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Bhoo-Pathy N, Taylor C, Unger-Saldaña K. Operationalizing patient-centered cancer care in low- and middle-income countries. Cell Rep Med 2024; 5:101517. [PMID: 38776876 PMCID: PMC11148561 DOI: 10.1016/j.xcrm.2024.101517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/17/2024] [Accepted: 03/25/2024] [Indexed: 05/25/2024]
Abstract
Rising cancer survival rates in low- and middle-income countries (LMICs) necessitate a paradigm shift to holistic, patient-driven care, focusing on meaningful outcomes aligned with individual values. Data, co-creation, continuous improvement, and collaboration are key. By prioritizing patient-defined metrics and patient empowerment, LMICs can transform cancer care, fostering sustained well-being beyond disease control.
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Affiliation(s)
- Nirmala Bhoo-Pathy
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
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2
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Fu W, Shi J, Liu C, Chen W, Liu G, He J. Health insurance and inequalities in catastrophic health spending in cancer patients. A cross-sectional study in China. GACETA SANITARIA 2024; 38:102397. [PMID: 38772059 DOI: 10.1016/j.gaceta.2024.102397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 01/23/2024] [Accepted: 03/19/2024] [Indexed: 05/23/2024]
Abstract
OBJECTIVE To determine the role of social health insurance programs in reducing inequality in the incidence and intensity of catastrophic health expenditure (CHE) of cancer patients in China. METHOD A convenient sample of 2534 cancer patients treated in nine hospitals in 2015 and 2016 were followed up through face-to-face interviews in March-December 2018. The incidence and intensity (mean positive overshoot) of CHE (≥ 40% household consumption) were calculated. RESULTS About 72% of cancer patients experienced CHE events after insurance compensation, with the catastrophic mean positive overshoot amounting to 28.27% (SD: 15.83%) of the household consumption. Overall, social insurance contributed to a small percentage of drop in CHE events. Income-related inequality in CHE persisted before and after insurance compensation. Richer patients benefit more than poorer ones. CONCLUSIONS Cancer treatment is associated with high incidence of CHE events in China. The alleviating effect of social health insurance on CHE events is limited.
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Affiliation(s)
- Wenqi Fu
- School of Health Management, Public Health, Harbin Medical University, Harbin, China
| | - Jufang Shi
- Office of Cancer Screening, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Wanqing Chen
- Office of Cancer Screening, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guoxiang Liu
- School of Health Management, Public Health, Harbin Medical University, Harbin, China.
| | - Jie He
- Office of Cancer Screening, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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3
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Nasimi Shad A, Akhlaghipour I, Alshakarchi HI, Saburi E, Moghbeli M. Role of microRNA-363 during tumor progression and invasion. J Physiol Biochem 2024:10.1007/s13105-024-01022-1. [PMID: 38691273 DOI: 10.1007/s13105-024-01022-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/05/2024] [Indexed: 05/03/2024]
Abstract
Recent progresses in diagnostic and therapeutic methods have significantly improved prognosis in cancer patients. However, cancer is still considered as one of the main causes of human deaths in the world. Late diagnosis in advanced tumor stages can reduce the effectiveness of treatment methods and increase mortality rate of cancer patients. Therefore, investigating the molecular mechanisms of tumor progression can help to introduce the early diagnostic markers in these patients. MicroRNA (miRNAs) has an important role in regulation of pathophysiological cellular processes. Due to their high stability in body fluids, they are always used as the non-invasive markers in cancer patients. Since, miR-363 deregulation has been reported in a wide range of cancers, we discussed the role of miR-363 during tumor progression and metastasis. It has been reported that miR-363 has mainly a tumor suppressor function through the regulation of transcription factors, apoptosis, cell cycle, and structural proteins. MiR-363 also affected the tumor progression via regulation of various signaling pathways such as WNT, MAPK, TGF-β, NOTCH, and PI3K/AKT. Therefore, miR-363 can be introduced as a probable therapeutic target as well as a non-invasive diagnostic marker in cancer patients.
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Affiliation(s)
- Arya Nasimi Shad
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Iman Akhlaghipour
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hawraa Ibrahim Alshakarchi
- Al-Zahra Center for Medical and Pharmaceutical Research Sciences (ZCMRS), Al-Zahraa University for Women, Karbala, Iraq
| | - Ehsan Saburi
- Department of Medical Genetics and Molecular Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Meysam Moghbeli
- Department of Medical Genetics and Molecular Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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4
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Jaganathan M, Ang BH, Ali A, Sharif SZ, Mohamad M, Mohd Khairy A, Muniandy K, Zainal H, Sabtu F, Sapiee N, Zainal NH, Zaipudin NFH, Muniandi M, Ghazali AF, Roimin FO, Chong CCL, Rajaram N, Jaafar N, Julaihi R, Rahim N, Zakaria NA, Menon I, Tajudeen NA, Ho KY, Md Yusof S, Abdul Wahab MY, Ab Hadi IS, Teo SH. Presentation of Breast Cancer and Impact of Patient Navigation on Timeliness of Diagnosis and Treatment and on Adherence to Treatment Recommendations in a Multicenter Network in Malaysia. JCO Glob Oncol 2024; 10:e2300297. [PMID: 38484197 PMCID: PMC10954078 DOI: 10.1200/go.23.00297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/09/2023] [Accepted: 01/30/2024] [Indexed: 03/19/2024] Open
Abstract
PURPOSE Breast cancer deaths disproportionately affect women living in low- and middle-income countries (LMICs). Patient navigation has emerged as a cost-effective and impactful approach to enable women with symptoms or suspicious mammogram findings to access timely diagnosis and patients with breast cancer to access timely and appropriate multimodality treatment. However, few studies have systematically evaluated the impact of patient navigation on timeliness of diagnosis and treatment in LMICs. METHODS We established a nurse- and community-navigator-led navigation program in breast clinics of four public hospitals located in Peninsular and East Malaysia and evaluated the impact of navigation on timeliness of diagnosis and treatment. RESULTS Patients with breast cancer treated at public hospitals reported facing barriers to accessing care, including having a poor recognition of breast cancer symptoms and low awareness of screening methods, and facing financial and logistics challenges. Compared with patients diagnosed in the previous year, patients receiving navigation experienced timely ultrasound (84.0% v 65.0%; P < .001), biopsy (84.0% v 78.0%; P = .012), communication of news (63.0% v 40.0%; P < .001), surgery (46% v 36%; P = .008), and neoadjuvant therapy (59% v 42%, P = .030). Treatment adherence improved significantly (98.0% v 87.0%, P < .001), and this was consistent across the network of four breast clinics. CONCLUSION Patient navigation improves access to timely diagnosis and treatment for women presenting at secondary and tertiary hospitals in Malaysia.
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Affiliation(s)
| | | | - Adibah Ali
- Hospital Umum Sarawak, Jalan Hospital, Kuching, Malaysia
| | | | | | | | | | - Hani Zainal
- Cancer Research Malaysia, Subang Jaya, Malaysia
| | | | - Norija Sapiee
- Hospital Umum Sarawak, Jalan Hospital, Kuching, Malaysia
| | | | | | | | | | | | | | | | | | | | | | | | - Isabella Menon
- Hospital Umum Sarawak, Jalan Hospital, Kuching, Malaysia
| | | | - Kah Yee Ho
- Hospital Queen Elizabeth II, Kota Kinabalu, Malaysia
| | | | | | | | - Soo-Hwang Teo
- Cancer Research Malaysia, Subang Jaya, Malaysia
- Faculty of Medicine, University Malaya Cancer Research Institute, University of Malaya, Jalan Universiti, Kuala Lumpur, Malaysia
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5
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Chamberlin M, Booth C, Brooks GA, Manirakiza A, Rubagumya F, Vanderpuye V. More Drugs Versus More Data: The Tug of War on Cancer in Low- and Middle-Income Countries. Hematol Oncol Clin North Am 2024; 38:229-238. [PMID: 37516631 DOI: 10.1016/j.hoc.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
Abstract
Although current value frameworks and economic models have allowed us to better quantify the net benefit associated with cancer therapy, holistic cancer care must consider patient time, family and social values, and overall life expectancy. Training programs must include training in health services research, difficult conversations, and shared decision-making strategies that are developed in social and cultural frameworks for their settings.
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Affiliation(s)
- Mary Chamberlin
- Dartmouth Cancer Center, 1 Medical Center Drive, Lebanon, NH 03765, USA
| | | | - Gabriel A Brooks
- Dartmouth Cancer Center, 1 Medical Center Drive, Lebanon, NH 03765, USA
| | | | - Fidel Rubagumya
- Department of Oncology, Rwanda Military Hospital, Kigali, Rwanda
| | - Verna Vanderpuye
- National Center for Radiotherapy, Oncology and Nuclear Medicine, Korlebu Teaching Hospital, PO Box KB 369, Accra.
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6
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Malik M, Valiyaveettil D, Joseph DM. The Growing Burden of Cancer in Adolescent and Young Adults in Asia: A Call to Action. J Adolesc Young Adult Oncol 2024; 13:1-7. [PMID: 37327043 DOI: 10.1089/jayao.2023.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
Recent estimates suggest that the lower middle income countries in Asia carry the heaviest burden of cancer among adolescents and young adults (AYAs) (defined as age 15-39 years). A larger proportion of the population in Asia is aged 15-39 compared with the developed countries. This age group is different from the pediatric or the adult group in terms of physical, social, psychological, and financial needs. Cancer incidence, disability, survivorship needs, financial toxicity, psychosocial issues, and so on are underestimated in this group, and available literature is scarce. Global data show an increasing trend of adult-onset cancers such as colorectal, breast, pancreas, and lung in the AYA population. Data suggest that the disease biology and prognosis are different in this group; however, further research is needed. An ESMO/SIOPE/SIOP Asia survey on the care of AYA cancer patients in Asia found a suboptimal availability of AYA specialized centers in the region and identified several unmet needs including lack of training, clinical trials, and high rates of treatment abandonment. There is an urgent need for cancer care systems in Asia to develop specialized services to be able to cater to this growing burden. Training and research in this area also need to be upscaled with the goal of establishing a sustainable infrastructure and quality services to ensure that this vulnerable group receives appropriate care. Management guidelines and national health policies should consider giving special attention to this group as the World Health Assembly reinforces the inclusion of children and adolescents in cancer control programs.
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Affiliation(s)
- Monica Malik
- Department of Radiation Oncology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Deepthi Valiyaveettil
- Department of Radiation Oncology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Deepa M Joseph
- Department of Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, India
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7
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Potaya S, Thongcharoen V, Raungratanaamporn S, Klaewklong N, Jirachatchawanwit T. A Scenario for a Model of Excellence in Comprehensive Cancer Care. Asian Pac J Cancer Prev 2024; 25:273-279. [PMID: 38285794 PMCID: PMC10911747 DOI: 10.31557/apjcp.2024.25.1.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/23/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Cancer is the leading cause of death in Thailand, and the incidence of cancer is increasing substantially. The aim of the research was to develop a scenario for a model of excellence in comprehensive cancer care. METHOD Using Ethnographic Delphi Futures Research (EDFR), 30 expert informants in the field of cancer care were selected using the snowball sampling technique. The research tools were an interview guide and questionnaires. Data were transcribed, analyzed, and synthesized to yield a proposed scenario of the model, which was validated by seven qualified persons. RESULTS The generated scenario for a model of excellence in comprehensive cancer care consisted of seven dimensions. The first five dimensions described excellence in service systems and comprised proactive prevention, early detection, rapid and accurate diagnosis, effective treatment from multidisciplinary teams, and palliative care to improve quality of life. The last two dimensions described supporting systems and comprised informatics technology and continuous research and innovation. CONCLUSION The scenario for a model of excellence in comprehensive cancer care can be summarized according to the "3 Ts": transformation of cancer care, team and capacity building, and total quality management.
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Affiliation(s)
- Soparn Potaya
- Department of Adult and Geriatric Nursing, Princess Agrarajakumari College of Nursing, Chulabhorn Royal Academy, Bangkok, Thailand.
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8
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Loh YSL, Siah AKL, Koh SGM, Cheong WL, Su TT. "What's up with price controls?" Stakeholders' views on the regulation of pharmaceutical pricing in Malaysia. PLoS One 2023; 18:e0291031. [PMID: 38060579 PMCID: PMC10703332 DOI: 10.1371/journal.pone.0291031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/18/2023] [Indexed: 12/18/2023] Open
Abstract
Escalating costs have made the accessibility of drugs one of the biggest challenges faced by the Malaysian government. The government agreed to regulate drug prices by means of external reference pricing, but its proposed policy had a setback owing to much opposition from the pharmaceutical industry. The policy did gain support from the public and from non-governmental organisations because it ensured easy access to affordable medicines. Comments from public consultations with key stakeholders were used to explore stakeholders' perceptions of the external reference pricing policy. A total of 140 comments were analysed for this study. Stakeholders' views were classified as being from the Socioeconomic, industrial, and government sectors. To summarise, the government must carefully manage and consider stakeholders' views to ensure a sound policy. Using Mendelow's stakeholder mapping, this study mapped out stakeholders' views in a systematic approach. The classification of different stakeholders' views and recommendations led to suggestions for reviewing current practices in pharmaceutical pricing regulations in the Malaysian healthcare system. The analyses can be extended to other countries that face similar concerns.
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Affiliation(s)
- Ye Shing Lourdes Loh
- Department of Economics, School of Business, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Audrey K. L. Siah
- Department of Economics, School of Business, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Sharon G. M. Koh
- Department of Economics, School of Business, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Wing Loong Cheong
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Tin Tin Su
- Jeffrey Cheah School of Medicine and Health Sciences (JCSMHS), Monash University Malaysia, Bandar Sunway, Malaysia
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Are C, Murthy SS, Sullivan R, Schissel M, Chowdhury S, Alatise O, Anaya D, Are M, Balch C, Bartlett D, Brennan M, Cairncross L, Clark M, Deo SVS, Dudeja V, D'Ugo D, Fadhil I, Giuliano A, Gopal S, Gutnik L, Ilbawi A, Jani P, Kingham TP, Lorenzon L, Leiphrakpam P, Leon A, Martinez-Said H, McMasters K, Meltzer DO, Mutebi M, Zafar SN, Naik V, Newman L, Oliveira AF, Park DJ, Pramesh CS, Rao S, Subramanyeshwar Rao T, Bargallo-Rocha E, Romanoff A, Rositch AF, Rubio IT, Salvador de Castro Ribeiro H, Sbaity E, Senthil M, Smith L, Toi M, Turaga K, Yanala U, Yip CH, Zaghloul A, Anderson BO. Global Cancer Surgery: pragmatic solutions to improve cancer surgery outcomes worldwide. Lancet Oncol 2023; 24:e472-e518. [PMID: 37924819 DOI: 10.1016/s1470-2045(23)00412-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 11/06/2023]
Abstract
The first Lancet Oncology Commission on Global Cancer Surgery was published in 2015 and serves as a landmark paper in the field of cancer surgery. The Commission highlighted the burden of cancer and the importance of cancer surgery, while documenting the many inadequacies in the ability to deliver safe, timely, and affordable cancer surgical care. This Commission builds on the first Commission by focusing on solutions and actions to improve access to cancer surgery globally, developed by drawing upon the expertise from cancer surgery leaders across the world. We present solution frameworks in nine domains that can improve access to cancer surgery. These nine domains were refined to identify solutions specific to the six WHO regions. On the basis of these solutions, we developed eight actions to propel essential improvements in the global capacity for cancer surgery. Our initiatives are broad in scope, pragmatic, affordable, and contextually applicable, and aimed at cancer surgeons as well as leaders, administrators, elected officials, and health policy advocates. We envision that the solutions and actions contained within the Commission will address inequities and promote safe, timely, and affordable cancer surgery for every patient, regardless of their socioeconomic status or geographic location.
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Affiliation(s)
- Chandrakanth Are
- Division of Surgical Oncology, Department of Surgery, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Shilpa S Murthy
- Division of Surgical Oncology, Department of Surgery, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Richard Sullivan
- Institute of Cancer Policy, School of Cancer Sciences, King's College London, London, UK
| | - Makayla Schissel
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sanjib Chowdhury
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Olesegun Alatise
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Daniel Anaya
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Madhuri Are
- Division of Pain Medicine, Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Charles Balch
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, Global Cancer Surgery: pragmatic solutions to improve USA
| | - David Bartlett
- Department of Surgery, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - Murray Brennan
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lydia Cairncross
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Matthew Clark
- University of Auckland School of Medicine, Auckland, New Zealand
| | - S V S Deo
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Vikas Dudeja
- Division of Surgical Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Domenico D'Ugo
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | | | - Armando Giuliano
- Cedars-Sinai Medical Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Satish Gopal
- Center for Global Health, National Cancer Institute, Washington DC, USA
| | - Lily Gutnik
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andre Ilbawi
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Pankaj Jani
- Department of Surgery, University of Nairobi, Nairobi, Kenya
| | | | - Laura Lorenzon
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | - Premila Leiphrakpam
- Division of Surgical Oncology, Department of Surgery, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Augusto Leon
- Department of Surgical Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Kelly McMasters
- Division of Surgical Oncology, Hiram C Polk, Jr MD Department of Surgery, University of Louisville, Louisville, KY, USA
| | - David O Meltzer
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Miriam Mutebi
- Department of Surgery, Aga Khan University Hospital, Nairobi, Kenya
| | - Syed Nabeel Zafar
- Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison, WI, USA
| | - Vibhavari Naik
- Department of Anesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | - Lisa Newman
- Department of Surgery, New York-Presbyterian, Weill Cornell Medicine, New York, NY, USA
| | | | - Do Joong Park
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - C S Pramesh
- Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Centre, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Saieesh Rao
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - T Subramanyeshwar Rao
- Department of Surgical Oncology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | | | - Anya Romanoff
- Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Isabel T Rubio
- Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Spain
| | | | - Eman Sbaity
- Division of General Surgery, Department of Surgery, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Maheswari Senthil
- Division of Surgical Oncology, Department of Surgery, University of California, Irvine, Irvine, CA, USA
| | - Lynette Smith
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Masakazi Toi
- Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Tokyo, Japan
| | - Kiran Turaga
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Ujwal Yanala
- Surgical Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Cheng-Har Yip
- Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
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Dee EC, Eala MAB, Robredo JPG, Ramiah D, Hubbard A, Ho FDV, Sullivan R, Aggarwal A, Booth CM, Legaspi GD, Nguyen PL, Pramesh CS, Grover S. Leveraging national and global political determinants of health to promote equity in cancer care. J Natl Cancer Inst 2023; 115:1157-1163. [PMID: 37402623 PMCID: PMC10560599 DOI: 10.1093/jnci/djad123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/26/2023] [Accepted: 06/22/2023] [Indexed: 07/06/2023] Open
Abstract
Health and politics are deeply intertwined. In the context of national and global cancer care delivery, political forces-the political determinants of health-influence every level of the cancer care continuum. We explore the "3-I" framework, which structures the upstream political forces that affect policy choices in the context of actors' interests, ideas, and institutions, to examine how political determinants of health underlie cancer disparities. Borrowing from the work of PA Hall, M-P Pomey, CJ Ho, and other thinkers, interests are the agendas of individuals and groups in power. Ideas represent beliefs or knowledge about what is or what should be. Institutions define the rules of play. We provide examples from around the world: Political interests have helped fuel the establishment of cancer centers in India and have galvanized the 2022 Cancer Moonshot in the United States. The politics of ideas underlie global disparities in cancer clinical trials-that is, in the distribution of epistemic power. Finally, historical institutions have helped perpetuate disparities related to racist and colonialist legacies. Present institutions have also been used to improve access for those in greatest need, as exemplified by the Butaro Cancer Center of Excellence in Rwanda. In providing these global examples, we demonstrate how interests, ideas, and institutions influence access to cancer care across the breadth of the cancer continuum. We argue that these forces can be leveraged to promote cancer care equity nationally and globally.
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Affiliation(s)
- Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Michelle Ann B Eala
- College of Medicine, University of the Philippines, Manila, Philippines
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Janine Patricia G Robredo
- School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines
- Blavatnik Institute of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Duvern Ramiah
- Division of Radiation Oncology, University of the Witwatersrand, Johannesburg and Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Anne Hubbard
- American Society for Radiation Oncology, Arlington, VA, USA
| | | | - Richard Sullivan
- Kings Health Partners Comprehensive Cancer Centre, King's College London, Institute of Cancer Policy, London, UK
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Clinical Effectiveness Unit, Institute of Cancer Policy, King’s College London, London, UK
| | - Christopher M Booth
- Department of Oncology, Queen’s University, Kingston, ON, Canada
- Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, Kingston, ON, Canada
| | - Gerardo D Legaspi
- Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Harvard Cancer Center, Boston, MA, USA
| | - C S Pramesh
- Tata Memorial Hospital, Thoracic Surgery (Surgical Oncology) at Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
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11
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Sullivan R, Cazap E. The reality of cancer care for many. Ecancermedicalscience 2023; 17:ed127. [PMID: 37533940 PMCID: PMC10393300 DOI: 10.3332/ecancer.2023.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Indexed: 08/04/2023] Open
Abstract
The global literature is heavy with technical documents on how we should deliver cancer care, as well as policy discourses and studies on cancer services and systems. But it is woefully short on the reality of lived experiences. "Adaptations to Deliver Chemotherapy in a District Hospital: Successes and Challenges" from Malawian colleagues based in the Kumuzu University of Health Sciences in the District Hospital of the same name shines a much needed light of realism on the lived experiences of cancer. Why is this letter so important? Because it is much more than a narrative about a district hospital in a low resource country struggling to deliver basic cancer care, it is about the intricate relationship and trade-offs between patients and cancer carers in all resource constrained settings. It bears witness to a reality that feels very far away from the shining bright lights of modern cancer care with all its attendant technological trappings and choices.
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Affiliation(s)
- Richard Sullivan
- Professor, Cancer & Global Health, Chair ecancer Trustees, Institute of Cancer Policy, King’s College London, London, UK
| | - Eduardo Cazap
- Editor-in-Chief, ecancer, 13 King Square Avenue, Bristol, BS2 8HU, UK and President, Latin American and Caribbean Society of Medical Oncology (SLACOM), Buenos Aires, Argentina
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Dee EC. Family and Caregiver Financial Toxicity Associated With Cancer-A Global, Inequitable, and Urgent Consideration. JAMA Netw Open 2023; 6:e2319317. [PMID: 37347488 DOI: 10.1001/jamanetworkopen.2023.19317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023] Open
Affiliation(s)
- Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
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Puteh SEW, Abdullah YR, Aizuddin AN. Catastrophic Health Expenditure (CHE) among Cancer Population in a Middle Income Country with Universal Healthcare Financing. Asian Pac J Cancer Prev 2023; 24:1897-1904. [PMID: 37378917 PMCID: PMC10505870 DOI: 10.31557/apjcp.2023.24.6.1897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The study investigated healthcare expenditure from the perspective of cancer patients, to determine the level of Catastrophic Health Expenditure (CHE) and its associated factors. METHODS This cross-sectional study was conducted in three Malaysian public hospitals namely Hospital Kuala Lumpur, Hospital Canselor Tuanku Muhriz and the National Cancer Institute using a multi-level sampling technique to recruit 630 respondents from February 2020 to February 2021. CHE was defined as incurring a monthly health expenditure of more than 10% of the total monthly household expenditure. A validated questionnaire was used to collect the relevant data. RESULTS The CHE level was 54.4%. CHE was higher among patients of Indian ethnicity (P = 0.015), lower level education (P = 0.001), those unemployed (P < 0.001), lower income (P < 0.001), those in poverty (P < 0.001), those staying far from the hospital (P < 0.001), living in rural areas (P = 0.003), small household size (P = 0.029), moderate cancer duration (P = 0.030), received radiotherapy treatment (P < 0.001), had very frequent treatment (P < 0.001), and without a Guarantee Letter (GL) (P < 0.001). The regression analysis identified significant predictors of CHE as lower income aOR 18.63 (CI 5.71-60.78), middle income aOR 4.67 (CI 1.52-14.41), poverty income aOR 4.66 (CI 2.60-8.33), staying far from hospital aOR 2.62 (CI 1.58-4.34), chemotherapy aOR 3.70 (CI 2.01-6.82), radiotherapy aOR 2.99 (CI 1.37-6.57), combination chemo-radiotherapy aOR 4.99 (CI 1.48-16.87), health insurance aOR 3.99 (CI 2.31-6.90), without GL aOR 3.38 (CI 2.06-5.40), and without health financial aids aOR 2.94 (CI 1.24-6.96). CONCLUSIONS CHE is related to various sociodemographic, economic, disease, treatment and presence of health insurance, GL and health financial aids variables in Malaysia.
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Affiliation(s)
| | - Yang Rashidi Abdullah
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Malaysia.
| | - Azimatun Noor Aizuddin
- Department of Community Health, Faculty of Medicine, Hospital Canselor Tuanku Muhriz, Jalan Yaakob Latif Bandar Tun Razak, Malaysia.
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Dare AJ, Bayle A, Hatoqai A, Mungo C, Velilla DG, Soto-Perez-de-Celis E, Gnangnon FHR, Lim MSH, Ralefala T, Mushininga VD. Ensuring Global Access to Cancer Medicines: A Generational Call to Action. Cancer Discov 2023; 13:269-274. [PMID: 36734325 DOI: 10.1158/2159-8290.cd-22-1372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 12/09/2022] [Indexed: 02/04/2023]
Abstract
SUMMARY Essential cancer treatments are not accessible, affordable, or available to patients who need them in many parts of the world. A new Access to Oncology Medicines (ATOM) Coalition, using public-private partnerships, aims to bring essential cancer medicines and diagnostics to patients in low- and lower middle-income countries.
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Affiliation(s)
- Anna J Dare
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Arnauld Bayle
- Oncostat U1018, Inserm, Paris-Saclay University, Gustave Roussy, Villejuif, France
| | - Asma Hatoqai
- Cancer Control Office, King Hussein Cancer Center, Amman, Jordan
| | - Chemtai Mungo
- Department of Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Diego Gimenez Velilla
- Departamento de Oncología Radiante, Instituto Nacional del Cáncer (INCAN), Capiatá, Paraguay
| | | | | | - Melissa Siaw Han Lim
- Department of Paraclinical Sciences, Faculty of Medicine and Health Sciences, University Malaysia Sarawak (UNIMAS), Sarawak, Malaysia
| | - Tlotlo Ralefala
- Princess Marina Hospital, Ministry of Health and Wellness, Gaborone, Botswana
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Ehsan AN, Wu CA, Minasian A, Singh T, Bass M, Pace L, Ibbotson GC, Bempong-Ahun N, Pusic A, Scott JW, Mekary RA, Ranganathan K. Financial Toxicity Among Patients With Breast Cancer Worldwide: A Systematic Review and Meta-analysis. JAMA Netw Open 2023; 6:e2255388. [PMID: 36753274 PMCID: PMC9909501 DOI: 10.1001/jamanetworkopen.2022.55388] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 12/20/2022] [Indexed: 02/09/2023] Open
Abstract
Importance Financial toxicity (FT) is the negative impact of cost of care on financial well-being. Patients with breast cancer are at risk for incurring high out-of-pocket costs given the long-term need for multidisciplinary care and expensive treatments. Objective To quantify the FT rate of patients with breast cancer and identify particularly vulnerable patient populations nationally and internationally. Data Sources A systematic review and meta-analysis were conducted. Four databases-Embase, PubMed, Global Index Medicus, and Global Health (EBSCO)-were queried from inception to February 2021. Data analysis was performed from March to December 2022. Study Selection A comprehensive database search was performed for full-text, English-language articles reporting FT among patients with breast cancer. Two independent reviewers conducted study screening and selection; 462 articles underwent full-text review. Data Extraction and Synthesis A standardized data extraction tool was developed and validated by 2 independent authors; study quality was also assessed. Variables assessed included race, income, insurance status, education status, employment, urban or rural status, and cancer stage and treatment. Pooled estimates of FT rates and their 95% CIs were obtained using the random-effects model. Main Outcomes and Measures FT was the primary outcome and was evaluated using quantitative FT measures, including rate of patients experiencing FT, and qualitative FT measures, including patient-reported outcome measures or patient-reported severity and interviews. The rates of patients in high-income, middle-income, and low-income countries who incurred FT according to out-of-pocket cost, income, or patient-reported impact of expenditures during breast cancer diagnosis and treatment were reported as a meta-analysis. Results Of the 11 086 articles retrieved, 34 were included in the study. Most studies were from high-income countries (24 studies), and the rest were from low- and middle-income countries (10 studies). The sample size of included studies ranged from 5 to 2445 people. There was significant heterogeneity in the definition of FT. FT rate was pooled from 18 articles. The pooled FT rate was 35.3% (95% CI, 27.3%-44.4%) in high-income countries and 78.8% (95% CI, 60.4%-90.0%) in low- and middle-income countries. Conclusions and Relevance Substantial FT is associated with breast cancer treatment worldwide. Although the FT rate was higher in low- and middle-income countries, more than 30% of patients in high-income countries also incurred FT. Policies designed to offset the burden of direct medical and nonmedical costs are required to improve the financial health of vulnerable patients with breast cancer.
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Affiliation(s)
- Anam N. Ehsan
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts
- Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Catherine A. Wu
- Harvard Medical School, Boston, Massachusetts
- Department of Plastic Surgery, University of California, Orange
| | - Alexandra Minasian
- Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Tavneet Singh
- School of Pharmacy, MCPHS University, Boston, Massachusetts
| | - Michelle Bass
- Countway Library of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Lydia Pace
- Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Geoffrey C. Ibbotson
- United Nations Institute for Training and Research, Palais des Nations, Geneva, Switzerland
- The Global Surgery Foundation, Geneva, Switzerland
| | - Nefti Bempong-Ahun
- United Nations Institute for Training and Research, Palais des Nations, Geneva, Switzerland
- The Global Surgery Foundation, Geneva, Switzerland
| | - Andrea Pusic
- Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - John W. Scott
- Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor
| | - Rania A. Mekary
- Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- School of Pharmacy, MCPHS University, Boston, Massachusetts
| | - Kavitha Ranganathan
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts
- Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Ng CT, Tan LL, Sohn IS, Gonzalez Bonilla H, Oka T, Yinchoncharoen T, Chang WT, Chong JH, Cruz Tan MK, Cruz RR, Astuti A, Agarwala V, Chien V, Youn JC, Tong J, Herrmann J. Advancing Cardio-Oncology in Asia. Korean Circ J 2023; 53:69-91. [PMID: 36792558 PMCID: PMC9932224 DOI: 10.4070/kcj.2022.0255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 10/25/2022] [Indexed: 11/25/2022] Open
Abstract
Cardio-oncology is an emerging multi-disciplinary field, which aims to reduce morbidity and mortality of cancer patients by preventing and managing cancer treatment-related cardiovascular toxicities. With the exponential growth in cancer and cardiovascular diseases in Asia, there is an emerging need for cardio-oncology awareness among physicians and country-specific cardio-oncology initiatives. In this state-of-the-art review, we sought to describe the burden of cancer and cardiovascular disease in Asia, a region with rich cultural and socio-economic diversity. From describing the uniqueness and challenges (such as socio-economic disparity, ethnical and racial diversity, and limited training opportunities) in establishing cardio-oncology in Asia, and outlining ways to overcome any barriers, this article aims to help advance the field of cardio-oncology in Asia.
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Affiliation(s)
- Choon Ta Ng
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN, USA
- Department of Cardiology, National Heart Centre Singapore, Singapore.
| | - Li Ling Tan
- Department of Cardiology, National University Heart Centre Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Il Suk Sohn
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | | | - Toru Oka
- Onco-Cardiology Unit, Department of Internal Medicine, Saitama Cancer Center, Saitama, Japan
| | | | - Wei-Ting Chang
- Division of Cardiology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | - Jun Hua Chong
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | | | - Rochelle Regina Cruz
- Department of Cardiology, Cardinal Santos Medical Center, Metro Manila, The Philippines
| | - Astri Astuti
- Department of Cardiology and Vascular Medicine, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Vivek Agarwala
- Department of Medical Oncology and Haemato-Oncology, Narayana Superspeciality Hospital and Cancer Institute, Howrah, India
| | - Van Chien
- Department of Cardiology, National Heart Institute, Hanoi, Vietnam
| | - Jong-Chan Youn
- Seoul St. Mary's Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jieli Tong
- Department of Cardiology, Tan Tock Seng Hospital, Singapore
| | - Joerg Herrmann
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN, USA.
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Alberto NRI, Alberto IRI, Puyat CVM, Antonio MAR, Ho FDV, Dee EC, Mahal BA, Eala MAB. Disparities in access to cancer diagnostics in ASEAN member countries. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 32:100667. [PMID: 36785859 PMCID: PMC9918780 DOI: 10.1016/j.lanwpc.2022.100667] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/30/2022] [Indexed: 01/09/2023]
Abstract
Diagnostics, including laboratory tests, medical and nuclear imaging, and molecular testing, are essential in the diagnosis and management of cancer to optimize clinical outcomes. With the continuous rise in cancer mortality and morbidity in the Association of Southeast Asian Nations (ASEAN), there exists a critical need to evaluate the accessibility of cancer diagnostics in the region so as to direct multifaceted interventions that will address regional inequities and inadequacies in cancer care. This paper identifies existing gaps in service delivery, health workforce, health information systems, leadership and governance, and financing and how these contribute to disparities in access to cancer diagnostics in ASEAN member countries. Intersectoral health policies that will strengthen coordinated laboratory services, upscale infrastructure development, encourage health workforce production, and enable proper appropriation of funding are necessary to effectively reduce the regional cancer burden.
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Affiliation(s)
| | | | | | | | | | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brandon A. Mahal
- Department of Radiation Oncology, University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Michelle Ann B. Eala
- College of Medicine, University of the Philippines, Manila, Philippines,Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA,Corresponding author.
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Kc M, Oral E, Rung AL, Trapido E, Rozek LS, Fontham ETH, Bensen JT, Farnan L, Steck SE, Song L, Mohler JL, Khan S, Vohra S, Peters ES. Prostate cancer aggressiveness and financial toxicity among prostate cancer patients. Prostate 2023; 83:44-55. [PMID: 36063402 PMCID: PMC10087487 DOI: 10.1002/pros.24434] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 06/13/2022] [Accepted: 08/25/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Financial toxicity (FT) is a growing concern among cancer survivors that adversely affects the quality of life and survival. Individuals diagnosed with aggressive cancers are often at a greater risk of experiencing FT. The objectives of this study were to estimate FT among prostate cancer (PCa) survivors after 10-15 years of diagnosis, assess the relationship between PCa aggressiveness at diagnosis and FT, and examine whether current cancer treatment status mediates the relationship between PCa aggressiveness and FT. METHODS PCa patients enrolled in the North Carolina-Louisiana Prostate Cancer Project (PCaP) were recontacted for long-term follow-up. The prevalence of FT in the PCaP cohort was estimated. FT was estimated using the COmprehensive Score for Financial Toxicity, a validated measure of FT. The direct effect of PCa aggressiveness and an indirect effect through current cancer treatment on FT was examined using causal mediation analysis. RESULTS More than one-third of PCa patients reported experiencing FT. PCa aggressiveness was significantly independently associated with high FT; high aggressive PCa at diagnosis had more than twice the risk of experiencing FT than those with low or intermediate aggressive PCa (adjusted odds ratio [aOR] = 2.13, 95% CI = 1.14-3.96). The proportion of the effect of PCa aggressiveness on FT, mediated by treatment status, was 10%, however, the adjusted odds ratio did not indicate significant evidence of mediation by treatment status (aOR = 1.05, 95% CI = 0.95-1.20). CONCLUSIONS Aggressive PCa was associated with high FT. Future studies should collect more information about the characteristics of men with high FT and identify additional risk factors of FT.
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Affiliation(s)
- Madhav Kc
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut, USA
- Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center-New Orleans, New Orleans, Louisiana, USA
| | - Evrim Oral
- Biostatistics Program, School of Public Health, Louisiana State University Health Sciences Center-New Orleans, New Orleans, Louisiana, USA
| | - Ariane L Rung
- Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center-New Orleans, New Orleans, Louisiana, USA
| | - Edward Trapido
- Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center-New Orleans, New Orleans, Louisiana, USA
| | - Laura S Rozek
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Elizabeth T H Fontham
- Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center-New Orleans, New Orleans, Louisiana, USA
| | - Jeannette T Bensen
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Laura Farnan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Susan E Steck
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Lixin Song
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina, USA
| | - James L Mohler
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Saira Khan
- Epidemiology Program, College of Health Sciences, University of Delaware, Newark, Delaware, USA
| | - Sanah Vohra
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Edward S Peters
- Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center-New Orleans, New Orleans, Louisiana, USA
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Giang NH, Vinh NT, Phuong HT, Thang NT, Oanh TTM. Household financial burden associated with healthcare for older people in Viet Nam: a cross-sectional survey. Health Res Policy Syst 2022; 20:112. [PMID: 36443746 PMCID: PMC9706832 DOI: 10.1186/s12961-022-00913-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 09/16/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Population ageing and the associated increase in the healthcare needs of older people are putting pressure on the healthcare system in Viet Nam. The country prioritizes healthcare for older people and has developed financial protection policies to mitigate financial hardship due to out-of-pocket health expenditures (OOPHEs) borne by their households. This study examines the level and determinants of the financial burden of OOPHE among households with people aged ≥ 60 years in Viet Nam. METHODS A cross-sectional household survey was conducted among a sample of 1536 older people living in 1477 households in three provinces representing the North, Central and South regions of Viet Nam during 2019-2020. The financial outcomes were catastrophic health expenditure (CHE), using WHO's definition, and financial distress due to OOPHE. Multivariate binary logistic regression analysis was employed to determine the factors associated with these outcomes. RESULTS OOPHE for older household members accounted for 86.3% of total household health expenditure. Of households with older people, 8.6% (127) faced CHE, and 12.2% (181) experienced financial distress due to OOPHE. Households were at a higher risk of incurring financial burdens related to health expenditures if they had fewer household members; included only older people; were in rural or remote, mountainous areas; and had older members with noncommunicable diseases. There was no significant association between health insurance coverage and financial burden. However, when older people sought tertiary care or private care, the possibility of a household facing CHE increased. Regardless of the type and level of care, health service utilization by older people results in a higher likelihood of a household encountering financial distress. CONCLUSIONS This study reveals that OOPHE for older people can impose substantial financial burdens on households, leading them to face CHE and financial distress. This study provides evidence to justify reforming financial protection policies and introducing policy interventions targeted at better protecting older people and their households from the financial consequences of OOPHE. There is also the need to strengthen the grassroots health facilities to provide primary care closer to home at lower costs, particularly for the management of noncommunicable diseases.
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Affiliation(s)
- Nguyen Hoang Giang
- grid.492361.b0000 0004 0642 7152Health Strategy and Policy Institute, Lane 196, Ho Tung Mau Street, Mai Dich Ward, Cau Giay District, Hanoi, Viet Nam
| | - Nguyen The Vinh
- grid.492361.b0000 0004 0642 7152Health Strategy and Policy Institute, Lane 196, Ho Tung Mau Street, Mai Dich Ward, Cau Giay District, Hanoi, Viet Nam
| | - Hoang Thi Phuong
- grid.492361.b0000 0004 0642 7152Health Strategy and Policy Institute, Lane 196, Ho Tung Mau Street, Mai Dich Ward, Cau Giay District, Hanoi, Viet Nam
| | - Nguyen Thi Thang
- grid.492361.b0000 0004 0642 7152Health Strategy and Policy Institute, Lane 196, Ho Tung Mau Street, Mai Dich Ward, Cau Giay District, Hanoi, Viet Nam
| | - Tran Thi Mai Oanh
- grid.492361.b0000 0004 0642 7152Health Strategy and Policy Institute, Lane 196, Ho Tung Mau Street, Mai Dich Ward, Cau Giay District, Hanoi, Viet Nam
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Meng X, An Z, Xu Y, Du J, Tan L, Yu H, Yu L. Living experiences of people with advance cancer with low socioeconomic status: A systematic review of qualitative evidence. Palliat Med 2022; 37:444-459. [PMID: 36411513 DOI: 10.1177/02692163221137106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The number of patients with advanced cancer is rapidly increasing, and the subgroup of this population with low socioeconomic status has suffered more disease burden than others. However, there is no recent qualitative synthesis of primary research studies into advanced cancer patients with low socioeconomic status. OBJECTIVE To synthesise qualitative research findings into advanced cancer patients' experiences with low socioeconomic status, and then to help provide targeted and effective strategies to improve their quality of life. DESIGN A systematic review and meta-synthesis of qualitative evidence (PROSPERO: CRD42021250423). DATA SOURCES PubMed, Web of Science Core Collection (ISI Web of Science), Cochrane Library, Embase, OVID LWW, CINAHL Complete (EBSCO), PsycINFO (EBSCO) and MEDLINE (ISI Web of Science), China National Knowledge Infrastructure (CNKI), WangFang, and Vip databases were systematically searched from their original dates to July 2022. Qualitative data were appraised using the Joanna Briggs Institute (JBI) qualitative assessment. FINDINGS The findings were synthesised into the following three analytical themes: (1) multi-dimensional disease distresses; (2) barriers in coping with disease distresses; and (3) strategies for dealing with disease distresses. CONCLUSIONS Patients with advanced cancer with low socioeconomic status experienced complicated and interactional distresses, unique life barriers, and a wide range of adaptation strategies. These findings will provide a comprehensive perspective to promote individual-centred health care systems and services to help these vulnerable people deal with the challenges of disease and improve their quality of life.
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Affiliation(s)
- Xianmei Meng
- Center for Nurturing Care Research, School of Nursing, Wuhan University, No. 115 Donghu Road, Wuhan, Hubei, China
| | - Zifen An
- Center for Nurturing Care Research, School of Nursing, Wuhan University, No. 115 Donghu Road, Wuhan, Hubei, China
| | - Yuying Xu
- Center for Nurturing Care Research, School of Nursing, Wuhan University, No. 115 Donghu Road, Wuhan, Hubei, China
| | - Jiayi Du
- Center for Nurturing Care Research, School of Nursing, Wuhan University, No. 115 Donghu Road, Wuhan, Hubei, China
| | - Lanhui Tan
- Center for Nurturing Care Research, School of Nursing, Wuhan University, No. 115 Donghu Road, Wuhan, Hubei, China
| | - Huidan Yu
- Center for Nurturing Care Research, School of Nursing, Wuhan University, No. 115 Donghu Road, Wuhan, Hubei, China
| | - Liping Yu
- Center for Nurturing Care Research, School of Nursing, Wuhan University, No. 115 Donghu Road, Wuhan, Hubei, China
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Deng P, Fu Y, Chen M, Si L. Factors associated with health care utilization and catastrophic health expenditure among cancer patients in China: Evidence from the China health and retirement longitudinal study. Front Public Health 2022; 10:943271. [PMID: 36438282 PMCID: PMC9684646 DOI: 10.3389/fpubh.2022.943271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022] Open
Abstract
Background Cancer, the leading cause of mortality in China, is a significant burden on patients, their families, the medical system, and society at large. However, there is minimal data on health service utilization and catastrophic health expenditure (CHE) among cancer patients in China. The objective of this study was to identify factors associated with health care utilization and CHE in Chinese cancer patients. Methods The 2018 wave of a nationally representative dataset, the China Health and Retirement Longitudinal Study, was used in our study. Of 18,968 respondents recruited for the analysis, 388 were clinically diagnosed with cancer. CHE was defined as household health expenditure that exceeded 40% of non-food household expenses. A binary logistic regression model was used to identify the risks of cancer exposure among all participants, along with the likelihood of CHE in households with cancer patients at the 40% threshold. A negative binomial regression model was used to identify determinants of health service utilization among cancer patients. Results Contracting a family physician (incidence rate ratio IRR: 2.38, 1.18-4.77), Urban Employee Basic Medical Insurance (IRR: 4.02, 1.91-8.46, compared to the uninsured), Urban and Rural Resident Basic Medical Insurance (IRR: 3.08, 1.46-6.49, compared to the uninsured), and higher per-capita household consumption were positively associated with inpatient service utilization. Patients with a college education and above reported a greater number of outpatient visits (IRR: 5.78, 2.56-13.02) but fewer inpatient hospital days (IRR: 0.37, 0.20-0.67). Being diagnosed with a non-cancer chronic non-communicable disease was associated with an increased number of outpatient visits (IRR: 1.20, 1.10-1.31). Of the 388 participants, 50.1% of households had CHE, which was negatively correlated with a larger household size (odds ratio OR: 0.52, 0.32-0.86) and lower socioeconomic status [for quintile 5 (lowest group) OR: 0.32, 0.14-0.72]. Conclusions The socioeconomic characteristics of cancer patients had a considerable impact on their healthcare utilization. Individualized and targeted strategies for cancer management should be implemented to identify high-risk populations and trace the utilization of care among Chinese cancer patients. Strategic purchasing models in cancer care and social health insurance with expanded benefits packages for cancer patients are crucial to tackling the cancer burden in China.
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Affiliation(s)
- Penghong Deng
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Yu Fu
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Mingsheng Chen
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China,Center for Global Health, Nanjing Medical University, Nanjing, China,*Correspondence: Mingsheng Chen
| | - Lei Si
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia,The George Institute for Global Health, University of New South Wales, Kensington, NSW, Australia
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Eala MAB, Maslog EAS, Dee EC, Ting FIL, Toral JAB, Dofitas RB, Co HCS, Cañal JPA. Geographic Distribution of Cancer Care Providers in the Philippines. JCO Glob Oncol 2022; 8:e2200138. [PMID: 36332171 PMCID: PMC9668555 DOI: 10.1200/go.22.00138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE In the Philippines, a lower middle-income country in Southeast Asia, 6 of 10 Filipinos die without seeing a doctor. To ensure universal access to cancer care, providers must be equitably distributed. Therefore, we evaluated the distribution of oncologists across all 17 regions in the Philippines. METHODS We gathered data from the official websites of national medical societies on their members' regional area of practice: Philippine Society of Medical Oncology, Philippine Radiation Oncology Society, Surgical Oncology Society of the Philippines, Society of Gynecologic Oncologists of the Philippines, and Philippine Society of Hospice and Palliative Medicine. We compared this with the regional census to determine the number of board-certified oncologists per 100,000 Filipinos. RESULTS For a population of almost 110 million, the Philippines has a total of 348 medical oncologists, 164 surgical oncologists, 99 radiation oncologists, 142 gynecologic oncologists, and 35 hospice and palliative medicine (HPM) specialists. This translates to 0.32 medical oncologists, 0.15 surgical oncologists, 0.09 radiation oncologists, 0.13 gynecologic oncologists, and 0.03 HPM specialists for every 100,000 Filipinos. The number of oncologists is highest in the National Capital Region in Luzon and lowest in the Bangsamoro Autonomous Region in Muslim Mindanao. All regions have at least one medical and gynecologic oncologist. Two regions (12%) have no surgical oncologists, five regions (29%) have no radiation oncologists, and eight regions (47%) have no HPM specialists. CONCLUSION Efforts are needed to increase the number of oncologists and improve equity in their distribution to ensure universal access to cancer care in the Philippines.
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Affiliation(s)
- Michelle Ann B. Eala
- College of Medicine, University of the Philippines, Manila, Philippines,Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA,Michelle Ann B. Eala, MD, College of Medicine, University of the Philippines, 547 Pedro Gil St, Manila 1000, Philippines; Twitter: @MichelleEalaMD; e-mail:
| | | | | | - Frederic Ivan L. Ting
- Department of Clinical Sciences, College of Medicine, University of St La Salle, Bacolod, Philippines,Section of Medical Oncology, Department of Internal Medicine, Corazon Locsin Montelibano Memorial Regional Hospital, Bacolod, Philippines
| | - Jean Anne B. Toral
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of the Philippines, Philippine General Hospital, Manila, Philippines
| | - Rodney B. Dofitas
- Division of Surgical Oncology, Department of Surgery, University of the Philippines, Philippine General Hospital, Manila, Philippines
| | - Henri Cartier S. Co
- Division of Radiation Oncology, Department of Radiology, University of the Philippines, Philippine General Hospital, Manila, Philippines
| | - Johanna Patricia A. Cañal
- Division of Radiation Oncology, Department of Radiology, University of the Philippines, Philippine General Hospital, Manila, Philippines
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Gan GG, Tey KWF, Mat S, Saad M, Bee PC, Malik RA, Ho GF, Ng CG. Quality of Life of Family Caregivers of Cancer Patients in a Developing Nation. Asian Pac J Cancer Prev 2022; 23:3905-3914. [PMID: 36444604 PMCID: PMC9930968 DOI: 10.31557/apjcp.2022.23.11.3905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Quality of life (QOL) of family caregivers of cancer patients is usually affected due to increase in caregiver burden. Their QOL has not garnered much attention by many including the health professionals and community. This study aims to explore the QOL of family caregivers of cancer patients in a multi-ethnic country in Asia and to investigate its associate factors. METHODS This is a cross-sectional study where family caregivers and patients who were diagnosed of cancers within 12 months were recruited. QOL of caregivers were measured using The Caregiver Quality of Life Index-Cancer (CQOLC). Psychological distress was measured using Hospital anxiety and depressive scale. Logistic regression analysis was performed to determine the related factors of QOL of caregivers. RESULTS A total of 458 patients/caregiver pairs were included. Symptoms of anxiety and depression reported by caregivers were 24.9% and 24.2% respectively. Caregivers of patients with solid tumors have better CQOLC score compared to those who cared for patients with hematological cancers (91.25 vs 86.75). Caregivers of non-Malay ethnicity, those caring for patients with advanced stage cancer and with hematological cancers had significantly poorer QOL. QOL of caregivers are also significantly affected when patients demonstrated anxiety symptoms. CONCLUSION This study provides detailed evaluation of the QOL of caregivers of cancer patients in Malaysia. The significant psychological distress and low caregiver QOL indicate the urgent need for comprehensive supports for caregivers with cancer patients, especially those caring for patients with haematological cancers.
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Affiliation(s)
- Gin Gin Gan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. ,For Correspondence:
| | - Kevin Wen Fei Tey
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Sumaiyah Mat
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Marniza Saad
- Department of Oncology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Ping Chong Bee
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Rozita Abd Malik
- Department of Oncology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Gwo Fuang Ho
- Department of Oncology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Chong Guan Ng
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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Prasad RN, Royce TJ, Chino F, Jagsi R, Palmer JD. Financial Toxicity as an End Point in Prospective Clinical Trials Involving Radiation Therapy. Adv Radiat Oncol 2022; 7:100970. [PMID: 35620674 PMCID: PMC9126781 DOI: 10.1016/j.adro.2022.100970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 04/12/2022] [Indexed: 12/02/2022] Open
Abstract
Prior research, predominately retrospective, has increased awareness that patients with cancer are at elevated risk for financial toxicity (FT). Radiation therapy (RT) can be particularly disruptive due to weeks of daily treatments. Yet, FT in patients receiving RT is less studied, and the extent to which FT has been incorporated as an end point in prospective clinical trials involving RT is unknown. Clinicaltrials.gov was queried to identify all observational or interventional studies from 2001 to 2020 wherein RT was administered for cancer. Studies with primary, secondary, or exploratory FT end points were identified through keyword search. For trials incorporating FT outcomes, pertinent study characteristics were collected. Detailed information regarding FT measures was recorded. Descriptive statistics, including frequency counts and proportions, were performed. The overall rate of inclusion of FT end points was calculated, and rates over 5-year intervals were compared using the χ2 test (α = 0.05). Overall, 10,550 studies involving RT were identified, of which 88 reported FT end points (0.8%). Included FT end points were typically secondary (78%), with just 15 studies (17%), including primary end points. Notably, only 19 studies (22%) reported a standalone FT end point. The majority measured FT as part of a larger quality of life (QoL) questionnaire. The rate of inclusion of FT end points significantly increased over time from 0.1% from 2001 to 2005 to 1.5% from 2016 to 2020, (P < .0001). FT is a major stressor for patients with cancer, yet even after a relative increase over time, the absolute rate of inclusion of FT end points remains low among RT-based trials. When included, FT outcomes were typically a single question within a QoL assessment not validated as a standalone measure of FT, preventing meaningful study and inference. To characterize and mitigate this burden more accurately, future prospective studies should include FT end points with greater frequency.
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Affiliation(s)
- Rahul N. Prasad
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Trevor J. Royce
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Flatiron Health, New York, New York
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Joshua D. Palmer
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
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Catastrophic expenditure and treatment attrition in patients seeking comprehensive colorectal cancer treatment in India: A prospective multicentre study. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2022; 6:None. [PMID: 36408078 PMCID: PMC9664978 DOI: 10.1016/j.lansea.2022.100058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Although colorectal cancer is increasing in India, the cost of comprehensive treatment and its consequences for patients and households are unknown. This study aimed to describe catastrophic expenditure and treatment attrition in patients with a treatment plan for colorectal cancer. METHODS A prospective, multicentre, cohort study was conducted in five tertiary hospitals in India from December 2020 to March 2022. Consecutive patients with a new treatment plan for colorectal cancer were followed-up for six months. The total cost of treatment was reported, including out-of-pocket payments (OOPP, paid by patients at the time-of-service use) and covered by third parties (insurance, public funds). The primary outcome was catastrophic expenditure, defined as OOPPs greater than 25% of patient's annual household income and the secondary outcome was treatment attrition, defined as unplanned interruption of the treatment course not recommended by the clinical team. FINDINGS Of 226 patients included, 20 died within six months of being offered a treatment plan and four were lost to follow-up. The median total cost of colorectal cancer treatment was 407,508 Indian Rupees (INR/5340 USD), to which the biggest contributor was the patient's OOPP (median 330,277 INR/4328 USD). Surgery and anaesthesia costs (median 85,944 INR/1126 USD) were higher than radiotherapy (median 55,525 INR/728 USD) and chemotherapy (median 14,780 INR/194 USD). The overall catastrophic expenditure rate was 90.1% (182/202) and the treatment attrition rate was 9.4% (19/202). Patients with treatment attrition made lower OOPPs than those who completed treatment (median 205,926 vs 349,398 INR, p < 0.01) but had a similar risk of catastrophic expenditure (OR 0.23, 95%CI 0.03-2.28, p = 0.186). INTERPRETATION Most treatment costs for colorectal cancer were paid out-of-pocket by patients and catastrophic expenditure was common. Treatment attrition rates at tertiary centres were low, suggesting greater attrition at previous stages of care. Better financial protection may allow more patients to receive comprehensive cancer treatment while avoiding household financial catastrophe. FUNDING This research was funded by the National Institute for Health Research (NIHR) (NIHR 16.136.79) using UK aid from the UK Government to support global health research, by the India Institute of the University of Birmingham and by the Global Challenges program of the University of Birmingham. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK government.
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Liew CH, Shabaruddin FH, Dahlui M. The Burden of Out-of-Pocket Expenditure Related to Gynaecological Cancer in Malaysia. Healthcare (Basel) 2022; 10:healthcare10102099. [PMID: 36292545 PMCID: PMC9601824 DOI: 10.3390/healthcare10102099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 01/09/2023] Open
Abstract
This study aimed to estimate the economic burden on gynaecological cancer patients and their households, in terms of out-of-pocket expenditure, catastrophic health expenditure (CHE) and poverty impact. A cross-sectional study was conducted at an academic tertiary-care health centre in an upper-middle-income country. Data were obtained via structured interviews of 120 gynaecological cancer patients alongside review of medical charts. Mean (SD) and median (IQR) annual household out-of-pocket expenditures were USD 2780 (SD = USD 3926) and USD 1396 (IQR = 3013), respectively. Two thirds (n = 77/120, 64%) of households experienced CHE and 17% (n = 20/120) were impoverished due to out-of-pocket expenditure related to gynaecological cancer. Factors associated with CHE, explored using multivariate logistic regression analysis, estimated that the highest income quintile households, Q5, were 90% less likely to incur CHE compared to the lowest income quintile households, Q1 (adjusted odds ratio = 0.100; p-value < 0.05) and that patients who were not receiving chemotherapy were 88% less likely to incur CHE compared to those receiving chemotherapy (adjusted odds ratio = 0.120; p-value < 0.05). These results indicate the necessity to broaden the coverage of existing financial assistance for patients from low- and middle-income households, such as extending coverage to adult patients of all ages and to those treated in all public hospitals, including academic health centres.
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Affiliation(s)
- Chee Hui Liew
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia
- Department of Pharmacy, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur 50586, Malaysia
| | - Fatiha Hana Shabaruddin
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Universiti Malaya, Kuala Lumpur 50603, Malaysia
- Correspondence:
| | - Maznah Dahlui
- Centre of Population Health, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia
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Teklemariam MF, Addise M, Asrat G, Gufue ZH. Perception about palliative care and factors influencing the likelihood of palliative care service utilisation among adult cancer patients in Ethiopia. Eur J Cancer Care (Engl) 2022; 31:e13735. [PMID: 36221904 DOI: 10.1111/ecc.13735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/17/2022] [Accepted: 09/27/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE This study aims to assess the perception about palliative care and factors influencing the likelihood of palliative care service utilisation among adult cancer patients in Tikur Anbessa Specialized Hospital, Ethiopia, 2019. METHODS A facility-based cross-sectional study was conducted among 304 systematically selected adult cancer patients receiving palliative care service in Tikur Anbessa Specialized Hospital, Ethiopia. A multivariable binary logistic regression model was carried out to identify the independent factors associated with palliative care service utilisation, and P-value < 0.05 was used to declare statistical significance. RESULTS One hundred thirty (42.8%) adult cancer patients utilise the available palliative care service in the hospital, and those who earn monthly income ≥$52.35 (AOR = 2.36, 95% CI 1.37,4.06) and those who have family members of more than two (AOR = 2.28, 95% CI 1.02,5.13) were associated with higher utilisation, but being a governmental employee and having formal schooling were the factors negatively associated with palliative care service utilisation with (AOR = 0.42, 95% CI 0.20, 0.87) and (AOR = 0.51, 95% CI 0.23, 0.94), respectively. CONCLUSIONS A significant number of cancer patients were not utilising palliative care services, and higher monthly income and having more than two family members were the factors strongly associated with higher palliative care service utilisation.
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Affiliation(s)
| | - Mesfin Addise
- Department of Reproductive Health and Health Service Management, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gashaye Asrat
- Department of Reproductive Health and Health Service Management, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zenawi Hagos Gufue
- Department of Public Health, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
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29
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Soo R, Mery L, Bardot A, Kanesvaran R, Keong TC, Pongnikorn D, Prasongsook N, Hutajulu SH, Irawan C, Manan AA, Thiagarajan M, Sripan P, Peters S, Storm H, Bray F, Stahel R. Diagnostic work-up and systemic treatment for advanced non-squamous non-small-cell lung cancer in four Southeast Asian countries. ESMO Open 2022; 7:100560. [PMID: 35988454 PMCID: PMC9588878 DOI: 10.1016/j.esmoop.2022.100560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/04/2022] [Accepted: 07/06/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Lung cancer is the second most common cancer and leading cause of cancer mortality worldwide. Recent advances in molecular testing and targeted therapy have improved survival among patients with metastatic non-small-cell lung cancer (NSCLC). We sought to quantify and describe molecular testing among metastatic non-squamous NSCLC cases in selected Southeast Asian countries and describe first-line therapy chosen. PATIENTS AND METHODS A retrospective study was conducted based on incident lung cancer cases diagnosed between 2017 and 2019 in Lampang (Thailand), Penang (Malaysia), Singapore and Yogyakarta (Indonesia). Cases (n = 3413) were defined using the International Classification of Diseases for Oncology third edition. In Singapore, a clinical series obtained from the National Cancer Centre was used to identify patients, while corresponding population-based cancer registries were used elsewhere. Tumor and clinical information were abstracted by chart review according to a predefined study protocol. Molecular testing of epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK) gene rearrangement, ROS1 gene rearrangement and BRAF V600 mutation was recorded. RESULTS Among 2962 cases with a specified pathological diagnosis (86.8%), most patients had non-squamous NSCLC (75.8%). For cases with staging information (92.1%), the majority presented with metastatic disease (71.3%). Overall, molecular testing rates in the 1528 patients with stage IV non-squamous NSCLC were 67.0% for EGFR, 42.3% for ALK, 39.1% for ROS1, 7.8% for BRAF and 36.1% for PD-L1. Among these patients, first-line systemic treatment included chemotherapy (25.9%), targeted therapy (35.6%) and immunotherapy (5.9%), with 31% of patients having no record of antitumor treatment. Molecular testing and the proportion of patients receiving treatment were highly heterogenous between the regions. CONCLUSIONS This first analysis of data from a clinically annotated registry for lung cancer from four settings in Southeast Asia has demonstrated the feasibility of integrating clinical data within population-based cancer registries. Our study results identify areas where further development could improve patient access to optimal treatment.
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Affiliation(s)
- R Soo
- Department of Hematology-Oncology, National University Hospital, Singapore, Singapore
| | - L Mery
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - A Bardot
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - R Kanesvaran
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - T C Keong
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - D Pongnikorn
- Cancer Registry Unit, Lampang Cancer Hospital, Lampang, Thailand
| | - N Prasongsook
- Medical Oncology Division, Department of Internal Medicine, Phramongkutklao Hospital, Bangkok, Thailand
| | - S H Hutajulu
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - C Irawan
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - A Ab Manan
- Malaysian National Cancer Registry Department, National Cancer Institute, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - M Thiagarajan
- Department of Radiotherapy and Oncology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - P Sripan
- Research Institute for Health Sciences, Chiang Mai University, Chiangmai, Thailand
| | - S Peters
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - H Storm
- Danish Cancer Society, Copenhagen, Denmark
| | - F Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - R Stahel
- ETOP IBCSG Partners Foundation, Bern, Switzerland.
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30
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Rosa WE, Ahmed E, Chaila MJ, Chansa A, Cordoba MA, Dowla R, Gafer N, Khan F, Namisango E, Rodriguez L, Knaul FM, Pettus KI. Can You Hear Us Now? Equity in Global Advocacy for Palliative Care. J Pain Symptom Manage 2022; 64:e217-e226. [PMID: 35850443 PMCID: PMC9482940 DOI: 10.1016/j.jpainsymman.2022.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/27/2022] [Accepted: 07/08/2022] [Indexed: 10/17/2022]
Abstract
Evidence-based advocacy underpins the sustainable delivery of quality, publicly guaranteed, and universally available palliative care. More than 60 million people in low- and middle-income countries (LMICs) have no or extremely limited access to either palliative care services or essential palliative care medicines (e.g., opioids) on the World Health Organization Model List. Indeed, only 12% of the global palliative care need is currently being met. Palliative care advocacy works to bring this global public health inequity to light. Despite their expertise, palliative care practitioners in LMICs are rarely invited to health policymaking tables - even in their own countries - and are underrepresented in the academic literature produced largely in the high-income world. In this paper, palliative care experts from Bangladesh, Colombia, Egypt, Sudan, Uganda, and Zambia affiliated with the International Association for Hospice & Palliative Care Advocacy Focal Point Program articulate the urgent need for evidence-based advocacy, focusing on significant barriers such as urban/rural divides, cancer-centeredness, service delivery gaps, opioid formulary limitations, public policy, and education deficits. Their advocacy is situated in the context of an emerging global health narrative that stipulates palliative care provision as an ethical obligation of all health systems. To support advocacy efforts, palliative care evaluation and indicator data should assess the extent to which LMIC practitioners lead and participate in global and regional advocacy. This goal entails investment in transnational advocacy initiatives, research investments in palliative care access and cost-effective models in LMICs, and capacity building for a global community of practice to capture the attention of policymakers at all levels of health system governance.
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Affiliation(s)
- William E Rosa
- Department of Psychiatry and Behavioral Sciences (W.E.R.), Memorial Sloan Kettering Cancer Center, New York, New York, USA; Institute for Advanced Study of the Americas, University of Miami (W.E.R. and F.M.K.), Coral Gables, Florida, USA.
| | - Ebtesam Ahmed
- Department of Clinical Health Professions (E.A.), St. John's University College of Pharmacy and Health Sciences, Queens, New York, USA; MJHS Institute for Innovation in Palliative Care (E.A.), New York, New York, USA
| | | | - Abidan Chansa
- National Palliative Care Program (A.C.), Ministry of Health, Lusaka, Zambia
| | - Maria Adelaida Cordoba
- Pediatric Palliative Section (M.A.C.), Fundación Hospital Pediátrico de La Misericordia, Bogotá, Colombia; Department of Pediatrics (M.A.C.), Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Rumana Dowla
- Palliative Medicine Cancer Care Centre (R.D.), United Hospital, Dhaka, Bangladesh
| | - Nahla Gafer
- Integrated Palliative and Oncology Unit (N.G.), Khartoum Oncology Hospital, Khartoum, Sudan
| | - Farzana Khan
- Fasiuddin Khan Research Foundation (F.K.), Uttara, Dhaka, Bangladesh; Global Health Academy (F.K.), University of Edinburgh, Scotland, United Kingdom
| | - Eve Namisango
- African Palliative Care Association (E.N.), Kampala, Uganda; Department of Palliative Care and Rehabilitation (E.N.), Cicely Saunders Institute, King's College, London, United Kingdom
| | - Luisa Rodriguez
- Department of Anesthesia (L.R.), Pain and Palliative Medicine, Universidad de La Sabana, Chia, Colombia; Asociación Colombiana de Cuidados Paliativos (L.R.), Bogotá, Colombia
| | - Felicia Marie Knaul
- Institute for Advanced Study of the Americas, University of Miami (W.E.R. and F.M.K.), Coral Gables, Florida, USA; Department of Public Health Sciences (F.M.K.), University of Miami Miller School of Medicine, Miami, Florida, USA; Tómatelo a Pecho, Mexico City (F.M.K.), Mexico; Fundación Mexicana para la Salud (F.M.K.), Mexico City, Mexico
| | - Katherine I Pettus
- International Association for Hospice and Palliative Care (K.I.P.), Houston, Texas, USA
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31
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FNU N, Kuan WC, Kong YC, Bustamam RS, Wong LP, Subramaniam S, Ho GF, Zaharah H, Yip CH, Bhoo-Pathy N. Cancer-related costs, the resulting financial impact and coping strategies among cancer survivors living in a setting with a pluralistic health system: a qualitative study. Ecancermedicalscience 2022; 16:1449. [PMID: 36405936 PMCID: PMC9666287 DOI: 10.3332/ecancer.2022.1449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Evidence on the financial experiences of cancer survivors living in settings with pluralistic health systems remains limited. We explored the out-of-pocket costs, the resulting financial impact and the coping strategies adopted by cancer survivors in Malaysia, a middle-income country with a government-led tax-funded public health sector, and a predominantly for-profit private health sector. METHODS Data were derived from 20 focus group discussions that were conducted in five public and private Malaysian hospitals, which included 102 adults with breast, cervical, colorectal or prostate cancers. The discussions were segregated by type of healthcare setting and gender. Thematic analysis was performed. RESULTS Five major themes related to cancer costs emerged: 1) cancer therapies and imaging services, 2) supportive care, 3) complementary therapies, 4) non-medical costs and 5) loss of household income. Narratives on out-of-pocket medical costs varied not only by type of healthcare setting, clinical factors and socioeconomic backgrounds, but also by private health insurance ownership. Non-health costs (e.g. transportation, food) and loss of income were nonetheless recurring themes. Coping mechanisms that were raised included changing of cancer treatment decisions, continuing work despite ill health and seeking financial assistance from third parties. Unmet needs in coping with financial distress were especially glaring among the women. CONCLUSION The long-term costs of cancer (medications, cancer surveillance, supportive care, complementary medicine) should not be overlooked even in settings where there is access to highly subsidised cancer care. In such settings, patients may also have unmet needs related to non-health costs of cancer and loss of income.
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Affiliation(s)
- Noorulain FNU
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Wai-Chee Kuan
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Yek-Ching Kong
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Ros Suzanna Bustamam
- Department of Radiotherapy and Oncology, Kuala Lumpur Hospital, 50586 Kuala Lumpur, Malaysia
| | - Li-Ping Wong
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - ShriDevi Subramaniam
- Institute of Clinical Research, National Institutes of Health, 40170 Shah Alam, Malaysia
| | - Gwo-Fuang Ho
- Department of Clinical Oncology, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Hafizah Zaharah
- Department of Radiotherapy and Oncology, National Cancer Institute, 62250 Putrajaya, Malaysia
| | - Cheng-Har Yip
- Subang Jaya Medical Centre, 47500 Subang Jaya, Malaysia
| | - Nirmala Bhoo-Pathy
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
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Yeoh K, Gray A. Health Economics and Cancer Care. Clin Oncol (R Coll Radiol) 2022; 34:e377-e382. [PMID: 35781405 DOI: 10.1016/j.clon.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/17/2022] [Accepted: 05/18/2022] [Indexed: 11/29/2022]
Affiliation(s)
- K Yeoh
- Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - A Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Miao W, Zhang X, Shi B, Tian W, Wu B, Lai Y, Li Y, Huang Z, Xia Q, Yang H, Ding F, Shan L, Xin L, Miao J, Zhang C, Li Y, Li X, Wu Q. Multi-dimensional vulnerability analysis on catastrophic health expenditure among middle-aged and older adults with chronic diseases in China. BMC Med Res Methodol 2022; 22:151. [PMID: 35614385 PMCID: PMC9134696 DOI: 10.1186/s12874-022-01630-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 05/11/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Middle-aged and older adults are more likely to suffer from chronic diseases because of their particular health characteristics, which lead to a high incidence of catastrophic health expenditure (CHE). This study plans to analyse the different factors affecting CHE in middle-aged and older adults with chronic diseases, target the vulnerable characteristics, and suggest groups that medical insurance policies should pay more attention to. METHODS The data used in this study came from the 2018 China Health and Retirement Longitudinal Study (CHARLS) database. The method of calculating the CHE was adopted from the World Health Organization (WHO). The logistic regression was used to determine the family characteristics of chronic disease in middle-aged and older adults with a high probability of incurring CHE. RESULTS The incidence of CHE in middle-aged and older adults with chronic disease was highest in sub-poverty level families (26.20%) was lowest in wealthier level families (20.07%). Households with malignant tumours had the highest CHE incidence under any circumstances, especially if the householder had been using inpatient service in the past year. Among the comparison of CHE incidence in different types of medical insurance, the Urban and Rural Residents' Basic Medical Insurance (URRBMI) was the highest (27.46%). The incidence of CHE was 2.73 times (95% CI 2.30-3.24) and 2.16 times (95% CI 1.81-2.57) higher among people who had used inpatient services in the past year or outpatient services in the past month than those who had not used them. CONCLUSIONS Relatively wealthy economic conditions cannot significantly reduce the financial burden of chronic diseases in middle-aged and older adults. For this particular group with multiple vulnerabilities, such as physical and social vulnerability, the high demand and utilization of health services are the main reasons for the high incidence of CHE. After achieving the goal of lowering the threshold of universal access to health services, the medical insurance system in the next stage should focus on multiple vulnerable groups and strengthen the financial protection for middle-aged and older adults with chronic diseases, especially for patients with malignant tumours.
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Affiliation(s)
- Wenqing Miao
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Xiyu Zhang
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Baoguo Shi
- Department of Economics, School of Economics, Minzu University of China, Beijing, China
| | - Wanxin Tian
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Bing Wu
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Yongqiang Lai
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Yuze Li
- Department of Medicine, Jiamusi University, Jiamusi, 154007, Heilongjiang, China
| | - Zhipeng Huang
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Qi Xia
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Huiqi Yang
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Fan Ding
- School of Public Health and Management, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Linghan Shan
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Ling Xin
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Jingying Miao
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Chenxi Zhang
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Ye Li
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China.
| | - Xiaodong Li
- The First Department of General Surgery, Heilongjiang Provincial Hospital, No. 82 Zhongshan Road, Xiangfang District, Harbin, 150036, Heilongjiang, China.
| | - Qunhong Wu
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China.
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Understanding Household Catastrophic Health Expenditures and Fairness of Financing for Cancer Treatment: A Cross-Sectional Case Study in West of Iran. HEALTH SCOPE 2022. [DOI: 10.5812/jhealthscope-119827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: Direct out-of-pocket (OOP) and indirect healthcare payments can limit the household budget and cause several financial problems for the household. Objectives: This study aimed to measure the financial protection and determinants of catastrophic health expenditures (CHEs) for cancer treatment in Shahid Rahimi Hospital, Khorramabad, located in western Iran. Methods: This study was conducted on 220 households of cancer patients in Lorestan Province, Iran. The framework of data collection was based on the World Health Organization (WHO) Global Health Survey. Interviews were conducted with individuals who met the inclusion criteria of this study; they were selected using a simple random sampling method. Data were analyzed using Chi-square test in STATA. Results: The present results showed that the incidence of CHEs and the fair financial contribution index (FFCI) were 70% and 86%, respectively. There was a significant relationship between the household CHEs and variables, such as supplementary insurance coverage, household income status, educational level of the household head, household size, age of the household head, type of cancer, and type of cancer treatment. Conclusions: More financial protection should be provided for the families of cancer patients due to the high incidence of CHEs and unfair financing of cancer care services. Moreover, healthcare systems should consider supportive policies for cancer patients and their household members by increasing the insurance coverage and expanding service packages to reduce cancer treatment expenditures.
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del Pozo-Rubio R, Ortega-Ortega M. Sociodemographic and health factors associated with the risk of financial catastrophe when informal care for patients with haematological neoplasms is replaced by formal care. HEALTH ECONOMICS REVIEW 2022; 12:20. [PMID: 35266072 PMCID: PMC8908606 DOI: 10.1186/s13561-022-00364-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/24/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Cancer is one of the diseases with the highest incidence and mortality in the world, and one that requires greater care (formal and informal). At present, the traditional informal caregiver is disappearing. The objective is to analyse the sociodemographic and health factors associated with the possible catastrophic financial effect on households of replacing informal care by formal care for patients with blood cancer, during the different stages of treatment in Spain. METHODS A total of 139 patients with haematological neoplasm who underwent stem cell transplantation completed a longitudinal questionnaire during each of three treatment phases. Of this population, 88.49% received informal care. The households were classified into those where the replacement of informal care with formal care would impose a financial burden exceeding 40% of equivalent household income, versus those who would not suffer this consequence. Three logistic regression models (one for each treatment phase) were estimated and the corresponding marginal effects determined. RESULTS The factors associated with a higher probability of financial catastrophe were married marital status, low education level, fair to very poor self-perceived health status, the diagnosis of leukaemia in the pre-transplant and first-year post-transplant phases and of multiple myeloma disease in the final post-transplant phase. CONCLUSIONS These findings reveal the need to design social policies to meet the care needs of patients with blood cancer which at present are covered by informal care. Given the foreseeable elimination of this option, these families must be protected from the financial burden incurred from the use of privately-contracted assistance.
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Affiliation(s)
- Raúl del Pozo-Rubio
- Department of Economics and Finance, Faculty of Social Sciences, University of Castilla-La Mancha, Avenida de los Alfares, 44. C.P.: 16.071, Cuenca, Spain
| | - Marta Ortega-Ortega
- Department of Applied and Public Economics, and Political Economy, Complutense University of Madrid, Campus de Somosaguas s/n. 28.023, Madrid, Pozuelo de Alarcón, Spain
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Kong YC, Kimman M, Subramaniam S, Yip CH, Jan S, Aung S, Khoa MT, Ngelangel CA, Nyein HL, Sangrajrang S, Tanabodee J, Bhoo-Pathy N. Out-of-pocket payments for complementary medicine following cancer and the effect on financial outcomes in middle-income countries in southeast Asia: a prospective cohort study. Lancet Glob Health 2022; 10:e416-e428. [PMID: 35180423 DOI: 10.1016/s2214-109x(21)00595-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 12/06/2021] [Accepted: 12/16/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Complementary medicine, which refers to therapies that are not part of conventional medicine, comprising both evidence-based and non-evidence-based interventions, is increasingly used following a diagnosis of cancer. We aimed to investigate out-of-pocket spending patterns on complementary medicine and its association with adverse financial outcomes following cancer in middle-income countries in southeast Asia. METHODS In this prospective cohort study, data on newly diagnosed patients with cancer were derived from the ASEAN Costs in Oncology (ACTION) cohort study, a prospective longitudinal study in 47 centres located in eight countries in southeast Asia. The ACTION study measured household expenditures on complementary medicine in the immediate year after cancer diagnosis. Participants were given cost diaries at baseline to record illness-related payments that were directly incurred and not reimbursed by insurance over the 12-month period after study recruitment. We assessed incidence of financial catastrophe (out-of-pocket cancer-related costs ≥30% of annual household income), medical impoverishment (reduction in annual household income to below poverty line following subtraction of out-of-pocket cancer-related costs), and economic hardship (inability to make necessary household payments) at 1 year. FINDINGS Between March, 2012, and September, 2013, 9513 participants were recruited into the ACTION cohort study, of whom 4754 (50·0%) participants were included in this analysis. Out-of-pocket expenditures on complementary medicine were reported by 1233 households. These payments constituted 8·6% of the annual total out-of-pocket health costs in lower-middle-income countries and 42·9% in upper-middle-income countries. Expenditures on complementary medicine significantly increased risks of financial catastrophe (adjusted odds ratio 1·52 [95% CI 1·23-1·88]) and medical impoverishment (1·75 [1·36-2·24]) at 12 months in upper-middle-income countries only. However, the risks were significantly higher for economically disadvantaged households, irrespective of country income group. INTERPRETATION Integration of evidence-supported complementary therapies into mainstream cancer care, along with interventions to address use of non-evidence-based complementary medicine, might help alleviate any associated adverse financial impacts. FUNDING None.
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Affiliation(s)
- Yek-Ching Kong
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Merel Kimman
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, Netherlands
| | - ShriDevi Subramaniam
- Centre for Clinical Epidemiology, Institute of Clinical Research, National Institutes of Health, Shah Alam, Malaysia
| | | | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Soe Aung
- Oncology Society, Myanmar Medical Association, Yangon, Myanmar
| | | | - Corazon A Ngelangel
- Section of Medical Oncology, University of the Philippines-College of Medicine, Philippine General Hospital, Manila, Philippines
| | - Htun Lwin Nyein
- Haematology Department, Yangon General Hospital, Yangon, Myanmar
| | | | | | - Nirmala Bhoo-Pathy
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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Rivera AS. Complementary medicine as a risk factor for catastrophic expenditures in people with cancer. THE LANCET GLOBAL HEALTH 2022; 10:e313-e314. [DOI: 10.1016/s2214-109x(22)00034-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 10/19/2022] Open
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Johnson SE, Jayasekar Zurn S, Anderson BO, Vetter BN, Katz ZB, Milner DA. International perspectives on the development, application, and evaluation of a multicancer early detection strategy. Cancer 2022; 128 Suppl 4:875-882. [PMID: 35133661 DOI: 10.1002/cncr.33927] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/25/2021] [Accepted: 08/30/2021] [Indexed: 11/11/2022]
Abstract
The development and implementation of a multicancer early detection (MCED) test that is effective and affordable has the potential to change cancer care systems around the world. However, careful consideration is needed within the context of different health care settings (both low- and middle-income countries and high-income countries) to roll out an MCED test and promote equity in access.
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Affiliation(s)
| | | | - Benjamin O Anderson
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | - Danny A Milner
- American Society for Clinical Pathology, Chicago, Illinois
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Catastrophic health expenditure and its determinants in households with lung cancer patients in China: a retrospective cohort study. BMC Cancer 2021; 21:1323. [PMID: 34893037 PMCID: PMC8665572 DOI: 10.1186/s12885-021-09030-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/17/2021] [Indexed: 12/28/2022] Open
Abstract
Background Numerous studies have examined catastrophic health expenditures (CHE) worldwide, mostly focusing on general or common chronic populations, rather than particularly vulnerable groups. This study assessed the medical expenditure and compensation of lung cancer, and explored the extent and influencing factors of CHE among households with lung cancer patients in China. Methods During 2018–2019, a hospital-based multicenter retrospective survey was conducted in seven provinces/municipalities across China as a part of the Cancer Screening Program of Urban China. CHE was measured according to the proportion of out-of-pocket (OOP) health payments of households on non-food expenditures. Chi-square tests and logistic regression analysis was adjusted to determine the factors that significantly influenced the likelihood of a household with lung cancer patient to incur in CHE. Results In total, 470 households with lung cancer patients were included in the analysis. Health insurance was shown to protect some households from the impact of CHE. Nonetheless, CHE incidence (78.1%) and intensity (14.02% for average distance and 22.56% for relative distance) were still relatively high among households with lung cancer patients. The incidence was lower in households covered by the Urban Employee Basic Medical Insurance (UEMBI) insurance, with higher income level and shorter disease course. Conclusion More attention is needed for CHE incidence among vulnerable populations in China. Households with lung cancer patients were shown to be more likely to develop CHE. Therefore, policy makers should focus on improving the financial protection and reducing the economic burden of this disease.
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Jane Bates M, Gordon MRP, Gordon SB, Tomeny EM, Muula AS, Davies H, Morris C, Manthalu G, Namisango E, Masamba L, Henrion MYR, MacPherson P, Squire SB, Niessen LW. Palliative care and catastrophic costs in Malawi after a diagnosis of advanced cancer: a prospective cohort study. Lancet Glob Health 2021; 9:e1750-e1757. [PMID: 34756183 PMCID: PMC8600125 DOI: 10.1016/s2214-109x(21)00408-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/09/2021] [Accepted: 08/27/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Inclusive universal health coverage requires access to quality health care without financial barriers. Receipt of palliative care after advanced cancer diagnosis might reduce household poverty, but evidence from low-income and middle-income settings is sparse. METHODS In this prospective study, the primary objective was to investigate total household costs of cancer-related health care after a diagnosis of advanced cancer, with and without the receipt of palliative care. Households comprising patients and their unpaid family caregiver were recruited into a cohort study at Queen Elizabeth Central Hospital in Malawi, between Jan 16 and July 31, 2019. Costs of cancer-related health-care use (including palliative care) and health-related quality-of-life were recorded over 6 months. Regression analysis explored associations between receipt of palliative care and total household costs on health care as a proportion of household income. Catastrophic costs, defined as 20% or more of total household income, sale of assets and loans taken out (dissaving), and their association with palliative care were computed. FINDINGS We recruited 150 households. At 6 months, data from 89 (59%) of 150 households were available, comprising 89 patients (median age 50 years, 79% female) and 64 caregivers (median age 40 years, 73% female). Patients in 55 (37%) of the 150 households died and six (4%) were lost to follow-up. 19 (21%) of 89 households received palliative care. Catastrophic costs were experienced by nine (47%) of 19 households who received palliative care versus 48 (69%) of 70 households who did not (relative risk 0·69, 95% CI 0·42 to 1·14, p=0·109). Palliative care was associated with substantially reduced dissaving (median US$11, IQR 0 to 30 vs $34, 14 to 75; p=0·005). The mean difference in total household costs on cancer-related health care with receipt of palliative care was -36% (95% CI -94 to 594; p=0·707). INTERPRETATION Vulnerable households in low-income countries are subject to catastrophic health-related costs following a diagnosis of advanced cancer. Palliative care might result in reduced dissaving in these households. Further consideration of the economic benefits of palliative care is justified. FUNDING Wellcome Trust; National Institute for Health Research; and EMMS International.
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Affiliation(s)
- Maya Jane Bates
- Department of Family Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Miriam R P Gordon
- Department of Economics, Global Development Institute, University of Manchester, Manchester, UK
| | - Stephen B Gordon
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Malawi Liverpool Wellcome Trust, Clinical Research Programme, Blantyre, Malawi
| | - Ewan M Tomeny
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Adamson S Muula
- Department of Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Helena Davies
- Worldwide Hospice Palliative Care Alliance, London, UK
| | - Claire Morris
- Worldwide Hospice Palliative Care Alliance, London, UK
| | - Gerald Manthalu
- Department of Planning, Ministry of Health, Lilongwe, Malawi
| | - Eve Namisango
- African Palliative Care Association, Kampala, Uganda
| | - Leo Masamba
- Department of Medicine, Queen Elizabeth Central Hospital, Ministry of Health, Blantyre, Malawi
| | - Marc Y R Henrion
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Malawi Liverpool Wellcome Trust, Clinical Research Programme, Blantyre, Malawi
| | - Peter MacPherson
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Malawi Liverpool Wellcome Trust, Clinical Research Programme, Blantyre, Malawi; London School of Hygiene & Tropical Medicine, London, UK
| | - S Bertel Squire
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Louis W Niessen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Johns Hopkins School of Public Health, Baltimore, MD, USA
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Doshmangir L, Hasanpoor E, Abou Jaoude GJ, Eshtiagh B, Haghparast-Bidgoli H. Incidence of Catastrophic Health Expenditure and Its Determinants in Cancer Patients: A Systematic Review and Meta-analysis. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2021; 19:839-855. [PMID: 34318445 DOI: 10.1007/s40258-021-00672-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Cancer is the third leading cause of mortality in the world, and cancer patients are more exposed to financial hardship than other diseases. This paper aimed to review studies of catastrophic healthcare expenditure (CHE) in cancer patients, measure their level of exposure to CHE, and identify factors associated with incidence of CHE. METHODS This study is a systematic review and meta-analysis. Several databases were searched until February 2020, including MEDLINE, Web of Science, Scopus, ProQuest, ScienceDirect and EMBASE. The results of selected studies were extracted and analyzed using a random effects model. In addition, determinants of CHE were identified. RESULTS Among the 19 studies included, an average of 43.3% (95% CI 36.7-50.1) of cancer patients incurred CHE. CHE varied substantially depending on the Human Development Index (HDI) of the country in which a study was conducted. In countries with the highest HDI, 23.4% of cancer patients incurred CHE compared with 67.9% in countries with the lowest HDI. Key factors associated with incidence of CHE at the household level included household income, gender of the household head, and at the patient level included the type of health insurance, education level of the patient, type of cancer and treatment, quality of life, age and sex. CONCLUSION The proportion of cancer patients that incur CHE is very high, especially in countries with lower HDI. The results from this review can help inform policy makers to develop fairer and more sustainable health financing mechanisms, addressing the factors associated with CHE in cancer patients.
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Affiliation(s)
- Leila Doshmangir
- Department of Health Policy & Management, Tabriz Health Services Management Research Center, School of Management & Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
- Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Edris Hasanpoor
- Research Center for Evidence-Based Health Management, Maragheh University of Medical Sciences, Maragheh, Iran.
| | - Gerard Joseph Abou Jaoude
- Institute for Global Health, Center for Global Health Economics, University College London, London, UK
| | - Behzad Eshtiagh
- Institute for Global Health, Center for Global Health Economics, University College London, London, UK
| | - Hassan Haghparast-Bidgoli
- Department of Health Policy & Management, Tabriz Health Services Management Research Center, School of Management & Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
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Patel JR, Rupani MP. Costs incurred by patients with oral potentially malignant disorders: is there a public health need for financial protection in India? BMC Res Notes 2021; 14:396. [PMID: 34689827 PMCID: PMC8543918 DOI: 10.1186/s13104-021-05814-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/15/2021] [Indexed: 12/03/2022] Open
Abstract
Objectives Financial protection mechanisms are in place to overcome the costs of a few diseases in India. Our objective was to estimate the costs incurred due to Oral Potentially Malignant Disorders (OPMD) and to determine predictors of such costs. Results We found that the median (Interquartile range IQR) total costs of OPMD was Indian Rupees (INR) 500 (350–750), direct medical costs was INR 0 (0–50), direct non-medical costs was INR 150 (40–200) and indirect costs was INR 350 (250–500). The travel cost to attend the health facilities [INR 100 (40–150)] and the patient’s loss of wages [INR 200 (150–400)] mainly accounted for the direct non-medical and indirect costs respectively. The median expenditure on smokeless and smoking forms of tobacco was INR 6000 (5400–7200) and INR 2400 (1800–3600) respectively. On multiple linear regression analysis, rural residence, belonging to below poverty line family, being a sole earner in the family, number of months since diagnosis and first visit at a private provider were found to be the significant predictors of total costs of OPMD. Financial protection mechanisms are needed for covering the direct non-medical and indirect costs. Early management of OPMD might mitigate the costs of OPMD. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-021-05814-2.
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Affiliation(s)
- Jay R Patel
- Department of Community Medicine, Government Medical College Bhavnagar (Maharaja Krishnakumarsinhji Bhavnagar University), Near ST bus stand, Jail Road, Bhavnagar, Gujarat, 364001, India
| | - Mihir P Rupani
- Division of Clinical Epidemiology, ICMR-National Institute of Occupational Health (NIOH), Meghani Nagar, Ahmedabad, Gujarat, 380016, India.
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Minamitani M, Mukai T, Yamashita H, Katano A, Nakagawa K. Effects on annual income changes after radical radiotherapy versus after prostatectomy in patients with localized prostate cancer with a specific employment status: A web-based pilot study. PLoS One 2021; 16:e0258116. [PMID: 34591929 PMCID: PMC8483344 DOI: 10.1371/journal.pone.0258116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 09/17/2021] [Indexed: 11/17/2022] Open
Abstract
Men with localized prostate cancers are insured for undergoing radical radiotherapy or prostatectomy. However, limited information is available on the influence of cancer treatments on patients’ employment status in Japan. Therefore, in this web-based survey, we aimed to compare the effects of post-treatment changes on the annual income of patients with prostate cancer after undergoing radical radiotherapy and prostatectomy and to identify the risk factors associated with the decrease in annual income. We investigated the clinical characteristics and demographics including pre-treatment working status, self-employment, non-regular employment, working for wage or salary, and joblessness of patients with localized prostate cancer. Multivariable logistic regression was performed to analyze the effects of various factors on the change in the annual income of self-employed and non-regularly employed workers. Seventy-eight eligible patients with localized prostate cancer had undergone radiotherapy, and 128 patients had undergone prostatectomy. Among self-employed and non-regularly employed workers, post-treatment income decline rates in those who underwent radiotherapy were smaller but not significant (12% vs. 42%, P = 0.074). Multivariable logistic regression analysis revealed that initial treatment for prostate cancer was the only significant risk factor for the post-treatment income decline among self-employed and non-regularly employed workers. Radiotherapy was associated with a smaller decrease in income (odds ratio, 0.22; 95% confidence interval, 0.052–0.95; P = 0.042). Our novel results implied the effectiveness of radiotherapy in preventing post-treatment income decline among patients with prostate cancer based on specific employment status: self-employed or non-regularly employed.
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Affiliation(s)
| | - Tomoya Mukai
- Graduate Schools for Law and Politics, The University of Tokyo, Tokyo, Japan
| | - Hideomi Yamashita
- Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
| | - Atsuto Katano
- Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
| | - Keiichi Nakagawa
- Department of Comprehensive Radiation Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Afiyanti Y, Besral B, Haryani H, Milanti A, Nasution LA, Wahidi KR, Gayatri D. Liens entre les besoins non satisfaits, la qualité de vie et les caractéristiques des survivantes de cancers gynécologiques en Indonésie. Can Oncol Nurs J 2021; 31:306-313. [PMID: 34395834 DOI: 10.5737/23688076313306313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Les survivantes de cancers gynécologiques ont des besoins complexes très souvent négligés. La présente étude indonésienne vise à établir les liens entre les besoins non satisfaits, la qualité de vie et certaines caractéristiques particulières de ces survivantes. Au total, 298 participantes ont rempli le questionnaire sur les besoins non satisfaits des survivants au cancer (Cancer Survivor Unmet Needs ou CaSUN), le questionnaire sur la qualité de vie EORTC QLQ-C30 ainsi que les questionnaires démographiques et cliniques. L'étude, réalisée suivant un devis corrélationnel transversal, a établi un lien entre les besoins non satisfaits et la dégradation de la qualité de vie perçue. Plusieurs facteurs sont associés à l'augmentation des besoins insatisfaits: patients jeunes, revenu moindre, niveau d'éducation moyen, diagnostic récent, stade avancé de la maladie, et polythérapie (p < .05). Chez les survivantes indonésiennes d'un cancer gynécologique, le soutien financier (70,5 %) constitue le besoin le plus souvent insatisfait. À la fin des traitements primaires, elles ont besoin de soins globaux et continus pour gérer les problèmes, nouveaux comme anciens, causés par le cancer et le traitement.
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Affiliation(s)
- Yati Afiyanti
- Faculté de sciences infirmières, Université d'Indonésie (Indonésie),
| | - Besral Besral
- Faculté de santé publique, Université d'Indonésie (Indonésie)
| | - Haryani Haryani
- Faculté de médecine, de santé publique et de sciences infirmières, École de soins infirmiers, Université Gadjah Mada (Indonésie)
| | - Ariesta Milanti
- École de soins infirmiers Nethersole, Université chinoise de Hong Kong (Hong Kong)
| | | | | | - Dewi Gayatri
- Faculté de sciences infirmières, Université d'Indonésie (Indonésie)
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Ürek D, Uğurluoğlu Ö. Predictors of financial toxicity and its associations with health-related quality of life and treatment non-adherence in Turkish cancer patients. Support Care Cancer 2021; 30:865-874. [PMID: 34392415 DOI: 10.1007/s00520-021-06491-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/07/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aims to determine the financial toxicity (FT) level in cancer patients, identify the risk factors associated with this level, and reveal the effect of this level on patient outcomes (health-related quality of life (HRQoL) and treatment non-adherence). METHODS The data of 316 cancer patients, who were receiving inpatient treatment in an oncology hospital affiliated to a public university in Ankara, Turkey, were ≥ 18 years old, and were receiving chemotherapy for at least 3 months, were evaluated. The data were collected through a face-to-face interview. FT was measured with the COmprehensive Score for financial Toxicity (COST) Measure (v2), HRQoL was measured with the Functional Assessment of Cancer Therapy-General (FACT-G) Scale (v4), and treatment adherence was measured using a questionnaire created by conducting a literature review. RESULTS Patients were found to experience FT above the moderate level (mean ± SD, 21.85 ± 12.02; median value, 24.0). Younger age, being married, low education level, low monthly household income, and receiving social/economic support for treatment were revealed to be the determinants of high FT. Moreover, as the FT score decreased (as the FT level felt increased), the HRQoL was observed to decrease, and treatment non-adherence increased. CONCLUSION The results indicate that FT problem is also valid for cancer patients in Turkey despite the system of general health insurance. The FT was found to result from socio-economic characteristics rather than the disease and treatment-related characteristics. The significant associations revealed between FT and patient outcomes emphasize the importance of reducing the FT in cancer patients.
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Affiliation(s)
- Duygu Ürek
- Department of Health Care Management, Faculty of Economics and Administrative Sciences, Hacettepe University, Beytepe Campus, 06800, Ankara, Turkey.
| | - Özgür Uğurluoğlu
- Department of Health Care Management, Faculty of Economics and Administrative Sciences, Hacettepe University, Beytepe Campus, 06800, Ankara, Turkey
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Catastrophic expenditure rates and barriers for treatment adherence in patients with colorectal cancer in India: The CROCODILE study protocol. Colorectal Dis 2021; 23:2161-2172. [PMID: 33848062 DOI: 10.1111/codi.15674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/05/2021] [Accepted: 04/05/2021] [Indexed: 02/08/2023]
Abstract
AIM Little is known about the delivery of colorectal cancer treatment in India and its associated costs. The aim of this study is to identify financial and nonfinancial barriers to adherence to colorectal cancer treatment in India. METHOD CROCODILE is a mixed-methods study with a quantitative and a qualitative workstream. The quantitative workstream will be a prospective cohort study to assess treatment adherence and catastrophic expenditure rates among patients with colorectal cancer in India. Consecutive newly diagnosed patients with histopathologically proven colorectal cancer from five tertiary hospitals in India will be included. Catastrophic expenditure will be defined as a treatment cost higher than 40% of nonsubsistence annual household income. Treatment costs will include medical, nonmedical and indirect expenses. Income assessment will be compared between three methods: patient-reported income, the International Wealth Index and the Gapminder tool. The qualitative workstream will explore the views and experiences of colorectal cancer patients and professionals about barriers to and facilitators for treatment adherence. Individual semistructured interviews with three to five patients and cancer care professionals in each centre will be performed. An analytical framework will be developed to perform the analysis, through a combined approach (deductive and inductive). The results will be triangulated with the quantitative workstream for mutual knowledge enrichment. CONCLUSION The CROCODILE study will identify barriers to and facilitators for colorectal cancer delivery in India, influencing research and policy decisions. It will explore the feasibility of collecting data on patient-level costs and income to inform future economic evaluations in cancer and surgical care.
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Cancer Drugs in Asian Populations: Availability, Accessibility, and Affordability. ACTA ACUST UNITED AC 2021; 26:323-329. [PMID: 32732675 DOI: 10.1097/ppo.0000000000000460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Accessibility to effective cancer treatments is a goal of Universal Health Coverage; yet, achieving this in the context of escalating costs in a diversity of Asian nations with different socioeconomic development is extremely challenging. Value-based assessments within the context of each health care system, financing infrastructure that will facilitate appropriate prioritization of high-cost medications, transparency in international pricing and reducing out-of-pocket costs through national insurance programs are measures that Asian countries should take toward Universal Health Coverage for cancer care. Encouraging sharing data on pricing through the World Health Organization, sharing expertise in health technology assessments and regulatory approvals, and exploring bulk negotiations would also strengthen the process of price control. For each individual country, rational selection of national cancer formulary, aiming at price reduction and sound procurement strategies for each drug, is important toward ensuring affordable access to quality cancer medications.
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Kadravello A, Tan SB, Ho GF, Kaur R, Yip CH. Exploring Unmet Needs from an Online Metastatic Breast Cancer Support Group: A Qualitative Study. ACTA ACUST UNITED AC 2021; 57:medicina57070693. [PMID: 34356974 PMCID: PMC8305467 DOI: 10.3390/medicina57070693] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 12/01/2022]
Abstract
Background and Objective: Despite the increasing treatment options for patients with metastatic breast cancer (MBC), unmet needs remain common, especially in low and middle-income countries where resources are limited and MBC patients face many challenges. They often join support groups to cope with their unmet needs. Currently, many MBC patients connect with each other via online support group in view of the constant availability of support and rapid information exchange. The objective of this study is to determine the unmet needs of women with MBC from an online support group. Material and Methods: Messages in an online support group of twenty-two MBC patients over a period of three years from August 2016 till August 2019 were thematically analyzed. Results: Three themes were generated, (1) unmet information needs (2) unmet financial needs (3) unmet support needs. Women needed information on side effects of treatment, new treatment options and availability of clinical trials. Although Malaysia has universal health care coverage, access to treatment remains a major challenge. When treatment was not available in the public hospitals, or waiting lists were too long, women were forced to seek treatment in private hospitals, incurring financial catastrophe. Insufficient private insurance and inadequate social security payments force many women to consider stopping treatment. Women felt that they were not getting support from their clinicians in the public sector, who were quick to stop active treatment and advise palliation. On the other hand, clinicians in the private sector advise expensive treatment beyond the financial capability of the patients. Women with families also face the challenge of managing their family and household in addition to coping with their illness. Conclusions: There is a need for healthcare professionals, policy makers, and civil society to better address the needs of MBC patients through patient-centered, multidisciplinary and multi-organizational collaboration.
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Affiliation(s)
- Aravinthan Kadravello
- Breast Cancer Welfare Association Malaysia, Petaling Jaya 46200, Malaysia; (A.K.); (R.K.)
| | - Seng-Beng Tan
- Faculty of Medicine, University Malaya Medical Centre, Kuala Lumpur 59100, Malaysia; (S.-B.T.); (G.-F.H.)
| | - Gwo-Fuang Ho
- Faculty of Medicine, University Malaya Medical Centre, Kuala Lumpur 59100, Malaysia; (S.-B.T.); (G.-F.H.)
| | - Ranjit Kaur
- Breast Cancer Welfare Association Malaysia, Petaling Jaya 46200, Malaysia; (A.K.); (R.K.)
| | - Cheng-Har Yip
- Breast Centre, Subang Jaya Medical Centre, Subang Jaya 47500, Malaysia
- Correspondence:
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Sun CY, Shi JF, Fu WQ, Zhang X, Liu GX, Chen WQ, He J. Catastrophic Health Expenditure and Its Determinants Among Households With Breast Cancer Patients in China: A Multicentre, Cross-Sectional Survey. Front Public Health 2021; 9:704700. [PMID: 34291034 PMCID: PMC8287064 DOI: 10.3389/fpubh.2021.704700] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/08/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Although numerous studies have examined catastrophic health expenditures (CHE) worldwide, most focus on the general population, not on specific vulnerable groups. We aimed to analyse the extent and the influencing factors of CHE in households with breast cancer patients in China, and explore the ability of different insurances to protect these households from CHE. Methods: A multicentre, cross-sectional interview surveys was conducted in households with breast cancer patients across seven provinces/municipalities in China. CHE were defined as out-of-pocket expenditures ≥ 40% of households' non-food expenditures. Chi-square tests and logistic regression analysis were performed to identify the determinants of CHE in household with breast cancer patients. Results: In the 639 participating households with breast cancer patients, the mean out-of-pocket (OOP) expenditure accounted for ~55.20% of the mean households' non-food expenditures. The overall incidence of CHE was 87.95 and 66.28% before and after insurance compensation, respectively. The logistic regression model revealed that education, disease course, health insurance, treatment method, and income were significant predictors of CHE. Conclusions: The results indicated that medical insurance protects some households with breast cancer patients from the impact of CHE. However, their reimbursement rates were relatively low. Therefore, breast cancer still had a significant catastrophic effect on the economy of households. Policy efforts should focus on improving insurance compensation rates and relieving the economic burden of critical illnesses such as breast cancer.
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Affiliation(s)
- Cheng-Yao Sun
- Department of Health Economics, College of Health Management of Harbin Medical University, Harbin, China
| | - Ju-Fang Shi
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wen-Qi Fu
- Department of Health Economics, College of Health Management of Harbin Medical University, Harbin, China
| | - Xin Zhang
- Department of Health Economics, College of Health Management of Harbin Medical University, Harbin, China
| | - Guo-Xiang Liu
- Department of Health Economics, College of Health Management of Harbin Medical University, Harbin, China
| | - Wan-Qing Chen
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie He
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Afiyanti Y, Besral B, Haryani H, Milanti A, Nasution LA, Wahidi KR, Gayatri D. The relationships of unmet needs with quality of life and characteristics of Indonesian gynecologic cancer survivors. Can Oncol Nurs J 2021; 31:298-305. [PMID: 34395833 DOI: 10.5737/23688076313298305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Gynecologic cancer survivors' complex needs are too often overlooked. This study aimed to identify the associations between unmet needs and quality of life, and selected characteristics of Indonesian gynecologic cancer survivors. This study was a cross-sectional, correlation study. A total of 298 participants completed the Cancer Survivor Unmet Needs (CaSUN), EORTC QLQ-C30, and demographic and clinical-related questionnaires. A higher level of unmet needs was linked to lower perceived quality of life. Higher levels of unmet needs were associated with younger age, lower income, higher educational background, shorter time since diagnosis, more advanced cancer stage, and having combination therapies (p < 0.05). The most frequently reported unmet need of the Indonesian gynecologic cancer survivors was financial support (70.5%). The gynecologic cancer survivors who had completed primary treatment need continuous comprehensive cancer care to help them cope with the lingering or emerging problems related to cancer and its treatment.
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Affiliation(s)
- Yati Afiyanti
- Faculty of Nursing, Universitas Indonesia, Indonesia
| | - Besral Besral
- Faculty of Public Health, Universitas Indonesia, Indonesia
| | - Haryani Haryani
- Faculty of medicine, public health, and nursing. School of Nursing, University Gadjah Mada, Indonesia
| | - Ariesta Milanti
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong
| | | | | | - Dewi Gayatri
- Faculty of Nursing, Universitas Indonesia, Indonesia
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