1.Did the Qualitative Analysis review address a clearly focused question?
Yes, the review was particular about the focused question. The population studied was cancer patients age 18 years and above, with difficulties covering health costs associated with cancer treatment. The authors examined 74 studies representing 598,751 cancer patients across the United States (US). The interventions include a thorough research on the causes and outcomes of financial challenges encountered during cancer treatment. The review results indicated a high financial commitment to cancer treatment among young people and socially disadvantaged individuals due to lack of health insurance, unemployment, and low income, resulting in difficulties in treatment adherence (Smith et al., 2019).
- Did the authors look for the right type of papers?
Yes, the researchers identified studies with primary data analysis on financial burdens. The authors searched for papers that indicate the relationship between the financial obligations and the socio-economic, demographic, clinical, intervention, and outcome aspects. The authors also searched for conceptual frameworks and studies on both the physical and psychological implications of the financial burdens. The study also included peer-reviewed and full-text studies conducted on cancer patients age 18 years and above in the US. The study’s eligibility is confirmed using NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies for bias risk assessment. The systematic review applied credible sources of literature. Additionally, the authors appraised the evidence’s strengths through the Grading of Recommendation Assessment Development Evaluation (GRADE) criteria (Smith et al., 2019).
- Do you think all the important, relevant studies were included?
Yes, the researchers used the MEDLINE, PubMed, PsycINFO, and Cochrane databases ranging from June 2018, thus providing recent data on the focused question. The authors searched for studies with an analysis of primary data regarding the financial burden among cancer patients. The authors excluded non-US studies and materials with no preliminary data. English-language, full-text and peer-reviewed studies conducted on cancer patients age 18 years and above were included in the study. The researchers excluded non-US studies and materials with no original data analysis, including those that did not report patient-level financial burden from the survey. The researchers manually examined the reference lists of the reviews related to the focused question. The authors also performed the abstract screening and full-text assessment before settling for the inclusion of the study. The authors engage a research librarian to guide the research in the databases (Smith et al., 2019).
4.Did the review’s authors do enough to assess quality of the included studies?
Yes, the study was precise from the planning stage to the reporting stage. There is a clearly defined eligibility criterion for inclusion and exclusion of the studies in the review at the planning stage. In the data collection stage, the authors indicate the search strategies applied to search for materials in the MEDLINE, Psych INFO, Cochrane, and the Embase databases through the guidance from the research Librarian. The authors also abstracted and double-checked the study characteristics, the design, and the studies’ eligibility. Conflicts during data collection were resolved by consensus. At the analysis stage, the reviewers use the “NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies “to assess the risk of bias and the GRADE criteria as the appraisal tool. Finally, data is reported using a table and a forest plot, and clear explanations for each analysis is provided (Smith et al., 2019).
- If the results of the review have been combined, was it reasonable to do so?
Can’t Tell, the study included 74 studies, and all the results included are displayed. There is substantial heterogeneity in the analysis. Results are reported differently according to the subject under the investigation. The results were classified under the following headings; “The risk factors predicting financial burdens with cancer treatment and “Health outcomes associated with financial burdens.” Therefore, it is difficult to tell the similarities and differences in the study characteristics. However, the forest plot is straightforward since numbers contributed to the plot. The results showing the comparison in financial burdens between the insured and the non-insured are precise, thus considered appropriate (Smith et al., 2019).
6.What are the overall results of the review?
The authors reviewed 74 studies representing 598,751 cancer patients.49% of the patients had the physical or psychological financial burden (95% CI,41%-56%). The identified socio-economic predictors for financial burden include; lack of insurance, low income, young age, and joblessness. A comparison between the insured and the non-insured indicates double odds of the financial burden (Pooled odds ratio(OR),2.09′;95% CI,1.33-3.30). The financial commitment is evident during the early stages of cancer treatment and is related to low health-related quality of life (OR,1.70;95%CI,1.13-2.56). Only one study indicated the relationship between the financial burden and high death rates. There were no studies on the interventions against financial obligations for cancer patients (Smith et al., 2019).
- How precise are the results?
To identify the range of values that can be affirmed in confidence (95%) that the study’s implications apply to the general population, then confidence levels are used. A narrower range in interval indicates a high level of precision of the results and reliability in the information regarding financial burden in cancer treatment. In this systematic review, the authors analyzed answers under two circumstances, which include; First, the risk factors that predict financial burden in cancer treatment, a comparison between the insured and the non-insured(OR,2.09:95%CI,1.33-3.30). Secondly, the health implications of the financial burden associated with early treatment stages and low health-related quality of life(OR,1.70;95%,1.13-2.56). According to the data, I consider a lack of insurance as a risk predictor for a financial burden for cancer treatment and low health-related quality of life due to the financial burden in cancer treatment (Smith et al., 2019).
- Can the results be applied to the local population?
Yes, the study is conducted in an all-inclusive population. Out of 598,571 cancer patients who participated in the study,566,531 patients were categorized by race as whites, Caucasians, or non-Hispanic whites,597,575 patients are categorized by sex with 54% being females and the average age is 59.5 years. The results also depict that the study was conducted among individuals with diverse social, economic backgrounds, thus making it possible to identify the social-economic predictors of the financial burden for cancer treatment. Therefore, the study results apply to the local population as it is an all-inclusive population with similar risks as encountered by the community under the study (Smith et al., 2019).
- Were all important outcomes considered?
yes, the systematic review identified several outcomes critical in informing the risk and consequences of cancer of financial burden in cancer treatment. The study reports that the threats are highly prevalent among socio-economically disadvantaged individuals. Additionally, financial burden results in poor adherence to treatment and low health-related quality of life. The study also considered the outcome from one research, which indicates that cancer treatment’s financial obligations result in a high mortality rate. Again, the authors stated that there was no literature about the interventions to eliminate financial burdens in cancer treatment; thus, they suggested for efforts to develop interventions to help the oncology team to address the adverse implications of financial obligations for cancer patients (Smith et al., 2019).
10.Are the benefits worth the harms and costs?
yes, the research was funded by the University of Texas MD Anderson Cancer Center; however, the authors did not mention the research’s actual cost. In my view, the costs of the benefits o the study outweigh the costs. The study outcomes addressed the focused question. The study helped in identifying the vulnerable population that may need the attention of the oncology. Again, the study identified a research gap that should be addressed to reduce cancer patients’ financial burden. The study outcomes are critical for further research, policy formulation, and awareness of general and patient populations (Smith et al., 2019).
Smith, G. L., Lopez-Olivo, M. A., Advani, P. G., Ning, M. S., Geng, Y., Giordano, S. H., & Volk, R. J. (2019). Financial burdens of cancer treatment: a systematic review of risk factors and outcomes. Journal of the National Comprehensive Cancer Network, 17(10), 1184-1192.