Fitch Margaret I, Sharp Linda, Hanly Paul, Longo Christopher J
Bloomberg Faculty of Nursing, University of Toronto, 207 Chisholm Ave, Toronto, Ontario, Canada.
Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK.
J Cancer Surviv. 2022 Apr;16(2):314-328. doi: 10.1007/s11764-021-01025-7. Epub 2021 Mar 15.
Understanding how patients and families experience, respond to, and cope with the financial burden associated with cancer could assist in identifying future research priorities and developing relevant interventions to assist patients and families facing financial hardship. This systematic review offers a synthesis of the qualitative evidence on cancer-related financial toxicity from the perspective of patients and/or informal caregivers in publicly funded healthcare systems where it might be expected that financial protection would be strongest.
Articles published between January 1, 2005, and March 7, 2019, describing financial burden experienced by cancer patients and/or informal caregivers were identified using OVID MEDLINE Embase and PsychInfo, CINAHL, Business Source Complete, and EconLit databases. English language, peer-reviewed qualitative papers describing studies conducted in countries with predominantly publicly funded healthcare systems were eligible. Quality appraisal was conducted using CASP Quality Appraisal Checklist. Narrative synthesis was completed with extracted data and themes identified inductively by all team members.
Twelve articles were identified as eligible. Articles reported on 10 studies conducted in Australia (n = 2), Canada (n = 2), England (n = 3), and Ireland (n = 3). The papers illustrate the complexity and multifaceted nature of experiencing financial hardship following a cancer diagnosis. Each contributes to the whole picture, providing different viewpoints regarding various and diverse forms of financial hardship, the process of confronting financial challenges, working to overcome difficulties, and coping with the resulting impacts. Synthesis of the studies suggested five themes: household and medical costs are increased, financial resources are reduced, financial change and financial hardship vary, financial hardship has many consequences, various mitigation strategies are used.
Cancer patients and their families can experience a broad range of impacts when they are facing and coping with financial toxicity. Consistent gaps in support highlight that strategies to mitigate financial effects related to travel, accommodation, medications, family support, and income replacement are needed for many patients and families even in the context of publicly funded healthcare systems.
Survivors need to be informed early in their cancer experience about the potential financial burden associated with cancer treatment and its impact on survivors and their family members.
了解患者及其家庭如何体验、应对和承受与癌症相关的经济负担，有助于确定未来的研究重点，并制定相关干预措施，以帮助面临经济困难的患者及其家庭。本系统评价从患者和/或非正式照料者的角度，对公共资助医疗体系中癌症相关经济毒性的定性证据进行了综合分析，在这种体系中，人们可能期望经济保护最为有力。
使用OVID MEDLINE、Embase、PsychInfo、CINAHL、Business Source Complete和EconLit数据库，检索2005年1月1日至2019年3月7日期间发表的描述癌症患者和/或非正式照料者所经历经济负担的文章。符合条件的是英文、同行评审的定性论文，这些论文描述了在主要由公共资助医疗体系的国家进行的研究。使用CASP质量评估清单进行质量评估。所有团队成员通过归纳提取的数据和主题完成叙述性综合分析。
确定了12篇符合条件的文章。这些文章报道了在澳大利亚（2项研究）、加拿大（2项研究）、英国（3项研究）和爱尔兰（3项研究）进行的10项研究。这些论文阐述了癌症诊断后经历经济困难的复杂性和多面性。每篇论文都为整体情况做出了贡献，提供了关于各种形式经济困难、应对经济挑战的过程、努力克服困难以及应对由此产生的影响的不同观点。研究综合分析提出了五个主题：家庭和医疗成本增加、财务资源减少、财务变化和经济困难各异、经济困难有诸多后果、采用了各种缓解策略。
癌症患者及其家庭在面对和应对经济毒性时可能会受到广泛影响。支持方面持续存在的差距表明，即使在公共资助医疗体系的背景下，许多患者和家庭也需要减轻与旅行、住宿、药物、家庭支持和收入替代相关的经济影响的策略。
幸存者需要在癌症经历早期就了解与癌症治疗相关的潜在经济负担及其对幸存者及其家庭成员的影响。
