Relationships Between Financial Toxicity and Symptom Burden in Cancer Survivors: A Systematic Review

Abstract

Financial toxicity (FT) is used to describe the financial distress or hardship associated with cancer and its treatment. The aim of this review was to examine the relationship between FT and symptom burden. A systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched MEDLINE, EMBASE, and CINAHL (from 2000 to Jan 2018). Data were extracted and appraised by two reviewers. We planned to include primary quantitative, mixed-methods, and qualitative research studies. Nine studies involving a total of 11,544 cancer survivors were included. Of the nine studies, eight were of high quality. The relationships between FT and psychological symptoms and physical symptoms were examined in eight and three studies, respectively. Six studies reported a positive relationship between FT and depression. Three studies found a positive association between FT and anxiety. Limited evidence was found on the association between FT and stress, fear of recurrence, spiritual suffering, pain, and overall symptom burden. A relatively clear association exists between FT and psychological symptoms. Clinicians should regularly screen for, assess, and manage emotional distress related to FT. Future interventional studies aimed at minimizing or preventing FT should evaluate psychological symptoms as secondary outcomes. Little is known about the relationships between FT and physical symptoms. Future research should overcome methodological limitations such as the lack of longitudinal data collection, use of mix-methods approaches, and homogeneity of samples.