52O_PR Prioritizing strategies to address the economic impact of cancer in Southeast Asia

Abstract

Aim/Background: The ASEAN CosTs In ONcology (ACTION) study revealed that a year after diagnosis, 29% of cancer patients died, 48% had financial catastrophe (FC: out of pocket medical costs exceeding 30% of annual household income), and only 23% were alive with no FC. We estimated the impact of cancer control interventions, and health insurance on economic outcomes and mortality of cancer patients in Southeast Asia (SEA). Methods: In ACTION study, 9,513 cancer patients with solid and non-solid tumors from 47 hospitals in 8 ASEAN countries were assessed at baseline, 3- and 12 months after diagnosis using questionnaires and cost diaries to determine their risk of FC, economic hardship (EC: inability to make necessary household payments) and impoverishment (living on less than USD2/day). Multinomial regression allowing death as a competing risk was used to assess the association between patient's baseline socio-demographic status and FC, and EH, respectively. Stepwise adjustments for i) health insurance, ii) cancer stage, and iii) cancer therapies were done. Results: One year after diagnosis, the incidence of mortality and FC ranged from 12% and 45%, respectively in Malaysia to 45% and 50% in Myanmar. Overall, cancer-induced EH was evident in one third of patients of which 45% could not pay for medicines, and 28% resorted to taking personal loans. Five percent of patients were pushed into poverty. Stepwise multivariable regression showed that cancer stage largely explained the incidence of FC and death, followed by cancer therapies. Health insurance did not appear to explain risk of FC. Analysis stratified by cancer stage however showed that low-income patients experienced substantially higher FC and deaths compared to high-income patients across all cancer stages. Patients without health insurance also remained vulnerable to premature deaths even when presenting at earlier cancer stages. Similar results were also observed in multivariable analyses with EH as the outcome. Conclusions: Cancer down staging via early detection provides the best opportunity to improve economic and survival outcomes of cancer patients in SEA. Nevertheless, providing access to cancer therapies is also important and governments need to improve the financial risk protection for patients.