The intersection of travel burdens and financial hardship in cancer care: a scoping review

Abstract

Background: In addition to greater delays in cancer screening and greater financial hardship, rural-dwelling cancer patients experience greater costs associated with accessing cancer care, including higher cumulative travel costs. This study aimed to identify and synthesize peer-reviewed research on the cumulative and overlapping costs associated with care access and utilization.

Methods: A scoping review was conducted to identify relevant studies published after 1995 by searching 5 electronic databases: PubMed, Scopus, Cumulative Index of Nursing and Allied Health Literature (CINAHL), PsycInfo, and Healthcare Administration. Eligibility was determined using the PEO (Population, Exposure, and Outcomes) method, with clearly defined populations (cancer patients), exposures (financial hardship, toxicity, or distress; travel-related burdens), and outcomes (treatment access, treatment outcomes, health-related quality of life, and survival/mortality). Study characteristics, methods, and findings were extracted and summarized.

Results: Database searches yielded 6439 results, of which 3366 were unique citations. Of those, 141 were eligible for full-text review, and 98 studies at the intersection of cancer-related travel burdens and financial hardship were included. Five themes emerged as we extracted from the full texts of the included articles: 1) Cancer treatment choices, 2) Receipt of guideline-concordant care, 3) Cancer treatment outcomes, 4) Health-related quality of life, and 5) Propensity to participate in clinical trials.

Conclusions: This scoping review identifies and summarizes available research at the intersection of cancer care-related travel burdens and financial hardship. This review will inform the development of future interventions aimed at reducing the negative effects of cancer-care related costs on patient outcomes and quality of life.

Figure 1.

PRISMA flow diagram. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram detailing the number of records in the initial database searches, the number of records whose abstracts we reviewed, and, thereafter, the number of full-text records that were screened and synthesized for this review.

Figure 2.

Conceptual framework linking cancer screening and care access inequities with financial burdens. A conceptual model representing potential relationships between inequities in cancer-related care access before and after diagnosis, and the financial burden of cancer care, with downstream outcomes that include worsened health-related quality of life (HRQoL), increased symptom burden, and increased risk of mortality. In this model, we introduce stress pathways (the biopsychosocial dimensions of financial burden or hardship) as a link between these dual burdens and worse patient outcomes among cancer survivors.