BACKGROUND: Evidence to guide policymakers in developing affordable and equitable cancer control plans are scarce in low- and middle-income countries (LMIC). METHODS: The 2012-2014 ASEAN Costs in Oncology Study prospectively followed-up 9513 newly diagnosed cancer patients from eight LMIC in Southeast Asia for 12 months. Overall and country-specific incidence of financial catastrophe (out-of-pocket health costs ≥ 30% of annual household income), economic hardship (inability to make necessary household payments), poverty (living below national poverty line), and all-cause mortality were determined. Stepwise multinomial regression was used to estimate the extent to which health insurance, cancer stage and treatment explained these outcomes. RESULTS: The one-year incidence of mortality (12% in Malaysia to 45% in Myanmar) and financial catastrophe (24% in Thailand to 68% in Vietnam) were high. Economic hardship was reported by a third of families, including inability to pay for medicines (45%), mortgages (18%) and utilities (12%), with 28% taking personal loans, and 20% selling assets (not mutually exclusive). Out of households that initially reported incomes above the national poverty levels, 4·9% were pushed into poverty at one year. The adverse economic outcomes in this study were mainly attributed to medical costs for inpatient/outpatient care, and purchase of drugs and medical supplies. In all the countries, cancer stage largely explained the risk of adverse outcomes. Stage-stratified analysis however showed that low-income patients remained vulnerable to adverse outcomes even when diagnosed with earlier cancer stages. CONCLUSION: The LMIC need to realign their focus on early detection of cancer and provision of affordable cancer care, while ensuring adequate financial risk protection, particularly for the poor.
BACKGROUND: Evidence to guide policymakers in developing affordable and equitable cancer control plans are scarce in low- and middle-income countries (LMIC). METHODS: The 2012-2014 ASEAN Costs in Oncology Study prospectively followed-up 9513 newly diagnosed cancerpatients from eight LMIC in Southeast Asia for 12 months. Overall and country-specific incidence of financial catastrophe (out-of-pocket health costs ≥ 30% of annual household income), economic hardship (inability to make necessary household payments), poverty (living below national poverty line), and all-cause mortality were determined. Stepwise multinomial regression was used to estimate the extent to which health insurance, cancer stage and treatment explained these outcomes. RESULTS: The one-year incidence of mortality (12% in Malaysia to 45% in Myanmar) and financial catastrophe (24% in Thailand to 68% in Vietnam) were high. Economic hardship was reported by a third of families, including inability to pay for medicines (45%), mortgages (18%) and utilities (12%), with 28% taking personal loans, and 20% selling assets (not mutually exclusive). Out of households that initially reported incomes above the national poverty levels, 4·9% were pushed into poverty at one year. The adverse economic outcomes in this study were mainly attributed to medical costs for inpatient/outpatient care, and purchase of drugs and medical supplies. In all the countries, cancer stage largely explained the risk of adverse outcomes. Stage-stratified analysis however showed that low-income patients remained vulnerable to adverse outcomes even when diagnosed with earlier cancer stages. CONCLUSION: The LMIC need to realign their focus on early detection of cancer and provision of affordable cancer care, while ensuring adequate financial risk protection, particularly for the poor.
Authors: Ophira Ginsburg; Cheng-Har Yip; Ari Brooks; Anna Cabanes; Maira Caleffi; Jorge Antonio Dunstan Yataco; Bishal Gyawali; Valerie McCormack; Myrna McLaughlin de Anderson; Ravi Mehrotra; Alejandro Mohar; Raul Murillo; Lydia E Pace; Electra D Paskett; Anya Romanoff; Anne F Rositch; John R Scheel; Miriam Schneidman; Karla Unger-Saldaña; Verna Vanderpuye; Tsu-Yin Wu; Safina Yuma; Allison Dvaladze; Catherine Duggan; Benjamin O Anderson Journal: Cancer Date: 2020-05-15 Impact factor: 6.860
Authors: Frederic Ivan L Ting; Danielle Benedict L Sacdalan; Mayou Martin T Tampo; Rosielyn T Apellido; Hermogenes J Monroy; Marie Dione P Sacdalan; Dennis L Sacdalan Journal: JCO Glob Oncol Date: 2020-02