Financial Hardships Experienced by Cancer Survivors: A Systematic Review

Abstract

Background: With rising cancer care costs, including high-priced cancer drugs, financial hardship is increasingly documented among cancer survivors in the United States; research findings have not been synthesized.

Methods: We conducted a systematic review of articles published between 1990 and 2015 describing the financial hardship experienced by cancer survivors using PubMed, Embase, Scopus, and CINAHL databases. We categorized measures of financial hardship into: material conditions (eg, out-of-pocket costs, productivity loss, medical debt, or bankruptcy), psychological responses (eg, distress or worry), and coping behaviors (eg, skipped medications). We abstracted findings and conducted a qualitative synthesis.

Results: Among 676 studies identified, 45 met the inclusion criteria and were incorporated in the review. The majority of the studies (82%, n = 37) reported financial hardship as a material condition measure; others reported psychological (7%, n = 3) and behavioral measures (16%, n = 7). Financial hardship measures were heterogeneous within each broad category, and the prevalence of financial hardship varied by the measure used and population studied. Mean annual productivity loss ranged from $380 to $8236, 12% to 62% of survivors reported being in debt because of their treatment, 47% to 49% of survivors reported experiencing some form of financial distress, and 4% to 45% of survivors did not adhere to recommended prescription medication because of cost.

Conclusions: Financial hardship is common among cancer survivors, although we found substantial heterogeneity in its prevalence. Our findings highlight the need for consistent use of definitions, terms, and measures to determine the best intervention targets and inform intervention development in order to prevent and minimize the impact of financial hardship experienced by cancer survivors.

Figure 1.

Financial hardship typology. The typology illustrates and provides examples of the three broad domains of financial hardship: the material conditions that arise from the increased out-of-pocket expenses and potentially lower income that results from the inability to work during/following cancer treatment; the psychological response to the increase in household expenses that must now be managed as patients navigate cancer care; and the coping behaviors that patients adopt to manage their medical care while experiencing increased household expenses during/following cancer care.

Figure 2.

Studies by year of publication. The figure depicts the distribution of peer-reviewed manuscripts from studies that measure financial hardship from cancer between 1990–2015.