Socio-economic inequalities in suffering at the end of life among advanced cancer patients: results from the APPROACH study in five Asian countries

International Journal for Equity in Health

Wynn Mon Ssu¹  Anjum Khan Joad²  Gayatri Palat³  Xiao Hong Ning⁴  Irene Teo⁵  Chetna Malhotra⁵  Semra Ozdemir⁵  Anirudh Krishnan⁵  Jing Rong Yong⁵  Eric Finkelstein⁵  Thushari Hapuarachchi⁶  Pham Nguyen Tuong⁷  Sushma Bhatnagar⁸ 

[1] Clinical Research Division, Yangon General Hospital;Department of Anesthesiology and Palliative Medicine, Bhagwan Mahaveer Cancer Hospital and Research Centre;Department of Palliative Medicine, MNJ Institute of Oncology and Regional Cancer Center;Geriatric Department, Peking Union Medical College Hospital;Lien Centre for Palliative Care, Duke-NUS Medical School;National Cancer Institute Maharagama;Oncology Center, Hue Central Hospital;Unit of Anesthesiology, Pain and Palliative Care, All India Institute of Medical Sciences;

关键词: Metastasis;    Economic status;    Inequalities;    End of life;   

DOI  :  10.1186/s12939-020-01274-5

来源: DOAJ

【 摘 要 】

Abstract Background A systematic understanding of socio-economic inequalities in end-of-life (EOL) suffering among advanced cancer patients is required to inform efforts to reduce these inequalities as part of Universal Health Coverage goals. Aims To assess inequalities in multiple domains of EOL suffering among advanced cancer patients – physical, functional, psychological, social, and spiritual –, using two socio-economic status (SES) indicators, education and perceived economic status of the household. Methods We used cross-sectional data from surveys of stage IV cancer patients (n = 1378) from seven hospitals across five countries (China, Sri Lanka, India, Vietnam and Myanmar). We conducted separate multivariable linear regression models for each EOL suffering domain. We also tested interactions between the two SES indicators and between each SES indicator and patient age. Results Patients living in low economic status households /with fewer years of education reported greater suffering in several domains. We also found significant interaction effects between economic status of the household and years of education for all EOL suffering outcomes. Age significantly moderated the association between economic status of the household and social suffering and between years of education and psychological, social, and spiritual suffering (p < 0.05 for all). Conclusion Results highlight that SES inequalities in EOL suffering vary depending on the suffering domain, the SES indicator assessed, and by patient age. Greater palliative care resources for patients with low SES may help reduce these inequalities.

【 授权许可】

Unknown