Table 2.

Overview of included studies (n = 28)

Citation (Country)	Purpose	Sample Size	Study Design	Key Findings and Conclusions
Abbasnezhad et a l. (2015) Iran [13]	To investigate the cancer care burden on primary family caregivers of hematologic cancer patients, in terms of physical, psychological, social, spiritual, and financial aspects	151 family caregivers	Descriptive quantitative study	The study revealed that primary family caregivers faced considerable financial distress, and many reported symptoms of anxiety and depression. Their physical quality of life was assessed as moderate. In contrast, the participants’ spiritual well-being and level of social support were deemed satisfactory
Adejoh et al. (2021) Nigeria, Uganda and Zimbabwe [24]	To explore the roles, experiences, and support needs of informal caregivers of patients with advanced cancer in their interactions with palliative care services in Nigeria, Uganda, and Zimbabwe	48 family caregivers	Qualitative study	The findings showed that informal caregivers are central to palliative care in sub-Saharan Africa, serving as both a major partner and a silent pillar in patient care. They carried most of the medical, physical, and emotional responsibilities for patients, often at considerable personal cost, including sacrifices to their health, finances, and employment
Ariyo et al. (2025) Nigeria [25]	To explore the underlying factors contributing to the financial and emotional burden among informal caregivers of elderly patients at University College Hospital, Ibadan	412 informal caregivers	cross-sectional, mixed-methods study	Caregivers’ emotional burden was significantly associated with household income. Financial hardships were primarily driven by out-of-pocket expenses, expensive medications and tests, and the nature and duration of the patient’s illness
Balfe et al. (2017) Ireland [26]	To examine the impact of treatment-related commuting on caregivers of patients with head and neck cancer	31 family caregivers	Qualitative study	Findings showed that commuting is a major but often overlooked burden that negatively affects the quality of life of head and neck cancer caregivers. The authors noted that this burden may worsen as specialized care becomes centralized and recommended supports such as free or subsidized parking, travel assistance, and affordable family accommodations
Balfe et al. (2016) Ireland [17]	To explore the overall financial impact of head and neck cancer on caregivers, and to describe the factors that mitigate this impact	31 family caregivers	Qualitative study	Caregivers of head and neck cancer patients often endure significant financial and emotional distress. Granting them and their families access to welfare benefits can help alleviate this burden
Bradley et al. (2023) USA [27]	To assess whether employed spousal caregivers of adults with cancer experience greater financial and mental health burden than comparable caregivers of spouses with other health conditions	103 family caregivers	longitudinal cohort study	About 35% of cancer caregivers stopped working, and 30% reported that they increased household debt. Financial hardship was most severe among lower-income households, with low-income cancer caregivers more likely than matched noncancer caregivers to report reduced income, greater debt, and work cessation. Although mental health findings were mixed, financial strain was clearly more pronounced among low-income cancer caregivers
de Vries et al. (2021) Columbia [14]	To evaluate the existence of financial burden caused by cancer on the caregiving families of terminally ill patients	176 family caregivers	Descriptive Quantitative study	One in four families (25%) delayed educational or other major plans, and about 10–11% reported moving to a different home or postponing medical care
DiGiacomo eta al. (2020) Australia [28]	To identify caregiving characteristics that are associated with financial stress in Australian carers of people with a chronic disease	3047 family caregivers	Cross-sectional	More than 13% of carers experienced financial hardship, with causes extending beyond just household income
Elgadi et al. (2022) Sudan [29]	This study aims to estimate the perceived economic burden in the following aspects: financial strain, inability to make ends meet, not enough money for necessities, and economic adjustment	143 family caregivers	Cross-sectional	Most caregivers could cover everyday essentials but had difficulty affording medical expenses and leisure activities. Overall, the results point to a moderate financial burden among cancer caregivers. Hardship was more likely for those who were unmarried, students, male, better educated, or had lower incomes. Additionally, financial strain was tied to a rise in maladaptive coping behaviors
Ferrell et al. (2019) USA [30]	The purpose of this study was to test a palliative care support intervention for oncology family caregivers	240 family caregivers	Randomized Controlled Trial	After the PC intervention, most caregivers experienced reduced financial stress and enhanced quality of life
Ferrell et al. (2018) USA [31] Hastert et al. (2024) USA [10]	To gain a deeper understanding of the quality-of-life needs of family caregivers who experience financial hardship due to the costs of cancer care and treatment To explore the associations between several types of caregiving costs (i.e., related to medications, medical bills, and logistics) and the prevalence of financial burden reported by caregivers of African American cancer survivors	20 families Caregivers 964 family caregivers	Qualitative study Correlational study	Family caregivers faced financial strain that undermined their spiritual well-being, emotional stability, and psychological health Approximately two-thirds of caregivers (64%) reported incurring costs related to caregiving. Logistical expenses were the most common (58%), followed by medications (35%) and medical bills (17%). Thirty-eight percent of caregivers experienced severe financial hardship, and those who had any caregiving costs faced a 52% higher prevalence of high hardship. Informal caregivers, much like cancer survivors themselves, bear significant cancer-related financial burdens
Hastert et al. (2020) USA [8]	To describe the prevalence of several forms of work impacts, financial burden, and psychosocial outcomes reported by caregivers of African American cancer survivors	199 family caregivers	Correlational study	Most caregivers (73.8%) adjusted their employment schedules. Sixty percent altered their work schedule, hours, duties, or job status; 15.3% took at least one month off to provide care; and 38% reported difficulty juggling work and caregiving responsibilities. Struggles with balancing employment and caregiving are common among those caring for African American cancer survivors and are linked to symptoms of depression and anxiety. Providing targeted support for caregivers facing work-related challenges may help improve their psychosocial well-being
Johnson et al. (2024) [32]	To estimate the replacement cost of informal care provided by family and friends in the last year of life, and to explore how these costs varied by carer and decedent characteristics	997 family caregivers	Cross-sectional survey	Higher caregiving costs were linked to longer and more intensive care, older caregiver age, home death with co-residence, non-cancer death, and greater deprivation. Higher costs for other support were also associated with female caregivers and not using other care services. These findings highlight a growing challenge for universal care coverage as ageing populations reduce the availability of informal caregivers
Kavanaugh et al.(2015) [33]	To identify factors associated with economic burden among spousal caregivers of patients with lung cancer	138 family caregivers	Cross-sectional survey	Economic burden was higher among caregivers with less education, more children at home, and spouses with more symptoms; younger age affected burden indirectly through patient symptoms. The findings highlight the need for healthcare providers to address psychosocial factors in families affected by lung cancer and to manage patient symptoms early to help protect the family’s economic well-being
Mathew et al. (2024) [34]	To examine financial toxicity and coping strategies among caregivers of patients with cancer	403 family caregivers	Prospective cross-sectional study	About 64% of caregivers reported moderate to severe financial toxicity. Common coping strategies included using savings, borrowing money, changing spending patterns, seeking financial help from the cancer center, and taking gold loans. The authors suggest that screening patients and primary caregivers with a modified COST tool may help families identify severe financial toxicity and guide timely support
Meehan et al. (2020) USA [35]	To assess the out-of-pocket expenses and time commitment of caregivers of hematopoietic stem cell transplantation recipients within the first 4 weeks after discharge from the hospital	49 family caregivers	Longitudinal study	The findings underscored an urgent need to bolster caregiver support, given the heavy out-of-pocket expenses and substantial time demands. Caregivers reported fatigue and emotional strain driven by both direct treatment costs and other related expenses
Metin et al. (2023) Turkey [36]	To assess the effect of financial well-being on caregiver quality of life in multiple myeloma	113 family caregivers	Cross-sectional	Findings show worsening financial well-being was associated with poorer caregiver quality of life, which may in turn affect the care provided to patients with multiple myeloma. The study recommends routine financial assessment by nurses, financial guidance from patient navigators, billing specialists, and social workers, and the development of policies to better support patients and caregivers financially
Nightingale et al. (2022) USA [37]	This study aims to enhance an existing conceptual model of financial burden by conducting concept elicitation interviews with caregivers to generate knowledge that can be translated to inform instrumental and psychosocial support in cancer care	24 family caregivers	Cross-sectional qualitative study	Seven age-specific themes emerged, bolstering the model’s framework: (1) the direct and indirect costs of cancer; (2) the role of socioeconomic status in financial strain; (3) caregivers’ urge to protect adolescents and young adults from money-related stress; (4) tactics for managing cancer-related expenses; (5) anxieties about AYAs’ future financial security; (6) pursuing and utilizing financial aid; and (7) navigating the healthcare system. The study also found that the COVID-19 pandemic amplified financial pressures for some caregivers
Ohno et al. (2020) Japan [38]	To quantify the humanistic and economic burden among caregivers of patients with cancer in Japan and compare it with that of caregivers of patients with other conditions and non-caregivers	251 caregivers of cancer patients	Cross-sectional	Cancer caregivers experienced more stress-related comorbidities, poorer mental health-related quality of life, greater impairment in work productivity and daily activities, and higher indirect costs compared to caregivers of other conditions. These findings highlight the need for healthcare planning in Japan to better recognize and address the significant burden on cancer caregivers
Salikhanov et al. (2023) Kazakhstan [39]	To evaluate the cost-effectiveness of hospice-based versus cancer center–based palliative care for patients with terminal cancer and examine the related burden on family caregivers	182 family caregivers	Cross-sectional	The findings suggest that hospice-based palliative care was a more cost-effective option than cancer center–based palliative care, offering better patient quality of life, lower caregiver burden, and lower out-of-pocket and overall costs. In resource-limited settings such as Kazakhstan, hospice-based care may provide a more practical and supportive model of care
Su et al. (2022) Singapore [40]	To examine whether health shocks in patients with advanced cancer are associated with caregivers’ employment over time, and to identify characteristics of caregivers who remain employed despite these shocks	270 family caregivers	Longitudinal cohort study	As patients’ health worsened, caregivers were more likely to reduce work or experience disruptions in employment over time, and vulnerable caregivers were especially likely to face household income loss. These findings suggest that caregiving can significantly affect employment throughout the caregiving journey and highlight the need for ongoing, targeted support to help vulnerable caregivers stay at work
Tanriverdi et al. (2016) Turkey [41]	To explore the personal, social, and economic burden, as well as the prevalence of depression, among primary caregivers of patients receiving chemotherapy, with particular attention to whether patients were aware of their cancer diagnosis	968 family caregivers	Cross-sectional survey	Caregivers of patients with advanced or metastatic cancer experienced substantial social and personal disruptions. About 36% reported financial loss, 18% lost employment, and another 18% sold property or livestock to cover treatment costs
Tur-Sinai et al. (2022) Israel [42]	To identify the areas of out-of-pocket (OOP) spending in the last half-year of the lives of cancer patients and examine the extent of that spending	491 family caregivers	Cross-sectional study	84% of cancer patients and their relatives incurred OOP expenses during the last half-year of the patient’s life. The average levels of expenditure were US$ 5800 on medicines, $8000 on private caregivers, and $2800 on private nurses. The probability of a financial burden due to OOP was higher among those unable to remain alone, the incapacitated, and those without insurance, and lower among those with above-average income, those with better education, and patients who died at home
Van. H et al. (2025) USA [16]	To describe multiple dimensions of economic costs for caregivers of persons with advanced cancer and short-term changes in costs	198 family caregivers	Longitudinal study	About one in three caregivers went into debt because of their caregiving duties, and 24% reported facing financial hardship. Most caregivers of patients with advanced‐stage cancer incurred both direct treatment costs and additional indirect expenses
Viola et al. (2023) USA [43]	To examine associations between financial hardship and suicidal ideation among bereaved informal caregivers of cancer patients	153 family caregivers	Longitudinal prospective study	Financial hardship after the loss remained strongly linked to suicidal thoughts. In a cohort of cancer caregivers tracked from active caregiving into bereavement, those facing economic strain post-loss were more likely to experience suicidal ideation
Yu et al. (2015) [44]	To compare the societal costs of end-of-life care between home death and hospital death within a home-based palliative care program	186 caregivers	Prospective cohort	Findings indicated no difference in total societal cost between home and hospital death, but home death shifted more burden to families through higher unpaid caregiver time and higher outpatient service costs. Families bore more than half of the total costs
Zhang et al. (2024) China [45]	To assess the level of financial toxicity of informal caregivers of colorectal cancer patients and explore the related key influencing factors	236 family caregivers	Cross-sectional study	Caregivers of colorectal cancer often experienced considerable financial toxicity, but this strain can be alleviated when their stress levels are lowered and they receive robust social support. In clinical practice, it’s important to thoroughly assess caregivers’ financial burden and introduce tailored measures such as improving communication channels and proactively sharing information about treatment costs to curb financial toxicity and enhance the overall quality of colorectal cancer care