TY - JOUR
T1 - Financial catastrophe, treatment discontinuation and death associated with surgically operable cancer in South-East Asia
T2 - Results from the ACTION Study
AU - Executive Committee ACTION Study
AU - ACTION Study Group
AU - Jan, Stephen
AU - Kimman, Merel
AU - Peters, Sanne A.E.
AU - Woodward, Mark
N1 - Funding Information:
Phetsamone Arounlangsy (Lao Cancer Center, Department of Health Care, Ministry of Health, Laos), Soe Aung (Witoriya General Hospital, Yangon, Myanmar), Soledad L. Balete (Section of Medical Oncology, Jose R. Reyes Memorial Medical Centre, Manila, Philippines), Nirmala Bhoo-Pathy (National Clinical Research Centre, Ministry of Health, Malaysia, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia), Bounthaphany Bounxouei (Mahosot Hospital, Laos), Dieu Bui (K Hospital, Vietnam), Jay Datukan (Section of Medical Oncology, St. Luke's Medical Centre, Quezon City, Metro Manila, Philippines), Agnes E. Gorospe, (Section of Medical Oncology, St Luke's Medical Centre, Quezon City, Metro Manila, Philippines), Cheng Har Yip (University of Malaya, Kuala Lumpur, Malaysia), Prasit Khopaibul (Suratthani Cancer Centre, Suratthani, Thailand), Thanut Khuayjarernpanishk (Ubonratchathani Cancer Centre, Ubonratchathani, Thailand), Thiravud Khuhaprema (National Cancer Institute of Thailand, Bangkok, Thailand), Myo Khin (Department of Medical Research, Lower Myanmar, Myanmar), Tawin Klinwimol (Ubonratchathani Cancer Centre, Ubonratchathani, Thailand), Somkiet Lalitwongsa (Lampang Cancer Hospital, Lampang, Thailand), Dhanoo Lawbundis (Lopburi Cancer Hospital, Lopburi, Thailand), Conrado Lola (Section of Medical Oncology, National Kidney and Transplant Institute, Quezon City, Metro Manila, Philippines), Leo Marbella (Section of Medical Oncology, National Kidney and Transplant Institute, Quezon City, Metro Manila, Philippines), Khoa Mai Trong (Bach Mai Hospital, Vietnam), Soe Oo Maung (Department of Radiotherapy, Yangon General Hospital, Yangon, Myanmar), Shu Mon (Bahosi Hospital, Myanmar), Win Pa Pa Naing (Department of Medical Research, Lower Myanmar, 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), Annielyn Beryl Ong-Cornel (Veterans Memorial Medical Centre, Quezon City, Philippines), Khin May Oo (Department of Medical Research, Lower Myanmar, Myanmar), Irisyl Orolfo-Real (Section of Medical Oncology, University of the Philippines - College of Medicine, Philippine General Hospital, Manila, Philippines), Dung Pham Xuan (Oncology Hospital, Ho Chi Minh city, Vietnam), Seang Pharin (Department of Onco-Hematology, Calmette Hospital, Cambodia), Pujianto (Department of Health Policy and Administration, School of Public Health, Universitas Indonesia, Indonesia), Oudayvone Rattanavong (Mahosot Hospital, Laos), Kouy Samnang (Department of Oncology, Khmer-Soviet Friendship Hospital, Cambodia), Somphob Sangkittipaiboon (Lopburi Cancer Hospital, Lopburi, Thailand), Suleeporn Sangrajrang, (National Cancer Institute of Thailand, Bangkok, Thailand), Cherelina Santiago-Ferreras (Section of Medical Oncology, Veterans Memorial Medical Centre, Quezon City, Metro Manila, Philippines), San Shwe (Department of Medical Research, Lower Myanmar, Myanmar), Eav Sokha (National Cancer Centre, Calmette Hospital, Cambodia), Thanadej Sinthusake (Mahavajiralongkorn Thanyaburi Hospital, Pathumthani, Thailand), Darunee Suanplu (Suratthani Cancer Hospital, Suratthani, Thailand), Jitraporn Tanabodee (Chonburi Cancer Hospital, Chonburi, Thailand), Hasbullah Thabrany (Center for Health Economics and Policy Studies, Universitas Indonesia, Indonesia), Kitisak Thepsuwan (Chonburi Cancer Hospital, Chonburi, Thailand), Yin Yin Tun (Department of Medicine, No. 2 Military Hospital, Myanmar), Heng Viroath (Department of Oncology, Khmer-Soviet Friendship Hospital, Cambodia), Le Le Win (Department of Medical Research, Lower Myanmar), Swe Swe Win (Department of Oral Medicine, University of Dental Medicine, Yangon, Myanmar), Tin Moe Win (Mandalay General Hospital, Myanmar).
Publisher Copyright:
© 2015 Elsevier Inc. All rights reserved.
PY - 2015/6/1
Y1 - 2015/6/1
N2 - 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.
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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U2 - 10.1016/j.surg.2015.02.012
DO - 10.1016/j.surg.2015.02.012
M3 - Article
C2 - 25934082
AN - SCOPUS:84929277358
SN - 0039-6060
VL - 157
SP - 971
EP - 982
JO - Surgery (United States)
JF - Surgery (United States)
IS - 6
M1 - 4085
ER -