Financial risk protection and distress financing for cervical cancer treatment in low- and middle-income countries: a systematic review

Abstract

Background: Cervical cancer is a major health challenge in low-and middle-income countries (LMICs), where households face high out-of-pocket costs and limited financial risk protection (FRP).Insufficient FRP for treatment leads to catastrophic health expenditure (CHE), impoverishing health expenditure (IHE) and distress financing.Objective: This review aimed to synthesise evidence and highlight gaps related to FRP and distress financing (cost-coping strategies) associated with treatment-related cervical cancer care in LMICs. Methods:A systematic search of PubMed, Scopus, Cochrane Library and EBSCOhost was conducted on 1 July 2024 for peer-reviewed observational studies published from 1 January 2003.Using the Population, Exposure and Outcome framework, the review focused on women with cervical cancer or caregivers (Population), treatment and follow-up care (Exposure) and outcomes on CHE, IHE and cost-coping strategies (Outcome).Eligible studies were quantitative or qualitative with independently extractable outcomes.Results: Twenty-nine studies (10 quantitative and 19 qualitative) met the inclusion criteria.Evidence on FRP for cervical cancer in LMICs remains scarce.Only four studies reported on CHE, with incidence ranging from 62% to 86%, all using unadjusted thresholds.No studies assessed IHE.Common coping strategies included selling assets and borrowing, while forgoing care for financial reasons was rarely examined.Predictors and long-term impacts of distress financing remain underexplored.Conclusion: This study underscores the need for more research into the financial burden associated with cervical cancer treatment in LMICs and calls for stronger financial protection measures to mitigate these hardships.