Prevalence and risk factors of self-reported financial toxicity in cancer survivors: A systematic review and meta-analysis

Abstract

Background: Similar to the side effects of cancer treatment，financial toxicity can affect the quality of life of patients, which has attracted increasing attention in the field of oncology. Despite the fact that the estimated prevalence and risk factors of financial toxicity are widely reported, these results have not been synthesized.Objectives: This review aimed to systematically assess the prevalence and risk factors of self-reported financial toxicity.Design: Systematic review and meta-analysis.Data Sources: A computer search of English literature using the database of PubMed, EMBASE, Web of Science, PsycINFO, CHINAHL, and reference list of the included articles between 2010 and September 2021. The observational studies that reported the prevalence or risk factors of financial toxcity used subjective measures will be included.Methods: A systematic review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The risk of bias was assessed by the NIH observational cohort and cross-sectional study quality assessment tool. The data were extracted by two reviewers and listed in a descriptive table for meta-analysis.Results: In the 22 studies available for the meta-analysis, the pooled prevalence of financial toxicity was estimated to be 45% (95% CI: 38% to 53%, I2 = 97.3%, P < 0.001), which was based on a random-effects model. The pooled analysis identified 9 potential risk factors of financial toxicity(7 in β and 8 in OR) : low income (OR = 2.48, 95% CI: 1.72 to 3.24, I2 =3.1%, P < 0.001), greater annual OOP(β = -4.26, 95% CI: -6.95 to -1.57, I2 =0%, P=0.002), younger age(OR = 2.05, 95% CI: 1.56 to 2.54, I2 =0%, P < 0.001), no private insurance(OR = 1.69, 95% CI: 1.02 to 2.37, I2 =0%, P < 0.001), unmarried(OR = 1.10, 95% CI: 0.95 to 1.25, I2 =53,3%, P < 0.001), non-white(OR = 1.59, 95% CI: 1.33 to 1.85, I2 =0%, P < 0.001), advanced cancer(β = -4.74, 95% CI: -6.90 to -2.57, I2 =0%, P < 0.001), unemployed(β = -2.90, 95% CI: -5.71 to -0.63, I2 =75,7%, P < 0.001), more recent diagnosis(OR = 1.31, 95% CI: 1.04 to 1.57, I2 =0%, P < 0.001). Conclusion This systematic review found a pooled prevalence of self-reported financial toxicity of 45%. Low income, greater annual OOP, younger age, unmarried, unemployed, non-white, no private insurance, advanced cancer, and more recent diagnosis constituted risk factors for self-reported financial toxicity. The Research on risk factors for financial toxicity can provide a theoretical basis for nursing staff to evaluate and intervene in the financial toxicity among cancer survivors.