Financial hardship in cancer family caregivers: a scoping review

Family caregivers of adults diagnosed with cancer usually face significant financial hardship due to employment disruptions and the cost of cancer-related expenses. This leads to physical, emotional, and psychological burden on them. However, despite this important contribution, family caregivers are rarely recognized as major stakeholders in palliative and supportive care during the caregiving trajectory.

To address these gaps and inform palliative care practice, policy, and future research, we conducted a scoping review to synthesize and critically evaluate the current state of the science on how financial hardship influences decision-making regarding coping strategies and sources of support among family caregivers.

Guided by the Arksey and O'Malley scoping review framework, EMBASE, CINAHL, and PubMed were searched for English language articles published between January 2015 and May 2025 using the keywords: "financial distress," AND "family caregiver," AND "cancer."

Of 816 articles screened, 28 met the eligibility criteria. Caregivers reported financial hardships due to cancer-related income loss, employment disruptions, and out-of-pocket costs, which contributed to psychosocial and emotional burden. Across the studies, most financial, psychosocial, and emotional outcomes were self-reported. Contributions from family and friends, community organizations, and insurance systems were the sources of support for family caregivers. Caregivers employed a range of coping strategies (e.g., borrowing from family/friends, forgoing leisure and medical treatments, and sale of possessions) to manage financial hardships. Most U.S. participants (>50%) were White/Caucasian, with minimal representation of caregivers identifying with racial/ethnic minority groups.

Financial hardships were common among family caregivers, which were linked to worse psychosocial and physical health outcomes. Findings highlight the prevalence of financial hardships among cancer caregivers. In clinical practice, clinicians may consider comprehensive screening for financial hardships and the timely introduction of cost conversations for patients. However, few articles focused on the experiences of caregivers from racial and ethnic minority groups, highlighting a critical gap and need for more inclusive research.