Abstract
BackgroundA 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.AimsTo 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.MethodsWe 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.ResultsPatients 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).ConclusionResults 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.
Highlights
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
Results did not find that patients with low education and low economic status households always had greater EOL suffering compared to others
Findings reveal socio-economic status (SES) inequalities in EOL suffering among advanced cancer patients in selected public hospitals in five low- and middle-income countries in Asia, with low SES patients dying ‘worse’ i.e. with more suffering, compared to patients from higher SES
Summary
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. Without access to palliative care, these patients are likely to experience considerable end-of-life (EOL) suffering [2, 3]. The Lancet Commission on Palliative Care and Pain Relief and the 2014 World Health Assembly resolution emphasized the urgency to reduce EOL suffering as part of Universal Health Coverage goal [5, 6]. A key tenet for achieving this goal is to reduce socio-economic status (SES) inequalities in EOL suffering. To do this first entails a systematic understanding of SES inequalities in EOL suffering
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