Cancer cases are expected to double within 20 years in Southeast Asia. Although certain cancers are preventable with existing screening methods, most countries in the region have failed to organize effective prevention programs. This is partially due to the paucity of data regarding the socio-economic impact of cancer on households.
The ASEAN CosTs In ONcology (ACTION) study aims to assess the economic impact of cancer in the year following a cancer diagnosis.
ACTION recruited 9513 adult patients, with a first time cancer diagnosis received in hospital in the last 12 weeks, using random sampling in 47 hospitals in Cambodia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Thailand and Vietnam. Data were compiled from routine medical records and by interview, using a study questionnaire.
Among females, breast cancer was most common (40%), followed by cervix (17%). Among males, mouth (20%) and colorectal (15%) cancers were most common. This suggests under-recruitment of the more virulent types of cancer (lung, liver), likely due to censoring by clinicians. At diagnosis, 41% had grade III or IV cancer; 48% reported a household income below the national mean; 54% had experienced economic hardship in the previous year; and 55% had no health insurance. Low household income, absence of paid work and, most especially, having experienced economic hardship in the past year (a 5.6 point difference, versus no hardship, for the EORTC QLQ-C30 global health score, p< 0.001, after adjustment) were associated with lower quality of life at the time of diagnosis.
Poor patients are in the majority and have the lowest quality of life at diagnosis. We anticipate this will have negative consequences on compliance to treatment and that they, and their families, will also have the worst outcomes in the following year: results will be presented at the Congress.