title: The perceived cancer-related financial hardship among patients and their families: a systematic review.
abstract: OBJECTIVE
  The escalating health-care spending for cancer management has caused cancer patients to struggle further as a result of financial burden. This systematic review was carried out to investigate the prevalence of perceived financial hardship and associated factors among cancer patients and their families.
  
  
  METHODS
  A systematic search for studies concerning the perception of financial burden among cancer patients and their families was conducted. Several electronic resources such as Medline, Elsevier (Science Direct), Web of Science, Embase, PubMed, CINAHL and Scopus (SciVerse) were searched. Additionally, manual search through indices citation was also thoroughly utilized. The main outcome of interest was the prevalence of perceived financial hardship among cancer patients and their families. Studies reported only the cost of cancer treatment and qualitative studies were excluded. Our search was limited to articles that were published from 2003 to 2013.
  
  
  RESULTS
  Ten studies were included in this review and with a majority originating from high-income countries. The prevalence of the financial burden perception was reported between 14.8 and 78.8 %. The most frequent and significant risk factor reported associated with the perception of financial difficulty was the households with low income. Discontinuation of treatment and poverty were conversely the important consequences of financial burden in cancer patients and their families.
  
  
  CONCLUSIONS
  Evidently, cancer is a long-term illness that requires a high financial cost, and a significant number of cancer patients and families struggle with financial difficulty. Identifying such groups with a high risk of facing financial difficulty is a crucial measure to ensure safety nets are readily available for these targeted population.
authors.affiliation: Centre for Population Health (CePH), Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia, dr_memeazzani@yahoo.com.
authors.forename: Meram
authors.initials: M
authors.lastname: Azzani
authors.forename: April Camilla
authors.initials: AC
authors.lastname: Roslani
authors.forename: Tin Tin
authors.initials: TT
authors.lastname: Su
mesh_terms: D000328:Adult; D017028:Caregivers / Q000191:economics / Q000706:statistics & numerical data; D017281:Cost of Illness; D003695:Delivery of Health Care / Q000191:economics; D005190:Family / Q000523:psychology; D005260:Female; D006801:Humans; D007182:Income; D009369:Neoplasms / Q000191:economics* / Q000453:epidemiology; D010465:Perception; D011203:Poverty