Aim: The very high cost of modern cancer treatments is raising the issue of health systems and individuals capacity to afford these resources. The term ‘financial toxicity’ is used to describe the scenario where financial distress or hardship is a side-effect of cancer treatment. This study involved a systematic review on the extent and predictors of financial toxicity in cancer survivors and to determine the role of income loss through work reductions.
Methods: A systematic review was performed on published journal articles from 2013 to June 2016. We identified studies describing financial toxicity among survivors of any cancer type and age. Searches and data extraction was performed by two researchers and the PRISMA guidelines for systematic reviews were used. Findings were synthesized narratively. Study quality was assessed using the National Institute of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.
Results: Twenty-four studies met our search criteria representing analyses performed in 16 countries and ~270,000 cancer survivors. Using monetary or objective indicators, financial toxicity was experienced in 28-38% of participants. Changes to work participation were reported by 7 studies (29%). Only 6 studies calculated cancer-related out-of-pocket expenses as a ratio of household income. In multivariate analyses, reduced work participation and associated lower income was a significant determinant of financial toxicity. Studies consistently show adjuvant therapies, more recent diagnosis, younger age and low income was significantly associated with increased financial hardship, increased treatment non-adherence and poorer quality of life. As most studies were cross-sectional and not population-based, causal and temporal inferences were not possible.
Conclusions: Financial toxicity is a complex but significant issue for many cancer survivors. Wage losses after cancer may be the most important determinant of financial decline however is not well studied compared with studies focussed on financial outgoings for cancer treatments.