Financial catastrophe, treatment discontinuation and death associated with surgically operable cancer in South-East Asia: Results from the ACTION Study

Stephen Jan, Merel Kimman, Sanne A E Peters, Mark Woodward

Research output: Contribution to journalArticle

Abstract

Background This study assessed the extent to which individuals with surgically operable cancer in Southeast Asia experience financially catastrophic out-of-pocket costs, discontinuation of treatment, or death. Methods The ACTION study is a prospective, 8-country, cohort study of adult patients recruited consecutively with an initial diagnosis of cancer from public and private hospitals. Participants were interviewed at baseline and 3 months. In this paper, we identified 4,584 participants in whom surgery was indicated in initial treatment plans and assessed the following competing outcomes: death, financial catastrophe (out-of-pocket costs of >30% of annual household income), treatment discontinuation, and hospitalization without financial catastrophe incurred. We then analyzed a range of predictors using a multinomial regression model. Results Of the participants, 72% were female and 44% had health insurance at baseline. At 3 months, 31% of participants incurred financial catastrophe, 8% had died, 23% had discontinued treatment, and 38% were hospitalized but avoided financial catastrophe. Health insurance status was found to be associated with lower odds of treatment discontinuation (odds ratio [OR], 0.60; 95% CI, 0.47-0.77) relative to hospitalization without financial catastrophe. Women had greater odds of financial catastrophe than men (OR, 1.35; 95% CI, 1.05-1.74), whereas lower socioeconomic status (range of indicators) was generally found to be associated with higher odds of death, treatment discontinuation, and financial catastrophe. Conclusion Priority should be given to measures such as programs to extend social health insurance to offset the out-of-pocket costs associated with surgery for cancer faced in particular by women, the uninsured, and individuals of low socioeconomic status in Southeast Asia.

Original languageEnglish (US)
Article number4085
Pages (from-to)971-982
Number of pages12
JournalSurgery
Volume157
Issue number6
DOIs
StatePublished - Jun 1 2015
Externally publishedYes

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Far East
Health Insurance
Health Expenditures
Neoplasms
Southeastern Asia
Social Class
Hospitalization
Therapeutics
Odds Ratio
Cancer Care Facilities
Private Hospitals
Insurance Coverage
Social Security
Public Hospitals
Health Status
Cohort Studies

ASJC Scopus subject areas

  • Surgery

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Financial catastrophe, treatment discontinuation and death associated with surgically operable cancer in South-East Asia : Results from the ACTION Study. / Jan, Stephen; Kimman, Merel; Peters, Sanne A E; Woodward, Mark.

In: Surgery, Vol. 157, No. 6, 4085, 01.06.2015, p. 971-982.

Research output: Contribution to journalArticle

Jan, Stephen ; Kimman, Merel ; Peters, Sanne A E ; Woodward, Mark. / Financial catastrophe, treatment discontinuation and death associated with surgically operable cancer in South-East Asia : Results from the ACTION Study. In: Surgery. 2015 ; Vol. 157, No. 6. pp. 971-982.
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AB - Background This study assessed the extent to which individuals with surgically operable cancer in Southeast Asia experience financially catastrophic out-of-pocket costs, discontinuation of treatment, or death. Methods The ACTION study is a prospective, 8-country, cohort study of adult patients recruited consecutively with an initial diagnosis of cancer from public and private hospitals. Participants were interviewed at baseline and 3 months. In this paper, we identified 4,584 participants in whom surgery was indicated in initial treatment plans and assessed the following competing outcomes: death, financial catastrophe (out-of-pocket costs of >30% of annual household income), treatment discontinuation, and hospitalization without financial catastrophe incurred. We then analyzed a range of predictors using a multinomial regression model. Results Of the participants, 72% were female and 44% had health insurance at baseline. At 3 months, 31% of participants incurred financial catastrophe, 8% had died, 23% had discontinued treatment, and 38% were hospitalized but avoided financial catastrophe. Health insurance status was found to be associated with lower odds of treatment discontinuation (odds ratio [OR], 0.60; 95% CI, 0.47-0.77) relative to hospitalization without financial catastrophe. Women had greater odds of financial catastrophe than men (OR, 1.35; 95% CI, 1.05-1.74), whereas lower socioeconomic status (range of indicators) was generally found to be associated with higher odds of death, treatment discontinuation, and financial catastrophe. Conclusion Priority should be given to measures such as programs to extend social health insurance to offset the out-of-pocket costs associated with surgery for cancer faced in particular by women, the uninsured, and individuals of low socioeconomic status in Southeast Asia.

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