A scoping review capturing financial experiences of cancer survivors: Are we on the same page?

Abstract

348 Background: There is great variation in how post-treatment financial consequences have been conceptualized and measured. This scoping review characterized the terms and measures used to capture the financial experiences of post-treatment cancer survivors. Methods: Reported according to PRISMA-ScR, electronic searches for published literature were conducted using Ovid MEDLINE, Embase.com, Web of Science Core Collection, Cochrane Central via Ovid, and ClinicalTrials.gov in March 2024. Eligible articles were U.S.-based empirical studies conducted with adult (≥18 years) cancer survivors (≥ 6 months post-treatment). Studies were managed using Covidence systematic review software. Results: Two coders screened 2452 titles and abstracts; 502 met inclusion criteria. Initial full-text review identified 127 articles for co-investigator assessment. Each article was evaluated for eligibility and quality by two investigators; 84 met criteria. Many terms were used, including financial hardship, burden, toxicity, stress/distress, worry, problems, impact, economic burden, difficulty, strain, and perceived financial security. Financial hardship and burden were most prevalent and often used interchangeably, categorized within material, psychological, and behavioral domains. Financial stress/distress , and financial worry , were consistently conceived as the psychological aspect of financial burden/hardship. Financial problems , strain , difficulty , impact , and economic burden were mainly measured using items pertaining to material/behavioral domains of financial consequences. Financial toxicity typically described the totality of effect of direct and indirect costs of cancer/treatment on one’s quality of life. Terms and definitions likely differed due to wide variation in the measures used; 47 measures were used. The most common tools included items from the Medical Expenditure Panel Survey Experiences with Cancer Survivorship Supplement (N= 20), the Comprehensive Score for Financial Toxicity (N= 13), and the National Health Interview Survey (N= 11). Conclusions: Findings suggest a general lack of consensus regarding the conceptualization and measurement of the financial experiences of cancer survivors. Financial hardship and burden were often used interchangeably, with financial toxicity capturing the greater encompassing effect of financial consequences of cancer. Future work is needed to arrive at a consensus that distinguishes between these critical outcomes.