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A Systematic Review of Financial Toxicity Among Cancer Survivors: We Can’t Pay the Co-Pay

Author

Listed:
  • Louisa G. Gordon

    (QIMR Berghofer Medical Research Institute)

  • Katharina M. D. Merollini

    (University of the Sunshine Coast)

  • Anthony Lowe

    (Prostate Cancer Foundation of Australia
    Griffith University)

  • Raymond J. Chan

    (Queensland University of Technology
    Royal Brisbane and Women’s Hospital)

Abstract

Objective To determine the extent of financial toxicity (FT) among cancer survivors, identify the determinants and how FT is measured. Methods A systematic review was performed in MEDLINE, CINAHL and PsycINFO, using relevant terminology and included articles published from 1 January, 2013 to 30 June, 2016. We included observational studies where the primary outcomes included FT and study samples were greater than 200. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Results From 417 citations, a total of 25 studies were included in this review. Seventy outcomes of FT were reported with 47 covering monetary, objective and subjective indicators of FT. A total of 28–48% of patients reported FT using monetary measures and 16–73% using subjective measures. The most commonly reported factors associated with FT were: being female, younger age, low income at baseline, adjuvant therapies and more recent diagnosis. Relative to non-cancer comparison groups, cancer survivors experienced significantly higher FT. Most studies were cross-sectional and causal inferences between FT and determinants were not possible. Measures of FT were varied and most were not validated, while monetary values of out-of-pocket expenses included different cost components across studies. Conclusions A substantial proportion of cancer survivors experience financial hardship irrespective of how it is measured. Using standardised outcomes and longitudinal designs to measure FT would improve determination of the extent of FT. Further research is recommended on reduced work participation and income losses occurring concurrently with FT and on the impacts on treatment non-adherence.

Suggested Citation

  • Louisa G. Gordon & Katharina M. D. Merollini & Anthony Lowe & Raymond J. Chan, 2017. "A Systematic Review of Financial Toxicity Among Cancer Survivors: We Can’t Pay the Co-Pay," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 10(3), pages 295-309, June.
    • Handle: RePEc:spr:patien:v:10:y:2017:i:3:d:10.1007_s40271-016-0204-x
    DOI: 10.1007/s40271-016-0204-x
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    Cited by:

    1. Katharina M. D. Merollini & Louisa G. Gordon & Joanne F. Aitken & Michael G. Kimlin, 2020. "Lifetime Costs of Surviving Cancer—A Queensland Study (COS-Q): Protocol of a Large Healthcare Data Linkage Study," IJERPH, MDPI, vol. 17(8), pages 1-16, April.
    2. Lucas Gonzalez & Andrea Alcaraz & Carolina Gabay & Monica Castro & Silvina Vigo & Eduardo Carinci & Federico Augustovski, 2023. "Health-related Quality of life, Financial Toxicity, Productivity Loss and Catastrophic Health Expenditures After Lung Cancer Diagnosis in Argentina," Papers 2312.16710, arXiv.org.
    3. Annie Bygrave & Kate Whittaker & Christine Paul & Elizabeth A. Fradgley & Megan Varlow & Sanchia Aranda, 2021. "Australian Experiences of Out-of-Pocket Costs and Financial Burden Following a Cancer Diagnosis: A Systematic Review," IJERPH, MDPI, vol. 18(5), pages 1-19, March.

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