Disparities in end-of-life outcomes among advanced cancer patients in Sri Lanka: Results from the APPROACH study

Abstract

Objective A Universal Health Coverage goal is to provide access to affordable palliative care to reduce disparities in end-of-life (EOL) outcomes. To assess progress toward this goal in Sri Lanka, our primary aim was to systematically assess differences in patients’ physical, psychological, social and spiritual outcomes, and their perceived quality of care by their socioeconomic status (SES). Methods As part of the multi-country APPROACH (Asian Patient Perspectives Regarding Oncology Awareness, Care and Health) study, we surveyed 199 patients with a stage IV solid malignant tumor and aged >21 years from the largest government cancer hospital in Sri Lanka. We assessed their physical (physical and functional well-being, symptom burden), psychological (anxiety, depression, emotional well-being), social (social well-being), and spiritual outcomes and perceived quality of care (physician communication, nursing care, and coordination/responsiveness). Results Low SES patients reported significantly lower physical and functional well-being, emotional well-being, spiritual well-being including meaning/peace and faith; and significantly higher symptom burden, anxiety and depressive symptoms compared with patients from high SES (p < 0.05 for all outcomes). Significance of results Results have implications regarding reducing barriers in access to appropriate palliative care and EOL care services to stage IV cancer patients from low SES in Sri Lanka.

An observational study of socioeconomic status and demographic profile of advanced cancer patients receiving palliative care in tertiary care institution of Bihar, India

“…Esophagectomy was observed to be performed more frequently on high-SES patients with oesophageal cancer than on low-SES individuals. In contrast to cancer patients from higher SES groups, low SES cancer patients are more likely to experience higher mortality, depression, and other comorbidities, as well as a greater burden of symptoms [5]. Low SES cancer patients are also less likely to obtain palliative care and die at home [17].…”

“…Socioeconomic status was shown by few studies as an independent risk factor for death in cancer patients [22]. According to research by Hapurachi et al [22], patients with low SES reported lower physical, emotional, spiritual, and social EOL outcomes than those with high SES [5]. Following a diagnosis of advanced cancer, poor households in low-income countries are exposed to catastrophic health-related expenses, according to a prospective cohort research by Bates and colleagues [1].…”

“…Equal access to palliative care treatments at the end of life (EOL) for all patients with advanced cancer, regardless of their socioeconomic status (SES), is a key component of universal health coverage. Though many patients with advanced cancer in low-and middleincome countries, particularly those from low SES, suffer poor outcomes at the EOL and believe that their care is of low quality, this is not always the case [5].…”

Development and validation of a Religious and Spiritual Support Scale in Sri Lanka: A psychometric study

“…A study conducted in the largest government cancer hospital in Sri Lanka revealed that spiritual and psychological support services have not been used adequately by cancer patients who come from lowincome brackets (Hapuarachchi et al, 2021) compared to those patients who come from higher income brackets. Another study conducted on disabled veterans in Sri Lanka revealed that Buddhist religious activities, cultural activities, and support received from family and friends tend to reduce symptoms of depression and post-traumatic stress disorder (PTSD) (Zoysa & Wickrama, 2011).…”