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

• Main 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
• Format: Article
• Language: English
• Published: BMC 2020-09-01
• Series: International Journal for Equity in Health
• Subjects: Metastasis; Economic status; Inequalities; End of life
• Online Access: http://link.springer.com/article/10.1186/s12939-020-01274-5

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.