Cancer Drives Patients to Financial Catastrophe in Southeast Asia

Underprivileged patients in Southeast Asia are at major risk of disease-related financial catastrophe (FC), economic hardship (EH), and mortality.

Researchers at the University of Malaya (Kuala Lumpur, Malaysia) conducted a study of 9,513 cancer patients from 47 hospitals in eight low and middle-income Southeast Asian countries (Cambodia, Indonesia, Laos, Malaysia, Myanmar, The Philippines, Thailand, and Vietnam). The patients were assessed at baseline, three months, and one year after diagnosis using cost diaries and questionnaires to determine risk of FC, EH, and impoverishment (living on less than USD 2/day). Analysis allowed death as a competing risk to assess the association between baseline socio-demographic status, FC, and EH.

The results showed that one year after diagnosis, 29% of the patients had died, 48% experienced FC, and just 23% were alive with no FC. The risk of dying from cancer and facing catastrophic payments was associated with some clinical variables, such as a more advanced disease stage at diagnosis, as was socioeconomic status pre-diagnosis. Participants in the low income category within each country had significantly higher odds of FC and death than participants with high income, as were those without health insurance.

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; 5% percent of patients were pushed into poverty. The study was presented at the inaugural European society for medical oncology (ESMO) Asia Congress, held during December 2015 in Singapore.

“Cancer stage explained most of the financial catastrophic risk and premature deaths observed in the study,” said senior author Nirmala Bhoo-Pathy, MD. “However, low-income patients remained financially vulnerable, even when diagnosed at very early cancer stages. There appeared to be missed opportunities for surgery in patients with operable malignancies, particularly in low-income groups. Patients without health insurance also remained at higher risk of incurring catastrophic expenditures and dying, even in early stages.”

“Early detection may provide the best avenue to favorably influence economic and disease outcomes in cancer patients from low- and middle-income Southeast Asian countries, followed by increasing accessibility to effective treatments and provision of financial risk protection,” concluded Dr. Bhoo-Pathy. “The health financing systems in these countries also requires re-examination to ensure that public funds are directed to patients who need them the most.”

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University of Malaya