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Cited by 864Economic and Financial Impacts of CancerCancer survivorship and careGlobal Cancer Incidence and Screening

Financial Hardships Experienced by Cancer Survivors: A Systematic Review

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Altice, Cheryl K., Banegas, Matthew P., Tucker-Seeley, Reginald D., Yabroff, K. Robin·2017·Journal of the National Cancer Institute
DOI 10.1093/jnci/djw205PMC PMC6075571
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Abstract

Background: With rising cancer care costs, including high-priced cancer drugs, financial hardship is increasingly documented among cancer survivors in the United States; research findings have not been synthesized. Methods: We conducted a systematic review of articles published between 1990 and 2015 describing the financial hardship experienced by cancer survivors using PubMed, Embase, Scopus, and CINAHL databases. We categorized measures of financial hardship into: material conditions (eg, out-of-pocket costs, productivity loss, medical debt, or bankruptcy), psychological responses (eg, distress or worry), and coping behaviors (eg, skipped medications). We abstracted findings and conducted a qualitative synthesis. Results: Among 676 studies identified, 45 met the inclusion criteria and were incorporated in the review. The majority of the studies (82%, n = 37) reported financial hardship as a material condition measure; others reported psychological (7%, n = 3) and behavioral measures (16%, n = 7). Financial hardship measures were heterogeneous within each broad category, and the prevalence of financial hardship varied by the measure used and population studied. Mean annual productivity loss ranged from $380 to $8236, 12% to 62% of survivors reported being in debt because of their treatment, 47% to 49% of survivors reported experiencing some form of financial distress, and 4% to 45% of survivors did not adhere to recommended prescription medication because of cost. Conclusions: Financial hardship is common among cancer survivors, although we found substantial heterogeneity in its prevalence. Our findings highlight the need for consistent use of definitions, terms, and measures to determine the best intervention targets and inform intervention development in order to prevent and minimize the impact of financial hardship experienced by cancer survivors.

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  • Awareness of the impacts of SDOH on health outcomes is evident from the oncology literature, largely due to the persistent disparities, substantial barriers to treatment, and the financial toxicity commonly associated with cancer care.

    “Awareness of the impacts of SDOH on health outcomes is evident from the oncology literature, largely due to the persistent disparities, substantial barriers to treatment, and the financial toxicity commonly associated with cancer care1,2,8,9,18.”

    From Documentation of individual-level social determinants of health among adults diagnosed with cancer in the United States (2025) · cites this paper as [18]

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Cited by

Sorted by citations

Authors
Altice, C. K., Banegas, M. P., Tucker-Seeley, R. D., & Yabroff, K. R.
Affiliations
  • National Cancer Institute (US)
  • Kaiser Permanente (US)
ORCID
Venue
Journal of the National Cancer Institute
Publisher
Oxford University Press (OUP)
Published
2016-10-17
Volume
109
Issue
2
Pages
djw205
ISSN
  • 0027-8874 (ISSN-L)
  • 1460-2105
DOI
10.1093/jnci/djw205
PMC
PMC6075571
OpenAlex
W2533574559
Cited by
864
References
3
Citations by year
2026: 101 · 2025: 109 · 2024: 107 · 2023: 104 · 2022: 120 · 2021: 122 · 2020: 75 · 2019: 68 · 2018: 42 · 2017: 14
FWCI
12.68
Type
journal article
Language
en
Open access
Locations
  • JNCI Journal of the National Cancer Institute (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion, public-domain)
  • PubMed Central (publishedVersion, public-domain)
  • PubMed (publishedVersion)
Funders
National Cancer Institute (K01CA169041)
Topics
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Financial Impacts of Cancer
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
Keywords
financial hardship, cancer survivors, out-of-pocket costs, productivity loss, medical debt, bankruptcy, financial distress, medication non-adherence, cancer care costs
MeSH terms
Efficiency, Fees and Charges, Humans, Neoplasms, United States, Cost of Illness, Survivors, Medication Adherence

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