A Systematic Review of Financial Toxicity Among Cancer Survivors: We Can’t Pay the Co-Pay

Objective To determine the extent of financial toxicity (FT) among cancer survivors, identify the determinants and how FT is measured. Methods A systematic review was performed in MEDLINE, CINAHL and PsycINFO, using relevant terminology and included articles published from 1 January, 2013 to 30 June...

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Vydáno v:	The patient : patient-centered outcomes research Ročník 10; číslo 3; s. 295 - 309
Hlavní autoři:	Gordon, Louisa G., Merollini, Katharina M. D., Lowe, Anthony, Chan, Raymond J.
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	Cham Springer International Publishing 01.06.2017 Springer Nature B.V
Témata:	Cancer Survivors - statistics & numerical data Cancer therapies Cost Sharing - economics Cross-Sectional Studies Evidence-based medicine Financing, Personal - economics Health Administration Health care expenditures Health care policy Health Economics Health Expenditures - statistics & numerical data Health insurance Humans Insurance policies Medical debt Medicine Medicine & Public Health Patients Pharmacoeconomics and Health Outcomes Prostate cancer Public Health Quality of Life Research Systematic Review Terminology Toxicity Cancer Survivor MeSH Financial Hardship Medical Tourism Financial Burden
ISSN:	1178-1653, 1178-1661
On-line přístup:	Získat plný text
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Abstract	Objective To determine the extent of financial toxicity (FT) among cancer survivors, identify the determinants and how FT is measured. Methods A systematic review was performed in MEDLINE, CINAHL and PsycINFO, using relevant terminology and included articles published from 1 January, 2013 to 30 June, 2016. We included observational studies where the primary outcomes included FT and study samples were greater than 200. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Results From 417 citations, a total of 25 studies were included in this review. Seventy outcomes of FT were reported with 47 covering monetary, objective and subjective indicators of FT. A total of 28–48% of patients reported FT using monetary measures and 16–73% using subjective measures. The most commonly reported factors associated with FT were: being female, younger age, low income at baseline, adjuvant therapies and more recent diagnosis. Relative to non-cancer comparison groups, cancer survivors experienced significantly higher FT. Most studies were cross-sectional and causal inferences between FT and determinants were not possible. Measures of FT were varied and most were not validated, while monetary values of out-of-pocket expenses included different cost components across studies. Conclusions A substantial proportion of cancer survivors experience financial hardship irrespective of how it is measured. Using standardised outcomes and longitudinal designs to measure FT would improve determination of the extent of FT. Further research is recommended on reduced work participation and income losses occurring concurrently with FT and on the impacts on treatment non-adherence.
AbstractList	To determine the extent of financial toxicity (FT) among cancer survivors, identify the determinants and how FT is measured. A systematic review was performed in MEDLINE, CINAHL and PsycINFO, using relevant terminology and included articles published from 1 January, 2013 to 30 June, 2016. We included observational studies where the primary outcomes included FT and study samples were greater than 200. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. From 417 citations, a total of 25 studies were included in this review. Seventy outcomes of FT were reported with 47 covering monetary, objective and subjective indicators of FT. A total of 28-48% of patients reported FT using monetary measures and 16-73% using subjective measures. The most commonly reported factors associated with FT were: being female, younger age, low income at baseline, adjuvant therapies and more recent diagnosis. Relative to non-cancer comparison groups, cancer survivors experienced significantly higher FT. Most studies were cross-sectional and causal inferences between FT and determinants were not possible. Measures of FT were varied and most were not validated, while monetary values of out-of-pocket expenses included different cost components across studies. A substantial proportion of cancer survivors experience financial hardship irrespective of how it is measured. Using standardised outcomes and longitudinal designs to measure FT would improve determination of the extent of FT. Further research is recommended on reduced work participation and income losses occurring concurrently with FT and on the impacts on treatment nonadherence. Objective To determine the extent of financial toxicity (FT) among cancer survivors, identify the determinants and how FT is measured. Methods A systematic review was performed in MEDLINE, CINAHL and PsycINFO, using relevant terminology and included articles published from 1 January, 2013 to 30 June, 2016. We included observational studies where the primary outcomes included FT and study samples were greater than 200. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Results From 417 citations, a total of 25 studies were included in this review. Seventy outcomes of FT were reported with 47 covering monetary, objective and subjective indicators of FT. A total of 28–48% of patients reported FT using monetary measures and 16–73% using subjective measures. The most commonly reported factors associated with FT were: being female, younger age, low income at baseline, adjuvant therapies and more recent diagnosis. Relative to non-cancer comparison groups, cancer survivors experienced significantly higher FT. Most studies were cross-sectional and causal inferences between FT and determinants were not possible. Measures of FT were varied and most were not validated, while monetary values of out-of-pocket expenses included different cost components across studies. Conclusions A substantial proportion of cancer survivors experience financial hardship irrespective of how it is measured. Using standardised outcomes and longitudinal designs to measure FT would improve determination of the extent of FT. Further research is recommended on reduced work participation and income losses occurring concurrently with FT and on the impacts on treatment non-adherence. OBJECTIVETo determine the extent of financial toxicity (FT) among cancer survivors, identify the determinants and how FT is measured.METHODSA systematic review was performed in MEDLINE, CINAHL and PsycINFO, using relevant terminology and included articles published from 1 January, 2013 to 30 June, 2016. We included observational studies where the primary outcomes included FT and study samples were greater than 200. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed.RESULTSFrom 417 citations, a total of 25 studies were included in this review. Seventy outcomes of FT were reported with 47 covering monetary, objective and subjective indicators of FT. A total of 28-48% of patients reported FT using monetary measures and 16-73% using subjective measures. The most commonly reported factors associated with FT were: being female, younger age, low income at baseline, adjuvant therapies and more recent diagnosis. Relative to non-cancer comparison groups, cancer survivors experienced significantly higher FT. Most studies were cross-sectional and causal inferences between FT and determinants were not possible. Measures of FT were varied and most were not validated, while monetary values of out-of-pocket expenses included different cost components across studies.CONCLUSIONSA substantial proportion of cancer survivors experience financial hardship irrespective of how it is measured. Using standardised outcomes and longitudinal designs to measure FT would improve determination of the extent of FT. Further research is recommended on reduced work participation and income losses occurring concurrently with FT and on the impacts on treatment non-adherence. To determine the extent of financial toxicity (FT) among cancer survivors, identify the determinants and how FT is measured. A systematic review was performed in MEDLINE, CINAHL and PsycINFO, using relevant terminology and included articles published from 1 January, 2013 to 30 June, 2016. We included observational studies where the primary outcomes included FT and study samples were greater than 200. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. From 417 citations, a total of 25 studies were included in this review. Seventy outcomes of FT were reported with 47 covering monetary, objective and subjective indicators of FT. A total of 28-48% of patients reported FT using monetary measures and 16-73% using subjective measures. The most commonly reported factors associated with FT were: being female, younger age, low income at baseline, adjuvant therapies and more recent diagnosis. Relative to non-cancer comparison groups, cancer survivors experienced significantly higher FT. Most studies were cross-sectional and causal inferences between FT and determinants were not possible. Measures of FT were varied and most were not validated, while monetary values of out-of-pocket expenses included different cost components across studies. A substantial proportion of cancer survivors experience financial hardship irrespective of how it is measured. Using standardised outcomes and longitudinal designs to measure FT would improve determination of the extent of FT. Further research is recommended on reduced work participation and income losses occurring concurrently with FT and on the impacts on treatment non-adherence.
Author	Chan, Raymond J. Gordon, Louisa G. Merollini, Katharina M. D. Lowe, Anthony
Author_xml	– sequence: 1 givenname: Louisa G. surname: Gordon fullname: Gordon, Louisa G. email: louisa.gordon@qimrberghofer.edu.au organization: Population Health, QIMR Berghofer Medical Research Institute – sequence: 2 givenname: Katharina M. D. surname: Merollini fullname: Merollini, Katharina M. D. organization: Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast – sequence: 3 givenname: Anthony surname: Lowe fullname: Lowe, Anthony organization: Prostate Cancer Foundation of Australia, Menzies Health Institute Queensland, Griffith University – sequence: 4 givenname: Raymond J. surname: Chan fullname: Chan, Raymond J. organization: School of Nursing, Queensland University of Technology, Cancer Care Services, Royal Brisbane and Women’s Hospital
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/27798816$$D View this record in MEDLINE/PubMed
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Snippet	Objective To determine the extent of financial toxicity (FT) among cancer survivors, identify the determinants and how FT is measured. Methods A systematic... To determine the extent of financial toxicity (FT) among cancer survivors, identify the determinants and how FT is measured. A systematic review was performed... To determine the extent of financial toxicity (FT) among cancer survivors, identify the determinants and how FT is measured. A systematic review was performed... OBJECTIVETo determine the extent of financial toxicity (FT) among cancer survivors, identify the determinants and how FT is measured.METHODSA systematic review...
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SubjectTerms	Cancer Survivors - statistics & numerical data Cancer therapies Cost Sharing - economics Cross-Sectional Studies Evidence-based medicine Financing, Personal - economics Health Administration Health care expenditures Health care policy Health Economics Health Expenditures - statistics & numerical data Health insurance Humans Insurance policies Medical debt Medicine Medicine & Public Health Patients Pharmacoeconomics and Health Outcomes Prostate cancer Public Health Quality of Life Research Systematic Review Terminology Toxicity
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Title	A Systematic Review of Financial Toxicity Among Cancer Survivors: We Can’t Pay the Co-Pay
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