Access to cancer medicines in Kenya: a scoping review of costs, financial toxicity, quality of life and policy impacts.

Background: Cancer, Kenya's third leading cause of death, imposes severe health and economic burdens, through high treatment costs and limited availability of cancer medicines. However, the full evidence landscape is fragmented. In this scoping review, we synthesise evidence on access to cancer medicines, financial toxicity (FT), Quality of life (QoL) and health policy impacts for the top five cancers in Kenya. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-analysis; extension for Scoping Reviews guidelines, we searched PubMed, African Journals Online, Google Scholar and grey literature (January 2018-May 2025) for studies on Kenyan adults, focusing on breast, cervical, prostate, esophageal or colorectal cancers. Eligible studies reporting outcomes on medicine access, FT, QoL or National/Social health insurance fund/Authority (SHA) were included. Studies were screened using Rayyan software and data synthesised descriptively and thematically. Results: A total of 60 articles were included. About one-quarter addressed health policy (15, 25%), while others focused on multiple objectives (14, 23.3%), medicine access (12, 20%), FT (10, 16.7%) and QoL (9, 15%). Most studies focused on breast (63%) and cervical cancers (50%). Medicine affordability was poor, costing 3.15-162.42 days of minimum wage per chemotherapy cycle, exceeding the World Health Organisation threshold, particularly for regimens including Trastuzumab. Public facility availability was below 50%, with procurement delays (4-8 months) contributing to stockouts. Treatment costs for stage I-III cancers ranged from USD 1,340-1,542 in public versus 10,915-11,862 in private facilities. FT affected 20%-54% of households and treatment abandonment due to costs was reported in over half (53.8%) of patients. QoL was generally poor (median scores 41.99-53), associated with FT and late-stage diagnosis (71% stage III/IV). Insurance provided inadequate coverage, although SHA's KES 400,000 cap showed potential to reduce costs despite underfunding and limited adoption of expert advice. Major evidence gaps included the scarcity of data regarding pricing and catastrophic health expenditure measures. Conclusion: High treatment costs, limited medicine availability and inadequate financial protection constrain access to cancer medicines in Kenya. Strengthening supply chains, expanding insurance coverage and improving measurement of FT are critical to inform policies aimed at improving equitable access to cancer treatment in Kenya.