Table 2.

Summary characteristics and key findings of included studies

Authors/Year/Country/Objectives	Cancer type/Sample characteristics	Study design	Time since diagnosis	Patients and/or caregivers perspective	Measures	Costs timeframe	Key findings	OOP cost per month (US$2019)
Amarasinghe et al. (2019) [21] Sri Lanka Objectives: To estimate costs of managing patients with oral cancer	Oral cancer n = 69 Male 87% and female 13% Participants aged 40–81	Descriptive cross-sectional study	12 month	Both perspectives	Household costs: direct and indirect costs	Costs were estimated from the stage of presentation for treatment to 1 year of follow-up	Mean household cost for stage II patient was US$518 The annual household costs for stage III or IV patient was US$480	$21.33 per month for stage II $18 per month for stage III or IV
Carey et al. (2012) [22] Australia Objectives: To examine the social and financial impacts associated with supporting haematological cancer survivors	Haematological cancer n = 182. Support persons male & female (The paper report only % of female which is 71%) Participants aged 18–80	Cross-sectional survey	Within the last 3 years	Caregivers perspective	Direct and indirect costs	Support persons were asked to indicate costs over the past month	Overall, 67 (46%) support persons reported having at least one personal expense and 91 (52%) experienced at least one financial impact Male support persons and support persons of survivors in active treatment experienced more costs than other support persons Older participants reported fewer financial consequences	N/A
Céilleachair et al. (2012) [23] Ireland Objectives: To investigate the economic costs of cancer in the context of patients’ emotions and how these both shaped the patient and family burden	Colorectal cancer n = 2 patients and 6 carers, male (n = 8) & female (n = 14) Participants aged 44–82	Qualitative interviews	Within the previous year	Both perspectives	OOP costs	N/A	Important OOP costs included: travel and parking; costs of procedures; increased household bills; and new clothing Cancer impacted on employed individuals’ ability to work and decreased their income. The opportunity cost of informal care for carers, especially after diagnosis, was a strong theme	N/A
Ceilleachair et al. (2017) [24] Ireland Objectives: To investigate OOP costs incurred by colorectal survivors	Colorectal cancer n = 497, male 62% and female 38% Participants aged < 70 and ≥ 70 years	Cohort study	6–30 months	Patients perspective	OOP costs	The first year post diagnosis	The average OOP cost was €1589. Mean OOP costs for stage III disease were significantly higher than for those with other disease stages. Those aged 70 + had lower mean OOP costs than those < 70 (€1160 versus €1948). Those employed at diagnosis had a slightly higher OOP costs than those who were not (€1963 versus €1367)	$165.5 per month
Gordon et al. (2007) [25] Australia Objectives: To identify and describe the direct and indirect economic losses to breast cancer survivors	Breast cancer n = 272, female Participants aged 20–75	Longitudinal study	18 months following diagnosis	Both perspectives	Direct and indirect costs	Survey were obtained at five time-points: 6, 9, 12, 15 and 18 months from the date of diagnosis	Economic costs related to breast cancer may continue to affect women 18 months after diagnosis. Lost income, health services costs, and lost unpaid work were the greatest sources of economic burden	N/A
Hanly et al. (2013) [26] Ireland Objectives: To estimate financial and time costs associated with informal care for colorectal cancer	Colorectal cancer n = 154, caregivers male 18.2% and female 81.8% Participants aged 21–83	Cohort study	6–30 months	Caregivers perspective	Hospital-based costs, domestic-based time costs, domestic-based OOP costs and travel costs	Costs were collected during two phases: up to 3 months post-diagnosis (diagnosis and treatment) and during the last 30 days before questionnaire completion (ongoing care)	In the diagnosis and treatment phase, weekly informal care costs per person were: hospital-based costs, incurred by 99% of carers (mean = €393); domestic-based time costs, incurred by 85% (mean = €609); and domestic-based OOP costs, incurred by 68% (mean = €69) Ongoing costs included domestic-based time costs incurred by 66% (mean = €66) and domestic-based OOP costs incurred by 52% (mean = €52) The approximate average first year informal care cost was €29,842, of which 85% was time costs, 13% OOP costs and 2% travel costs	$399 per month
Jagsi et al. (2014) [27] The USA Objectives: To evaluate the financial experiences of a racially and ethnically diverse cohort of long-term breast cancer survivors (17% African American, 40% Latina) identified through population-based registries	Breast cancer n = 1502, female Participants aged 22–79	Longitudinal cohort study	4 years after diagnosis	Patients perspective	Changes in work and OOP costs	2005 to 2007 (4 year)	Overall, 33% reported financial decline since diagnosis. The median OOP expenses were  ≤ $2000; 17% of respondents reported spending > $5000 Of the respondents who worked at some time after diagnosis, 27% decreased work hours, 7% were denied job opportunities because of cancer	N/A
Lauzier et al. (2008) [28] Canada Objectives: To estimate the burden from wage losses for Canadian patients	Breast cancer n = 459, women Participants aged 23–71	Prospective cohort study	Over the first 12 months after diagnosis	Both perspectives	Wage losses	The interviews conducted 6, and 12 months after the start of definitive treatment	On average, working women lost 27% of their projected usual annual wages (median = 19%) after compensation received had been taken into account. Higher percentage of lost wages was associated with a lower level of education, living 50 km or more from the hospital, lower social support, having invasive disease, receipt of chemotherapy, self-employment, shorter tenure in the job, and part-time work	N/A
Lauzier et al. (2013) [29] Canada Objectives: To 1) describe the extent of OOP costs among women and their spouses during the first year after diagnosis. 2) Identify women at risk of experiencing higher levels of OOP costs. 3) Describe effects of both OOP costs and wage losses on the family’s financial situation during the same period	Breast cancer n = 829, women and 391 spouses Participants aged 23–88	Longitudinal study	During the first year after diagnosis	Both perspectives	OOP costs	1-month interview focused on OOP costs related to surgery, 6-month interview focused on OOP costs related to adjuvant treatments, and 12-month interview focused on OOP costs related to any late treatments (surgical or adjuvant) and on other types of costs	Median OOP costs were $1002 (Canadian dollars). Spouses’ median costs were $111, or 9% of couples’ total expenses. Higher OOP costs were associated with higher education, working at diagnosis, living > 50 km from the hospital, and having multiple types of adjuvant treatment. When considered simultaneously with wage losses, OOP costs were not associated with perceived deterioration in the family’s financial situation; rather, wage losses were the driving factor	$95.58 per month for patients $16.38 per month for Spouses
Li et al. (2013) [30] The USA Objectives: To estimate lost productivity and informal caregiving and associated costs among partner caregivers of localized prostate cancer patients	Prostate cancer n = 88 partner caregivers Participants aged 34–80	Longitudinal cohort study	Within 1 year after diagnosis	Caregivers perspective	Care time and changes in work	Mailed follow-up surveys to patients and caregivers were administered at 6 and 12 months	The average working hours decreased from 14.0 h/week to 10.9 h/week. The mean annual economic burden among partner caregivers was $6063	N/A
Mahmood et al. (2018) [31] Pakistan Objectives: To explore the cost burden (i.e. direct medical costs, direct non-medical costs and indirect non-medical costs) incurred by breast cancer patients and their families over diagnosis and treatment	Breast cancer n = 200, women Participants aged 18 +	Cohort study	3 months to 2 years since diagnosis	Both perspectives	Direct medical, direct non-medical, indirect non-medical costs	N/A	The study found that direct medical care (US$ 1262.18) is the largest cost, followed by direct non-medical (US$ 310.88) and indirect non-medical costs (US$ 273.38)	$131 per month
Marti et al. (2016) [32] The UK Objectives: To describe the economic burden of UK cancer survivorship for breast, colorectal and prostate cancer patients treated with curative intent, 1 year post‐diagnosis	Breast, colorectal and prostate cancer n = 298, breast (n = 136), colorectal (n = 83), prostate (n = 79) Male 45% & female 55% Participants aged 18 +	Cohort study	12–15 months post-diagnosis	Both perspectives	Patients’ OOP costs and costs of informal care	The previous three months	Patients’ OOP expenses (mean: $US40) [mean: £25] and the cost of informal care (mean: $US110) [mean: £70]	$40 per month
Pisu et al. (2011) [33] The USA Objectives: (1) To describe OOP costs among minority and Caucasian participants in the in the BCEI, Breast Cancer Education Intervention, a randomized clinical trial of psychoeducational quality of life interventions for breast cancer survivors. (2) To examine the OOP burden, as measured by the proportion of income spent OOP, between the two racial/ethnic groups	Breast cancer n = 261, women Participants aged 21–83	Cross‐sectional	Within 2 years since diagnosis	Patients perspective	OOP costs	Authors examined the monthly OOP costs	OOP costs averaged $316 per month since diagnosis. Direct medical costs were $281 and direct non-medical were $66	$316 per month
Tison et al. (2016) [34] France Objectives: To investigate whether the labour market mobility of a population of cancer survivors 2 years after diagnosis differed compared to the French general population by focusing on the differences between self-employed workers and salaried staff	Mixed cancers The first dataset included 3967 individuals The second dataset (control group) contained 8066 respondents The paper did not report the % of male and female Participants aged 18–82	Case control study	2 years after diagnosis	Patients perspective	Changes in work	N/A	Salaried employees and self-employed workers from the general population were more likely to remain employed 2 years after 2010 compared to salaried employees and self-employed workers who survived cancer Among those who were employed in 2010, 14% for both self-employed and salaried cancer survivors were not employed 2 years later	N/A
Su et al. (2018) [35] Malaysia Objectives: This study aimed, firstly, to assess the determinants of return to work, secondly, to explore the amount of annual wage loss, and finally, to discover the determinants of wage loss among breast cancer survivors	Breast cancer n = 256, women Participants aged 20–79	Cross-sectional study	Within 1 year after diagnosis	Patients perspective	Wage losses	The data was collected over a period of 12 months	There was a 21% loss of or reduction in mean income within 1 year after diagnosis. The main risk factors for reduced wages or wage loss were belonging to the age group of 40–59 years, being of Chinese or Indian ethnicity, having low educational status, and not returning to work	N/A
Vayr et al. (2020) [36] France Objectives: To assess the rate of work adjustments 1 year after the diagnosis in a population of female breast cancer survivors, in the context of the French system of social protection	Breast cancer n = 185, women Participants aged 18—65	Prospective study	1 year after the diagnosis	Patients perspective	Work changes	1 year after the diagnosis	One year after the diagnosis, among 185 breast cancer survivors, 78 (42.2%) patients were working. Among them, 13 patients did not interrupt their occupational activity and 65 returned to work after a period of sick leave	N/A
Zhang et al. (2017) [37] China Objectives: To calculate the total cost of lung cancer treatment for lung cancer survivors in China within five years from the date of diagnosis	Lung cancer n = 195, male (n = 122) 62.56% & female (n = 73) Participants aged 29–89	Cohort study	5 years following diagnosis	Both perspectives	Direct medical costs, direct non-medical costs and indirect costs	First year after diagnosis	The average economic burden was $43,336 per patient, of which the direct cost per capita was $42,540 (98.16%) and the indirect cost per capita was $795 (1.84%). Of the total direct medical costs, 35.66% was paid by the insurer and 9.84% was not covered by insurance. The economic burden in the first year following diagnosis was $30,277 per capita	$2,523 per month
Humphries, et al. (2020) [38] Canada Objectives: To evaluate the wage losses incurred by spouses of women with nonmetastatic breast cancer	Nonmetastatic breast cancer n = 279, male 269, female 4 and unknown 6 Participants aged ≥ 18 years	Prospective cohort study	6 months after the diagnosis	Caregivers perspective	Wage losses	1 and 6 months after the diagnosis	Overall, 78.5% experienced work absences Spouses were compensated for 66.3% of their salary on average during their absence. The median wage loss was (mean, $1820) (Canadian dollars)	N/A

OOP, out of pocket costs