Financial Burdens of Cancer Treatment: A Systematic Review of Risk Factors and Outcomes

Abstract

Background: Patients with cancer experience financial toxicity from the costs of treatment, as well as material and psychologic stress related to this burden. A synthesized understanding of predictors and outcomes of the financial burdens associated with cancer care is needed to underpin strategic responses in oncology care. This study systematically reviewed risk factors and outcomes associated with financial burdens related to cancer treatment. Methods: MEDLINE, Embase, PubMed, PsychINFO, and the Cochrane Library were searched from study inception through June 2018, and reference lists were scanned from studies of patient-level predictors and outcomes of financial burdens in US patients with cancer (aged ≥18 years). Two reviewers conducted screening, abstraction, and quality assessment. Variables associated with financial burdens were synthesized. When possible, pooled estimates of associations were calculated using random-effects models. Results: A total of 74 observational studies of financial burdens in 598,751 patients with cancer were identified, among which 49% of patients reported material or psychologic financial burdens (95% CI, 41%–56%). Socioeconomic predictors of worse financial burdens with treatment were lack of health insurance, lower income, unemployment, and younger age at cancer diagnosis. Compared with patients with health insurance, those who were uninsured demonstrated twice the odds of financial burdens (pooled odds ratio [OR], 2.09; 95% CI, 1.33–3.30). Financial burdens were most severe early in cancer treatment, did not differ by disease site, and were associated with worse health-related quality of life (HRQoL) and nearly twice the odds of cancer medication nonadherence (pooled OR, 1.70; 95% CI, 1.13–2.56). Only a single study demonstrated an association with increased mortality. Studies assessing the comparative effectiveness of interventions to mitigate financial burdens in patients with cancer were lacking. Conclusions: Evidence showed that financial burdens are common, disproportionately impacting younger and socioeconomically disadvantaged patients with cancer, across disease sites, and are associated with worse treatment adherence and HRQoL. Available evidence helped identify vulnerable patients needing oncology provider engagement and response, but evidence is critically needed on the effectiveness of interventions designed to mitigate financial burden and impact.

Off‐label prescribing of targeted anticancer therapy at a large pediatric cancer center

“…13 The slightly higher frequency of public insurance seen in our study may reflect the duration of illness and consequent financial impact on families, as the number of patients with public insurance generally increases over time, either as an addition to their private insurance or as a sole insurance for families who may have experienced financial burden. 14,15 Due to limitations of our study design, the impact of insurance coverage on access to off-label targeted therapies was not studied and should be investigated in the future. The comparable frequency of public insurance in our study to that seen in published data suggests that a significant proportion of patients had access to treatment despite potential barriers to access for publicly insured children.…”

The power of one: Evaluating the impact of a single multi‐disciplinary treatment visit on time to treatment

“…A diagnosis of breast cancer can be overwhelming for patients and their families. Delays in completing pretreatment evaluations and consultations can lengthen TTI causing further distress for patients and may worsen outcomes including survival 2,5,6 . We therefore have continued our initiatives to reduce TTI, focusing on enhanced communication and lean processes while identifying barriers to single visits.…”

“…Patients often require consultations with breast surgery, medical oncology, radiation oncology, and potentially plastic surgery and/or medical genetics in order to develop a treatment plan, regardless of whether treatment starts with surgery or systemic therapy. However, these consultations often require multiple trips to the center for the patient, potentially delaying time to treatment initiation (TTI), as well as increasing costs for patients 2 . This represents a major challenge as studies have previously demonstrated that increasing TTI is associated with distress for patients as well as potentially having a negative impact on survival 3 .…”

USP4 function and multifaceted roles in cancer: a possible and potential therapeutic target

“…It is estimated that people suffering from cancers will increase to over 29.5 million globally by 2040 [ 1 ]. The occurrence of cancers can cause great financial burden and psychologic stress to both individuals and the whole society due to various factors, such as lower income, unemployment and the time-consuming and inefficiency adjuvant and palliative therapy, especially to younger and socioeconomically disadvantaged patients [ 2 , 3 ]. Insidious onset, early metastasis and scarce effective targeted drugs may cause tumor refractory and recurrence, especially in lung cancer and pancreatic cancer, which can lead to a higher mortality [ 4 , 5 ].…”