title: Additional financial costs borne by cancer patients: a narrative review.
abstract: OBJECTIVE
  To review out-of-pocket costs related to cancer that are borne by patients and their families.
  
  
  METHODS
  A literature search using key terms relating to out-of-pocket costs incurred by cancer patients and their families was undertaken to generate a comprehensive narrative synthesis of the information available.
  
  
  RESULTS
  Four themes were identified: measuring costs; sources of costs; the impact of costs and reducing costs. The wide variety of measures for ascertaining hidden costs makes comparison of findings difficult; some articles cover a very narrow range of costs. Qualitative research is useful for elucidating a wide range of costs. Costs pertaining to hospital visits, nutrition and clothing are widely mentioned. Low additional expenditure may indicate that needs/wants are going unmet. Financial capacity to cope and subjective perception of impact are important. Low income, younger age, chemotherapy and living rurally are associated with greater impact. Extra expense can exert long-term effects on family finances. Primary care follow-up, telemedicine and treatments that entail fewer visits may serve to reduce patient costs.
  
  
  CONCLUSIONS
  The key question is how to organise/deliver cancer care in order to reduce additional expenses to patients and families. Future research could identify critical time-points and demographic groups susceptible to significant additional costs, in order to target support at those most in need.
authors.affiliation: Centre for Applied Psychological Research, University of Huddersfield, Queensgate, UK. J.M.Brooks@hud.ac.uk
authors.forename: Joanna
authors.initials: J
authors.lastname: Brooks
authors.forename: Kate
authors.initials: K
authors.lastname: Wilson
authors.forename: Ziv
authors.initials: Z
authors.lastname: Amir
mesh_terms: D017281:Cost of Illness; D017048:Health Care Costs; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D033262:Narration; D009369:Neoplasms / Q000191:economics*; D006113:United Kingdom