03531nas a2200517   4500000000100000008004100001653001000042653001100052653001100063653000900074653000900083653001500092653001600107653001900123653002400142653002000166653001800186653002000204653001800224653002600242653002600268653002300294653001500317653003500332653005000367653005300417653003100470653007200501653003700573653005800610653001100668653005200679653003600731653002100767653005400788100001800842700001400860700001400874700001600888245015600904250001501060300001101075490000801086520186801094020005102962       2015                            d10aAdult10aFemale10aHumans10aAged10aMale10aOdds Ratio10aMiddle Aged10aCohort Studies10aProspective Studies10aRisk Assessment10aLinear Models10aCost of Illness10aSurvival Rate10aSocioeconomic Factors10aMultivariate Analysis10aAsia, Southeastern10aBankruptcy10aDeveloping Countries/economics10aHealth Care Costs/statistics & numerical data10aHealth Expenditures/ statistics & numerical data10aHealth Personnel/economics10aHealth Services Accessibility/economics/statistics & numerical data10aHealth Services Needs and Demand10aHospitalization/economics/statistics & numerical data10aIncome10aMedically Uninsured/statistics & numerical data10aNeoplasm Invasiveness/pathology10aNeoplasm Staging10aNeoplasms/ economics/mortality/pathology/ surgery1 aWoodward Mark1 aPeters S.1 aKimman M.1 aJan Stephen00aFinancial catastrophe, treatment discontinuation and death associated with surgically operable cancer in South-East Asia: Results from the ACTION Study  a2015/05/03  a971-820 v1573 a<p>
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 &gt;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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