Financial burden of colorectal cancer treatment among patients and their families in a middle-income country

Azzani, Meram; Roslani, April Camilla; Su, Tin Tin

doi:10.1007/s00520-016-3283-2

Cited by 28 publications

(30 citation statements)

References 27 publications

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“…While most studies used the broad categories of strategies for coping with healthcare costs commonly covered in international household surveys (eg, using income/savings, borrowing money or selling assets) some drilled down to distinguish between types of borrowing and asset sales 19–28. For example, some studies examined who households borrowed from, noting that those forced to borrow from moneylenders faced higher interest rates than those borrowing from family or friends 25 26 28.…”

Section: Resultsmentioning

confidence: 99%

Coping with healthcare costs for chronic illness in low-income and middle-income countries: a systematic literature review

et al. 2019

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BackgroundExperiencing illness in low-income and middle-income countries (LMICs) can incur very high out-of-pocket (OOP) payments for healthcare and, while the existing literature typically focuses on levels of expenditure, it rarely examines what happens when households do not have the necessary money. Some will adopt one or more ‘coping strategies’, such as borrowing money, perhaps at exorbitant interest rates, or selling assets, some necessary for their future income, with detrimental long-term effects. This is particularly relevant for chronic illnesses that require consistent, long-term OOP payments. We systematically review the literature on strategies for financing OOP costs of chronic illnesses in LMICs, their correlates and their impacts on households.MethodsWe searched MEDLINE, EconLit, EMBASE, Global Health and Scopus on 22 October 2018 for literature published on or after 1 January 2000. We included qualitative or quantitative studies describing at least one coping strategy for chronic illness OOP payments in a LMIC context. Our narrative review follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines.ResultsForty-seven papers were included. Studies identified coping strategies for chronic illness costs that are not traditionally addressed in financial risk protection research (eg, taking children out of school, sending them to work, reducing expenditure on food or education, quitting work to give care). Twenty studies reported socioeconomic or other correlates of coping strategies, with poorer households and those with more advanced disease more vulnerable to detrimental strategies. Only six studies (three cross-sectional and three qualitative) included evidence of impacts of coping strategies on households, including increased labour to repay debts and discontinuing treatment.ConclusionsMonitoring of financial risk protection provides an incomplete picture if it fails to capture the effect of coping strategies. This will require qualitative and longitudinal research to understand the long-term effects, especially those associated with chronic illness in LMICs.

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Section: Resultsmentioning

confidence: 99%

Coping with healthcare costs for chronic illness in low-income and middle-income countries: a systematic literature review

et al. 2019

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“…Our study findings concur with existing studies that financial burden from CRC treatment and follow-up care was one of the key challenges influencing optimal long-term survivorship. [22][23][24] CRC survivors' unmet financial need was highly varied, ranging from insufficient personal coverage on medical claims and cost for colostomy bags and other accessories to having the responsibility to provide some degree of financial security for the family. This underscores the importance of involving clinicians as part of routine follow-up to briefly screen and refer patients to relevant services, as some might not be aware of financial subsidies and assistance that are available.…”

Section: Navigating a Healthcare Journey With Limited Directionmentioning

confidence: 99%

Living with long‐term consequences: Experience of follow‐up care and support needs among Asian long‐term colorectal cancer survivors

et al. 2020

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Objectives: This study aimed to provide an in-depth exploration of follow-up care experiences and supportive care needs in long-term colorectal cancer (CRC) survivors within multiethnic Asian communities. Methods: Semi-structured in-depth interviews were conducted on a purposive sample of 30 long-term CRC survivors who had completed all treatment without recurrence ranging 2 to 17 years in Singapore. Interviews were audio-recorded and transcribed verbatim. Thematic analysis was conducted following grounded theory approach. Results: Four themes represented the experience of the Asian long-term CRC survivors: (a) living with long-term consequences, (b) dealing with unceasing adaptation demands, (c) navigating a healthcare journey with limited direction, (d) regaining mastery through adversity. CRC and its treatment had profound physical impacts on some long-term survivors and these effected their psychological well-being. A sense of abandonment and vulnerability following the cessation of a 5-year follow-up care was repeatedly expressed. Participants defined recovery from CRC as not merely surviving but also having high physical function and full independence. They often sought less conventional remedies and medicine based on cultural beliefs rather than current evidence. Participants noted pervasive social stigma associated with CRC that impeded their inclusion in the workforce. Conclusions: Asian long-term CRC survivors experienced multiple challenges and needs relating to the care experience, information provision and workforce stigmatization, and several of which were unique to the Asian context. Future work will need to consider the implementation of culturally tailored cancer survivorship care plans that incorporate the specific needs of Asian CRC survivors.

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“…Notably, according to our survey, some lung cancer patients still have no medical insurance, and their CCE was paid entirely out of pocket. A study investigating the financial burdens of cancer patients showed that 94.2% of cancer patients at the diagnosis stage and 86.2% of cancer patients at six months after diagnosis found their financial burden to be at least somewhat difficult to handle 44. Thus, we can surmise that the plight and financial burden of lung cancer patients without medical insurance in China are worse than those who have medical insurance.…”

Section: Discussionmentioning

confidence: 98%

Research on Current Curative Expenditure among Lung Cancer Patients Based on the “System of Health Accounts 2011”: Insights into Influencing Factors

Zang¹,

Han-hui²,

Zhou³

et al. 2019

J. Cancer

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Purpose: To investigate the total current curative expenditure (CCE) of lung cancer in Hunan Province, China under the framework of the System of Health Accounts 2011 (SHA 2011) and explore the effect of insurance status, surgery and length of stay on the hospitalization expenses of patients with lung cancer. Methods: Through multistage stratified cluster random sampling, a total of 46,214 patients with lung cancer were enrolled from 1,072 medical institutions in Hunan Province in 2016. Under the SHA 2011 framework, the lung cancer CCE was analyzed. The relationships between hospitalization expenditure and the following factors (surgery, type of hospital, insurance status, length of stay, institution level, age and sex) were analyzed using Spearman's correlation analyses, and how these factors influenced hospital expenditure was explored through multiple stepwise regression analysis and structural equation modelling. Results: The CCE for lung cancer patients was 8063.75 million CNY. In total, 96.03% of the CCE for lung cancer occurred in hospitals and 58.88% of the expenditure flowed to general hospitals. The highest expenditures were incurred in the group aged 55-74 y, which accounted for 61.58% of the CCE. Drugs accounted for the greatest share expenditure to lung cancer patients at 34.31% of the CCE. Surgery, insurance status, institution level, sex and hospital type explained 57.5% of the variance in hospital expenses. The hospitalization expenses were related to surgery, insurance status, institution level and sex (rs = 0.033-0.688, p < 0.001). Surgery, insurance status and length of stay had direct effects on hospitalization expenses. Length of stay mediated the relationship between surgery and hospitalization expenses for lung cancer patients. Surgery mediated the relationship between insurance status and hospitalization expenses. All of these variables can explain 45% of the variance in hospitalization expenses. Conclusions: The CCE of lung cancer is extremely high. The problems related to treatment efficiency and equity are serious for lung cancer patients in China. It is essential to expand health insurance coverage and reduce the curative expenditure of lung cancer.

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Financial burden of colorectal cancer treatment among patients and their families in a middle-income country

Cited by 28 publications

References 27 publications

Coping with healthcare costs for chronic illness in low-income and middle-income countries: a systematic literature review

Coping with healthcare costs for chronic illness in low-income and middle-income countries: a systematic literature review

Living with long‐term consequences: Experience of follow‐up care and support needs among Asian long‐term colorectal cancer survivors

Research on Current Curative Expenditure among Lung Cancer Patients Based on the “System of Health Accounts 2011”: Insights into Influencing Factors

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