснованные методы реабилитации. Опыт может служить моделью для создания аналогичных программ в других регионах. Дальнейшие исследования будут направлены на количественную оценку эффективности описанных модулей.
Hearing and balance disorders represent some of the most challenging conditions encountered in pediatric healthcare [...].
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Measures of speech intelligibility in noise show limited correspondence with difficulties people with hearing loss report from daily life. This mismatch suggests that standard measurement conditions do not sufficiently capture aspects that are relevant for speech perception, such as dip listening and spatial release from masking. In the present study we developed and evaluated a test condition that incorporates these aspects and compared it with a standard condition. Speech intelligibility was measured in 100 participants with normal hearing (NH, N=17) and hearing loss (HL, N=83) ranging from mild to severe. Measurements were conducted using the German matrix sentence test (OLSA) in the standard condition with frontal presentation of stationary noise co-located with the target speech, and the proposed condition with fluctuating, speech-like maskers spatially separated (±60°) from the target. Stimuli were presented via headphones using virtual acoustics. Tests were performed unaided and with individualized amplification. The proposed condition revealed reduced speech intelligibility also for listeners with HL that showed close-to-normal speech intelligibility in the standard condition. With individualized amplification, more listeners with HL showed reduced speech intelligibility compared to NH listeners than in the standard condition. Benefit of amplification varied widely across individuals with similar hearing thresholds, with some listeners showing little or no benefit. The advantages of the proposed condition were driven by masker fluctuations rather than by spatial separation of sound sources. These findings demonstrate that speech intelligibility measurements incorporating fluctuating maskers provide potentially relevant information beyond standard assessments and can support a more individualized assessment of hearing loss.
Children with cleft lip and palate (CLP) frequently experience middle-ear dysfunction and conductive hearing loss, which may affect functional listening in noise. This study examined speech-in-noise recognition and visual-task latency cost during concurrent auditory-visual task performance in children with unilateral CLP and minimal conductive hearing loss. Twenty-five children with unilateral CLP and minimal conductive hearing loss and 28 age-matched typically developing controls, aged 7-15 years, completed audiological assessment, a single-task speech-in-noise condition (SIN), a concurrent auditory-visual condition combining speech recognition in noise with a randomized visual saccade task (SIN-WS), and a saccade-only condition. Word recognition accuracy and mean saccadic latency were recorded. Articulation was assessed in the CLP group using a standardized cleft speech assessment. Children with CLP showed poorer word recognition accuracy than controls in both SIN and SIN-WS conditions. Model-based analysis showed significant main effects of group and condition, whereas the Group × Condition interaction for word recognition was not significant. Mean saccadic latency increased during the concurrent-task condition in both groups, with a significantly greater increase in the CLP group. Within the CLP group, higher articulation error counts were associated with poorer word recognition accuracy and greater saccadic-latency cost. Children with unilateral CLP and minimal conductive hearing loss showed reduced speech-in-noise recognition and greater visual-task latency cost during concurrent auditory-visual task performance. These findings support the clinical value of assessing functional listening beyond isolated auditory thresholds in children with CLP.
There is increasing interest among ear, nose, and throat (ENT) surgeons in performing ultrasound and ultrasound-guided fine-needle aspiration biopsy (US-FNAB). Surgeon-performed ultrasound has the potential to streamline the diagnostic pathway and reduce waiting times for patients evaluated for suspected head and neck cancer. However, concerns have been raised about diagnostic accuracy when surgeons, rather than radiologists, perform US-FNAB. This study aimed to assess the diagnostic quality and time to diagnosis of surgeon-performed US-FNAB with same-day cytology for all patients referred to an academic head and neck cancer outpatient clinic. This retrospective study reviewed patients' records from a fast-track head and neck cancer outpatient clinic. All patients underwent surgeon-performed US-FNAB with same-day final cytological evaluation by a dedicated cytopathologist. Data included demographics, biopsy site, cytology and histology results, and time from referral to a diagnostic plan. The primary outcome was the inadequacy rate of US-FNAB from cytology reports, while the secondary outcomes included the time to diagnostic plan and diagnostic accuracy. The time to the diagnostic plan was defined as the time from referral to the establishment of a final diagnostic plan. Diagnostic accuracy was assessed using US-FNAB results and final histology diagnoses when available. A total of 155 US-FNAB samples from 117 patients were analyzed. The overall inadequacy rate was 11%, with the highest rate observed in thyroid lesions (five of 23; 21.7%). No significant difference was found between residents (5.6%) and consultants (15.3%) (p=0.054). Same-day cytology results were available for 114 (97.4%) patients. A diagnostic plan was established at the initial visit in 71 (60.7%) cases, while the remaining patients had a median time to diagnostic plan of 11.5 days (IQR 8-16). The overall median time from referral to diagnostic plan was six days (IQR 4-16). Histopathological correlation was available for 62 (53%) patients. The risk of malignancy was 0% for benign, 45.5% for undetermined, 29.4% for suspicious for malignancy, and 85.2% for malignant cytology. Surgeon-performed US-FNABs with same-day cytology achieved high adequacy rates, allowing most patients to receive a diagnostic plan during their initial visit. Residents performed similarly to consultants, supporting the feasibility of integrating US-FNAB into routine practice across different experience levels.
Conversations are an important part of our social lives, although for people with hearing impairment (HI), conversations can pose a considerable challenge and can often lead to miscommunications. In conversations recorded from 25 groups consisting of one HI interlocutor and two normal hearing (NH) interlocutors, all miscommunications were identified to evaluate how HI, background noise level, and hearing-aid signal processing affected miscommunications. A subset of miscommunications is so-called other-initiated repairs (OIRs) where one interlocutor signals a communication breakdown, using unspecific open requests (e.g., "What?") or increasingly more specific restricted requests or offers (e.g., "Who?" or "Did you say blue?"). An "open request" signals a problem without specifying what is misheard/understood, while the restricted request specifies what part of the sentence is not heard, and finally, the most specific "restricted offer" is asking the conversation partner to confirm the supposed word/phrase. With increasing communication difficulty, open OIRs are expected to be more frequently used due to poorer speech understanding. The results showed that HI interlocutors generally had more miscommunications and that, across interlocutors, open OIRs were mostly used. At low noise levels, the HI interlocutor had fewer miscommunications and used more specific OIRs when wearing a hearing aid relative to being unaided. At the high noise level, all interlocutors had more miscommunications. When listening to directional sound processing (dir) at the high noise level, the HI interlocutor produced fewer open OIRs. It is interesting that the NH interlocutors were also affected by having more miscommunications and more open OIRs when the HI interlocutor listened to dir. The speech levels of the HI interlocutors were reduced in dir, and a relationship was found between the HI speech levels and the number of OIRs made by the NH interlocutors. Our results highlight how sensitive the number and nature of miscommunications and OIRs in conversations are, not only to the sound environment, but also to the experience of a single (HI) interlocutor, even in triadic interactions, where only two interlocutors are strictly needed to keep the conversation going.
Integrating auditory and visual information can improve intelligibility and neural tracking of the speech envelope. Speech-relevant tactile information also improves tracking, yet effects on intelligibility are mixed, possibly due to no regular exposure to speech-relevant tactile information. We used short-term audio-tactile training to advance understanding of audio-tactile integration during speech perception. 64 younger adult participants (aged 18-29) took part over five days, during which electroencephalography was recorded. Participants completed a speech-in-noise task, with audio-tactile and audio-only stimuli. They then received training with either tactile information that was congruent with sentences heard (trained group) or incongruent (pseudo-trained group). After three training sessions, participants completed the speech-in-noise task again. Two weeks later, participants returned for a follow-up. Effect of session (pre- or post-training) on speech intelligibility was significant, with no significant effect of group (trained, or pseudo-trained) or stimulus (audio-only, or audio-tactile). Before training, there was a significant increase in speech-envelope tracking accuracy with audio-tactile stimuli, suggesting enhanced neural representation of audio-tactile stimuli. However, there was no benefit of congruent training to audio-tactile tracking. There was an enhancement of audio-only speech-envelope tracking following incongruent training. This suggests that speech intelligibility and tracking of audio-tactile speech are not enhanced by short-term training. This work challenges prevailing assumptions by demonstrating increased speech-envelope tracking accuracy that was not linked to enhanced speech intelligibility. However, these findings are limited to short-term, bottom-up audio-tactile training. Alternate training approaches and further controls, such as tactile-only sentences or audio-only training groups, should be explored in future research.
Timely access to hearing technology is paramount to ensure early auditory access to the sounds needed for listening and learning in children with early hearing loss (HL). Although children typically move to cochlear implants (CIs) after first having tried hearing aids (HAs), there are some cases where the HA trial may create unnecessary additional delays. This clinical focus article presents three categories of patients where implantation appears warranted without an HA trial. This study examines 3 years of retrospective chart data for pediatric CI patients at a tertiary care center who did not complete an HA trial before surgery. We identified 22 cases and examined their diagnostic audiological profiles and preimplant trajectory of care. Our results coalesced around three broad categories where omission of the HA trial appears warranted: cases of late-onset/progressive HL, cases of children lost to follow-up after newborn hearing screening, and cases of auditory neuropathy spectrum disorder where hearing technology was deferred until behavioral testing was possible. Following surgery, we observed wide variability in device use rates, suggesting that some families may struggle with full-time use of CIs despite the streamlined candidacy process. Taken together, our results show that, in appropriate cases, CIs may be considered for children with HL without first completing an HA trial. This has important implications for closing the timing gaps introduced by loss to follow-up in the United States' national Early Hearing Detection and Intervention program.
With age-related hearing loss on the rise and a large bilingual (BI) population in the United States, there is an increasing need for effective assessment tools for Spanish-speaking and BI older adults. Research in this area is limited. The AzBio Sentence Test (AzBio) is used to assess speech perception in challenging listening environments. A Spanish version was recently developed to address the needs of Spanish-speaking patients, and opens new opportunities for research with BI individuals to better understand speech perception processes in both the native and the second language. This preliminary study aims to explore the characteristics of speech recognition among older BI adults by examining the performance of younger and older proficient Spanish-English BIs on the AzBio in quiet and noisy conditions. Preliminary quasi-experimental group design. Twenty-one participants were divided into three groups: eight young American English monolinguals (M = 28.12 years, range: 24-32), eight young Spanish-English BIs (M = 28.38 years, range: 23-33), and five older Spanish-English BIs (M = 58 years, range: 55-62). The AzBio was used to assess speech perception in quiet and noisy conditions in both English and Spanish, with two signal-to-noise ratios: 0 and -3 dB. Independent and paired sample statistical tests were conducted. In quiet conditions, older BIs outperformed younger ones on the Spanish version, whereas younger BIs performed better in English. However, for the older group, the linguistic advantage observed in quiet conditions disappeared in noisy environments, because performance differences with the younger group diminished when background noise was introduced. Young monolinguals and BIs showed no difference in performance on the English version. Aging poses challenges for speech recognition in noisy environments. For BIs, these difficulties extend to both languages, including the dominant one. The combined effects of bilingualism and aging negatively impact speech recognition in both languages. Understanding how individuals perform on the AzBio and other BI sentence recognition tools is essential for improving clinical assessment and intervention for those impacted by language background and age-related hearing changes.
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Financial toxicity (FT), encompassing objective and subjective impacts of cancer care costs, is linked to poorer quality of life, reduced treatment adherence, and higher mortality. While patient-level risk factors have been examined, a system-level perspective incorporating socioeconomic context is needed to understand global variation in FT. MEDLINE, CINAHL, Embase, and Web of Science were searched from inception to 06/27/2025 for peer-reviewed, English-language studies describing self-reported FT outcomes among adults with cancer. Reviewers extracted study characteristics, FT prevalence, predictors, and measurement tools. Financial, physical, and social asset measures from the World Bank were merged with FT data by study country and year of data collection. Focusing on studies reporting Comprehensive Score for Financial Toxicity (COST) scores, multilevel random effects meta-analysis was performed. Univariate and multivariate multilevel meta-regression evaluated relationships between country-level assets and COST. One hundred thirty-two studies from 22 countries were included, with FT prevalence ranging from 4.0% to 100.0%. Three-level meta-analysis of 75 COST-based studies (15 countries; 83,623 patients) yielded a pooled mean COST score of 21.2 (95% CI: 19.1-23.3; 95% prediction interval: 13.3-32.4), though substantial heterogeneity (I2 = 99.2%) and a predominance of studies from the US (55%) limited its standalone interpretability. Variance decomposition showed that 46% of heterogeneity was attributable to between-country differences. Higher log GDP per capita was associated with higher COST (β = 4.44, 95% CI: 2.90-5.98), explaining 43.1% of between-country variance. Higher out-of-pocket health expenditure, population-level financial hardship, and vulnerable employment were associated with worse FT. GDP associations were robust to sensitivity analyses excluding US-based studies. FT among cancer patients is linked to structural conditions governing access to education, employment, and financial systems, although expanded research in low-resource settings is needed. These findings highlight the roles of economic development strategies and investment in human capital in helping to safeguard against population-level FT.