Quality of Life Research

, Volume 24, Issue 4, pp 937–949 | Cite as

The relationship between economic characteristics and health-related quality of life in newly diagnosed cancer patients in Southeast Asia: results from an observational study

  • Merel Kimman
  • Stephen Jan
  • Helen Monaghan
  • Mark Woodward



We investigate whether cancer patients’ economic characteristics are independent determinants of health-related quality of life (HRQoL) in low- and middle-income settings to identify priorities for health policy and research.


A cross-sectional survey of 9,513 cancer patients from Southeast Asia provided data on demographics, economic status and HRQoL. HRQoL was measured using the EORTC QLQ-C30 and EQ-5D. Information on cancer site and stage was collected using the patients’ medical records. Multiple linear regression analysis estimated the relative impact of economic characteristics (i.e. health insurance, employment status, household income and economic hardship) on HRQoL.


All economic characteristics were significant independent determinants of HRQoL, when we controlled for demographic and clinical characteristics. Economic hardship was found to be most important. The adjusted mean differences in HRQoL scores between patients who had experienced economic hardship in the year before diagnosis compared to patients who did not were −5.6, −6.7, −7.3 and −0.06, respectively, for global health, physical function, emotional function and the EQ-5D index (all p values <0.001). Subgroup analyses showed that this significant result for economic hardship as a predictor of poor HRQoL was consistent across all age groups, for males and females, and across all levels of education.


Living in poor economic circumstances before a cancer diagnosis is associated with greatly impaired HRQoL after diagnosis. There is wide scope for research on innovative interventions that provide low-cost and targeted support aimed to improve health outcomes of disadvantaged cancer patients in low- and middle-income settings.


Patient-reported outcomes Health-related quality of life Cancer Low- and middle-income settings Economic status Southeast Asia 



Health-related quality of life


Association of Southeast Asian Nations


EuroQoL 5 dimensions



The ACTION study is funded through an unrestricted educational grant from the Roche Asia Pacific Regional Office. Principal investigators in each of the countries were as follows: Seang Pharin, MD, Calmette Hospital, Kouy Samnang, PhD, Khmer Soviet Hospital, Eav Sokha, PhD, Calmette Hospital, Heng Viroath, MD, Khmer Soviet Hospital (Cambodia); Pujianto, PhD, School of Public Health, Universitas Indonesia, Hasbullah Thabrany, MD, PhD, Universitas Indonesia (Indonesia); Phetsamone Arounlangsy, MD, PhD, Laos Cancer Center, Oudayvone Rattanavong, MD, Mahosot Hospital (Laos); NirmalaBhoo-Pathy, MD, PhD, University of Malaysia, Cheng-Har Yip, MD, Subang Jaya Medical Centre (Malaysia); Myo Khin, MD, Department of Medical Research, Lower Myanmar (Myanmar); Soledad L. Balete, MD, Jose R Reyes Memorial Medical Center, Annielyn Beryl Ong-Cornel, MD, Veterans Memorial Medical Center, Jay Datukan, MD, St. Luke’s Medical Center, Quezon City, Agnes E.Gorospe, MD, St Lukes Medical Center, Quezon City, Conrado Lola, MD, National Kidney and Transplant Institute, Leo Marbella, MD, National Kidney and Transplant Institute, Corazon A. Ngelangel, MD, PhD, University of the Philippines-College of Medicine, Philippine General Hospital, Irisyl O. Real, MD, University of the Philippines-College of Medicine, Philippine General Hospital, Cherelina Santiago-Ferreras, MD, Veterans Memorial Medical Center (Philippines); Prasit Khopaibul, MD, Suratthani Cancer Center, Thanut Khuayjarernpanishk, MD, Ubonratchathani Cancer Centre, Thiravud Khuhaprema, MD, National Cancer Institute of Thailand, Tawin Klinwimol, Ubonratchathani Cancer Centre, Somkiet Lalitwongsa, Lampang Cancer Centre, Dhanoo Lawbundis, MD, Lopburi Cancer Hospital, Somphob Sangkittipaiboon, MD, Lopburi Cancer Hospital, Suleeporn Sangrajrang, PhD, National Cancer Institute of Thailand, Thanadej Sinthusake, MD,Mahavajiralongkorn Cancer Center, Darunee Suanplu, MD, Suratthani Cancer Centre Jitraporn Tanabodee, MD, Chonburi Cancer Centre, Kitisak Thepsuwan, Chonburi Cancer Centre, (Thailand); Dieu Bui, MD, PhD, K Hospital, Khoa Mai Trong, MD, PhD, Bach Mai Hospital (Vietnam). We thank Roche Asia Pacific for supporting this work.

Conflict of interest

We declare that we have no conflicts of interest.


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Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Merel Kimman
    • 1
    • 3
  • Stephen Jan
    • 1
  • Helen Monaghan
    • 1
  • Mark Woodward
    • 1
    • 2
  1. 1.The George Institute for Global HealthSydneyAustralia
  2. 2.The George Institute for Global Health, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
  3. 3.The University of SydneySydneyAustralia

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