The number of patients with advanced cancer is rapidly increasing, and the subgroup of this population with low socioeconomic status has suffered more disease burden than others. However, there is no recent qualitative synthesis of primary research studies into advanced cancer patients with low socioeconomic status.
Objective:
To synthesise qualitative research findings into advanced cancer patients’ experiences with low socioeconomic status, and then to help provide targeted and effective strategies to improve their quality of life.
Design:
A systematic review and meta-synthesis of qualitative evidence (PROSPERO: CRD42021250423).
Data sources:
PubMed, Web of Science Core Collection (ISI Web of Science), Cochrane Library, Embase, OVID LWW, CINAHL Complete (EBSCO), PsycINFO (EBSCO) and MEDLINE (ISI Web of Science), China National Knowledge Infrastructure (CNKI), WangFang, and Vip databases were systematically searched from their original dates to July 2022. Qualitative data were appraised using the Joanna Briggs Institute (JBI) qualitative assessment.
Findings:
The findings were synthesised into the following three analytical themes: (1) multi-dimensional disease distresses; (2) barriers in coping with disease distresses; and (3) strategies for dealing with disease distresses.
Conclusions:
Patients with advanced cancer with low socioeconomic status experienced complicated and interactional distresses, unique life barriers, and a wide range of adaptation strategies. These findings will provide a comprehensive perspective to promote individual-centred health care systems and services to help these vulnerable people deal with the challenges of disease and improve their quality of life.
SungHFerlayJSiegelRL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin2021; 71: 209–249.
2.
AllemaniCMatsudaTDi CarloV, et al. Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet2018; 391:1023–1075.
3.
WangJJLeiKFHanF. Tumor microenvironment: recent advances in various cancer treatments. Eur Rev Med Pharmacol Sci2018; 22: 3855–3864.
4.
KokkonenKTasmuthTLehtoJT, et al. Cancer Patients’ symptom burden and health-related quality of life (HRQoL) at Tertiary Cancer Center from 2006 to 2013: A cross-sectional study. Anticancer Res2019; 39: 271–277.
5.
NaserAYHameedANMustafaN, et al. Depression and anxiety in patients with cancer: a cross-sectional study. Front Psychol2021; 12: 585534.
6.
GonzalezLBardachAPalaciosA, et al. Health-related quality of life in patients with breast cancer in Latin America and the Caribbean: A systematic review and meta-analysis. Oncologist2021; 26: e794–e806.
7.
CáceresMCNadal-DelgadoMLópez-JuradoC, et al. Factors related to anxiety, depressive symptoms and quality of life in breast cancer. Int J Environ Res Public Health2022; 19: 3547–3560.
8.
AuluckAWalkerBBHislopG, et al. Socio-economic deprivation: a significant determinant affecting stage of oral cancer diagnosis and survival. BMC Cancer2016; 16: 569.
9.
WilliamsBR. Dying young, dying poor: a sociological examination of existential suffering among low-socioeconomic status patients. J Palliat Med2004; 7: 27–37.
10.
MarmotM; Commission on Social Determinants of Health. Achieving health equity: from root causes to fair outcomes. Lancet2007; 370: 1153–1163.
11.
MehaffeyJHHawkinsRBCharlesEJ, et al. Socioeconomic “Distressed Communities Index” improves surgical risk-adjustment. Ann Surg2020; 271: 470–474.
12.
MichaelsADMeneveauMOHawkinsRB, et al. Socioeconomic risk-adjustment with the area deprivation index predicts surgical morbidity and cost. Surgery2021; 170: 1495–1500.
13.
PornetCDelpierreCDejardinO, et al. Construction of an adaptable European transnational ecological deprivation index: the French version. J Epidemiol Community Health2012; 66: 982–989.
14.
JangBSChangJH. Socioeconomic status and survival outcomes in elderly cancer patients: a national health insurance service-elderly sample cohort study. Cancer Med2019; 8: 3604–3613.
15.
ChâteletVLobbedezTHarambatJ, et al. Précarité et greffe rénale : pourquoi et comment estimer son effet sur la santé des populations ?Néphrologie & Thérapeutique2018; 14: 81–84.
16.
McCutchanGWoodFSmitsS, et al. Barriers to cancer symptom presentation among people from low socioeconomic groups: a qualitative study. BMC Public Health2016; 16: 1052.
17.
WalkerGVGrantSRGuadagnoloBA, et al. Disparities in stage at diagnosis, treatment, and survival in nonelderly adult patients with cancer according to insurance status. J Clin Oncol2014; 32: 3118–3125.
18.
ACTION Study Group, JanSKimmanMPetersSA, et al. Financial catastrophe, treatment discontinuation and death associated with surgically operable cancer in south-East Asia: Results from the ACTION Study. Surgery2015; 157: 971–982.
19.
ShahRChanKKW. The impact of socioeconomic status on stage at presentation, receipt of diagnostic imaging, receipt of treatment and overall survival in colorectal cancer patients. Int J Cancer2021; 149: 1031–1043.
20.
ElorantaSLambertPCCavalli-BjorkmanN, et al. Does socioeconomic status influence the prospect of cure from colon cancer–a population-based study in Sweden 1965-2000. Eur J Cancer2010; 46: 2965–2972.
21.
MarcuABlackGVedstedP, et al. Educational differences in responses to breast cancer symptoms: a qualitative comparative study. Br J Health Psychol2017; 22: 26–41.
22.
MacleodUMitchellEDBurgessC, et al. Risk factors for delayed presentation and referral of symptomatic cancer: evidence for common cancers. Br J Cancer2009; 101(Suppl 2): S92–S101.
23.
ACTION Study Group, KimmanMJanSYipCH, et al. Catastrophic health expenditure and 12-month mortality associated with cancer in Southeast Asia: results from a longitudinal study in eight countries. BMC Med2015; 13: 190.
24.
NippRDShuiAMPerezGK, et al. Patterns in health care access and affordability among cancer survivors during implementation of the Affordable Care Act. JAMA Oncol2018; 4: 791–797.
25.
AlbrightBBChinoFChinoJP, et al. Associations of insurance churn and catastrophic health expenditures with implementation of the Affordable Care Act among nonelderly patients with cancer in the United States. JAMA network open2021; 4: e2124280.
26.
YeagerKAQuestTEVenaC, et al. Living with symptoms: a qualitative study of black adults with advanced cancer living in poverty. Pain Manag Nurs2018; 19: 34–45.
27.
KaulSAvilaJCMehtaHB, et al. Cost-related medication nonadherence among adolescent and young adult cancer survivors. Cancer2017; 123: 2726–2734.
28.
LiuCYChenWTLKungPT, et al. Characteristics, survival, and related factors of newly diagnosed colorectal cancer patients refusing cancer treatments under a universal health insurance program. BMC Cancer2014; 14: 446.
29.
LuZKXiongXBrownJ, et al. Impact of cost-related medication nonadherence on economic burdens, productivity loss, and functional abilities: management of cancer survivors in medicare. Front Pharmacol2021; 12: 706289.
30.
Delgado-GuayMFerrerJRieberAG, et al. Financial distress and its associations with physical and emotional symptoms and quality of life among advanced cancer patients. Oncologist2015; 20: 1092–1098.
31.
MercadanteSAielliFAdileC, et al. Financial distress and its impact on symptom expression in advanced cancer patients. Support Care Cancer2021; 29: 485–490.
32.
NippRDEl-JawahriAMoranSM, et al. The relationship between physical and psychological symptoms and health care utilization in hospitalized patients with advanced cancer. Cancer2017; 123: 4720–4727.
33.
ParkSAChungSHLeeY. Factors influencing the quality of life of patients with advanced cancer. Appl Nurs Res2017; 33: 108–112.
34.
KankeuHTSaksenaPXuK, et al. The financial burden from non-communicable diseases in low- and middle-income countries: a literature review. Health Res Policy Syst2013; 11: 31.
35.
de VriesEVergara-GarcíaOEKarduss-PreciadoS, et al. The financial impact of a terminal cancer on patient’s families in Colombia - A survey study. J Cancer Policy2021; 28: 100272.
36.
LaiYJChenYYKoMC, et al. Low socioeconomic status associated with lower utilization of hospice care services during end-of-life treatment in patients with cancer: a population-based cohort study. J Pain Symptom Manag2020; 60: 309–315.e301.
37.
YeagerKASterkCEQuestTE, et al. Managing one’s symptoms: a qualitative study of low-income African Americans with advanced cancer. Cancer Nurs2016; 39: 303–312.
38.
GuoPAlajarmehSAlarjaG, et al. Compounded trauma: a qualitative study of the challenges for refugees living with advanced cancer. Palliat Med2021; 35: 916–926.
39.
MalhotraCHardingRTeoI, et al. Financial difficulties are associated with greater total pain and suffering among patients with advanced cancer: results from the COMPASS study. Support Care Cancer2020; 28: 3781–3789.
40.
MalhotraCKrishnanAYongJR, et al. Socio-economic inequalities in suffering at the end of life among advanced cancer patients: results from the APPROACH study in five Asian countries. Int J Equity Health2020; 19: 158.
41.
van RoijJBromLYoussef-El SoudM, et al. Social consequences of advanced cancer in patients and their informal caregivers: a qualitative study. Support Care Cancer2019; 27: 1187–1195.
42.
LewisJMDiGiacomoMCurrowDC, et al. Social capital in a lower socioeconomic palliative care population: a qualitative investigation of individual, community and civic networks and relations. BMC Palliat Care2014; 13: 30.
43.
FitchMISharpLHanlyP, et al. Experiencing financial toxicity associated with cancer in publicly funded healthcare systems: a systematic review of qualitative studies. J Cancer Surviv2022; 16: 314–328.
44.
SandelowskiMDochertySEmdenC. Focus on qualitative methods. Qualitative metasynthesis: issues and techniques. Res Nurs Health1997; 20: 365–371.
45.
HigginsJPTThomasJChandlerJ, et al. Cochrane handbook for systematic reviews of interventions version 6.2, www.training.cochrane.org/handbook (2021, accessed 12 July 2021).
46.
LockwoodCMunnZPorrittK. Qualitative research synthesis: methodological guidance for systematic reviewers utilizing meta-aggregation. Int J Evid Based Healthc2015; 13: 179–187.
47.
PearsonA. Balancing the evidence: incorporating the synthesis of qualitative data into systematic reviews. JBI Rep2004; 2: 45–64.
48.
MunnZPorrittKLockwoodC, et al. Establishing confidence in the output of qualitative research synthesis: the ConQual approach. BMC Med Res Methodol2014; 14: 108.
49.
HughesAGudmundsdottirMDaviesB. Everyday struggling to survive: experience of the urban poor living with advanced cancer. Oncol Nurs Forum2007; 34: 1113–1118.
50.
RosenzweigMQWiehagenTBrufskyA, et al. Challenges of illness in metastatic breast cancer: a low-income African American perspective. Palliat Support Care2009; 7: 143–152.
51.
GlaserJCoulterYZThompson-LastadA, et al. Experiences of advanced breast cancer among Latina immigrants: a qualitative pilot study. J Immigr Minor Health2020; 22: 1287–1294.
52.
GrantEMurraySAGrantA, et al. A good death in rural Kenya? listening to Meru patients and their families talk about care needs at the end of life. J Palliat Care2003; 19: 159–167.
53.
RosenzweigMQWiehagenTBrufskyA, et al. The unique perspective of illness among women with metastatic breast cancer according to race and Income. J Hosp Palliat Nurs2009; 11: 27–38.
54.
WoodJ. Cicely Saunders, ‘Total Pain’ and emotional evidence at the end of life. Med Humanit2021; 0:1–11. DOI: 10.1136/medhum-2020-012107
55.
HensonLAMaddocksMEvansC, et al. Palliative care and the management of common distressing symptoms in advanced cancer: pain, breathlessness, nausea and vomiting, and fatigue. J Clin Oncol2020; 38: 905–914.
56.
BennettMPaiceJAWallaceM. Pain and opioids in cancer care: benefits, risks, and alternatives. Am Soc Clin Oncol Educ Book2017; 37: 705–713.
57.
McCutchanGMWoodFEdwardsA, et al. Influences of cancer symptom knowledge, beliefs and barriers on cancer symptom presentation in relation to socioeconomic deprivation: a systematic review. BMC Cancer2015; 15: 1000.
58.
Kübler-RossEWesslerSAvioliLV. On death and dying. JAMA1972; 221: 174–179.
59.
NewtonJCO’ConnorMSaundersC, et al. The role of psychosocial support in the experiences of people living with advanced cancer: A qualitative exploration of patients’ perspectives. Psychooncology2021; 30: 287–295.
60.
GrindrodA. Choice depends on options: A public health framework incorporating the social determinants of dying to create options at end of life. Prog Palliat Care2020; 28: 94–100.
61.
TangPLMayerDKChouFH, et al. The experience of cancer stigma in Taiwan: a qualitative study of female cancer patients. Arch Psychiatr Nurs2016; 30: 204–209.
62.
HuynhLHenryBDosaniN. Minding the gap: access to palliative care and the homeless. BMC Palliat Care2015; 14: 62.
63.
MarcusenC. Information and communication needs of individuals living with advanced cancer. Semin Oncol Nurs2010; 26: 151–156.
64.
SaracinoRMPolacekLCApplebaumAJ, et al. Health information preferences and Curability Beliefs among Patients with Advanced Cancer. J Pain Symptom Manag2021; 61: 121–127.
65.
El-JawahriATraegerLParkER, et al. Associations among prognostic understanding, quality of life, and mood in patients with advanced cancer. Cancer2014; 120: 278–285.
66.
Hsiu ChenCWenFHHouMM, et al. Transitions in prognostic awareness among terminally ill cancer patients in their last 6 months of life examined by multi-state Markov modeling. Oncologist2017; 22: 1135–1142.
67.
GastonCMMitchellG. Information giving and decision-making in patients with advanced cancer: a systematic review. Soc Sci Med2005; 61: 2252–2264.
68.
Försäkringskassan. Social insurance in figures 2015. Sweden: The Swedish Social Insurance Agency, 2015.
69.
TakenakaYYasuiTEnomotoK, et al. Health insurance status and survival among patients with head and neck cancer in Japan. Int J Clin Oncol2016; 21: 517–522.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
