Relationships Between Financial Toxicity and Symptom Burden in Cancer Survivors: A Systematic Review

• Published in: Journal of pain and symptom management Vol. 57; no. 3; pp. 646 - 660.e1
• Main Authors: Chan, Raymond Javan, Gordon, Louisa G., Tan, Chia Jie, Chan, Alexandre, Bradford, Natalie K., Yates, Patsy, Agbejule, Oluwaseyifunmi Andi, Miaskowski, Christine
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2019; Elsevier Limited
• Subjects: Anxiety; Anxiety - psychology; Cancer; Cancer survivors; Cancer Survivors - psychology; Cost of Illness; Depression - psychology; Emotional distress; Evidence-based medicine; Fatigue - psychology; Fear & phobias; financial burden; financial toxicity; Humans; Medical debt; Mental depression; Pain; Physical symptoms; Psychological distress; Psychological problems; Quality of Life; Recurrence; Suffering; Survivor; symptom burden; symptom distress; Systematic review; Cancer survivors; symptom burden; symptom distress; financial toxicity; systematic review; financial burden
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2018.12.003

Financial toxicity (FT) is used to describe the financial distress/hardship associated with cancer and its treatment. The aim of this review was to explore the relationship between FT and symptom burden. A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE, EMBASE, and CINAHL (from January 2000 to January 2018) and accepted quantitative, mixed-methods and qualitative studies. Data were extracted and appraised by two reviewers. Owing to significant heterogeneity in the included studies, a narrative synthesis was performed. Nine studies involving 11,544 cancer survivors were included. Of these nine studies, eight were of high quality. The relationships between FT and psychological symptoms and physical symptoms were examined in eight and three studies, respectively. Six studies reported a positive relationship between FT and depression. Three studies found a positive association between FT and anxiety. Limited evidence was found for an association between FT and stress, fear of recurrence, spiritual suffering, pain, and overall symptom burden. A relatively clear association exists between FT and psychological symptoms. Clinicians should regularly screen for, assess, and manage emotional distress that may be attributed to FT. Although the causal pathway is not known, future intervention studies aimed at minimizing or preventing FT should evaluate psychological symptoms as secondary outcomes. Little is known about the relationships between FT and physical symptoms. Future research should overcome methodological limitations by incorporating longitudinal data collection, use of mixed-methods approaches, and homogeneity of samples.