OBJECTIVES: Cancer care poses a substantial burden to patients and their families, and is often not covered by national health systems and health insurance. Catastrophic health expenditures (CHE) are a globally recognized key performance indicator to assess the direct impact of out-of-pocket (OOP) expenditures on households caring for patients. This literature review aims to characterize the evidence summarizing the reported levels of catastrophic health expenditures (CHEs) within cancer worldwide.

METHODS: A search for existing systematic literature reviews (SLRs) and/or meta-analyses (MAs) reporting on CHEs was completed in November 2022 and registered in PROSPERO (CRD4202340456). First and second level screening were completed by two reviewers, with discrepancies being verified by a third reviewer. CHE thresholds per publication were extracted and summarized across geographies and cancer type. In addition, the proportions of households that succumb to CHE at globally identified thresholds (10%, 25%, 40%) were recorded. Quality assessment was conducted using AMSTAR-2.

RESULTS: A total of 16 included SLRs and/or MAs reported on over two dozen individual studies. The majority of studies focused on geographic regions in North America, Europe and APAC. Several studies identified CHE thresholds as 10%, 20%, 25%, 40% and 50%. Overall, the results for out-of-pocket expenditures as a function of income for cancer care were quite heterogeneous; however, the majority of studies reported CHE proportions above 40%. Variations of CHE were seen across different time points (e.g. after diagnosis, before hospital discharge, etc.) within subgroups (e.g. gender, socioeconomic status, etc.) and geographical regions.

CONCLUSIONS: Households caring for family members with cancer, experience CHEs at concerning levels that put families at risk of poverty and financial distress. Further research is needed to identify gaps in LATAM and African regions, and to understand how cancer programs and treatments may alleviate this societal burden.