Cancer holds the second position among the non-communicable diseases under study of World Health organization (WHO)(Islam et al., 1970). The World Health Organization (WHO) estimates approximately 2.09 million new breast cancer cases each year, resulting in 627,000 deaths in 2018 that is approximately 15% of all cancer death among woman. (WHO,2018). Unsurprisingly, mortality rates are much higher in the developing world where women often only seek medical assistance and diagnosis in the late stages—unaware of what is wrong and reluctant to shell out on medical costs. (The Hindu.com) In Bangladesh, poor access to medical facilities, stigmatization along with lack of knowledge about the disease mean that a mere 11 percent of Bangladeshi women receive diagnosis in the early stages. Like in much of the world, breast cancer is the most common cancer amongst Bangladesh's female population, with 32.8 percent of female cancer patients suffering from this strain of the disease. The nation’s public medical services—overstretched and underfunded—simply cannot provide the care required by breast cancer sufferers(The Daily Star) .
Though Bangladesh is the third quickest growth in the number of high net-worth individuals in the world in the next five years, as poor people’s residence Bangladesh is in 5th position. (The Prothom alo) 2 crore 41 lacs peoples are still in extreme poverty level. Wages in Bangladesh increased to 13258 BDT/Month in 2017 from 12897 BDT/Month in 2016. The current minimum wage of 5,300 taka (the equivalent of about 63 USD) has not been revised since 2013, and it is far below any credible living wage estimate (Clean Cloth Campaign,2018). Living Wage Family in Bangladesh remained unchanged at 15100 BDT/Month in 2018 from 15100 BDT/Month in 2017 (Trading Economics,2018)
Concerns about financial burden among breast cancer patients are particularly troubling due to the costly multidisciplinary approach currently required to treat breast cancer. This multidisciplinary approach, regardless of insurance status, results in increased out-of-pocket expenses such as deductibles, and co-pays for hospitalizations and physician visits (Obeng-Gyasi S).
Patients’ reasons for late presentation were fear (40%), not aware of disease severity (40%), fear of losing a breast (40%), referral problems (34%), financial problems (8%), and transportation problems (6%). Approximately 33% sought medical help from traditional healers, and 65% regularly attended clinics. (Čačala & Gilart, 2017) Maximum cost for health care is met by Out-of-pocket expenditure. Out-of-pocket healthcare expenditures of households in Bangladesh comprise 64.3% share of the total health expenditure and collectively spent approximately Taka 103.46 billion (US$1.49 billion) in yearly on health. Hence, Out-of - pocket expenditure for health care services have been sufficiently costly in Bangladesh. However, identified factors that are associated with higher individual out-of pocket costs include advanced disease and associated medications, hormone therapy, insurance gap payments, and greater traveling distances to the hospital (L. et al., 2007).
It is reported that magnitude of cancer is increasing in a rapid pace globally. The disease poses huge burden of mortality and morbidity. Magnitude of cancer has also increased among the countries of South East Asia region. There are 13 to 15 lakh cancer patients in Bangladesh, with about two lakh patients newly diagnosed with cancer each year. About 2 lakh new cases of cancer are diagnosed each year and 13 to 15 lakh people are living with different types of cancer. (Hossain). Breast Cancer is the 3rd leading cancer in Bangladesh with overall incidence rate of 106 per 100,000 populations in Bangladesh. (Globocan 2018 ) Rising burden of cancer in Bangladesh will pose serious implications for the management and financing of the health sector. For this, health strategies may have to be reformed and activities of the health sector may have to be drastically reorganized in order to meet the challenges of the increasing burden of cancer along with other non-communicable diseases. Cancer causes serious economic damage to the households since medical care required against the disease is usually very expensive. Cancer exerts huge economic pressure both on the household economy as well as public health sector. It is imperative to estimate the disability and economic burden of cancer patients as no comprehensive and rigorous study in this regard is available at present in the context of Bangladesh. The purpose of this study is to identify the exact financial situation of the respondents; the magnitude of cancer care affected by economic which will provide data essential for formulating policies and strategies to combat this burning public health problem by determining the socio-economic condition that affects breast cancer care of Bangladeshi breast cancer patients.