Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2020

Open Access 01-12-2020 | Research

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

Authors: Chetna Malhotra, Anirudh Krishnan, Jing Rong Yong, Irene Teo, Semra Ozdemir, Xiao Hong Ning, Thushari Hapuarachchi, Gayatri Palat, Sushma Bhatnagar, Anjum Khan Joad, Pham Nguyen Tuong, Wynn Mon Ssu, Eric Finkelstein

Published in: International Journal for Equity in Health | Issue 1/2020

Login to get access

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.
Appendix
Available only for authorised users
Literature
1.
Committee IMU. The Cancer Burden in Low- and Middle-Income Countries and How It Is Measured. In: Sloan FA GH, editor. Cancer Control Opportunities in Low- and Middle-Income Countries. Washington (DC): The National Academies Press (U.S.); 2007.
2.
Krikorian A, Limonero JT, Maté J. Suffering and distress at the end-of-life. Psycho-Oncology. 2012;21(8):799–808.PubMed
3.
Wilson KG, Chochinov HM, McPherson CJ, LeMay K, Allard P, Chary S, et al. Suffering with advanced cancer. J Clin Oncol. 2007;25(13):1691–7.PubMed
4.
Sleeman KE, de Brito M, Etkind S, Nkhoma K, Guo P, Higginson IJ, et al. The escalating global burden of serious health-related suffering: projections to 2060 by world regions, age groups, and health conditions. Lancet Glob Health. 2019;7(7):e883–e92.PubMedPubMedCentral
5.
Knaul FM, Farmer PE, Krakauer EL, De Lima L, Bhadelia A, Kwete XJ, et al. Alleviating the access abyss in palliative care and pain relief—an imperative of universal health coverage: the lancet commission report. Lancet. 2018;391(10128):1391–454.PubMed
6.
World Health Organization. Strengthening of palliative care as a component of integrated treatment throughout the life course. J Pain Palliat Care Pharmacother. 2014;28(2):130–4.
7.
Braveman P, Tarimo E. Social inequalities in health within countries: not only an issue for affluent nations. Soc Sci Med. 2002;54(11):1621–35.PubMed
8.
Manser CN, Bauerfeind P. Impact of socioeconomic status on incidence, mortality, and survival of colorectal cancer patients: a systematic review. Gastrointest Endosc. 2014;80(1):42–60 e9.PubMed
9.
Chang CM, Su YC, Lai NS, Huang KY, Chien SH, Chang YH, et al. The combined effect of individual and neighborhood socioeconomic status on cancer survival rates. PLoS One. 2012;7(8):e44325.PubMedPubMedCentral
10.
Parise CA, Caggiano V. Disparities in race/ethnicity and socioeconomic status: risk of mortality of breast cancer patients in the California Cancer registry, 2000-2010. BMC Cancer. 2013;13:449.PubMedPubMedCentral
11.
Ward E, Jemal A, Cokkinides V, Singh GK, Cardinez C, Ghafoor A, et al. Cancer disparities by race/ethnicity and socioeconomic status. CA Cancer J Clin. 2004;54(2):78–93.PubMed
12.
Louwman WJ, Aarts MJ, Houterman S, van Lenthe FJ, Coebergh JWW, Janssen-Heijnen MLG. A 50% higher prevalence of life-shortening chronic conditions among cancer patients with low socioeconomic status. Br J Cancer. 2010;103:1742.PubMedPubMedCentral
13.
Tomic K, Ventimiglia E, Robinson D, Häggström C, Lambe M, Stattin P. Socioeconomic status and diagnosis, treatment, and mortality in men with prostate cancer. Nationwide population-based study. Int J Cancer. 2018;142(12):2478–84.PubMedPubMedCentral
14.
Fagundes C, Jones D, Vichaya E, Lu C, Cleeland CS. Socioeconomic status is associated with depressive severity among patients with advanced non–small-cell lung Cancer: treatment setting and minority status do not make a difference. J Thorac Oncol. 2014;9(10):1459–63.PubMedPubMedCentral
15.
Ilowite MF, Al-Sayegh H, Ma C, Dussel V, Rosenberg AR, Feudtner C, et al. The relationship between household income and patient-reported symptom distress and quality of life in children with advanced cancer: a report from the PediQUEST study. Cancer. 2018;124(19):3934–41.PubMedPubMedCentral
16.
Lewis JM, DiGiacomo M, Currow DC, Davidson PM. Dying in the margins: understanding palliative care and socioeconomic deprivation in the developed world. J Pain Symptom Manag. 2011;42(1):105–18.
17.
Beccaro M, Costantini M, Merlo DF. The ISG. Inequity in the provision of and access to palliative care for cancer patients. Results from the Italian survey of the dying of cancer (ISDOC). BMC Public Health. 2007;7(1):66.PubMedPubMedCentral
18.
Braveman PA, Cubbin C, Egerter S, Chideya S, Marchi KS, Metzler M, et al. Socioeconomic status in health research: one size does not fit all. Jama. 2005;294(22):2879–88.PubMed
19.
Shavers VL. Measurement of socioeconomic status in health disparities research. J Natl Med Assoc. 2007;99(9):1013–23.PubMedPubMedCentral
20.
Adler NE, Newman K. Socioeconomic disparities in health: pathways and policies. Health Aff (Project Hope). 2002;21(2):60–76.
21.
Geyer S, Hemström Ö, Peter R, Vågerö D. Education, income, and occupational class cannot be used interchangeably in social epidemiology. Empirical evidence against a common practice. J Epidemiol Community Health. 2006;60(9):804–10.PubMedPubMedCentral
22.
Marmot M. The influence of income on health: views of an epidemiologist. Health Aff (Project Hope). 2002;21(2):31–46.
23.
Adler NE. Health disparities through a psychological lens. Am Psychol. 2009;64(8):663–73.PubMed
24.
Idler EL, Benyamini Y. Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav. 1997;38(1):21–37.
25.
Mishra S, Carleton RN. Subjective relative deprivation is associated with poorer physical and mental health. Soc Sci Med (1982). 2015;147:144–9.
26.
Carreon D, Noymer A. Health-related quality of life in older adults: testing the double jeopardy hypothesis. J Aging Stud. 2011;25(4):371–9.
27.
Gerber Y, Goldbourt U, Drory Y. Interaction between income and education in predicting long-term survival after acute myocardial infarction. Eur J Cardiovasc Prev Rehabil. 2008;15(5):526–32.PubMed
28.
Bonaccio M, Di Castelnuovo A, Costanzo S, Persichillo M, Donati MB, de Gaetano G, et al. Interaction between education and income on the risk of all-cause mortality: prospective results from the MOLI-SANI study. Int J Public Health. 2016;61(7):765–76.PubMed
29.
Chang CM, Wu CC, Yin WY, Juang SY, Yu CH, Lee CC. Low socioeconomic status is associated with more aggressive end-of-life care for working-age terminal cancer patients. Oncologist. 2014;19(12):1241–8.PubMedPubMedCentral
30.
Robert SA, Cherepanov D, Palta M, Dunham NC, Feeny D, Fryback DG. Socioeconomic status and age variations in health-related quality of life: results from the national health measurement study. J Gerontol B Psychol Sci Soc Sci. 2009;64(3):378–89.PubMed
31.
Andrea E. Willson, Kim M. Shuey, Glen H. Elder J . Cumulative advantage processes as mechanisms of inequality in life course health. Am J Sociol 2007;112(6):1886–1924.
32.
Brown TH, Richardson LJ, Hargrove TW, Thomas CS. Using multiple-hierarchy stratification and life course approaches to understand health inequalities: the intersecting consequences of race, gender, SES, and age. J Health Soc Behav. 2016;57(2):200–22.PubMedPubMedCentral
33.
Singh-Manoux A, Marmot MG, Adler NE. Does subjective social status predict health and change in health status better than objective status? Psychosom Med. 2005;67(6):855–61.PubMed
34.
Williams VF, Smith AA, Villanti AC, Rath JM, Hair EC, Cantrell J, et al. Validity of a subjective financial situation measure to assess socioeconomic status in US young adults. J Public Health Manag Pract. 2017;23(5):487–95.PubMed
35.
Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, et al. The functional assessment of Cancer therapy scale: development and validation of the general measure. J Clin Oncol. 1993;11(3):570–9.
36.
Cleeland C, Ryan K. Pain assessment: global use of the brief pain inventory. Annals. Singapore: Academy of Medicine; 1994.
37.
Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the hospital anxiety and depression scale: an updated literature review. J Psychosom Res. 2002;52(2):69–77.PubMed
38.
Carroll BT, Kathol RG, Noyes R Jr, Wald TG, Clamon GH. Screening for depression and anxiety in cancer patients using the hospital anxiety and depression scale. Gen Hosp Psychiatry. 1993;15(2):69–74.PubMed
39.
Lyons KD, Bakitas M, Hegel MT, Hanscom B, Hull J, Ahles TA. Reliability and validity of the functional assessment of chronic illness therapy-palliative care (FACIT-pal) scale. J Pain Symptom Manag. 2009;37(1):23–32.
40.
Schnittker J. Education and the changing shape of the income gradient in health. J Health Soc Behav. 2004;45(September):286–305.PubMed
41.
Link BG, Phelan J. Social Conditions As Fundamental Causes of Disease. J Health Soc Behav. 1995;35(Special Issue):80–94.
42.
Böhnke P. Are the poor socially integrated? The link between poverty and social support in different welfare regimes. J Eur Soc Policy. 2008;18(2):133–50.
43.
Mood C, Jonsson JO. The social consequences of poverty: an empirical test on longitudinal data. Soc Indic Res. 2016;127(2):633–52.PubMed
44.
Howe LD, Hargreaves JR, Huttly SRA. Issues in the construction of wealth indices for the measurement of socio-economic position in low-income countries. Emerg Themes Epidemiol. 2008;5(1):3.PubMedPubMedCentral
Metadata
Title
Socio-economic inequalities in suffering at the end of life among advanced cancer patients: results from the APPROACH study in five Asian countries
Authors
Chetna Malhotra
Anirudh Krishnan
Jing Rong Yong
Irene Teo
Semra Ozdemir
Xiao Hong Ning
Thushari Hapuarachchi
Gayatri Palat
Sushma Bhatnagar
Anjum Khan Joad
Pham Nguyen Tuong
Wynn Mon Ssu
Eric Finkelstein
Publication date
01-12-2020
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2020
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-020-01274-5

Other articles of this Issue 1/2020

International Journal for Equity in Health 1/2020 Go to the issue

Research

Responsiveness of health care services towards the elderly in Tanzania: does health insurance make a difference? A cross-sectional study

Research

Tackling segmentation to advance universal health coverage: analysis of policy architectures of health care in Chile and Uruguay

Letter to the Editor

“Pairing assistance”: the effective way to solve the breakdown of health services system caused by COVID-19 pandemic

Research

The potential of mobile health clinics in chronic disease prevention and health promotion in universal healthcare systems. An on-field experiment

Research

Socio-economic and demographic factors associated with reproductive and child health preventive care in Mozambique: a cross-sectional study

Research

How to adapt sexual and reproductive health services to the needs and circumstances of trans people— a qualitative study in Colombia