ArticleThe Lancet. Global health2021
Palliative care and catastrophic costs in Malawi after a diagnosis of advanced cancer: a prospective cohort study.
Article in The Lancet. Global health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 17 papers, 2 of them syntheses that pooled it.
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Who cites it
17 citing papers in PubMed, 2 syntheses or guidelines pooled it, 40 citations in OpenAlex.
- Magnitude of catastrophic health expenditure and its determinants among cancer patients in low and middle-income countries: a systematic review and meta-analysis.BMC health services research · 2025Pooled it
- The financial toxicity of cancer: unveiling global burden and risk factors - a systematic review and meta-analysis.BMJ global health · 2025Pooled it
- Availability and Access to Palliative Sedation Medications in Ecuador: A National Survey of Palliative Care Physicians.International journal of environmental research and public health · 2026Article
- Mapping Existing Informal Home Caregiver Support Guidelines for Palliative Care: A Scoping Review.Rwanda journal of medicine and health sciences · 2026Review
- Cost of chemotherapy-related care for breast cancer care: evidence and implications from a provider perspective at a public tertiary hospital in South Africa.Health economics review · 2026Article
- Palliative care needs and health seeking behavior of people in two rural districts of nepal: a house-to-house survey.BMC palliative care · 2025Article
- The Invisible Costs of Cancer Treatment: Quantifying Non-Medical Economic Consequences for Cancer Survivors Undergoing Systemic and Radiation Therapies.Cancer medicine · 2025Article
- "I am the one taking care of her and donating blood": lived experiences of role-routines of hospital-based informal caregiving in Nigeria.International journal of qualitative studies on health and well-being · 2024Article
- The financial burden of noncommunicable diseases from out-of-pocket expenditure in sub-Saharan Africa: a scoping review.Health promotion international · 2024Article
- Health promoting palliative care interventions in African low-income countries: a scoping review.BMJ public health · 2024Article
- Measuring palliative care integration in Malawi through service provision, access, and training indicators: the Waterloo Coalition Initiative.BMC palliative care · 2024Article
- Catastrophic Health Expenditure and Associated Factors Among Hospitalized Cancer Patients in Addis Ababa, Ethiopia.Risk management and healthcare policy · 2024Article
- Remote Symptom Monitoring to Enhance the Delivery of Palliative Cancer Care in Low-Resource Settings: Emerging Approaches from Africa.International journal of environmental research and public health · 2023Article
- Palliative care needs and barriers in an urban Ugandan Emergency Department: A mixed-methods survey of emergency healthcare workers and patients.African journal of emergency medicine : Revue africaine de la medecine d'urgence · 2023Article
- The roles and experiences of informal carers providing care to people with advanced cancer in Africa-A systematic review and critical interpretive analysis.PLOS global public health · 2023Article
- Cost of childhood cancer treatment in Ethiopia.PloS one · 2023Article
- Medical Costs of Palliative and Hospice Care versus Usual Care in Terminal Cancer: A Systematic Review and Meta-Analysis.Indian journal of palliative careReview
Corrections and comments
- Erratum issued
Authors and funding
14 authors at 8 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundInclusive universal health coverage requires access to quality health care without financial barriers. Receipt of palliative care after advanced cancer diagnosis might reduce household poverty, but evidence from low-income and middle-income settings is sparse.
methodsIn this prospective study, the primary objective was to investigate total household costs of cancer-related health care after a diagnosis of advanced cancer, with and without the receipt of palliative care. Households comprising patients and their unpaid family caregiver were recruited into a cohort study at Queen Elizabeth Central Hospital in Malawi, between Jan 16 and July 31, 2019. Costs of cancer-related health-care use (including palliative care) and health-related quality-of-life were recorded over 6 months. Regression analysis explored associations between receipt of palliative care and total household costs on health care as a proportion of household income. Catastrophic costs, defined as 20% or more of total household income, sale of assets and loans taken out (dissaving), and their association with palliative care were computed.
findingsWe recruited 150 households. At 6 months, data from 89 (59%) of 150 households were available, comprising 89 patients (median age 50 years, 79% female) and 64 caregivers (median age 40 years, 73% female). Patients in 55 (37%) of the 150 households died and six (4%) were lost to follow-up. 19 (21%) of 89 households received palliative care. Catastrophic costs were experienced by nine (47%) of 19 households who received palliative care versus 48 (69%) of 70 households who did not (relative risk 0·69, 95% CI 0·42 to 1·14, p=0·109). Palliative care was associated with substantially reduced dissaving (median US$11, IQR 0 to 30 vs $34, 14 to 75; p=0·005). The mean difference in total household costs on cancer-related health care with receipt of palliative care was -36% (95% CI -94 to 594; p=0·707).
interpretationVulnerable households in low-income countries are subject to catastrophic health-related costs following a diagnosis of advanced cancer. Palliative care might result in reduced dissaving in these households. Further consideration of the economic benefits of palliative care is justified.
fundingWellcome Trust; National Institute for Health Research; and EMMS International.
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