Cancer drives patients to poverty in Southeast Asia

December 17, 2015

SINGAPORE/LUGANO - Five percent of cancer patients and their families were pushed into poverty in Southeast Asia between March 2012 and September 2013, because of high disease-related costs, a study (1) at the inaugural ESMO Asia 2015 Congress in Singapore shows.

The research, conducted earlier this year, evaluated data collected in eight low and middle-income Southeast Asian countries (Cambodia, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Thailand and Vietnam) to assess patient risk of financial catastrophe (medical expenditures exceeding 30% of annual household income), economic hardship (inability to make necessary household payments) and impoverishment (living on less than 2 US dollars per day), and the association between economic struggles and risk of death. The study shows that cancer resulted in 'financial catastrophe' for almost half of the patients who suffered from economic hardship at the time of diagnosis.

Out-of-pocket healthcare expenditure could have a direct or indirect negative impact on patient's life, potentially affecting quality of life, compliance and death risk. According to study results, up to 20% of patients did not attend their medical appointments or could not pay for medicines. Disadvantaged patients had an 80% higher risk of death within 12 months following diagnosis compared to their counterparts without economic difficulties at baseline.

Commenting on the study, Professor Christoph Zielinski, Medical University of Vienna, Austria, ESMO Board Member and Editor-in-Chief of ESMO Open-Cancer Horizons, said: "Cancer places a significant financial burden on patients, even in middle- and high-income countries. It is therefore no surprise that patients in low and middle-income countries face a relatively larger burden upon their diagnosis. While early detection of cancer can somewhat alleviate this financial burden, patients are still in a precarious situation and are at risk of financial catastrophe.

"Cancer can be an even more terrible disease for poor or socially underprivileged people, and cancer treatment costs constitute only a portion of the problem. Cancer is also linked to morbidity resulting from treatment side-effects, evolvement of the underlying disease, resulting in the inability to follow basic tasks of daily life requiring support by the immediate surroundings, and even terminally severe restrictions in work abilities. Some or many of these aspects can be neutralised by appropriate social programmes, albeit lots of problems remain or become only slightly alleviated by even the best of social systems."

Advanced cancer stages, no health insurance, low income, unemployment and lowest level of education were listed as potential sources of household financial crisis in the prior phase of the ASEAN CosTs In ONcology (ACTION) study (2). "Cancer stage explained most of the financial catastrophic risk and premature deaths observed in the study", senior author, Dr. Nirmala Bhoo-Pathy of the Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia, said. "However, low-income patients remained financially vulnerable, even when diagnosed at very early cancer stages. There appeared to be missed opportunities for surgery in patients with operable malignancies, particularly in low-income groups. Patients without health insurance also remained at higher risk of incurring catastrophic expenditures and dying, even in early stages".

The World Health Organization (WHO) reports 1.7 million new cancer cases every year in Southeast Asia, and the prevalence of cancer mortality is expected to be up to 45% higher in 2030 (3). "Southeast Asia is population- and area-wise comparable to the European Union (EU)," Zielinski said. "However, the similarities end here, as countries of Southeast Asia have a completely different social insurance and security structure, as compared to the EU, and although economic growth is impressive, individual income structures are quite restricted".

Strategies to limit the negative financial impact on cancer patients from low- and middle-income countries should be a priority, as are strategies for treating the disease. Many would be feasible options, according to health policy expert Professor Tikki Pang of the National University of Singapore. "Screening programmes for early detection is a proven strategy in many countries to reduce cancer-related direct and indirect costs, as well as education and awareness raising among the population," he said. "Innovative health insurance models, e.g. a mix of public and private, may also be a useful strategy but each country must decide what schemes suits them best. Another strategy could be promoting the production of generics at national or regional level."

"Our study provides health authorities with significant data to enable them to prioritise cost-effective strategies in cancer control", Bhoo-Pathy said. "Early detection may provide the best avenue to favourably influence economic and disease outcomes in cancer patients from low- and middle-income Southeast Asian countries, followed by increasing accessibility to effective treatments and provision of financial risk protection. The health financing systems in these countries also requires re-examination to ensure that public funds are directed to patients who need them the most."
-end-
References

(1) Abstract 52O "Prioritizing strategies to address the economic impact of cancer in Southeast Asia - N. Bhoo-Pathy, Social and Preventive Medicine, University of Malaya Faculty of Medicine, Kuala Lumpur, Malaysia" will be presented during the ESMO Asia 2015 Congress Presidential Symposium on Sunday 20 December, 16:30 (Singapore time)

Abstract will be available online on 17th December 2015, 23:55 hours (SGT) https://cslide.ctimeetingtech.com/library/esmo/browse/itinerary/5225

(2) "Catastrophic health expenditure and 12-month mortality associated with cancer in Southeast Asia: results from a longitudinal study in eight countries", Author(s): Kimman, Merel; Jan, Stephen; Yip, Cheng Har; et al. Source: Bmc Medicine Volume: 13 Published: AUG 18 2015

(3) World health Organisation (WHO), http://www.who.int/gho/countries/en/

Notes to Editors

Disclaimer


Information contained in this press release was provided by the abstracts authors and reflects the content of the studies. It does not necessarily express ESMO's point of view.

About the European Society for Medical Oncology

ESMO is the leading professional organisation for medical oncology, with the overarching goal of improving outcomes for cancer patients everywhere. We are the society of reference for oncology education and information, and are committed to supporting our members to develop and advance in a fast-evolving professional environment.

Founded in 1975, ESMO has European roots with a global reach: we welcome oncology professionals from around the world. We are a home for all oncology stakeholders, connecting professionals with diverse expertise and experience, and speaking with one voice for our discipline. Our education and information resources support an integrated multi-professional approach to cancer care, from a medical oncology perspective. We seek to erase boundaries in cancer care, whether between countries or specialities, and pursue our mission across oncology, worldwide.

The ESMO community brings together more than 12,000 oncology professionals from over 130 countries. Drawing on 40 years of experience and around 500 expert committee members, ESMO serves its members and the oncology community through:Cancer care is rapidly becoming more integrated and more specialised; whether their field is research, diagnosis, treatment, care, or advocacy, oncology professionals need to both build their specialist knowledge and connect with the best practitioners in other disciplines worldwide. ESMO membership makes this possible.

Please visit esmo.org to learn more. Across Oncology. Worldwide.

ABSTRACT 52O_PR

Prioritizing strategies to address the economic impact of cancer in Southeast Asia

N. Bhoo-Pathy Social and Preventive Medicine, University of Malaya Faculty of Medicine, Kuala Lumpur, Malaysia

Aim/Background: The ASEAN CosTs In ONcology (ACTION) study revealed that a year after diagnosis, 29% of cancer patients died, 48% had financial catastrophe (FC: out of pocket medical costs exceeding 30% of annual household income), and only 23% were alive with no FC. We estimated the impact of cancer control interventions, and health insurance on economic outcomes and mortality of cancer patients in Southeast Asia (SEA).

Methods: In ACTION study, 9,513 cancer patients with solid and non-solid tumors from 47 hospitals in 8 ASEAN countries were assessed at baseline, 3- and 12 months after diagnosis using questionnaires and cost diaries to determine their risk of FC, economic hardship (EC: inability to make necessary household payments) and impoverishment (living on less than USD2/day). Multinomial regression allowing death as a competing risk was used to assess the association between patient's baseline socio-demographic status and FC, and EH, respectively. Stepwise adjustments for i) health insurance, ii) cancer stage, and iii) cancer therapies were done.

Results: One year after diagnosis, the incidence of mortality and FC ranged from 12% and 45%, respectively in Malaysia to 45% and 50% in Myanmar. Overall, cancer-induced EH was evident in one third of patients of which 45% could not pay for medicines, and 28% resorted to taking personal loans. Five percent of patients were pushed into poverty. Stepwise multivariable regression showed that cancer stage largely explained the incidence of FC and death, followed by cancer therapies. Health insurance did not appear to explain risk of FC. Analysis stratified by cancer stage however showed that low-income patients experienced substantially higher FC and deaths compared to high-income patients across all cancer stages. Patients without health insurance also remained vulnerable to premature deaths even when presenting at earlier cancer stages. Similar results were also observed in multivariable analyses with EH as the outcome.

Conclusions: Cancer down staging via early detection provides the best opportunity to improve economic and survival outcomes of cancer patients in SEA. Nevertheless, providing access to cancer therapies is also important and governments need to improve the financial risk protection for patients.

Disclosure: The author has declared no conflicts of interest.

Keywords: cancer control, economic impact, cancer burden, low- middle income countries

European Society for Medical Oncology

Related Cancer Articles from Brightsurf:

New blood cancer treatment works by selectively interfering with cancer cell signalling
University of Alberta scientists have identified the mechanism of action behind a new type of precision cancer drug for blood cancers that is set for human trials, according to research published in Nature Communications.

UCI researchers uncover cancer cell vulnerabilities; may lead to better cancer therapies
A new University of California, Irvine-led study reveals a protein responsible for genetic changes resulting in a variety of cancers, may also be the key to more effective, targeted cancer therapy.

Breast cancer treatment costs highest among young women with metastic cancer
In a fight for their lives, young women, age 18-44, spend double the amount of older women to survive metastatic breast cancer, according to a large statewide study by the University of North Carolina at Chapel Hill.

Cancer mortality continues steady decline, driven by progress against lung cancer
The cancer death rate declined by 29% from 1991 to 2017, including a 2.2% drop from 2016 to 2017, the largest single-year drop in cancer mortality ever reported.

Stress in cervical cancer patients associated with higher risk of cancer-specific mortality
Psychological stress was associated with a higher risk of cancer-specific mortality in women diagnosed with cervical cancer.

Cancer-sniffing dogs 97% accurate in identifying lung cancer, according to study in JAOA
The next step will be to further fractionate the samples based on chemical and physical properties, presenting them back to the dogs until the specific biomarkers for each cancer are identified.

Moffitt Cancer Center researchers identify one way T cell function may fail in cancer
Moffitt Cancer Center researchers have discovered a mechanism by which one type of immune cell, CD8+ T cells, can become dysfunctional, impeding its ability to seek and kill cancer cells.

More cancer survivors, fewer cancer specialists point to challenge in meeting care needs
An aging population, a growing number of cancer survivors, and a projected shortage of cancer care providers will result in a challenge in delivering the care for cancer survivors in the United States if systemic changes are not made.

New cancer vaccine platform a potential tool for efficacious targeted cancer therapy
Researchers at the University of Helsinki have discovered a solution in the form of a cancer vaccine platform for improving the efficacy of oncolytic viruses used in cancer treatment.

American Cancer Society outlines blueprint for cancer control in the 21st century
The American Cancer Society is outlining its vision for cancer control in the decades ahead in a series of articles that forms the basis of a national cancer control plan.

Read More: Cancer News and Cancer Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.