Financial Toxicity Across the Thyroid Cancer Care Continuum: A Systematic Review.

Abstract

Objective: To describe the financial toxicity (FT) associated with thyroid cancer (TC) across the care continuum and elucidate factors contributing to FT in this patient population.

Data sources: PubMed, Embase, Cochrane, Web of Science, and Scopus.

Review methods: A systematic review was conducted of peer-reviewed studies on FT in patients with a history of TC, between 1995 and 2024, using search terms "thyroid cancer," "financial toxicity," and their relevant synonyms. Full-text, English-language studies reporting subjective (self-reported FT) and objective (out-of-pocket [OOP], employment changes, and bankruptcy) FT outcomes were included.

Results: A total of 927 studies were identified, with 13 meeting the inclusion criteria. Nine studies addressed subjective FT, with prevalence rates ranging from 16% to 47%. Younger age, lack of health insurance, belonging to a racial minority, and having a lower annual household income were significantly associated with increased FT. Patients with TC had higher OOP costs and bankruptcy rates compared to other cancer types or matched controls.

Conclusion: Despite a generally favorable prognosis, patients with TC experience significant FT, particularly among vulnerable groups such as younger individuals, the uninsured, and racial/ethnic minorities. In the setting of the rising incidence of TC, it is essential to identify and address FT in this population. Addressing FT requires a multifaceted approach, which includes incorporating financial counseling and cost discussions in routine care, ensuring comprehensive insurance coverage, and implementing employer-level protections to mitigate income and insurance loss. Further research is needed to understand the potential financial implications of different care pathways in the treatment of TC.