Financial toxicity of cancer care in low- and middle-income countries: a systematic review and meta-analysis.

Abstract

INTRODUCTION:

The costs associated with cancer diagnosis, treatment and care present enormous financial toxicity. However, evidence of financial toxicity associated with cancer in low- and middle-income countries (LMICs) is scarce.

AIM:

To determine the prevalence, determinants and how financial toxicity has been measured among cancer patients in LMICs.

METHODS:

Four electronic databases were searched to identify studies of any design that reported financial toxicity among cancer patients in LMICs. Random-effects meta-analysis was used to derive the pooled prevalence of financial toxicity. Sub-group analyses were performed according to costs and determinants of financial toxicity.

RESULTS:

A total of 31 studies were included in this systematic review and meta-analysis. The pooled prevalence of objective financial toxicity was 56.96% (95% CI, 30.51, 106.32). In sub-group meta-analyses, the objective financial toxicity was higher among cancer patients with household size of more than four (1.17% [95% CI, 1.03, 1.32]; p = 0.02; I2 = 0%), multiple cycles of chemotherapy (1.94% [95% CI, 1.00, 3.75]; p = 0.05; I2 = 43%) and private health facilities (2.87% [95% CI, 1.89, 4.35]; p < 0.00001; I2 = 26%). Included studies hardly focused primarily on subjective measures of financial toxicity, such as material, behavioural and psychosocial. One study reported that 35.4% (n = 152 of 429) of cancer patients experienced high subjective financial toxicity.

CONCLUSIONS:

This study indicates that cancer diagnosis, treatment and care impose high financial toxicity on cancer patients in LMICs. Further rigorous research on cancer-related financial toxicity is needed.

• Authors: Andrew Donkor, Vivian Della Atuwo-Ampoh, Frederick Yakanu, Eric Torgbenu, Edward Kwabena Ameyaw, Doris Kitson-Mills, Verna Vanderpuye, Kofi Adesi Kyei, Samuel Anim-Sampong, Omar Khader, Jamal Khader
• Journal: Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer (Support Care Cancer) Vol. 30 Issue 9 Pg. 7159-7190 (Sep 2022) ISSN: 1433-7339 [Electronic] Germany
• PMID: 35467118 (Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)
• Copyright: © 2022. The Author(s).

Topics

• Developing Countries
• Financial Stress
• Humans
• Neoplasms (therapy)
• Poverty
• Prevalence