Australian Experiences of Out-of-Pocket Costs and Financial Burden Following a Cancer Diagnosis: A Systematic Review

Abstract

(1) Background: This systematic review was conducted to identify cancer patient experiences, and the impact of out-of-pocket costs and financial burden in Australia. (2) Methods: A systematic review, following the Preferring Reporting Items for Systematic Reviews and Meta-Analyses, was conducted. Cumulative Index of Nursing and Allied Health Literature and PubMed were searched. The primary outcome was financial burden among cancer patients and their families in Australia. The secondary outcome was out-of-pocket costs associated with cancer care and treatment within the population sample, and the impact of financial burden. (3) Results: Nineteen studies were included, covering more than 70,000 Australians affected by cancer. Out-of-pocket costs varied by cancer type and ranged from an average of AUD 977 for breast cancer and lymphoedema patients to AUD 11,077 for prostate cancer patients. Younger aged patients (≤65 years), Aboriginal and Torres Strait Islander people, people in rural and/or remote areas, households with low income, those who were unemployed and people with private health insurance were at increased risk of experiencing out-of-pocket costs, financial burden or a combination of both. (4) Conclusions: Australians diagnosed with cancer frequently experience financial burden, and the health and financial consequences are significant. Focusing efforts on the costs of care and options about where to have care within the context of informed decisions about cancer care is necessary.

The impacts of unmet supportive care needs of cancer survivors in Australia: A qualitative systematic review

“…For example, financial burden was caused by the practical unmet need of a loss of ability to work (McGrath et al, 2012) and the physical unmet need of lymphoedema development after cancer treatment (Philp et al, 2017). A recent systematic review similarly revealed recurrent financial burdens resulting from out-of-pocket expenses related to cancer (Bygrave et al, 2021), despite the existence of Medicare, Australia's universal health insurance scheme. Certain populations of cancer survivors, also identified in the present review, were considered at greater risk of financial burden, including those living in nonmetropolitan regions with limited access to services and those experiencing lymphoedema (Bygrave et al, 2021).…”

“…A recent systematic review similarly revealed recurrent financial burdens resulting from out‐of‐pocket expenses related to cancer (Bygrave et al, 2021), despite the existence of Medicare, Australia's universal health insurance scheme. Certain populations of cancer survivors, also identified in the present review, were considered at greater risk of financial burden, including those living in nonmetropolitan regions with limited access to services and those experiencing lymphoedema (Bygrave et al, 2021). Financial burden on cancer survivors can be both direct (e.g., cost of medications) and indirect (e.g., inability to work, car parking fees and travel expenses) causing negative impacts on QoL and mental health (Durber et al, 2021; McLean et al, 2021).…”

Tackling the next taboo in cancer: the urgency of talking about and addressing financial toxicity

“…Although people living with and beyond cancer in lower-income countries experience higher financial toxicity, cancer patients in the United States appear particularly vulnerable because of uneven insurance coverage leading to high distress, treatments delayed or even personal bankruptcy. [9] In countries with universal health care system coverage such as Canada, [2,10] Australia, [11] France, or UK, [6] a significant proportion of cancer patients experience financial difficulties. The expenses reported in these health care systems are related to various factors (eg, follow-up visits transportation, parking fees, insurance co-payments, medications).…”

The influence of cross-regional medical treatment on total medical expenses, medical insurance payments, and out-of-pocket expenses of patients with malignant tumors in Chinese low-income areas

“…Such critical diseases are well characterized by planned cross-regional medical treatment. In addition, malignant neoplasms pose a high disease economic burden, especially for patients in low-income areas, who are also an important group for cross-regional medical care [33][34][35][36][37][38]. Therefore, this study wants to explore the influence of the temporal and spatial characteristics of cross-regional medical treatment on the total medical expenses, medical insurance payments, and individual outof-pocket expenses of patients with malignant tumors in low-income areas under the background of China's current health care policies, providing strong evidence for improving the fairness of medical security for cross-regional medical patients and reducing their direct economic burden of disease.…”