# Catastrophic health expenditure and 12-month mortality associated with cancer in Southeast Asia: results from a longitudinal study in eight countries

Source: https://onco.cc/key-papers/paper-kimman-action-catastrophic-expenditure-southeast-asia-bmc-med-2015/  
OnCo record `paper-kimman-action-catastrophic-expenditure-southeast-asia-bmc-med-2015` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The ACTION study followed 9,513 adults with newly diagnosed cancer in eight Southeast Asian countries for a year: across all eight, 29% had died and 48% faced costs above 30% of household income, so only 23% were alive without financial catastrophe. Malaysia's cancer plan cites it.

## Summary

The ASEAN Costs in Oncology (ACTION) study, started in 2012, prospectively recruited 9,513 consecutive adults with a first diagnosis of cancer in the Association of Southeast Asian Nations region. Twelve months after diagnosis it recorded deaths and household financial catastrophe, defined as out-of-pocket medical costs above 30% of annual household income, and modelled their predictors.

Malaysia's National Strategic Plan for Cancer Control Programme 2021-2025 cites this study for its statement that about 45% of Malaysian cancer survivors spend over a third of household income on cancer care in the first year after diagnosis; that country figure is the plan's, and is not in the paper's abstract.

## Fields

- Kind: Key paper
- Last checked: 2026-11-04
- Also known as: ACTION study
- Journal: BMC Medicine
- Year: 2015
- DOI: 10.1186/s12916-015-0433-1
- Authors: Kimman M, Jan S, Yip CH, et al.
- Findings: A year after diagnosis 29% had died, 48% had faced financial catastrophe and 23% were alive with no financial catastrophe.; Participants in the lowest income group had higher odds of financial catastrophe (odds ratio 5.86, 95% CI 4.76 to 7.23) and of death (5.52, 4.34 to 7.02) than those with high income.; People without insurance were more likely to face financial catastrophe (1.27, 1.05 to 1.52) and to die (1.51, 1.21 to 1.88).
- What it means: Cost and survival are linked in the region: a later stage at diagnosis and a lower income each raised the chance of both outcomes, which is the case Malaysia's cancer plan makes for financial protection and earlier diagnosis.
- Caveats: The pooled results cover eight countries; the abstract gives no Malaysia-only figure.

## Sources

- BMC Medicine 2015: https://doi.org/10.1186/s12916-015-0433-1
- PubMed: https://pubmed.ncbi.nlm.nih.gov/26282128/

## Connected records

- institutions: [Ministry of Health Malaysia](https://onco.cc/institutions/ministry-of-health-malaysia/), [ProtectHealth Corporation](https://onco.cc/institutions/protecthealth-malaysia/)

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