The socio-economic impact of cervical cancer on patients and their families in Argentina, and its influence on radiotherapy compliance. Results from a cross-sectional study

doi:10.1016/j.ygyno.2006.12.010

Gynecologic Oncology

Volume 105, Issue 2, May 2007, Pages 335-340

https://doi.org/10.1016/j.ygyno.2006.12.010 Get rights and content

Abstract

Objective.

We aimed to measure the socio-economic impact of cervical cancer borne by patients and their families in Argentina, and to analyze its influence on radiotherapy compliance.

Methods.

We carried out a cross-sectional survey of 120 new cervical cancer patients. We measured impact of disease in 6 domains of family life: employment, income, household budget, education, access to health-care, and child care. Data on compliance with radiotherapy were also collected.

Results.

Households of patients reported a reduction in hours worked (45%), work interruption (28%), loss of family income (39%), a reduction in the daily amount of food consumed (37%), delays in paying for essential services such as electricity or telephone (43%), and the sale of property or use of savings (38%). In 28% of households children regularly missed school days. An increased risk of non-compliance with radiotherapy was found in patients from households that lost family income (OR: 3.8, 95% CI 1.5–9.5), or where a member reduced school attendance (OR: 3.6, 95% CI 1.4–9.1).

Conclusions.

The socio-economic impact of cervical cancer is considerable and can have negative consequences on treatment compliance. Cervical cancer prevention must be considered a public health priority. Effective social support systems for cancer patients should be implemented.

Introduction

Cervical cancer is a major cause of disability and death among women from developing countries [1]. However, despite the fact that the disease is preventable with existing screening methods [2], [3], [4], [5], most developing countries have failed to organize effective prevention programs [6]. One of the reasons for this failure is the lack of knowledge about the socio-economic impact of disease on the family.

In addition to facing pain, disability and fear of death, cancer patients have to deal with increased treatment-related expenses, loss of employment and consequent income, and changes in household responsibilities [7], [8], [9], [10], [11]. Cancer of the cervix disproportionately affects women in the low socio-economic level [12], and thus the disease can have dramatic consequences for the living conditions of patients and their families, including falling into poverty or being pushed into deeper poverty. Nonetheless, research on the socio-economic impact of cervix cancer on the family in developing countries is, to our knowledge, virtually absent. A study of the psychosocial burden of caring for women with breast and cervical cancer in Nigeria [13] reported that 68% of patients and 31% of family members suffered a major loss of income because of illness. However, as the main objective of the Nigerian study was to measure burden of disease on the main informal caregiver, it was unable to measure impacts that affect other family members, e.g., absences of children from school.

The study of socio-economic impact of cancer is important not only from a social perspective, but also from a clinical and epidemiological point of view. Several authors have suggested that the socio-economic impact of cancer on the family might reduce the capacity of patients to comply with treatment [7], [10], [14], [15]. However, to our knowledge, there has been no attempt to analyze the association between socio-economic impact of cancer and non-compliance. For cancer of the cervix, radiotherapy constitutes a proven treatment that can considerably increase quality-of-life and survival if appropriately followed [16], [17]. If compliance with radiotherapy is affected by the socio-economic impact of cancer, these patients will not only face increased socio-economic problems, but will also have a poorer quality of life and reduced chances of survival.

In this paper we report results of a cross-sectional study of the socio-economic impact of cervical cancer on patients and their families in Buenos Aires, Argentina, and we analyze its influence on compliance with radiotherapy. This research will contribute to a better understanding of socio-economic problems faced by families of cancer patients in developing countries and facilitate the promotion of policies targeted at improving their living conditions. In addition, understanding the link between compliance and the socio-economic impact of cancer will allow the implementation of measures to help patients to increase their capacity to comply with treatment, and hence to improve tumor control and survival.

Section snippets

Materials and methods

This retrospective cross-sectional study was carried out between November 2002 and March 2004 in Buenos Aires, Argentina, at the Institute of Oncology “Angel H Roffo”, in collaboration with the Department of Chemical and Environmental Carcinogenesis. The study protocol and questionnaire were approved by the Institute's Ethical Committee. After obtaining a signed informed consent from patients, their informal caregivers were personally interviewed using a structured questionnaire on

Results

Between October 2002 and March 2004 192 new patients with cervical cancer were prescribed radiotherapy treatment at the Roffo Institute. Of those, 120 (63%) were included in the study. 72 patients did not participate in the study due to different reasons: 52 (27%) were lost to follow-up, 4 (2%) died before or during treatment and 16 (8%) never initiated or quit treatment.

Discussion

Despite the fact that treatment costs were covered in 96% of the cases, we found that the socio-economic impact of cervical cancer on the household of patients was considerable. We also found that the burden of cervical cancer is not limited to the disability or death of the woman, but it also includes important disease effects borne by the close social network. For almost half of the patients, at least two households were involved in arrangements needed to provide caregiving and face the

Acknowledgments

The authors gratefully acknowledge the generous support of the Bill & Melinda Gates Foundation through the Alliance for Cervical Cancer Prevention (ACCP), IARC-WHO. Authors would like to thank Jacques Magaud from the Université de Lyon for his support in project design and data analysis, Dora Loria from the Institute of Oncology “Angel H Roffo” and Vincent James Cogliano from IARC for their comments on the manuscript, and Richard Muwonge for his advice on statistical analysis. The authors thank

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View full text

The socio-economic impact of cervical cancer on patients and their families in Argentina, and its influence on radiotherapy compliance. Results from a cross-sectional study

Abstract

Objective.

Methods.

Results.

Conclusions.

Introduction

Section snippets

Materials and methods

Results

Discussion

Acknowledgments

Ann. Oncol.

Soc. Sci. Med.

Lancet

Radiother. Oncol.

Radiother. Oncol.

Cervical cancer as a priority for prevention in different world regions: an evaluation using years of life lost

Int. J. Cancer

Screening for cancer of the uterine cervix

Safety, acceptability, and feasibility of a single-visit approach to cervical-cancer prevention in rural Thailand: a demonstration project

Lancet

Chapter 13: primary screening of cervical cancer with human papillomavirus tests

J. Natl. Cancer Inst. Monogr.

A cluster randomized controlled trial of visual, cytology and human papillomavirus screening for cancer of the cervix in rural India

Int. J. Cancer

Effective screening programmes for cervical cancer in low- and middle-income developing countries

Bull. World Health Organ

Childhood cancer: nonmedical costs of the illness

Cancer

Financial burden of childhood cancer

Br. Med. J. (Clin. Res. Ed.)

Nonmedical costs to patients and their families associated with outpatient chemotherapy

Cancer