The ACTION Study: Understanding the impact of cancer in Southeast Asia

Partnership objectives 

  • Quantify and understand the impact of cancer on household economic wellbeing, and patient survival and quality of life in countries of the Association of Southeast Asian Nations (ASEAN).
  • Provide a body of evidence on which countries in the region can base decisions about how to address the burden of cost of illness, and improve access to cancer care.

The ACTION Study was the first of its kind to examine the human cost of cancer to populations across eight countries in Southeast Asia. The ACTION Study was the first of its kind to examine the human cost of cancer to populations across eight countries in Southeast Asia. Copyright Roche

What are the health needs and challenges? 

More than 75% of people with cancer in Southeast Asian countries experience death or financial catastrophe within a year of diagnosis. Treatments are costly and the disease significantly impairs people’s ability to work, resulting in economic hardship that can, in turn, have a devastating impact on cancer outcomes. 

But cancer care is not a high priority in ASEAN countries, and only a few governments identify cancer as an impediment to economic growth. With little evidence available to articulate the economic impact of cancer on low and middle income households, and its relationship to treatment and health outcomes, a profound lack of understanding surrounds the burden of the disease. 

And yet it is a burden that is growing. It is estimated that there were over 770,000 new cases of cancer and 527,000 cancer deaths in the region in 2012. The number of new cases is expected to rise by around 70% by 2030, to reach 1.3 million.

Roche wanted to quantify the true cost of cancer, and improve understanding of its impact. Providing evidence would be a crucial step in supporting countries in the region to identify where investment can be targeted most effectively to reduce the burden the disease represents.

Description of partnership activities and how they address needs and challenges

The ACTION study (Asean CosTs In Oncology) was the largest study ever conducted in the region. Led by the George Institute for Global Health and supported by Roche, it was the first of its kind to examine the human cost of cancer to populations across eight countries in Southeast Asia: Cambodia, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Thailand and Vietnam.

The study was designed to assess the impact of cancer on household economic wellbeing, as well as patient survival and quality of life. It would also provide evidence to help countries in the region make decisions that would improve access to cancer care and provide adequate financial protection from the burden of costs associated with the illness.

The longitudinal cohort study followed 9,513 cancer patients through their first year following diagnosis. It represented a broad, partly working-age population with a mean age of 52 years, and involved a mix of public and private hospitals.

Key activities were planned around the publication of the report’s findings in August 2015. These included a keynote presentation at a regional conference, roundtables with senior health advisors from the ASEAN countries, and patient association events. All eight countries were represented at every event.

Summary of impact and forward looking information

The data generated by the ACTION study improved understanding of the challenges faced by cancer patients in Southeast Asia, and provided a factual basis for decisions around cancer services by policy-makers in the region.

In Malaysia, patient organisation Together Against Cancer (TAC), used the study results to appeal for cancer drugs to receive an exemption from Goods and Services Tax (GST). Their efforts were successful. There was also a 33% increase in allocation for radiotherapy and oncology services.

In Indonesia, local evidence was instrumental to the creation of new cancer treatment guidelines. Moreover, a large stakeholder forum highlighting the ACTION study contributed to had a positive impact on reimbursement decisions for Herceptin and other cancer drugs in 2016.

Similar initiatives are now underway in the Middle East and LATAM regions, in collaboration with the Harvard T.H. Chan School of Public Health and The Economist Intelligence Unit respectively.

Measurement of progress towards objectives 

The ACTION study provided a rigorous, scientific and detailed assessment of the impact of cancer on patients in Southeast Asia. Offering the first evidence of its kind to quantify the burden of cost the illness can represent, the study proved to be a vital tool for health advisors and policy makers

Partnership information

Company(ies) Roche

Partner(s) George Institute for Global Health

Type of Partner(s) Academia / Hospitals

Therapeutic Focus Non-Communicable Diseases

Disease(s) Cancer

Program Type(s) Prevention Programs - Awareness & Outreach

Region(s) East Asia & Pacific

Number of Countries 8

Country(ies) Cambodia, Indonesia, Lao PDR, Malaysia, Myanmar, Philippines, Thailand, Vietnam

Start Date 2015

Anticipated completion date Ongoing

« We hope the evidence from the ACTION Study will help governments of countries in Southeast Asia develop strategies and policies for combating cancer for the long term. »

Professor Mark Woodward, MSc, PhD, George Institute for Global Health.