Effects of cancer treatment on household impoverishment: a multicentre cross-sectional study in China

Abstract

ObjectivesTo determine the incidence and intensity of household impoverishment induced by cancer treatment in China.DesignAverage income and daily consumption per capita of the households and out-of-pocket payments for cancer care were estimated. Household impoverishment was determined by comparing per capita daily consumption against the Chinese poverty line (CPL, US$1.2) and the World Bank poverty line (WBPL, US$1.9) for 2015. Both pre-treatment and post-treatment consumptions were calculated assuming that the households would divert daily consumption money to pay for cancer treatment.ParticipantsCancer patients diagnosed initially from 1 January 2015 to 31 December 2016 who had received cancer treatment subsequently. Those with multiple cancer diagnoses were excluded.Data sourcesA household questionnaire survey was conducted on 2534 cancer patients selected from nine hospitals in seven provinces through two-stage cluster/convenience sampling.Findings5.89% (CPL) to 12.94% (WBPL) households were impoverished after paying for cancer treatment. The adjusted OR (AOR) of post-treatment impoverishment was higher for older patients (AOR=2.666–4.187 for ≥50 years vs <50 years, p<0.001), those resided in central region (AOR=2.619 vs eastern, p<0.01) and those with lower income (AOR=0.024–0.187 in higher income households vs the lowest 20%, p<0.001). The patients without coverage from social health insurance had higher OR (AOR=1.880, p=0.040) of experiencing post-treatment household impoverishment than those enrolled with the insurance for urban employees. Cancer treatment is associated with an increase of 5.79% (CPL) and 12.45% (WBPL) in incidence of household impoverishment. The median annual consumption gap per capita underneath the poverty line accumulated by the impoverished households reached US$128 (CPL) or US$212 (WBPL). US$31 170 395 (CPL) or US$115 238 459 (WBPL) were needed to avoid household impoverishment induced by cancer treatment in China.ConclusionsThe financial burden of cancer treatment imposes a significant risk of household impoverishment despite wide coverage of social health insurance in China.

A systematic review of financial toxicity among cancer patients in China

“…After removing duplicates, 7466 studies remained for relevancy screening, and 662 remained for full-text review. Finally, 13 articles published in Chinese and reporting 12 studies [29][30][31][32][33][34][35][36][37][38][39][40][41] and 18 articles published in English [42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59] were included in the review. Fig.…”

“…Of the 30 included studies, only 13 38,41,42,[46][47][48][49]52,53,[56][57][58][59] clearly defined the inclusion criteria; only 7 42,46,48,50,52,53,56 described the study subjects and settings in detail; and 3 36,39,41 were rated as "unclear" for statistical analysis, as they did not describe how the categorical variables were assigned values or how dummy variables were set for polytomous variables, although their selection of statistical analysis method (multiple linear regression) was appropriate. Of the 25 analytical cross-sectional studies, 29,31,[34][35][36][37][38][39][40][41][45][46][47][48][49][50][51][52][53][54][55][56][57][58]…”

“…Twenty-one studies (70%) were published after 2016. [37][38][39][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59] All 30 studies used a cross-sectional design, of which 26 were survey based, [30][31][32]34,35,[37][38][39][40][41][42][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59] 2 were medical or insurance record based, 29,43 and 2 were both survey based and medical record based. 33,…”

“…33,36 The sample sizes ranged from 59 to 2746. A variety of cancer types were included, with 20 studies [31][32][33][34][35][36][37][39][40][41]44,[47][48][49][50][51][54][55][56]58,59 focusing on a single cancer type and 10 29,30,38,42,43,45,46,52,53,57 focusing on multiple cancer types. Of the 20 studies focusing on a single cancer type, [31][32][33][34][35][36][37][39][40][41]44,[47][48][49][50][51][54][55]…”

Catastrophic health expenditure and its determinants in households with lung cancer patients in China: a retrospective cohort study

“…The former covers rural residents, and the latter covers urban residents who are not eligible for UEBMI, such as unemployed individuals and children. The reimbursement rates are the highest for the UEBMI, followed by the URBMI, and the NCMS [ 13 ].…”