Financial toxicities of cancer in low‐ and middle‐income countries: Perspectives from Southeast Asia

Abstract

Patients with cancer in the United States are 71% more likely to experience a severe adverse financial event and 28% more likely to have past-due credit card payments than patients without cancer. 1 We write from Southeast Asia (SEA), a region of 660 million people with immense diversity in cancer epidemiology, health care systems, socioeconomic status, and culture, where cancer is a leading cause of death. The region is composed of 11 nations:

Geographic Distribution of Cancer Care Providers in the Philippines

“…She may not even seek consult in the first place given the burden of travel, not to mention the other direct and indirect costs of cancer treatment, including childcare and loss of productivity. 27 - 30 …”

“…She may not even seek consult in the first place given the burden of travel, not to mention the other direct and indirect costs of cancer treatment, including childcare and loss of productivity. [27][28][29][30] Local cancer care providers are needed to inform public health policy and cancer prevention strategies. [31][32][33] In the Philippines, rates of smoking continue to be high; a greater number of oncologists may improve advocacy for legislation and education targeted at reducing rates of smoking.…”

“…Social workers and health insurance officers assist patients in mitigating the financial toxicities that often accompany cancer diagnosis and treatment. [27][28][29][30] Hospital chaplains and other support personnel attend to religious and spiritual needs. An account of disparities in access to these important care providers is merited.…”

The ripple effect: Cancer‐related financial toxicity for family members and caregivers

“…In addition to the cultural context of Southeast Asia, socioeconomic factors play a large role in the complex manifestations of financial toxicity experienced by patients with cancer and their families and caregivers. The vast majority of Southeast Asians live in lower‐middle income countries, such that family financial toxicity is likely far more common than in high‐income settings such as Singapore, where the work of Su and Malhotra was conducted 36 . The Asean CosTs In ONcology (ACTION) study found in a cohort of over 9000 Southeast Asian patients with cancer, within 1 year of diagnosis, 29% had died and 48% experienced financial catastrophe 37,38 …”

Improving cancer care in the Philippines: The need for deliberate and careful implementation of the National Integrated Cancer Control Act

“…These significantly impact the Filipino patient's ability and willingness to understand, seek, and accept healthcare and modern medicine, the frameworks of which are heavily based on Western cultures and populations, and often come at high out-of-pocket costs. 6 From education initiatives and screening to survivorship, psycho-oncology care, and end-of-life care, cultural sensitivity must be ensured, financial toxicity must be mitigated, 6 and interventions must be tailored to the needs and social contexts of patients and their families, especially among vulnerable populations including women, children, indigenous peoples, gender minorities, and those living below the poverty line. Research that focuses on the needs of Filipino cancer patients is necessary given the nation's unique genetic ancestry, cancer epidemiology, social determinants of health, and healthcare access barriers.…”