title: The burden of cancer and its distribution and consequences for Australia: evidence from health economic evaluation and advanced statistical modelling
Creators: name: Mahumud, Md Rashidul Alam
Publisher: name: University of Southern Queensland
Year: 2020
Subjects: subject: 010402 Biostatistics
subject: 111706 Epidemiology
subject: 140208 Health Economics

description: Cancer is expected to rank as the most significant global public health problem and a leading cause of death and illness in the world in the 21st century. The burden of cancer is rapidly increasing globally, including Australia. The responses to this growing burden of cancer have been limited owing to a poor understanding of the long-term burden of cancer and its consequences. The overarching aim of this thesis is to investigate the burden of cancer on patients, households, as well as on society over time. This thesis also aims to generate evidence for health policymakers, who make nationwide cancer control and management decisions on cancer prevention (e.g., cancer vaccination) and cancer treatment programs. This thesis has examined the burden of cancer using a geographical lens, including regional, rural, and remote areas in Australia. To accomplish this aim, five empirical studies for assessing the impact of the cancer burden in terms of long-term cancer outcomes (an incidence-based approach); health status burden, chronic comorbid conditions, productivity-related work disability (mixed longitudinal approach); and the economics of cancer vaccination (economic evaluation) have been conducted.

This thesis is constructed using three main themes of study including ‘understanding the challenges of cancer outcomes’, ‘the long-term cancer burden (i.e., health status burden, chronic comorbid conditions, productivity-related work disability, and its consequences)’, and ‘evaluation of cancer vaccination’ in the context of Australia. These inter-related studies result in a thesis by publication. These studies are constructed based on a quantitative approach, using health economic evaluation and advanced statistical modelling. The thesis is based on six articles, national health data sets are utilised for the first article, three of them (Articles 2 to 4) being mixed-longitudinal nature survey-data driven from the Household Income and Labour Dynamics in Australia survey, and two of them (Articles 5 and 6) based on national and international contexts and published data sources related to cancer and health economics modelling.

The findings of this thesis have been theorised inductively, which means the analytical exploration has been data-grounded, rather than theory-dictated. In this thesis, every finding is underpinned by a suitable theoretical framework. Three inductively generated theories are adopted: social conflict theory, stress-coping theory, and portfolio theory perspectives.

The thesis revealed that all of these factors (e.g., cancer incidence, hospitalisation, cancer-related mortality, and burden of cancer) increased significantly over the period. Furthermore, survival inequality was most pronounced for cervix, prostate, melanoma, Non-Hodgkin Lymphoma, and breast cancers. Additionally, socioeconomically disadvantaged people were more likely to bear an increasing cancer burden in terms of incidence, mortality, and death. The findings of the thesis showed that approximately 36% of cancer patients had an initial high health status burden in 2013, which had declined significantly to 21% by 2017. Adequate levels of sleep, physical activity, social support, and higher economic status were significantly associated with improving health status.

This thesis revealed that 61% of cancer patients experienced at least one chronic condition over the period, and 21% of patients experienced three or more chronic conditions. An inadequate level of physical activity, patients who suffered from extreme health burden or moderate health burden, and patients living in the poorest households were significantly associated with a higher risk of chronic comorbid conditions. This research also found that approximately 50% of cancer patients had experienced with long-term productivity-related work disability, 18% of patients had experienced extreme work disability, which was more pronounced with the magnitude of their health status burden. Finally, cancer prevention program (cancer vaccination) demonstrated ‘good value for money’, if the adopted vaccination strategies could accomplish a high vaccination coverage and provide protection. With a continued assessment of the potential vaccine properties as well as vaccine delivery and scale-up strategies, the two-dose 9vHPV vaccine would provide significant health and economic benefits for preadolescents and society.

This thesis provides a better understanding of the challenges of cancer outcomes and long-term consequences on health status burden, chronic comorbid conditions, and productivity-related work disability, and has provided an evaluation of cancer vaccination for preventing cancer-related infections, along with contributing to the ongoing debate of cancer research. The findings are also significant for health care providers, including physical therapists and oncologists, who must manage the unique problems that challenge this population and who should advocate for prevention and evidence-based interventions that incorporate comprehensive social supports. The findings of this thesis will contribute to the decision-making process regarding the prevention of cancer illness, better outline the management of a sequelae course of treatment for cancer survivors, both of which aim to reduce the long-term burden in Australia.