Journal of Cancer Policy最新文献

Background: Advanced-stage cancer imposes a substantial economic burden on patients and families, even within universal public healthcare systems. Non-reimbursed direct costs-such as medications, parapharmacy products, and orthopaedic materials-pose a particularly severe impact on individuals with functional dependence and limited institutional support. This study focuses on the objective component of financial burden, operationalised as unreimbursed out-of-pocket (OOP) costs from a patient/household perspective.

Methods: A cross-sectional observational study was conducted at a public hospital in Spain between January 2022 and January 2024, including 201 patients with advanced-stage cancer. Socio-demographic, clinical, and economic data were collected through structured interviews, including annual out-of-pocket expenses for the previous 12 months (nominal euros, 2022-2024, without inflation adjustment), alongside functional assessments (Barthel Index, Lawton-Brody Scale, ECOG Performance Status, EQ-5D). Non-parametric tests (Mann-Whitney U and Kruskal-Wallis; α = 0.05) examined associations, and exploratory multivariate regression models were applied to adjust for functional and socioeconomic factors.

Results: In the previous year, 67.7% of participants reported pharmacy or parapharmacy expenses, and 10% spent more than €1,200. Orthopaedic costs were incurred by 54.2%, despite theoretical public coverage; 23.9% spent more than €600. Functional impairment was frequent, with 38.3% of patients presenting ECOG ≥3. Only 25.4% received any financial support, while the majority reported none. Pharmacy-related expenses were significantly higher among patients with greater functional dependence and income reductions (p < 0.05). Additional associations were found with marital status and pre-diagnosis income.

Conclusion: Unreimbursed out-of-pocket costs represent a major source of objective financial burden in advanced cancer, disproportionately affecting patients with functional dependence and reduced household income. Current co-payment exemptions insufficiently capture vulnerable profiles. Policy summary These findings support national (Spain's Cancer Strategy 2021-2025) and European (Cancer Inequalities Registry) frameworks aimed at reducing social and economic inequalities in cancer care.

Background: In 2022, breast cancer (BC) had a global mortality rate of 12.7 per 100,000 and 13.2 per 100,000 in Latin America. In Colombia, BC ranked among the leading cancers in terms of incidence and mortality. Delayed diagnosis and treatment worsen prognosis and increase both morbidity and mortality. This review aimed to describe the health system barriers to early detection and timely treatment of BC.

Methods: A scoping review was conducted following the methodology of the Joanna Briggs Institute (JBI). The literature search was carried out in three databases (Medline/PubMed, LILACS, and ScienceDirect). Qualitative and quantitative studies published between 2000 and 2024, in either English or Spanish that examined the health system barriers to the early detection and timely treatment of BC were included. Identified barriers were categorized using the World Health Organization's Health Systems Framework, which includes service delivery, health workforce, health information systems, access to essential medical products and technologies, health system financing, and leadership and governance.

Results: The search yielded 2603 records, of which 18 studies were included in the review. Eight studies focused on barriers to BC treatment, while the remaining addressed barriers to early detection and diagnosis. The most common barrier identified was related to the service delivery, with geographic inaccessibility emerging as the most significant factor. The second most frequently reported barrier concerned health workforce. Financial limitations, out-of-pocket costs, and lack of resources for BC treatment were identified as financial barriers.

Policy summary: Barriers to early detection and timely treatment of BC are primarily by service delivery constraints related to geographic access and health workforce barriers, particularly the absence of a doctor-patient relationship. Personal barriers, such as fear of diagnosis or associated pain, religious beliefs and practices, social stigma, and misperceptions about screening programs, were also identified.

Background: Self-sampled HPV testing followed by timely treatment has shown promise in increasing screening uptake and improving cervical cancer outcomes. However, in low-resource countries like Ghana, its adoption and sustainability face significant challenges.

Methods: This cross-sectional pilot study comprised a convenience sample of women presenting at two healthcare facilities in Ghana: Kumasi South Hospital and South Suntreso Hospital. Following consent, a pre-and post-collection survey was administered by a trained study nurse to examine women's preferences and experiences with self-sampling. Participants were then asked to self-collect an HPV sample followed by a clinician-conducted exam using visual inspection with acetic acid (VIA). Samples were tested for HPV genotypes using the Seegene Anyplex HPV28 Test.

Results: Sixty women were enrolled. After performing HPV self-collection, 91.7% (n = 55) stated that they would prefer self-sampling instead of a clinician-collected Pap smear. Prior to the self-collection process, 40.0% (24 women) gave high ratings for the overall acceptability of HPV self-collection. This increased to 86.7% (52 women) after the self-collection process. Of the 60 women, 25% (15/60) tested positive for HPV and 6.7% (4/60) were confirmed positive by VIA examination. Overall agreement between the two procedures was fair (κ=0.24).

Conclusions: This pilot study supports the feasibility of HPV self-sampling and its potential to increase access to cervical screening in Ghana.