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      Describing financial toxicity among cancer patients in different income countries: a systematic review and meta-analysis

      systematic-review

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          Abstract

          Background

          There is limited evidence of financial toxicity (FT) among cancer patients from countries of various income levels. Hence, this study aimed to determine the prevalence of objective and subjective FT and their measurements in relation to cancer treatment.

          Methods

          PubMed, Science Direct, Scopus, and CINAHL databases were searched to find studies that examined FT. There was no limit on the design or setting of the study. Random-effects meta-analysis was utilized to obtain the pooled prevalence of objective FT.

          Results

          Out of 244 identified studies during the initial screening, only 64 studies were included in this review. The catastrophic health expenditure (CHE) method was often used in the included studies to determine the objective FT. The pooled prevalence of CHE was 47% (95% CI: 24.0–70.0) in middle- and high-income countries, and the highest percentage was noted in low-income countries (74.4%). A total of 30 studies focused on subjective FT, of which 9 used the Comprehensive Score for FT (COST) tool and reported median scores ranging between 17.0 and 31.9.

          Conclusion

          This study shows that cancer patients from various income-group countries experienced a significant financial burden during their treatment. It is imperative to conduct further studies on interventions and policies that can lower FT caused by cancer treatment.

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          Most cited references91

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          Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries

          This article provides a status report on the global burden of cancer worldwide using the GLOBOCAN 2018 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer, with a focus on geographic variability across 20 world regions. There will be an estimated 18.1 million new cancer cases (17.0 million excluding nonmelanoma skin cancer) and 9.6 million cancer deaths (9.5 million excluding nonmelanoma skin cancer) in 2018. In both sexes combined, lung cancer is the most commonly diagnosed cancer (11.6% of the total cases) and the leading cause of cancer death (18.4% of the total cancer deaths), closely followed by female breast cancer (11.6%), prostate cancer (7.1%), and colorectal cancer (6.1%) for incidence and colorectal cancer (9.2%), stomach cancer (8.2%), and liver cancer (8.2%) for mortality. Lung cancer is the most frequent cancer and the leading cause of cancer death among males, followed by prostate and colorectal cancer (for incidence) and liver and stomach cancer (for mortality). Among females, breast cancer is the most commonly diagnosed cancer and the leading cause of cancer death, followed by colorectal and lung cancer (for incidence), and vice versa (for mortality); cervical cancer ranks fourth for both incidence and mortality. The most frequently diagnosed cancer and the leading cause of cancer death, however, substantially vary across countries and within each country depending on the degree of economic development and associated social and life style factors. It is noteworthy that high-quality cancer registry data, the basis for planning and implementing evidence-based cancer control programs, are not available in most low- and middle-income countries. The Global Initiative for Cancer Registry Development is an international partnership that supports better estimation, as well as the collection and use of local data, to prioritize and evaluate national cancer control efforts. CA: A Cancer Journal for Clinicians 2018;0:1-31. © 2018 American Cancer Society.
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            The PRISMA 2020 statement: an updated guideline for reporting systematic reviews

            The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews.
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              Measuring inconsistency in meta-analyses.

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                Author and article information

                Contributors
                Journal
                Front Public Health
                Front Public Health
                Front. Public Health
                Frontiers in Public Health
                Frontiers Media S.A.
                2296-2565
                02 January 2024
                2023
                : 11
                : 1266533
                Affiliations
                [1] 1Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA , Sungai Buloh, Selangor, Malaysia
                [2] 2Centre of Occupational Safety, Health and Wellbeing, Universiti Teknologi MARA , Puncak Alam, Selangor, Malaysia
                [3] 3Department of Parasitology, Faculty of Medicine, Universiti Malaya , Kuala Lumpur, Malaysia
                [4] 4Department of Microbiology and Parasitology, Faculty of Medicine and Health Sciences, University of Aden , Aden, Yemen
                [5] 5Department of Microbiology, International Medical School (IMS), Management & Science University (MSU) , Shah Alam, Selangor, Malaysia
                [6] 6Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif , Kuala Lumpur, Malaysia
                [7] 7Physiology Department, Human Biology Division, School of Medicine, International Medical University (IMU) , Kuala Lumpur, Malaysia
                Author notes

                Edited by: Jeffrey Harrison, University of North Florida, United States

                Reviewed by: Zuzana Špacírová, Andalusian School of Public Health, Spain; Chiara Cadeddu, Erasmus University Rotterdam, Netherlands

                *Correspondence: Vinoth Kumarasamy, vinoth@ 123456ukm.edu.my
                Article
                10.3389/fpubh.2023.1266533
                10789858
                38229668
                ed07734d-f551-47f8-a00d-386a6f3f064c
                Copyright © 2024 Azzani, Atroosh, Anbazhagan, Kumarasamy and Abdalla.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 25 July 2023
                : 17 October 2023
                Page count
                Figures: 2, Tables: 2, Equations: 0, References: 92, Pages: 17, Words: 10565
                Funding
                Funding for this study was provided by Universiti Kebangsaan Malaysia GGPM grant, (GGPM-2023-020). The authors gratefully acknowledge Universiti Kebangsaan Malaysia for the approved funding that allows this important research to be carried out.
                Categories
                Public Health
                Systematic Review
                Custom metadata
                Health Economics

                direct medical cost,direct non-medical cost,indirect medical cost,catastrophic health expenditure,perceived financial hardship,systematic review,meta-analysis

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