Nearly Half of Cancer Patients Suffer a 'Financial Catastrophe'

AUGUST 21, 2015

Bali. Cancer will put a strain on patients and governments across Southeast Asia, with the number of new cases expected to reach 1.3 million a year by 2030, a new study shows.

Prepared by Sydney-based George Institute for Global Health, "The Asean Costs in Oncology" (ACTION), examined the human cost of cancer of  9,513 patients who were newly diagnosed with cancer across the region from 2012 to 2014. The study also revealed, 2,335 of those patients are from Indonesia.

The study found that 48 percent of patients surveyed suffered from a "financial catastrophe" within the first 12 month after they were diagnosed, meaning that they used up more than 30 percent of their income on out-of-pocket expenses for their treatment.

The study also showed that 29 percent of patients surveyed, succumbed to their illnesses within the 12 months after they were diagnosed, creating another burden for the patients' families, particularly if they are the bread winners in their respective families. 47 percent of those surveyed were of  working age.

"Most people look at the financial catastrophe caused and ignore the fact that some [the cancer patients] have died. That is the worst outcome of all,"  said Mark Woodward, Professor of Statistics and Epidemiology at the institute during the launch of the study on Thursday.

Woodward added that there were only 23 percent of those surveyed who did not have their wellbeing, survival, and quality of life strained from cancer.

Woodward said the economic conditions of the patients and the stages of cancer the respondents were diagnosed with played important factors on how severe the patients were impacted financially.

"You'd like people to come at the early stages [of cancer] because the earlier they come, the greater their chances of doing something good about it," he said.

"Unfortunately only 12 percent of the subjects in our study came with stage one cancer. 24 percent came at the last stage of cancer which means their prognosis are bound to be poor."

Nirmala Bhoo-Pathy, a cancer epidemiologist at the University of Malaya, Malaysia explained that treatment for breast cancer in the early stage costs as little as $3,000 per year in her country.

"If you get to the later stages, then you require surgery, chemotherapy," she said adding that breast cancer patients can pay up to $15,000 a year.

That is beyond the reach of many, Nirmala continued, with most cancer patients having to use money from their savings and as a result experienced a financial catastrophe in maintaining their standard of living. The average GDP per capita for the 8 countries surveyed is $3,553, according to data in 2014.

For Indonesia, this issue could put a strain on the country's healthcare system, said Hasbullah Thabrany, a lecturer on public health policy at the Univeristy of Indonesia.

This year, Indonesia earmarked Rp 68.1 trillion for health, which also includes family planning and food and drug monitoring and the government promised to earmark more than Rp 100 trillion next year.

The Indonesian government's health insurer BPJS Kesehatan is already experiencing a Rp 5 trillion deficit to provide healthcare for 140 million people covered under the scheme, despite the government allocating Rp 21 trillion this year for the insurer.

Cancer is one of the leading causes of death in Indonesia, affecting 0.14 percent of Indonesia's 250 million population, according to a 2013 health ministry's estimate.

The figure could escalate, Hasbullah said, with laxed regulation on tobacco and the fast food industry. In Indonesia, there are 70 million smokers and cigarettes cost an average of $1 a pack.

"Cancer is not only a health problem, but it is also a social and economic problem," he said. "So we should get everyone involved not only the health ministry."

Hasbullah said that Indonesia should impose tighter regulations and stricter regulations on the tobacco industry, something the health ministry cannot tackle alone.

The industry contributes around 10 percent of state revenue and employs 80,000 workers. But  Hasbullah said with lung and throat cancers being a major contributor for cancer among men in Indonesia, Indonesia stands to save trillions of rupiah in health funds if it imposes tighter regulations on the tobacco in indonesia.

Indonesia is also suffering from a shortage of cancer specialists  leaving many patients untreated. "The government ended up spending more and lives are lost because cancer patients are not treated until the later stages of cancer," Hasbullah said.

The institute said there is a need for governments to set up high-quality screening programs bearing in mind that early detection will reduce the costs of treating cancer to their government and individual households. Governments should also raise better awareness on the economic impact of cancer to get people to adopt a healthier lifestyle.