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The relationship between economic characteristics and health-related quality of life in newly diagnosed cancer patients in Southeast Asia: results from an observational study

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Abstract

Purpose

We investigate whether cancer patients’ economic characteristics are independent determinants of health-related quality of life (HRQoL) in low- and middle-income settings to identify priorities for health policy and research.

Methods

A cross-sectional survey of 9,513 cancer patients from Southeast Asia provided data on demographics, economic status and HRQoL. HRQoL was measured using the EORTC QLQ-C30 and EQ-5D. Information on cancer site and stage was collected using the patients’ medical records. Multiple linear regression analysis estimated the relative impact of economic characteristics (i.e. health insurance, employment status, household income and economic hardship) on HRQoL.

Results

All economic characteristics were significant independent determinants of HRQoL, when we controlled for demographic and clinical characteristics. Economic hardship was found to be most important. The adjusted mean differences in HRQoL scores between patients who had experienced economic hardship in the year before diagnosis compared to patients who did not were −5.6, −6.7, −7.3 and −0.06, respectively, for global health, physical function, emotional function and the EQ-5D index (all p values <0.001). Subgroup analyses showed that this significant result for economic hardship as a predictor of poor HRQoL was consistent across all age groups, for males and females, and across all levels of education.

Conclusions

Living in poor economic circumstances before a cancer diagnosis is associated with greatly impaired HRQoL after diagnosis. There is wide scope for research on innovative interventions that provide low-cost and targeted support aimed to improve health outcomes of disadvantaged cancer patients in low- and middle-income settings.

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Abbreviations

HRQoL:

Health-related quality of life

ASEAN:

Association of Southeast Asian Nations

EQ-5D:

EuroQoL 5 dimensions

References

  1. Stewart, B. W., & Wild, C. P. (2014). World Cancer Report 2014. Lyon: International Agency for Research on Cancer.

    Google Scholar 

  2. Lancet, T. (2010). Moving cancer up the global health agenda. Lancet, 375(9731), 2051. doi:10.1016/s0140-6736(10)60942-7.

    Article  Google Scholar 

  3. Kimman, M., Norman, R., Jan, S., Kingston, D., & Woodward, M. (2012). The Burden of Cancer in Member Countries of the Association of Southeast Asian Nations (ASEAN). Asian Pacific Journal of Cancer Prevention, 13(2), 411–420.

    Article  PubMed  Google Scholar 

  4. Guyatt, G. H., Feeny, D. H., & Patrick, D. L. (1993). Measuring health-related quality of life. Annals of Internal Medicine, 118(8), 622–629. doi:10.7326/0003-4819-118-8-199304150-00009.

    Article  CAS  PubMed  Google Scholar 

  5. Farmer, P., Frenk, J., Knaul, F. M., Shulman, L. N., Alleyne, G., Armstrong, L., et al. (2010). Expansion of cancer care and control in countries of low and middle income: A call to action. Lancet, 376(9747), 1186–1193. doi:10.1016/S0140-6736(10)61152-X.

    Article  PubMed  Google Scholar 

  6. Farkkila, N., Torvinen, S., Roine, R. P., Sintonen, H., Hanninen, J., Taari, K., et al. (2013). Health-related quality of life among breast, prostate, and colorectal cancer patients with end-stage disease. Quality of Life Research,. doi:10.1007/s11136-013-0562-y.

    PubMed  Google Scholar 

  7. Farooqui, M., Hassali, M. A., Knight, A., Shafie, A. A., Farooqui, M. A., Saleem, F., et al. (2013). Cross Sectional Assessment of Health Related Quality of Life (HRQoL) among patients with cancer in Malaysia. Asian Pacific Journal of Cancer Prevention, 14(5), 3017–3021.

    Article  PubMed  Google Scholar 

  8. Jordan, K., Proskorovsky, I., Lewis, P., Ishak, J., Payne, K., Lordan, N., et al. (2013). Effect of general symptom level, specific adverse events, treatment patterns, and patient characteristics on health-related quality of life in patients with multiple myeloma: Results of a European, multicenter cohort study. Supportive Care in Cancer,. doi:10.1007/s00520-013-1991-4.

    PubMed Central  Google Scholar 

  9. Jordhoy, M. S., Fayers, P., Loge, J. H., Saltnes, T., Ahlner-Elmqvist, M., & Kaasa, S. (2001). Quality of life in advanced cancer patients: The impact of sociodemographic and medical characteristics. British Journal of Cancer, 85(10), 1478–1485.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  10. Lehto, U.-S., Ojanen, M., & Kellokumpu-Lehtinen, P. (2005). Predictors of quality of life in newly diagnosed melanoma and breast cancer patients. Annals of Oncology, 16(5), 805–816. doi:10.1093/annonc/mdi146.

    Article  PubMed  Google Scholar 

  11. Lundh, M. H., Lampic, C., Nordin, K., Ahlgren, J., Bergkvist, L., Lambe, M., et al. (2013). Changes in health-related quality of life by occupational status among women diagnosed with breast cancer-a population-based cohort study. Psychooncology,. doi:10.1002/pon.3285.

    PubMed  Google Scholar 

  12. Parker, P. A., Baile, W. F., Moor, C. D., & Cohen, L. (2003). Psychosocial and demographic predictors of quality of life in a large sample of cancer patients. Psycho-Oncology, 12(2), 183–193. doi:10.1002/pon.635.

    Article  PubMed  Google Scholar 

  13. Shen, F. R., Liu, M., Zhang, X., Feng, Y. H., Zhou, L. S., & Chen, Y. G. (2012). Health-related quality of life among breast cancer patients and its influencing factor in a Chinese population. Asian Pacific Journal of Cancer Prevention, 13(8), 3747–3750.

    Article  PubMed  Google Scholar 

  14. Vissers, P. A., Thong, M. S., Pouwer, F., Zanders, M. M., Coebergh, J. W., & van de Poll-Franse, L. V. (2013). The impact of comorbidity on Health-Related Quality of Life among cancer survivors: Analyses of data from the PROFILES registry. Journal of Cancer Survivorship, 7(4), 602–613. doi:10.1007/s11764-013-0299-1.

    Article  CAS  PubMed  Google Scholar 

  15. Wong, C. K., Lam, C. L., Poon, J. T., & Kwong, D. L. (2013). Clinical correlates of health preference and generic health-related quality of life in patients with colorectal neoplasms. PLoS ONE, 8(3), e58341. doi:10.1371/journal.pone.0058341.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  16. Hoyer, M., Johansson, B., Nordin, K., Bergkvist, L., Ahlgren, J., Lidin-Lindqvist, A., et al. (2011). Health-related quality of life among women with breast cancer: A population-based study. Acta Oncologica, 50(7), 1015–1026. doi:10.3109/0284186x.2011.577446.

    Article  PubMed  Google Scholar 

  17. Kimman, M., Jan, S., Kingston, D., Monaghan, H., Sokha, E., Thabrany, H., et al. (2012). Socioeconomic Impact of Cancer in Member Countries of the Association of Southeast Asian Nations (ASEAN): The ACTION study protocol. Asian Pacific Journal of Cancer Prevention, 13(2), 421–425.

    Article  PubMed  Google Scholar 

  18. Tangcharoensathien, V., Patcharanarumol, W., Ir, P., Aljunid, S. M., Mukti, A. G., Akkhavong, K., et al. (2011). Health-financing reforms in southeast Asia: Challenges in achieving universal coverage. Lancet, 377(9768), 863–873. doi:10.1016/s0140-6736(10)61890-9.

    Article  PubMed  Google Scholar 

  19. Saw, Y. M., Win, K. L., Shiao, L. W., Thandar, M. M., Amiya, R. M., Shibanuma, A., et al. (2013). Taking stock of Myanmar’s progress toward the health-related Millennium Development Goals: Current roadblocks, paths ahead. International Journal for Equity in Health, 12, 78. doi:10.1186/1475-9276-12-78.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Aaronson, N. K., Ahmedzai, S., Bergman, B., Bullinger, M., Cull, A., Duez, N. J., et al. (1993). The European Organization for Research and Treatment of Cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology. Journal of the National Cancer Institute, 85(5), 365–376.

    Article  CAS  PubMed  Google Scholar 

  21. Fayers, P., Aaronson, N., Bjordal, K., & Sullivan, M. (1995). EORTC QLQ-C30 Scoring Manual. EORTC Study Group on Quality of Life.

  22. Duijts, S. F. A., van Egmond, M. P., Spelten, E., van Muijen, P., Anema, J. R., & van der Beek, A. J. (2014). Physical and psychosocial problems in cancer survivors beyond return to work: A systematic review. Psycho-Oncology, 23(5), 481–492. doi:10.1002/pon.3467.

    Article  PubMed  Google Scholar 

  23. Cocks, K., King, M. T., Velikova, G., Martyn St-James, M., Fayers, P. M., & Brown, J. M. (2011). Evidence-based guidelines for determination of sample size and interpretation of the European organisation for the research and treatment of cancer quality of life questionnaire core 30. Journal of Clinical Oncology, 29(1), 89–96. doi:10.1200/jco.2010.28.0107.

    Article  PubMed  Google Scholar 

  24. EuroQoL Group. (1990). EuroQol–a new facility for the measurement of health-related quality of life. The EuroQol Group. Health Policy, 16(3), 199–208.

    Article  Google Scholar 

  25. Tongsiri, S., & Cairns, J. (2011). Estimating population-based values for EQ-5D health states in Thailand. Value Health, 14(8), 1142–1145. doi:10.1016/j.jval.2011.06.005.

    Article  PubMed  Google Scholar 

  26. Pickard, A. S., Neary, M. P., & Cella, D. (2007). Estimation of minimally important differences in EQ-5D utility and VAS scores in cancer. Health Qual Life Outcomes, 5, 70. doi:10.1186/1477-7525-5-70.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Galobardes, B., Lynch, J., & Smith, G. D. (2007). Measuring socioeconomic position in health research. British Medical Bulletin, 81–82(1), 21–37. doi:10.1093/bmb/ldm001.

    Article  PubMed  Google Scholar 

  28. Heeley, E., Anderson, C. S., Huang, Y., Jan, S., Li, Y., Liu, M., et al. (2009). Role of health insurance in averting economic hardship in families after acute stroke in China. Stroke, 40(6), 2149–2156. doi:10.1161/strokeaha.108.540054.

    Article  PubMed  Google Scholar 

  29. Ferlay, J., Soerjomataram, I., Ervik, M., Dikshit, R., Eser, S., Mathers, C., et al. (2013). GLOBOCAN 2012 v1.0, cancer incidence and mortality worldwide. IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer.

  30. Coates, A., Porzsolt, F., & Osoba, D. (1997). Quality of life in oncology practice: Prognostic value of EORTC QLQ-C30 scores in patients with advanced malignancy. European Journal of Cancer, 33(7), 1025–1030. doi:10.1016/S0959-8049(97)00049-X.

    Article  CAS  PubMed  Google Scholar 

  31. Quinten, C., Martinelli, F., Coens, C., Sprangers, M. A. G., Ringash, J., Gotay, C., et al. (2014). A global analysis of multitrial data investigating quality of life and symptoms as prognostic factors for survival in different tumor sites. Cancer, 120(2), 302–311. doi:10.1002/cncr.28382.

    Article  PubMed  Google Scholar 

  32. Dowie, J. (2002). Decision validity should determine whether a generic or condition-specific HRQOL measure is used in health care decisions. Health Economics, 11(1), 1–8. doi:10.1002/hec.667.

    Article  PubMed  Google Scholar 

  33. Link, B. G., & Phelan, J. C. (1996). Understanding sociodemographic differences in health–the role of fundamental social causes. American Journal of Public Health, 86(4), 471–473.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  34. McIntyre, D., Thiede, M., Dahlgren, G., & Whitehead, M. (2006). What are the economic consequences for households of illness and of paying for health care in low- and middle-income country contexts? Social Science and Medicine, 62(4), 858–865. doi:10.1016/j.socscimed.2005.07.001.

    Article  PubMed  Google Scholar 

  35. Xu, K., Evans, D. B., Kawabata, K., Zeramdini, R., Klavus, J., & Murray, C. J. (2003). Household catastrophic health expenditure: A multicountry analysis. Lancet, 362(9378), 111–117. doi:10.1016/s0140-6736(03)13861-5.

    Article  PubMed  Google Scholar 

  36. Cleary, J., Ddungu, H., Distelhorst, S. R., Ripamonti, C., Rodin, G. M., & Bushnaq, M. A., et al. (2013). Supportive and palliative care for metastatic breast cancer: Resource allocations in low- and middle-income countries. A Breast Health Global Initiative 2013 consensus statement. The Breast, 22(5), 616–627, doi:10.1016/j.breast.2013.07.052.

  37. Ganz, P. A., Yip, C. H., Gralow, J. R., Distelhorst, S. R., Albain, K. S., & Andersen, B. L., et al. (2013). Supportive care after curative treatment for breast cancer (survivorship care): Resource allocations in low- and middle-income countries. A Breast Health Global Initiative 2013 consensus statement. The Breast, 22(5), 606–615, doi:10.1016/j.breast.2013.07.049.

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Acknowledgments

The ACTION study is funded through an unrestricted educational grant from the Roche Asia Pacific Regional Office. Principal investigators in each of the countries were as follows: Seang Pharin, MD, Calmette Hospital, Kouy Samnang, PhD, Khmer Soviet Hospital, Eav Sokha, PhD, Calmette Hospital, Heng Viroath, MD, Khmer Soviet Hospital (Cambodia); Pujianto, PhD, School of Public Health, Universitas Indonesia, Hasbullah Thabrany, MD, PhD, Universitas Indonesia (Indonesia); Phetsamone Arounlangsy, MD, PhD, Laos Cancer Center, Oudayvone Rattanavong, MD, Mahosot Hospital (Laos); NirmalaBhoo-Pathy, MD, PhD, University of Malaysia, Cheng-Har Yip, MD, Subang Jaya Medical Centre (Malaysia); Myo Khin, MD, Department of Medical Research, Lower Myanmar (Myanmar); Soledad L. Balete, MD, Jose R Reyes Memorial Medical Center, Annielyn Beryl Ong-Cornel, MD, Veterans Memorial Medical Center, Jay Datukan, MD, St. Luke’s Medical Center, Quezon City, Agnes E.Gorospe, MD, St Lukes Medical Center, Quezon City, Conrado Lola, MD, National Kidney and Transplant Institute, Leo Marbella, MD, National Kidney and Transplant Institute, Corazon A. Ngelangel, MD, PhD, University of the Philippines-College of Medicine, Philippine General Hospital, Irisyl O. Real, MD, University of the Philippines-College of Medicine, Philippine General Hospital, Cherelina Santiago-Ferreras, MD, Veterans Memorial Medical Center (Philippines); Prasit Khopaibul, MD, Suratthani Cancer Center, Thanut Khuayjarernpanishk, MD, Ubonratchathani Cancer Centre, Thiravud Khuhaprema, MD, National Cancer Institute of Thailand, Tawin Klinwimol, Ubonratchathani Cancer Centre, Somkiet Lalitwongsa, Lampang Cancer Centre, Dhanoo Lawbundis, MD, Lopburi Cancer Hospital, Somphob Sangkittipaiboon, MD, Lopburi Cancer Hospital, Suleeporn Sangrajrang, PhD, National Cancer Institute of Thailand, Thanadej Sinthusake, MD,Mahavajiralongkorn Cancer Center, Darunee Suanplu, MD, Suratthani Cancer Centre Jitraporn Tanabodee, MD, Chonburi Cancer Centre, Kitisak Thepsuwan, Chonburi Cancer Centre, (Thailand); Dieu Bui, MD, PhD, K Hospital, Khoa Mai Trong, MD, PhD, Bach Mai Hospital (Vietnam). We thank Roche Asia Pacific for supporting this work.

Conflict of interest

We declare that we have no conflicts of interest.

Author information

Authors and Affiliations

  1. The George Institute for Global Health, PO Box M201, Missenden Rd, Sydney, NSW, 2050, Australia

    Merel Kimman, Stephen Jan, Helen Monaghan & Mark Woodward

  2. The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, UK

    Mark Woodward

  3. The University of Sydney, Edward Ford Building A27, Sydney, NSW, 2006, Australia

    Merel Kimman

Authors
  1. Merel Kimman
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  2. Stephen Jan
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  3. Helen Monaghan
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  4. Mark Woodward
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Corresponding author

Correspondence to Merel Kimman.

Additional information

On behalf of the ACTION Study Group (listed in Appendix 1).

Appendices

Appendix 1: The ACTION Study Group

Writing committee

Merel Kimman, PhD, The George Institute for Global Health, University of Sydney, Australia

Stephen Jan, PhD, The George Institute for Global Health, University of Sydney, Australia

Helen Monaghan, BSc (Hons), The George Institute for Global Health, Australia

Mark Woodward, PhD, The George Institute for Global Health, Australia & The George Institute for Global Health, University of Oxford, UK

Executive Committee ACTION Study

Professor Mark Woodward, Professor Stephen Jan, Dr. Merel Kimman, Dr. David Kingston, Professor Eav Sokha, Professor Hasbullah Thabrany, Dr. Bounthaphany Bounxouei, Dr. NirmalaBhoo-Pathy, Dr. Myo Khin, Dr. Gloria Cristal-Luna, Dr. Thiravud Khuhaprema, Professor Nguyen Chan Hung

Principal Investigators ACTION Study

Cambodia

Seang Pharin, MD, Calmette Hospital

Kouy Samnang, PhD, Khmer Soviet Hospital

Eav Sokha, PhD, Calmette Hospital

Heng Viroath, MD, Khmer Soviet Hospital

Indonesia

Pujianto, PhD, School of Public Health, Universitas Indonesia

Hasbullah Thabrany, MD, PhD, Universitas Indonesia

Laos

Phetsamone Arounlangsy, MD, PhD, Laos Cancer Centre

Oudayvone Rattanavong, MD, Mahosot Hospital

Malaysia

NirmalaBhoo-Pathy, MD, PhD, University of Malaysia

Cheng-Har Yip, MD, Subang Jaya Medical Centre

Myanmar

Myo Khin, MD, Department of Medical Research (Lower Myanmar)

Philippines

Soledad L. Balete, MD, Jose R Reyes Memorial Medical Centre

Annielyn Beryl Ong-Cornel, MD, Veterans Memorial Medical Centre

Jay Datukan, MD, St. Luke’s Medical Centre, Quezon City

Agnes E.Gorospe, MD, St Lukes Medical Centre, Quezon City

Conrado Lola, MD, National Kidney and Transplant Institute

Leo Marbella, MD, National Kidney and Transplant Institute

Corazon A. Ngelangel, MD, PhD, University of the Philippines-College of Medicine, Philippine General Hospital

Irisyl O. Real, MD, University of the Philippines-College of Medicine, Philippine General Hospital

Cherelina Santiago-Ferreras, MD, Veterans Memorial Medical Centre

Thailand

Prasit Khopaibul, MD, Suratthani Cancer Centre

Thanut Khuayjarernpanishk, MD, Ubonratchathani Cancer Centre

Thiravud Khuhaprema, MD, National Cancer Institute of Thailand

Tawin Klinwimol, Ubonratchathani Cancer Centre

Somkiet Lalitwongsa, Lampang Cancer Centre

Dhanoo Lawbundis, MD, Lopburi Cancer Hospital

Somphob Sangkittipaiboon, MD, Lopburi Cancer Hospital

Suleeporn Sangrajrang, PhD, National Cancer Institute of Thailand

Thanadej Sinthusake, MD,Mahavajiralongkorn Cancer Centre

Darunee Suanplu, MD, Suratthani Cancer Centre

Jitraporn Tanabodee, MD, Chonburi Cancer Centre

Kitisak Thepsuwan, Chonburi Cancer Centre

Vietnam

Dieu Bui, MD, PhD, K Hospital

Khoa Mai Trong, MD, PhD, Bach Mai Hospital

Appendix 2

See Table 6.

Table 6 Questions on economic status as used in the ACTION study
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Appendix 3

See Figs. 2 and 3.

Fig. 2
figure 2

Most common cancers in females, per country, as a percentage of total cancers

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Fig. 3
figure 3

Most common cancers in males, per country, as a percentage of total cancers

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Kimman, M., Jan, S., Monaghan, H. et al. The relationship between economic characteristics and health-related quality of life in newly diagnosed cancer patients in Southeast Asia: results from an observational study. Qual Life Res 24, 937–949 (2015). https://doi.org/10.1007/s11136-014-0828-z

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