Financial toxicity and employment status in cancer survivors. A systematic literature review

• Published in: Supportive care in cancer Vol. 28; no. 12; pp. 5693 - 5708
• Main Authors: Mols, Floortje, Tomalin, Bianca, Pearce, Alison, Kaambwa, Billingsley, Koczwara, Bogda
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.12.2020; Springer; Springer Nature B.V
• Subjects: Cancer; Cancer Survivors; Employment; Employment - economics; Female; Health care reform; Humans; Literature reviews; Male; Medical debt; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Neoplasms - economics; Neoplasms - psychology; Nursing; Nursing Research; Oncology; Out of pocket costs; Pain Medicine; Quality of Life; Rehabilitation Medicine; Review; Review Article; Systematic review; Financial toxicity; Cancer survivors; Costs; Employment
• ISSN: 0941-4355; 1433-7339; 1433-7339
• DOI: 10.1007/s00520-020-05719-z

Background Financial toxicity has traditionally been attributed to the rising costs of cancer care. As ability to work impacts one’s financial situation, limited employment and reduced income may also contribute to financial toxicity. We examined evidence of the association between financial toxicity and employment status in cancer survivors. Methods A systematic literature review was performed via PubMed, Web of Science, CINAHL, and PsycINFO with search terms including “Cancer,” “Financial toxicity,” and “Employment” on September 25, 2019. Results Thirty-one papers met eligibility criteria. Thirteen studies were rated as having high quality, 16 as adequate, and two as low. Being actively treated for cancer had serious negative consequences on employment and medical expenditures. Unemployment, changed or reduced employment, lost days at work, poor work ability, and changes to employment were associated with a higher risk of financial toxicity. Patients who were younger, non-white, unmarried, of low education, living with dependents, residing in non-metropolitan service areas, with lower income, and of low socioeconomic status were more at risk of financial toxicity. Other variables associated with financial toxicity included having a mortgage/personal loan, higher out of pocket costs and household bills, limited health insurance, more severely ill, on active treatment, and lower functioning or quality of life. Conclusion Cancer negatively affects employment, and these changes are significant contributors to financial toxicity. Researchers, healthcare professionals, and patients themselves should all cooperate to tackle these complex issues.