A Scoping Review of Interventions to Address Financial Toxicity in Pediatric and Adult Patients and Survivors of Cancer

IF 3.1 2区医学 Q2 ONCOLOGY Cancer Medicine Pub Date : 2025-04-18 DOI:10.1002/cam4.70879

Christina Ping, D. Carolina Andrade, Ashley Housten, Michelle Doering, Eliana Goldstein, Mary C. Politi

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Abstract

Background

Financial toxicity (FT) is a common and significant challenge for people with cancer, impacting immediate clinical outcomes such as treatment adherence, as well as long-term outcomes such as quality of life and mortality. Multiple studies have tested interventions to address FT and develop recommendations for their implementation.

Methods

In this scoping review, we analyzed thirty-six studies across 35,405 participants examining institution-based interventions for FT in both pediatric and adult patients and survivors of cancer in the U.S.

Results

Common interventions included: financial navigation (n = 15), direct financial/medical assistance (n = 8), financial counseling or coaching (n = 5), and cost conversations prompters or encounter decision aids for treatment and cost (n = 5). Outcome measures varied widely, including the COmprehensive Score for financial Toxicity (COST), the Medical Expenditure Panel Survey (MEPS), total out-of-pocket costs or savings, and mental/psychological quality-of-life measured by the Patient-Reported Outcomes Measurement Information System (PROMIS). Many interventions showed promising results on improving FT, including financial assistance (e.g., free medication, copay assistance), treatment and insurance decision aids, and financial counseling. These strategies improved FT-related metrics, including patient out-of-pocket costs, care-related financial burden, health insurance knowledge, quality of life, and even overall survival. There was no dominant intervention method, with both low- and high-resource options proving effective.

Discussion

Future research should seek to understand causal relationships between interventions and FT through robust study designs, such as randomized controlled trials with longitudinal follow-up, and evaluate interventions' implementation potential. There is also a need for standardized metrics for evaluating and reporting FT to better compare different interventions' success.

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针对儿童、成人患者和癌症幸存者的财务毒性干预措施的范围综述

财务毒性（Financial toxicity， FT）是癌症患者面临的一个常见而重大的挑战，既影响到治疗依从性等即时临床结果，也影响到生活质量和死亡率等长期结果。多项研究已经测试了解决金融危机的干预措施，并提出了实施这些措施的建议。方法：在这一范围综述中，我们分析了36项研究，涉及35,405名参与者，研究了美国儿童、成人患者和癌症幸存者中基于机构的FT干预措施。财务指导（n = 15），直接财务/医疗援助（n = 8），财务咨询或指导（n = 5），以及费用对话提示或遇到治疗和费用决策辅助（n = 5）。结果测量方法差异很大，包括财务毒性综合评分（COST）、医疗支出小组调查（MEPS）、总自付费用或储蓄，以及由患者报告的结果测量信息系统（PROMIS）测量的精神/心理生活质量。许多干预措施在改善FT方面显示出有希望的结果，包括财政援助（例如，免费药物、共同支付援助）、治疗和保险决策辅助以及财务咨询。这些策略改善了ft相关指标，包括患者自付费用、与护理相关的经济负担、健康保险知识、生活质量，甚至总体生存率。没有主要的干预方法，低资源和高资源的选择都证明是有效的。未来的研究应通过稳健的研究设计，如纵向随访的随机对照试验，寻求理解干预措施与FT之间的因果关系，并评估干预措施的实施潜力。还需要标准化的指标来评估和报告金融危机，以便更好地比较不同干预措施的成功。

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来源期刊

Cancer Medicine ONCOLOGY-

CiteScore

5.50

自引率

2.50%

发文量

907

审稿时长

19 weeks

期刊介绍： Cancer Medicine is a peer-reviewed, open access, interdisciplinary journal providing rapid publication of research from global biomedical researchers across the cancer sciences. The journal will consider submissions from all oncologic specialties, including, but not limited to, the following areas: Clinical Cancer Research Translational research ∙ clinical trials ∙ chemotherapy ∙ radiation therapy ∙ surgical therapy ∙ clinical observations ∙ clinical guidelines ∙ genetic consultation ∙ ethical considerations Cancer Biology: Molecular biology ∙ cellular biology ∙ molecular genetics ∙ genomics ∙ immunology ∙ epigenetics ∙ metabolic studies ∙ proteomics ∙ cytopathology ∙ carcinogenesis ∙ drug discovery and delivery. Cancer Prevention: Behavioral science ∙ psychosocial studies ∙ screening ∙ nutrition ∙ epidemiology and prevention ∙ community outreach. Bioinformatics: Gene expressions profiles ∙ gene regulation networks ∙ genome bioinformatics ∙ pathwayanalysis ∙ prognostic biomarkers. Cancer Medicine publishes original research articles, systematic reviews, meta-analyses, and research methods papers, along with invited editorials and commentaries. Original research papers must report well-conducted research with conclusions supported by the data presented in the paper.