Summary

Cancer rates are rising in South-East Asia, but comprehensive access to, and coverage for, cancer care remains low.1 2 This is partially attributed to a lack of data on the impact of cancer to create evidence-based policy. The ASEAN Costs in Oncology (ACTION) study was initiated in 2011 by The George Institute for Global Health to address these gaps in data.3 The study followed 9,513 patients for a year after their cancer diagnosis, to assess the economic and personal impact of the diagnosis and look at survival rates. The results showed that 29% of participants died, and 48% experienced financial catastrophe as a result of healthcare spending.2 These data were then used to produce a set of policy priorities to reduce the economic and personal burden of cancer in the region.4 5 The results of the study have been used to increase access to, and coverage for, cancer care in countries including the Philippines, Vietnam, Indonesia and Malaysia.3

Challenge

Cancer rates are rising globally, and South-East Asia is predicted to experience a 65% increase in cases by 2045.1 Coverage for, and access to, cancer care in the region is limited. This is partially attributed to a lack of data that can be used to inform evidence-based policy; only 20% of LMICs have reliable data to inform policy.3 Due to the lack of data, there is little to no knowledge about the impact of a cancer diagnosis. For example, there are limited data on the burden on cancer in the region, and on whether there are links between health insurance coverage, socioeconomic status, and treatment uptake and continuation. This knowledge gap means that healthcare policies aren’t tailored to the local population.

Solution

Recognising this gap in data, the ASEAN Costs in Oncology (ACTION) study was initiated in 2011 by The George Institute for Global Health.3 The landmark study followed 9,513 patients in the region for a year after their cancer diagnosis. The study was conducted in private and public hospitals in Cambodia, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Thailand and Vietnam.2 The mean age of participants was 52 years, and 44% of them had health insurance.

The study aimed to provide a snapshot of the burden of cancer in the region and determine whether there are links between health insurance coverage, socioeconomic status and treatment uptake.3 The study tracked patient survival and quality of life (QoL), economic hardship, and treatment stoppage rates.

The results of the study were sobering. A year after diagnosis, 29% of participants had died and 48% had experienced financial catastrophe (defined as spending more than 40% of the household income on healthcare). Fewer than 25% of participants survived and experienced no financial hardship.2 6 The study also found that 5% of participants were pushed into poverty due to health expenditure.5

The results demonstrated that, regardless of universal healthcare coverage in the country (from 8% in Laos to 100% in Malaysia), out-of-pocket spending still occurred, and had a devastating impact on cancer patients.7 The study also found that many participants were diagnosed at a late stage, when survival rates are lowest.

What has been achieved?

After the study’s conclusion in 2015, a roundtable was conducted to enable international experts and health officials to agree on priorities for tackling the catastrophic cost of cancer in the region, based on the ACTION study results.4

Since the publication of the study, there have been a number of policy changes that aim to provide financial coverage for cancer care and improve access to early-detection strategies in the region.3

  • In 2019, the Philippines passed the National Integrated Cancer Control Act, which promises to provide expanded care services, such as psychosocial and palliative care; develop national and regional cancer centres; implement a national cancer registry; support cancer research; and expand financial support for patients.8 The politician who brought the bill to parliament cited the results of the ACTION study to demonstrate the financial hardship incurred by many Filipino cancer patients.3
  • In Indonesia, early-detection programmes have been implemented at local health clinics, and basic cancer care has been included in the country’s universal health coverage programme.9 Using data from the ACTION study, Indonesian cancer advocacy groups are working with policymakers to inform the policymaking process.3
  • Malaysia has increased cancer care coverage under its national health insurance scheme, and advocacy groups are using ACTION data to demonstrate the need for price controls on cancer drugs.3
  • Vietnam has updated its cancer control plan and expanded access to breast cancer care.3

The collection of comprehensive economic and health impact data has been consistently cited as a key factor in updating cancer policy across South-East Asia. This demonstrates the importance of gathering and disseminating data to facilitate policy change.

Next steps

Countries in the region are working to update their cancer control plans, improve access to early cancer care, and expand financial coverage for cancer care.3

Based on the success of the ACTION study, The George Institute for Global Health has initiated a study on the economic and QoL impact of breast and cervical cancer in North India. The study hopes to guide reimbursement decisions for cancer care packages under government-funded schemes.10

References:

  1. International Agency for Research on Cancer. 2024. Cancer Tomorrow. Available from: Available here: https://gco.iarc.fr/tomorrow/en/dataviz/bars?populations=724 [accessed: October 2024]
  2. Kimman M, Jan S, Yip CH, et al. 2015. Catastrophic health expenditure and 12-month mortality associated with cancer in Southeast Asia: results from a longitudinal study in eight countries. BMC Med 13: 190 [accessed: October 2024]
  3. The Project & Research Impact Story Mapping (PRISM) Initiative. 2020. Transforming cancer care in Southeast Asia: The ACTION study. Sydney [accessed: October 2024]
  4. The George Institute for Global Health. 2015. Policy Roundtable on Southeast Asia Countries’ Readiness in Cancer Control “Turning ACTION Results into Policy Actions”. Sydney [accessed: October 2024]
  5. Bhoo-Pathy N, Yip C-H, Peters SAE, et al. 2017. Policy and priorities for national cancer control planning in low- and middle-income countries: Lessons from the Association of Southeast Asian Nations (ASEAN) Costs in Oncology prospective cohort study. European Journal of Cancer 74: 26-37 [accessed: October 2024]
  6. World Health Organization. Households with out-of-pocket payments greater than 40% of capacity to pay for health care (food, housing and utilities approach - developed by WHO/Europe). Available from: Available here: https://www.who.int/data/gho/indicator-metadata-registry/imr-details/4989 [accessed: October 2024]
  7. Tangcharoensathien V, Patcharanarumol W, Ir P, et al. 2011. Health-financing reforms in southeast Asia: challenges in achieving universal coverage. Lancet (London, England) 377(9768): 863-73 [accessed: October 2024]
  8. Dee EC, Ang CDU, Ting FIL, et al. 2022. Improving cancer care in the Philippines: The need for deliberate and careful implementation of the National Integrated Cancer Control Act. The Lancet Regional Health – Western Pacific 28 [accessed: October 2024]
  9. Schaefers J, Wenang S, Afdal A, et al. 2022. Population-based study on coverage and healthcare processes for cancer during implementation of national healthcare insurance in Indonesia. The Lancet Regional Health - Southeast Asia 6 [accessed: October 2024]
  10. The George Institute for Global Health. Pilot study to examine cost of cancer care and adverse health outcomes in women diagnosed with breast, cervical and ovarian cancer in India. Available here: https://www.georgeinstitute.org/projects/pilot-study-to-examine-cost-of-cancer-care-and-adverse-health-outcomes-in-women-diagnosed [accessed: October 2024]