Financial toxicity associated with a cancer diagnosis in publicly funded healthcare countries: a systematic review
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REVIEW ARTICLE
Financial toxicity associated with a cancer diagnosis in publicly funded healthcare countries: a systematic review Christopher J. Longo 1
&
Margaret I. Fitch 2 & Laura Banfield 3 & Paul Hanly 4 & K. Robin Yabroff 5 & Linda Sharp 6
Received: 2 April 2020 / Accepted: 7 July 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Financial toxicity related to cancer diagnosis and treatment is a common issue in developed countries. We seek to systematically summarize the extent of the issue in very high development index countries with publicly funded healthcare. Methods We identified articles published Jan 1, 2005, to March 7, 2019, describing financial burden/toxicity experienced by cancer patients and/or informal caregivers using OVID Medline Embase and PsychInfo, CINAHL, Business Source Complete, and EconLit databases. Only English language peer-reviewed full papers describing studies conducted in very high development index countries with predominantly publicly funded healthcare were eligible (excluded the USA). All stages of the review were evaluated in teams of two researchers excepting the final data extraction (CJL only). Results The searches identified 7117 unique articles, 32 of which were eligible. Studies were undertaken in Canada, Australia, Ireland, UK, Germany, Denmark, Malaysia, Finland, France, South Korea, and the Netherlands. Eighteen studies reported patient/caregiver out-of-pocket costs (range US$17–US$506/month), 18 studies reported patient/caregiver lost income (range 17.6–67.3%), 14 studies reported patient/caregiver travel and accommodation costs (range US$8–US$393/month), and 6 studies reported financial stress (range 41–48%), strain (range 7–39%), or financial burden/distress/toxicity among patients/caregivers (range 22–27%). The majority of studies focused on patients, with some including caregivers. Financial toxicity was greater in those with early disease and/or more severe cancers. Conclusions Despite government-funded universal public healthcare, financial toxicity is an issue for cancer patients and their families. Although levels of toxicity vary between countries, the findings suggest financial protection appears to be inadequate in many countries. Keywords Cancer . Financial burden . Lost income . Financial stress . Financial strain . Financial toxicity . Out-of-pocket costs
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00520-020-05620-9) contains supplementary material, which is available to authorized users. * Christopher J. Longo [email protected]
1
Health Policy and Management, DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada
2
Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
Laura Banfield [email protected]
3
Health Sciences Library, McMaster University, Hamilton, Ontario, Canada
Paul Hanly [email protected]
4
National College of Ireland, Dublin, Ireland
5
Health Services Research, American Cancer Society, Atl
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