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.

No abstract

background: the aim of the study was to identify strategies adopted by radiotherapy centres in low-and middle-income countries (lMics) to mitigate the effects of cOviD-19. Studies summarising cOviD-19 mitigation strategies designed and implemented by radiotherapy centres in lMics to avoid delays, deferrments and interruptions of radiotherapy services are lacking.Materials and methods: a systematic review was conducted and reported in accordance with the preferred reporting items for systematic review and meta-analysis guideline. Ovid embase, Ovid MeDliNe and ciNaHl were searched for peer-reviewed articles that reported measures adopted by radiotherapy centres in lMics to reduce the risk of cOviD-19. information on different strategies were extracted from the included studies and textual narrative synthesis was conducted. results: Of 60 articles retrieved, eleven were included. Majority of the studies were conducted in china. ten of the included studies employed a qualitative design. Four themes were identified: preparing and equipping staff; reinforcing infection prevention and control policies; strengthening coordination and communication; and maintaining physical distancing. Studies reported that radiotherapy centres had: formed cOviD-19 response multidisciplinary team; maximised the use of telehealth; adjusted the layout of waiting areas; divided staff into teams; dedicated a room for isolating suspected cases; and adopted triage systems. conclusions: local adaptation of established global strategies coupled with timely development of guidelines, flexibility and innovation have allowed radiotherapy leaders to continue to deliver radiotherapy services to cancer patients in lMics during the cOviD-19 crisis. robust data collection must be encouraged in lMics to provide an evidence-based knowledge for use in the event of another pandemic.

Aim: To identify strategies adopted by radiotherapy centres in low and middle-income countries (LMICs) to mitigate the effects of COVID-19.Background: Studies summarising COVID-19 mitigation strategies designed and implemented by radiotherapy centres in LMICs to avoid delays, deferrments and interruptions of radiotherapy services are lacking.Materials and Methods: A systematic review was conducted and reported in accordance with the preferred reporting items for systematic review and meta-analysis guideline. Ovid Embase, Ovid MEDLINE and CINAHL were searched for peer-reviewed articles that reported measures adopted by radiotherapy centres in LMICs to reduce the risk of COVID-19. Information on different strategies were extracted from the included studies and textual narrative synthesis was conducted.Results: Of the 60 articles retrieved, eleven were included. Majority of the studies were conducted in China. Ten of the included studies employed a qualitative design. Four themes were identified: preparing and equipping staff; reinforcing infection prevention and control policies; strengthening coordination and communication; and maintaining physical distancing. Studies reported that radiotherapy centres have: formed COVID-19 response multidisciplinary team; maximised the use of telehealth; adjusted the layout of waiting areas; divided staff into teams; dedicated a room for isolating suspected cases; and adopted triage systems.Conclusions: Local adaptation of established global strategies coupled with timely development of guidelines, flexibility and innovation have allowed radiotherapy leaders to continue to deliver radiotherapy services to cancer patients in LMICs during the COVID-19 crisis. Robust and quality data collection must be encouraged in LMICs to provide an evidence-based knowledge for use in the event of another pandemic.

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 identify the extent of cancer-related financial toxicity and how it has been measured 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 financial toxicity was 56.96% [95% CI, 30.51, 106.32]. In sub-group meta-analyses, the 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%). Mean medical costs per cancer patients were $2,740.18 [95% CI, $1,953.62, $3,526.74]. The ratio of cost of care to gross domestic product (GDP) per capita varied considerably across the LMICs included in this review, which ranged from 0.06 in Vietnam to 327.65 in Ethiopia.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.