Interventions to mitigate cancer-related medical financial hardship: A systematic review and meta-analysis

Ali Rashidi; Jinho Jung; Raymond Kao; Emily Lan Nguyen; Theresa Le; Brandon Ton; Wen-Pin Chen; Argyrios Ziogas; Gelareh Sadigh

doi:10.1002/cncr.35367

Interventions to mitigate cancer-related medical financial hardship: A systematic review and meta-analysis

Cancer. 2024 May 17. doi: 10.1002/cncr.35367. Online ahead of print.

Authors

Ali Rashidi¹, Jinho Jung¹, Raymond Kao¹, Emily Lan Nguyen¹, Theresa Le¹, Brandon Ton¹, Wen-Pin Chen², Argyrios Ziogas^{2

3}, Gelareh Sadigh¹

Affiliations

¹ Department of Radiological Sciences, University of California Irvine, Irvine, California, USA.
² Chao Family Comprehensive Cancer Center, University of California Irvine, Irvine, California, USA.
³ Department of Medicine, Genetic Epidemiology Research Institute, University of California Irvine, Irvine, California, USA.

PMID: 38758809
DOI: 10.1002/cncr.35367

Abstract

Background: This study systematically reviewed interventions mitigating financial hardship in patients with cancer and assessed effectiveness using a meta-analytic method.

Methods: PubMed, Cochrane, Scopus, CINAHL, and Web of Science were searched for articles published in English during January 2000-April 2023. Two independent reviewers selected prospective clinical trials with an intervention targeting and an outcome measuring financial hardship. Quality appraisal and data extraction were performed independently by two reviewers using a quality assessment tool. A random-effects model meta-analysis was performed. Reporting followed the preferred reporting items for systematic review and meta-analyses guidelines.

Results: Eleven studies (2211 participants; 55% male; mean age, 59.29 years) testing interventions including financial navigation, financial education, and cost discussion were included. Financial worry improved in only 27.3% of 11 studies. Material hardship and cost-related care nonadherence remained unchanged in the two studies measuring these outcomes. Four studies (373 participants; 37% male, mean age, 55.88 years) assessed the impact of financial navigation on financial worry using the comprehensive score of financial toxicity (COST) measure (score range, 0-44; higher score = lower financial worry) and were used for meta-analysis. There was no significant change in the mean of pooled COST score between post- and pre-intervention (1.21; 95% confidence interval, -6.54 to 8.96; p = .65). Adjusting for pre-intervention COST, mean change of COST significantly decreased by 0.88 with every 1-unit increase in pre-intervention COST (p = .02). The intervention significantly changed COST score when pre-intervention COST was ≤14.5.

Conclusion: A variety of interventions have been tested to mitigate financial hardship. Financial navigation can mitigate financial worry among high-risk patients.

Keywords: COST score; cancer; financial hardship; meta‐analysis; systematic review.

Abstract

Grants and funding