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Cancer treatment-related financial toxicity experienced by patients in low- and middle-income countries: a scoping review

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Abstract

Purpose

In the past decade, literature has called attention to financial toxicities experienced by cancer patients. Though studies have addressed research questions in high-income countries, there remains a paucity of in-depth reviews regarding low- and middle-income countries (LMICs). Our scoping review provides an overview of treatment-related financial toxicities experienced by cancer patients in LMICs.

Methods

A systematic search was conducted in MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials. English peer-reviewed articles that (a) explored patients’ experience with financial toxicity due to cancer treatment (b) were specific to LMICs as defined by the World Bank and (c) focused on qualitative data were included. Details regarding participants and main findings were extracted and synthesized.

Results

The search yielded 6290 citations, and 42 studies across 3 low-income, 9 lower-middle-income and 8 upper-middle-income countries. Main themes identified included cancer patients encountered various material hardships, managed costs with different coping behaviours and experienced negative psychological responses to their financial burden. Higher levels of financial toxicities were associated with patient characteristics such as lower socio-economic status and lack of insurance, as well as patient outcomes such as lower quality of life.

Conclusion

Cancer patients in LMIC experience deleterious financial toxicities as a result of treatment. This comprehensive characterization of financial toxicities will better allow health systems to adopt evidence-based mitigation strategies to reduce the financial burden on patients.

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Data availability

All data generated or analysed during this study are included in this published article (and its supplementary information files).

Code availability

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Acknowledgements

The authors are thankful to Mr. Henry Lam from Sunnybrook Library Services for his expert guidance on search strategy. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Sunnybrook Research Institute, Toronto, ON, Canada

    Suji Udayakumar, Eden Solomon & Kelvin K. W. Chan

  2. Health Intervention and Technology Assessment Program, Bangkok, Thailand

    Wanrudee Isaranuwatchai

  3. Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada

    Danielle L. Rodin

  4. Princess Margaret Cancer Centre, Toronto, ON, Canada

    Danielle L. Rodin

  5. St. Michael’s Hospital, Toronto, ON, Canada

    Yoo-Joung Ko

  6. Department of Medicine, University of Toronto, Toronto, ON, Canada

    Yoo-Joung Ko, Kelvin K. W. Chan & Ambica Parmar

  7. Odette Cancer Centre, Sunnybrook Health Sciences Centre, ON, Toronto, Canada

    Kelvin K. W. Chan & Ambica Parmar

  8. Canadian Centre for Applied Research in Cancer Control, Toronto, ON, Canada

    Kelvin K. W. Chan

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  1. Suji Udayakumar
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Contributions

S.U., K.K.W.C. and A.P. were involved in conception and design. S.U. and E.S. performed the literature search and data analysis. S.U. drafted the work and all authors critically revised the work.

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Correspondence to Ambica Parmar.

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Kelvin K. W. Chan and Ambica Parmar contributed equally

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Udayakumar, S., Solomon, E., Isaranuwatchai, W. et al. Cancer treatment-related financial toxicity experienced by patients in low- and middle-income countries: a scoping review. Support Care Cancer 30, 6463–6471 (2022). https://doi.org/10.1007/s00520-022-06952-4

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