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Improving Cancer Care in South East Asia – The ACTION case Study

Background

The number of new cancer cases is expected to rise by up by 70 per cent in South East Asia by 2030.

Yet cancer care is not a priority in many countries in the region and without social safety nets, such as health insurance and universal health care, many patients are struggling to access and pay for expensive on-going treatments.

In such settings, poverty is a devastating consequence of the costs associated with cancer treatment and its impact on people’s ability to work.

The ACTION study (Asean CosTs In Oncology) examined the economic impact of cancer on households across the Association of South East Asian Nations (ASEAN) by quantifying the incidence of financial catastrophe and economic hardship associated with the illness.

What did The George Institute do?

The ACTION study was the largest study ever conducted in the region. Led by The George Institute for Global Health and George Clinical and supported by Roche, it was the first of its kind to examine the human cost of cancer to populations across eight countries in Southeast Asia: Cambodia, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Thailand and Vietnam.

The study assessed the impact of cancer on household economic well-being, as well as patient survival and quality of life. It also provided evidence to help countries in the region make decisions that would improve access to cancer care and provide adequate financial protection from the burden of costs associated with the illness.

The study followed 9,513 cancer patients through their first year following diagnosis and involved a mix of public and private hospitals.

Results and success

The findings published in August 2015 showed 75 per cent of patients either died or had (within their family) suffered financial catastrophe a year after diagnosis. People from low-income groups were hardest hit.

Roundtables with senior health advisors from the ASEAN countries, and patient association events followed with all eight countries represented. Since then there has been significant progress in cancer care. Examples follow.

In the Philippines the Senate passed a motion in October 2018 to establish a national cancer program citing the ACTION study. The far-ranging bill will lead to improvements in health insurance by significantly expanding benefit packages. People who cannot work due to treatment will be compensated by sickness and disability benefits and a Philippine Cancer Centre will be established for the treatment and accommodation of cancer patients, as well as initiating cancer research. Regional cancer centres will also be created.

In Malaysia, the patient organisation, Together Against Cancer (TAC), used the study results to appeal for cancer drugs to receive an exemption from Goods and Services Tax (GST). Their efforts were successful. There was also a 33% increase in allocation for radiotherapy and oncology services. New advocacy patient groups have also been formed to seek equitable cancer care from the government. 

In Indonesia, local evidence was instrumental to the creation of new cancer treatment guidelines. Moreover, a large stakeholder forum highlighting the ACTION study led to a positive impact on reimbursement decisions for Herceptin, and other cancer drugs, in 2016.