Financial toxicity of cancer care in low and middle-income countries: a systematic review and meta-analysis

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Financial toxicity of cancer care in low and middle-income countries: a systematic review and meta-analysis


JournalResearch Square
Article typePre-print – Systematic review
Publication date – Feb – 2021
Authors – Andrew Donkor, Vivian Della Atuwo-Ampoh, Frederick Yakanu, Eric Torgbenu, Edward Kwabena Ameyaw, Doris Kitson-Mills, Verna Vanderpuye, Kofi Adesi Kyei, Samuel Anim-Sampong, Omar Khader, Jamal Khader
Keywordscancer, Financial Toxicity, Low-and middle-income countries, Treatment
Open access – Yes
SpecialitySurgical oncology
World region Global

Language – English
Submitted to the One Surgery Index on February 16, 2021 at 8:10 am
Abstract:

Abstract
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.

OSI Number – 20939

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