Socio-economic inequalities in suffering at the end of life among advanced cancer patients: results from the APPROACH st
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(2020) 19:158
RESEARCH
Open Access
Socio-economic inequalities in suffering at the end of life among advanced cancer patients: results from the APPROACH study in five Asian countries Chetna Malhotra1,2* , Anirudh Krishnan1, Jing Rong Yong1, Irene Teo1,2,3, Semra Ozdemir1,2, Xiao Hong Ning4, Thushari Hapuarachchi5, Gayatri Palat6, Sushma Bhatnagar7, Anjum Khan Joad8, Pham Nguyen Tuong9, Wynn Mon Ssu10 and Eric Finkelstein1,2
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. Keywords: Metastasis, Economic status, Inequalities, End of life
* Correspondence: [email protected] 1 Lien Centre for Palliative Care, Duke-NUS Medical School, 8 College Road, Level 4, Singapore 169857, Singapore 2 Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creativ
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