News: ASEAN research: Cancer forced low income patients to poverty

Poor or socially underprivileged patients are at “financial catastrophic risk”, reports a study of eight South East Asian nations

 Cancer affliction is so potentially disastrous in Southeast Asia that over 75% of patients in the Association of South East Asian Nation (ASEAN) region were driven to poverty or death within one year of diagnosis, reported a study recently.

 In a presentation entitled ‘Prioritizing Strategies to Address the Economic Impact of Cancer in Southeast Asia’ by Dr Nirmala Bhoo-Pathy from University of Malaya Faculty of Medicine, Malaysia, the study listed advanced cancer stages, no health insurance, low income, unemployment and lowest level of education as potential sources of household financial crisis.

 The findings, presented during the inaugural ESMO Asia 2015 Congress Presidential Symposium held recently in Singapore, found that that cancer resulted in “financial catastrophe” for almost half of the patients who suffered from economic hardship at the time of diagnosis.

Source: The ACTION Study Group, BMC Medicine

 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, the study reported.

 The prospective longitudinal study of new cancer patients in eight low- and middle-income ASEAN countries (Cambodia, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Thailand, and Vietnam) – dubbed the Asean CosTs In Oncology (ACTION) study – was initiated in 2012 to assess the economic and health impact of cancer.

 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, were examined.

“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.”-Dr Bhoo-Pathy

 The study found that participants in the low income category within each country had significantly higher odds of financial catastrophe (odds ratio, 5.86; 95% confidence interval, 4.76–7.23) and death (5.52; 4.34–7.02) than participants with high income. Those without insurance were also more likely to experience financial catastrophe (1.27; 1.05–1.52) and die (1.51; 1.21–1.88) than participants with insurance.

 “Cancer stage explained most of the financial catastrophic risk and premature deaths observed in the study,” explained Dr. Bhoo-Pathy who was the lead author of the ACTION study. Low-income patients remained financially vulnerable, even when diagnosed at very early cancer stages, according to her.

 “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,” Dr Bhoo-pathy added.

 1.7 million new cancer cases are reported every year in Southeast Asia, according to the World Health Organization, and cancer deaths are expected to rise 45% higher in 2030. “Southeast Asia is population- and area-wise comparable to the European Union (EU),” said Professor Christoph Zielinski, an ESMO Board Member from Medical University of Vienna, Austria, when commenting on the study.

 “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,” Zielinski said.

 The study adds compelling evidence to the argument for policies that improve access to care and provide adequate financial protection from the costs of illness. “Our study provides health authorities with significant data to enable them to prioritize cost-effective strategies in cancer control,” Dr Bhoo-Pathy said.

Source: ‘Prioritizing strategies to address the economic impact of cancer in Southeast Asia’ slide presentation, ESMO ASIA 2015

 “Early detection may provide the best avenue to favorably 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,” she added.

 The ACTION study echoes the view advocated by Dr Omar Abdel-Rahman, the Editor-in-Chief of Advances in Modern Oncology Research (AMOR) journal, who called for more research being done to alleviate the devastating impact of cancer care cost on patients.

 “Cancer is a global health problem with profound healthcare, social and economic consequences,” he noted. “Every year, researchers explore newer therapeutics which pave the way towards better treatment outcomes. However, these new therapeutics pose an extra burden on the already compromised economies all over the world,” he said.

 Dr Abdel-Rahman highlighted a study published in AMOR’s December 2015 issue by associate professor Chieh-Yu Liu from the School of Nursing at National Taipei University of Nursing and Health Sciences, which analyzed the cost-effectiveness of healthcare resource utilization of certain cancer drugs in the treatment of patients with inoperable advanced breast cancer (IABC).

 Liu found no significant differences observed in terms of outpatient cost, inpatient cost and total costs in neither early nor late administration of the drug capecitabine. Patients being prescribed the drug trastuzumab, however, faced a financial burden.

 The economic difficulties of IABC on patients receiving early or late second-line capecitabine or trastuzumab after the first-line anthracycline- or taxane-based treatments therefore substantially influences the overall cost of breast cancer care, Liu concluded in his report. “[O]ur results facilitate the development of cost-effective evaluations of breast cancer therapies,” Liu hoped.