Abstract
Simple SummaryA comprehensive understanding of risk factors associated with experiencing subjective financial distress is needed to inform the development of valid instruments and effective interventions to tackle financial toxicity. Several studies from the US indicate a strong correlation of the US-healthcare system’s systematic organisation and its particular socioeconomic risk factors for cancer patients experiencing financial toxicity. It is assumed that risk factors differ in other high-income countries due to the different structure of universal healthcare coverage. As an exhaustive analysis for other countries is lacking, this review aims to identify risk factors for subjective financial distress in universal healthcare systems.Financial toxicity is a side effect of cancer that results from the perceived financial distress an individual may experience in the course of the disease. The purpose of this paper is to analyse underlying factors related to subjective financial distress in high-income countries with universal healthcare coverage. A systematic literature review was conducted to identify qualitative and quantitative studies of cancer patient-reported subjective financial distress by performing a search in the databases of PubMed, PsycINFO and CINAHL up to December 2020. A qualitative synthesis was performed linking the time-dependent occurrence of risk factors to derived categories of risk factors. Out of 4321 identified records, 30 quantitative and 16 qualitative studies were eligible. Classification of risk factors resulted in eight categories with a total of 34 subcategories. Subjective financial distress is primarily determined by pre-diagnosis sociodemographic- factors as well as financial and work factors that might change during the course of the disease. The design of healthcare and social security systems shapes the country-specific degree of subjective financial distress. Further research should focus on evolving multidisciplinary intervention schemes and multidimensional instruments for subjective financial distress to account for identified risk factors in universal healthcare systems more precisely.
Highlights
As the currently used instruments to measure financial toxicity are mainly designed for a US-context, finding domains of risk factors that are important in other contexts could inform the evolvement of precise measurements in countries with universal healthcare coverage
This review filled the gap of an exhaustive determination of associated risk factors for subjective financial distress in cancer patients in high-income countries with universal healthcare coverage
Subjective financial distress is primarily determined by pre-diagnosis sociodemographic, financial and work factors changing during the course of the disease, so that previously sociodemographic disadvantaged and working-aged persons are at a greater risk of experiencing financial toxicity
Summary
Cancers 2021, 13, 5015 several socioeconomic, demographic and clinical variables as the main risk factors of objective and subjective financial distress leading to financial toxicity. An individual analysis of risk factors for countries with universal healthcare coverage is needed, as the determination of them contributes to a comprehensive understanding about the occurrence, degree and extent of financial toxicity. It could benefit the development of effective interventions by identifying patients at a greater risk of experiencing financial toxicity. As the currently used instruments to measure financial toxicity are mainly designed for a US-context, finding domains of risk factors that are important in other contexts could inform the evolvement of precise measurements in countries with universal healthcare coverage
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