Eur J Cancer. 2017 Mar;74:26-37. doi: 10.1016/j.ejca.2016.12.014. Epub 2017 Feb 6.
Evidence to guide policymakers in developing affordable and equitable cancer control plans are scarce in low- and middle-income countries (LMIC).
The 2012-2014 ASEAN Costs in Oncology Study prospectively followed-up 9513 newly diagnosed cancer patients from eight LMIC in Southeast Asia for 12 months. Overall and country-specific incidence of financial catastrophe (out-of-pocket health costs ≥ 30% of annual household income), economic hardship (inability to make necessary household payments), poverty (living below national poverty line), and all-cause mortality were determined. Stepwise multinomial regression was used to estimate the extent to which health insurance, cancer stage and treatment explained these outcomes.
The one-year incidence of mortality (12% in Malaysia to 45% in Myanmar) and financial catastrophe (24% in Thailand to 68% in Vietnam) were high. Economic hardship was reported by a third of families, including inability to pay for medicines (45%), mortgages (18%) and utilities (12%), with 28% taking personal loans, and 20% selling assets (not mutually exclusive). Out of households that initially reported incomes above the national poverty levels, 4·9% were pushed into poverty at one year. The adverse economic outcomes in this study were mainly attributed to medical costs for inpatient/outpatient care, and purchase of drugs and medical supplies. In all the countries, cancer stage largely explained the risk of adverse outcomes. Stage-stratified analysis however showed that low-income patients remained vulnerable to adverse outcomes even when diagnosed with earlier cancer stages.
The LMIC need to realign their focus on early detection of cancer and provision of affordable cancer care, while ensuring adequate financial risk protection, particularly for the poor.
在低收入和中等收入国家（LMIC），指导政策制定者制定负担得起且公平的癌症控制计划的证据很少。
2012 - 2014年东盟肿瘤成本研究对东南亚八个低收入和中等收入国家的9513名新诊断癌症患者进行了为期12个月的前瞻性随访。确定了总体及各国因灾难性医疗支出（自付医疗费用≥家庭年收入的30%）、经济困难（无法支付必要的家庭开支）、贫困（生活在国家贫困线以下）以及全因死亡率的发生率。采用逐步多项回归来估计医疗保险、癌症分期和治疗对这些结果的解释程度。
死亡率（马来西亚为12%，缅甸为45%）和灾难性医疗支出（泰国为24%，越南为68%）的一年发生率很高。三分之一的家庭报告有经济困难，包括无法支付药品费用（45%）、抵押贷款（18%）和水电费（12%），28%的家庭申请了个人贷款，20%的家庭出售了资产（并非相互排斥）。在最初报告收入高于国家贫困水平的家庭中，4.9%在一年后陷入贫困。本研究中的不良经济后果主要归因于住院/门诊护理、药品和医疗用品的购买费用。在所有国家，癌症分期在很大程度上解释了不良后果的风险。然而，按分期分层分析表明，即使是早期癌症患者，低收入患者仍然容易出现不良后果。
低收入和中等收入国家需要重新调整重点，关注癌症的早期检测和提供负担得起的癌症治疗，同时确保提供足够的财务风险保护，特别是对贫困人口。
