Financial toxicity and employment status in cancer survivors. A systematic literature review
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REVIEW ARTICLE
Financial toxicity and employment status in cancer survivors. A systematic literature review Floortje Mols 1,2
&
Bianca Tomalin 3 & Alison Pearce 4,6
&
Billingsley Kaambwa 5
&
Bogda Koczwara 3
Received: 16 April 2020 / Accepted: 26 August 2020 # The Author(s) 2020
Abstract Background Financial toxicity has traditionally been attributed to the rising costs of cancer care. As ability to work impacts one’s financial situation, limited employment and reduced income may also contribute to financial toxicity. We examined evidence of the association between financial toxicity and employment status in cancer survivors. Methods A systematic literature review was performed via PubMed, Web of Science, CINAHL, and PsycINFO with search terms including “Cancer,” “Financial toxicity,” and “Employment” on September 25, 2019. Results Thirty-one papers met eligibility criteria. Thirteen studies were rated as having high quality, 16 as adequate, and two as low. Being actively treated for cancer had serious negative consequences on employment and medical expenditures. Unemployment, changed or reduced employment, lost days at work, poor work ability, and changes to employment were associated with a higher risk of financial toxicity. Patients who were younger, non-white, unmarried, of low education, living with dependents, residing in non-metropolitan service areas, with lower income, and of low socioeconomic status were more at risk of financial toxicity. Other variables associated with financial toxicity included having a mortgage/personal loan, higher out of pocket costs and household bills, limited health insurance, more severely ill, on active treatment, and lower functioning or quality of life. Conclusion Cancer negatively affects employment, and these changes are significant contributors to financial toxicity. Researchers, healthcare professionals, and patients themselves should all cooperate to tackle these complex issues. Keywords Financial toxicity . Employment . Cancer survivors . Costs
Abbreviations MeSH Medical Subject Heading MM Multiple myeloma
OOP PRISMA QOL (USA)
out-of-pocket Preferred Reporting Items for Systematic Reviews and Meta-Analyses Quality of life United States of America
* Floortje Mols [email protected] 1
CoRPS—Center of Research on Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
2
Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
3
Flinders Centre for Innovation in Cancer (FCIC), Flinders Medical Centre and Flinders University, Adelaide, SA, Australia
4
Centre for Health Economics Research and Evaluations, University of Technology Sydney, Sydney, NSW, Australia
5
Health Economics, Flinders University, Adelaide, SA, Australia
6
Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
Introduction Financial toxicity refers to the financial burden or financial hardship experienced by cancer survivors because
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