Patient-Reported Financial Distress in Cancer: A Systematic Review of Risk Factors in Universal Healthcare Systems
Abstract
:Simple Summary
Abstract
1. Introduction
- (a)
- Material conditions: impact of individual financial spending and financial resources used (e.g., more expenses than expected, use of saving to cover spending)
- (b)
- Psychosocial response: individual perception and psychological consequences of financial burden (e.g., concerns or worry about financial situation)
- (c)
- Coping behaviour: personal approach to cope with financial burden (e.g., using financial assistance or reducing leisure activities)
2. Methods
2.1. Information Sources, Search Strategy and Study Selection
2.2. Eligibility Criteria
2.3. Quality Appraisal
2.4. Data Extraction and Qualitative Synthesis
3. Results
3.1. Measuring Subjective Financial Distress
3.2. Quality Appraisal
3.3. Risk Factors for Experiencing Financial Toxicity
3.3.1. Categories of Risk Factors and Their Prevalence
3.3.2. Incidence of Risk Factors during the Course of the Disease
3.3.3. Quantified Influence of Risk Factors
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics | Quantitative Studies (n = 30) | Qualitative Studies (n = 16) |
---|---|---|
Study design Cross-sectional study Cohort study | 23 7 | 15 1 |
Continent setting Asia Australia/New Zealand Europe North America | 3 8 19 1 | 0 4 8 4 |
Cancer entities Gastrointestional Gynaecological Head and neck Haematological malignancies Skin Thorac Urogenital Other Unspecified | 17 17 8 5 3 8 12 7 0 | 4 9 0 2 0 6 6 0 6 |
Time since diagnosis 0–2 years after diagnosis 2–5 years after diagnosis >5 years after diagnosis Unspecified | 21 4 5 8 | 2 1 0 13 |
Sample size Minimum Median Arithmetic mean Maximum | 43 278.5 915.3 8830 | 8 22.5 80.75 378 |
Definition Instrument | Material | Psychosocial | Behavioural | Not Reported |
---|---|---|---|---|
Full questionnaire (n = 6) Validated Non-validated | 5 1 | 5 1 | 0 1 | 0 0 |
Subscale (n = 28) Validated Non-validated | 15 6 | 0 9 | 0 3 | 0 0 |
Interviews (n = 13) Individual interviews Focus groups | 10 0 | 5 1 | 5 0 | 2 0 |
Categories | Subcategories | Promotive | Preventive |
---|---|---|---|
Sociodemographic factors | Age | Age < 65 [31,45,49] Age > 65 [31] Increasing age (until 60 years) [47] Increasing age [46,47] | Greater Age [55] Age > 64 [42,57] Increasing Age [43,47,51,54,69] |
Country | Depending on country of living [61] | ||
Education | High Education [69] | ||
Familial status | Being single [54,55] Being divorced or separated [46] Having one or more dependants [56,58] | Living in a family home [45] Being married, living with partner [47,69] | |
Gender | Male [47] Female [7,54] | ||
Geography | Living in a major city [62] Living away from treatment center [70] | ||
Socioeconomic status | Medium or high socioeconomic status [47] | ||
Social circumstances | Support | Support by family and friends [56] | |
Medical and treatment related factors | Time since occurrence | Short time since diagnosis (<1 year) [31] Longer time since diagnosis (>5 years) [31] Long-term survivor (5–9 years) [30,31] Very long-term survivor (>10 years) [28,30,31] | Medium time since diagnosis (3 years since diagnosis) [31] |
Cancer Status | Metastatic cancer [54,55] Cancer entity [47] | ||
Treatment | Combination therapy (surgery + X) [39,57], Surgery [55] Stoma [56] | Undergoing psychological counselling [39] | |
Well-being | Comorbidities > 2 [39] Higher scores of HADS or ESAS [46,55] Poor social/family well-being [46] | Low HADS-D score [55] High emotional, cognitive, social functioning [47,55] Better functional and social well-being [55] | |
Financial resources | Pre-diagnosisfinancial status | Lower income [54,58,62] Less income in metropolitan region [62] Pre-diagnosis financial stress [57,58] | Having savings [43] |
Financial impact | Objective financial burden [7,54] Subjective financial difficulties [54,59] | ||
Coping | Using up savings [56] Having no savings to use up [56] | ||
Financial spending | Cancer-related total costs | Total costs [69] OOP costs [49,69] | |
Direct medical costs | High direct medical costs [58] | Low direct medical costs [58] | |
Direct non-medical costs | Increased household bills [58] | ||
Consequences of OOP | Coping strategies used to cover expenses [43] | ||
Financial commitment | Having a mortgage and/or personal loan(s) [58] | ||
Employment | Return to work | Change in: - Working hours [27] - Leaving former employment [27,32] | |
Pre-diagnosis work status | Change in work status because of cancer: - Becoming unemployed [39] - Retiring [39,43] - Disabled [39] Working part-time [43] | Work status before diagnosis: - Having paid employment [47] - Not working [58] - Being retired [58] | |
Insurance | Health insurance | Obtaining healthcare assistance after diagnosis [58] | Private health insurance [7,44,49,58] |
Categories | Subcategories | Risk Factors |
---|---|---|
Social circumstances | Family | Distress through children at home or in education [36,65] Illness of further family members [52] Work adjustments of carers [35] Social isolation [64] |
Financial role | Cancer patient as previous main earner of family [36,41,68] | |
Social activities | Reduction in leisure activities [36] | |
Support | Financial support by family members [35,36] Community and NGOs’ support [68,71] | |
Financial resources | Pre-diagnosis financial status | Income of partner [36] |
Financial commitment | Home owner/mortgage [41,52,64,68] Repayments of credits [68] Expenses for dependant children [33] | |
Financial support | Contributions through social security system [64,68] Receiving sick pay [33,64] Coverage of private insurance [36,68,71] | |
Financial spending | Consequences of OOP costs | Economising on household expenditure [35,36] - Expenses for daily living [33,65,67] - Transportation [67] - Major purchases [67] - Medical remedies [67] - Holidays [67] - Leisure acitivities [67] |
Employment | Return to work | Return to work during disease [65,67] |
Direct implications | Changes in employment during disease [33,35,41,48,52,63,65,71] Loss/reduction in income [35,36,37,48,52,63,65,66] Changes in partner’s employment [63,65,71] | |
Employer | Employer benefit scheme [35,36,52,65,71] Supportive employer [48] Working in public sector [36] | |
Insurance | Health insurance | Increased insurance premiums [33] Time between travel expenses and reimbursement [52] |
Social security system | Disability coverage [34,65,66] Institutional support [36,48,64,67] Ineligible for social welfare benefits [64] | |
Knowledge | Access to healthcare | Treatment provider [71] Expenses [71] |
Access to social benefits | Lack of knowledge about available benefits [34,36,37] Dealing with bureaucratic system [34] | |
Assistance | Assistance by social worker/welfare rights advisor [34,36] Time between diagnosis and receipt of advice [36,37] Professionals who did not alert patients to benefit entitlements [37] | |
Knowledge about illness | Cancer-related financial distress [33] Course of disease [33] | |
Personal beliefs and attitudes | Stigma of financial distress [33] Negative attitudes benefit system [36,37] Beliefs about the extent and severity of illness [36] |
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Share and Cite
Pauge, S.; Surmann, B.; Mehlis, K.; Zueger, A.; Richter, L.; Menold, N.; Greiner, W.; Winkler, E.C. Patient-Reported Financial Distress in Cancer: A Systematic Review of Risk Factors in Universal Healthcare Systems. Cancers 2021, 13, 5015. https://doi.org/10.3390/cancers13195015
Pauge S, Surmann B, Mehlis K, Zueger A, Richter L, Menold N, Greiner W, Winkler EC. Patient-Reported Financial Distress in Cancer: A Systematic Review of Risk Factors in Universal Healthcare Systems. Cancers. 2021; 13(19):5015. https://doi.org/10.3390/cancers13195015
Chicago/Turabian StylePauge, Sophie, Bastian Surmann, Katja Mehlis, Andrea Zueger, Luise Richter, Natalja Menold, Wolfgang Greiner, and Eva C. Winkler. 2021. "Patient-Reported Financial Distress in Cancer: A Systematic Review of Risk Factors in Universal Healthcare Systems" Cancers 13, no. 19: 5015. https://doi.org/10.3390/cancers13195015
APA StylePauge, S., Surmann, B., Mehlis, K., Zueger, A., Richter, L., Menold, N., Greiner, W., & Winkler, E. C. (2021). Patient-Reported Financial Distress in Cancer: A Systematic Review of Risk Factors in Universal Healthcare Systems. Cancers, 13(19), 5015. https://doi.org/10.3390/cancers13195015