• Julie Ritter, Savannah Allen, Phillip D Cohen, Andrés Felipe Fajardo, Kelsey Marx, Patrícia Loggetto, Carmen Auste, Hedley Lewis, Karla Emília de Sá Rodrigues, Sharmeen Hussain, Ayomide Omotola, Nancy S Bolous, Harsha Thirumurthy, Beverley M Essue, Eva Steliarova-Foucher, I-Chan Huang, Filip Meheus, and Nickhill Bhakta.
• Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA. Electronic address: julie.ritter@stjude.org.
• Lancet Oncol. 2023 Sep 1; 24 (9): e364e375e364-e375.

AbstractFinancial hardship in childhood cancer contributes to poor health outcomes and global disparities in survival, but the extent of the financial burden on families is not yet fully understood. We systematically reviewed financial hardship prevalence and individual components characterising financial hardship across six domains (medical, non-medical, and indirect costs, financial strategies, psychosocial responses, and behavioural responses) and compared characteristics across country income levels using an established theory of human needs. We included 123 studies with data spanning 47 countries. Extensive heterogeneity in study methodologies and measures resulted in incomparable prevalence estimates and limited analysis. Components characterising financial hardship spanned the six domains and showed variation across country income contexts, yet a synthesis of existing literature cannot establish whether these are true differences in characterisation or burden. Our findings emphasise a crucial need to implement a data-driven methodological framework with validated measures to inform effective policies and interventions to address financial hardship in childhood cancer.Copyright © 2023 Elsevier Ltd. All rights reserved.

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