Socioeconomic Impact of Cancer in Member Countries of the Association of Southeast Asian Nations (ASEAN): the ACTION Study Protocol

Abstract

Cancer can be a major cause of poverty. This may be due either to the costs of treating and managing the illness as well as its impact upon people's ability to work. This is a concern that particularly affects countries that lack comprehensive social health insurance systems and other types of social safety nets. The ACTION study is a longitudinal cohort study of 10,000 hospital patients with a first time diagnosis of cancer. It aims to assess the impact of cancer on the economic circumstances of patients and their households, patients' quality of life, costs of treatment and survival. Patients will be followed throughout the first year after their cancer diagnosis, with interviews conducted at baseline (after diagnosis), three and 12 months. A cross-section of public and private hospitals as well as cancer centers across eight member countries of the Association of Southeast Asian Nations (ASEAN) will invite patients to participate. The primary outcome is incidence of financial catastrophe following treatment for cancer, defined as out-of-pocket health care expenditure at 12 months exceeding 30% of household income. Secondary outcomes include illness induced poverty, quality of life, psychological distress, economic hardship, survival and disease status. The findings can raise awareness of the extent of the cancer problem in South East Asia and its breadth in terms of its implications for households and the communities in which cancer patients live, identify priorities for further research and catalyze political action to put in place effective cancer control policies.

Financial catastrophe, treatment discontinuation and death associated with surgically operable cancer in South-East Asia: Results from the ACTION Study

“…As such, this study was not prespecified in the published protocol. 17 The rationale for assessing 3-month outcomes was our specific interest in the economic burden incurred in the acute phase of the disease as a result of surgery. This study was approved by the University of Sydney's Human Research Ethics Committee.…”

“…The ACTION (Asean CosTs In ONcology) study is a prospective, longitudinal study examining the economic impact of cancer on households in 8 countries in ASEAN. 17 Patients diagnosed with a first time cancer (aged $ 18 years) were recruited consecutively from 47 sites including public and private hospitals and cancer centers. Participants completed interviews at baseline, and 3 and 12 months after diagnosis.…”

Health-related quality of life and psychological distress among cancer survivors in Southeast Asia: results from a longitudinal study in eight low- and middle-income countries

“…The ACTION study was a longitudinal study of 9513 newly diagnosed cancer patients in eight LMICs in Southeast Asia, set up to prospectively assess the impact of cancer on households’ economic wellbeing and health [9]. Results of the study reported thus far have demonstrated that families living in Southeast Asia struggled to manage the costs associated with cancer care; over half the households faced catastrophic out-of-pocket payments (defined as spending more than 30% of household income for cancer-related costs) in the year after diagnosis [10, 11].…”

Costs During the First Five Years Following Cancer Diagnosis in Korea

“…However, the use of new, expensive antineoplastics and therapeutic techniques increases the cost of treatment (Jönsson et al, 2007;Meropol et al, 2007;Yabroff et al, 2007;Kimman et al, 2012). Cancer accounts for 13-17% of all disease burden and 4-7% of total global medical expenditure (Jönsson et al, 2007).…”