Research on the issue of financial toxicity in cancer: A systematic review of the literature

Abstract

Introduction

This review aims to investigate Financial Toxicity (FT) among cancer patients across several different healthcare systems. It identifies factors that contribute to FT and proposes policies to mitigate its effects on cancer patients.

Methods

Articles published between January 1st 2017 and March 31st 2022, describing Financial Toxicity experienced by cancer patients, were identified using PubMed, Scopus, Springer, and Science Direct databases. Papers written in English language, quantitative papers describing studies conducted in countries with public and mixed healthcare systems were considered eligible.

Results

Based on 7917 records screened, 61 publications met our inclusion criteria. According to our findings, the referred prevalence of financial toxicity among cancer patients was up to 54 % in the United States, 44.7 % in high-income nations with public healthcare systems, and 80.4 % in low-income nations. Worse financial toxicity is linked to age under 65 years, low income, insurance status, high monthly out-of-pocket expenses, and cancer-related factors.

Conclusion

Financial toxicity is a widespread issue among cancer patients, and it is influenced by both socioeconomic and cancer-related factors, even in different countries and healthcare systems.

Plain language summary

Patients who suffer from cancer often face very serious financial problems. The source of these problems is the increased cost of both the treatments and the drugs that they have to take for long periods and often for their entire lives, so there is a risk that patients do not have the necessary income to cover these costs, leading to patients’ developing coping mechanisms such as not fully adhering doctors' instructions for treatment or even forgoing treatment, hence, putting their lives in immediate danger. This phenomenon is called financial toxicity.

The cost of treatments as well as the financial burden borne by patients is not the same for everyone and depends both on the coverage of these expenses provided by each country's health system and on the personal characteristics of each patient such as age, amount of income, the existence or not of insurance coverage, daily out-of-pocket expenses as well as characteristics of the cancer such as the stage, type and metastatic disease.

To improve the situation, it will be necessary to implement coordinated efforts between patients, providers, health systems, payers, and policy makers at multiple levels.

For example, to tackle financial toxicity among cancer patients, tools could be implemented to identify those most vulnerable, considering factors like income, insurance coverage, and treatment costs. Hospitals could also establish financial counseling structures to help patients make the best treatment decisions based on to their financial status.