The Effect of Socio-Economic Standing On

Cancer Patients Disease Management Process

A Research Plan constructed by:

Asesor, Rupert RN
Pasamonte, Kaylie RN
Peros, Ann Margarett RN
Teglia, Olivia RN

Background of the Study

There are disproportions in groups of people suffering
from cancer. Factors relating to disproportion are
Race, Belief and Health Care Coverage (National
Cancer Institute,2008)
Cancer is an expensive disease, and sometimes
terminal. Managing cancer does not involve cure but
alleviation of its symptoms. Treatment varies
depending from what type of cancer you have.
However, some of these treatments are given
chronically, there are one-shot-wonders but with
metastatic cancer one-time treatment rarely occurs.

Background of the Study

There are researches that had tackled such
disparity. Most research conducted in American
soil. They had identified prevalence of cancer
among race and age and gender and these
studies had helped in programs to reduce the
incidence of cancer through involve population.
The progress of such programs over the decade
are regrettably slow and more research on cancer
disparity and equity is needed to identify other
factors that could affect the incidence of mortality
and morbidity among people with cancer.

Review of Related Literature

In the article Health Disparities in Cancer one of the main
factors for cancer survival is the patients social economic
status. The article defined social status as the educational
attainment of a person and the economic status as the
ability of the person to avail certain medical treatment or
regimen. The article mentioned that a person who has a
high social and economic status tend to have higher cancer
survival since he/she is more knowledgeable upon the
understanding of the disease, its process and management
and urgency and health care need. Moreover, a person who
has high financial stability could afford in spending for
diagnostic and treatment. Thus, these factors could affect
the behavior of a person to undergo medical treatment.
(Center for Control and Disease Prevention 2014)

Related Studies
Developed countrys mortality rates relatively
decreased due to increasing standard in
healthcare, however people with low socioeconomic status greatly suffer in higher
mortality rates that was the findings showed on
the literature review of Feinstein in his study
The relationship between socio-economic status
and health: a review of related literature.
Furthermore, the study recommended to explore
more on reasons of continuous existence of low
socio-economic status in developed countries.

Related Studies
These findings put more weight that
according to the study Impact of Socioeconomic status in etiology and
management of urinary stone disease by
Ansari and Gupta, the main concern in
developing countries is a good medical
insurance system. For the study proposed
that a country providing financial support to
medical insurance system would greatly
contribute to the health needs of its people.

Related Studies
A qualitative study conducted to determine the
how the patients socio-economic status
influence the physicians clinical management
decisions. Findings showed that patients socioeconomic status greatly influence medical
regimen. The respondents observed that upon
recommending such medical regimen they find it
hard for the patients to comply and they have to
consider patients socio-economic status prior to
providing such medical management or
treatment. (Bernheim MD et. al. 2008)

Related Studies
Chronically ill patients were facing economic stressors due
to having high cost in medical treatment. Such socioeconomic status found to be responsible and the
expensive medical regimen resulting in increase in
morbidity of patients. The study mentioned that patients
ability to afford health care regimen is a factor in decisionmaking whether patient would adhere to treatment or not.
This is based on the study Economic hardship associated
with managing chronic illness: a qualitative inquiry.
Moreover, study recommended formulation of policy
addressing this economic problem people of the country is
experiencing. (Yun-Hee Jeon, Beverley Essue, Stephen Jan,
Robert Wells and Judith A Whitworth 2009)

Related Studies
In relation to cancer, a systematic review of
studies in Cancer Survival by Socioeconomic
status in seven countries found that patients
who have higher socioeconomic status have
greater chance of survival such cancer are in
colon, rectum, breast, and cervix. In addition,
the researchers recommended to plan a
program to bridge the gap between
socioeconomic status and mortality of cancer
patients. (Carola T M Schrijvers, Johan P
Mackenbach)

Related Studies
Socioeconomic status has been know as one of the key
determinant of the increasing incident of cancer, cancer stages
as well as the choice of treatment. A study conducted on Qilu
Hospital in China entitled The effect of socioeconomic status on
health-care delay and treatment of esophageal cancer explains
that socioeconomic status was found to be connected to health
care-delay, tumor stage, treatment modalities in esophageal
cancer through a multi-variable logistic regression analysis. It is
shown in the study that a delay of care in more than 2 months is
seen in patients having esophageal cancer with low
socioeconomic status. A surgical resection was less performed in
patient with higher socioeconomic status and treatment for
chemotherapy had a three-fold likelihood as compared to those
with low socioeconomic status due to high cost of the
medications used. ( Wang et al. 2015)

Related Studies
In a study of survival data from eight cancer namely lung
cancer, multiple myeloma, gastric cancer, pancreatic
cancer, breast cancer, Hodgkins disease and Leukema
Group B using a retrospective study considering the
difference in survival rate attributable to type of cancer,
performance status, age, protocol specific predictor of
survival time and the connection of socioeconomic status is
evaluated. It was concluded that people with lower income
and lower educational level showed survival time
significantly shorter. It is also emphasized the need for
provision of treatment programs which includes education
regarding treatment and compliance even after initial
diagnosis and treatment is started. SES is related to survival
independence in fighting cancer. (Maurer LH et al.)

Conceptual Framework

Figure 1. The Effect of Socio-Economic Standing on the Disease

Management Process

Theoretical Framework

Statement of the problem

This study would explore the effect of socio-economic standing of
individuals with metastatic cancer to their ability to manage and
undergo treatments for their disease. In lieu of this, the study will aim
to answer the following:
1. What are the socio-economic data of respondents?
a. Age
b. Gender
c. Civil Status
d. Educational attainment
e. No. of dependents in family
f. Employed or Unemployed (including whether it is Blue or White
collar)
g. Estimated monthly income
h. Subsidy from government (if applicable)

Statement of the problem

2. What socio-economic standing to these respondents
belong?
a. Lower class
b. Middle Class
c. Upper Class
3. What disease management do the respondents undergo
a. Medical (medications, hospital or clinic procedures or
treatments)
b. Traditional
c. Mixed
d. No regimen

Statement of the problem

4. How do the respondents perform this regimen in
terms of:
a. Ability to attend treatments
b. Availability of medication/substances (regular,
intermittent, lapsed)
c. Unable to perform both
5. What is the effect of the socio-economic standing
of respondent to his disease management?

Hypotheses
H0 : There is no relationship between
the respondents socio-economic
standing and his disease management
process

Definition of Terms
Socio-Economic Data
Pertains to the respondents in terms of, 1) Age, 2) Gender, 3) Civil Status
4) Educational Attainment, 5) No. of dependents in family, 6) Employed or Unemployed (including
whether it is Blue or White collar) and their, 7) Estimated monthly income
Socio-Economic Standing
Refers to the present social class in which the respondents belong, Lower class,
Middle class and
Upper class. Classifications would be based on the Distribution of Families by Income Class by Main
Source of Income Table year 2012 from the Philippine Statistics Authority [1]. Lower Class these are
the respondents that belong to a family with an annual income of under Php40,000 up to
Php59,999. Middle Class would encompass respondents with families earning PHP60,000 up to
Php249,999 annually. Meanwhile, Upper Class are respondents from a family that earns Php250,000
and above annually.
Disease Management Process
Health practices of respondents that address their health problem as well as their capability to
maintain said practices, that may or may not be reflected by their socio-economic standing.
Dynamic Systems Model
The conceptual model of Imogene King in her Theory of Goal Attainment. The model termed three
systems an individual can move to be able to perform and achieve his goals.

Methodology
Research Design
- The study utilizes a comparative design. In
a comparative design the independent
variable is left as it is and the dependent
variable is measured in two or more groups.
This study will show Socio-Economic
Standing of clients with metastatic cancer
and will compare their Disease
Management Processes according to their
standing.

Methodology
Sample
Cluster sampling will be utilized for 3
Barangay in Metro Manila. From
these Barangay the researchers
would identify those diagnosed with
metastatic cancer as their Sample
and will proceed to gather data using
their selected techniques.

Methodology
Setting
The data collection will be performed
within 3 Barangay of Metro Manila over
the last week of August 2016.

METHODOLOGY
Measures
The researchers will use structured questionnaire to determine the effect of
The Effect of Socio-Economic Standing on Cancer Patients Disease
Management Process
The first part of questionnaire is to determine the socio-economic data of
the respondents such as:
a. Age
b. Gender
c. Civil Status
d. Educational attainment
e. No. of dependents in family
f. Employed or Unemployed (including whether it is Blue or White collar)
g. Estimated monthly income
h. Subsidy from government (if applicable)

METHODOLOGY
The second part of the questionnaire is
to classify the respondents according
to the following socio-economic
standing:
a. Lower class
b. Middle Class
c. Upper Class

METHODOLOGY
The third part of the questionnaire is to
gather data on what are the kinds of
disease management process the
patients have in terms of:
a. Medical (medications, hospital or
clinic procedures or treatments)
b. Traditional
c. Mixed
d. No regimen

METHODOLOGY
The fourth part of the questionnaire is
to determine the manner how the
respondents perform this regimen in
terms of:
a. Ability to attend treatments
b. Availability of
medication/substances
( regular,
intermittent, lapsed)
c. Unable to perform both

METHODOLOGY
Procedures
The researchers choose controlled interview
approach to gather data. With closed-ended
questions providing direction on the
conversation the researcher will be able to
screen and plot the response on their data
sheet. This will also provide a more
systematic and purposeful conversation
among researcher and respondent.

METHODOLOGY
First, 3 Barangay will be chosen. Second the
researchers will proceed with the Community
clinic to review pertinent data and identify
the residents with medical history of cancer
to be potential respondents. From there the
conduction of interview via questionnaire will
be performed. Once researchers are satisfied
with the completion of data collection,
interpretation and analysis will ensue.

METHODOLOGY
Data Analysis
Measures of Central Tendency. The mean, median and mode will
use as a determinant on the socio-economic profile of the respondents
Frequency Distribution. The frequency distribution will use to treat
data of socio-economic standing and profile of the respondents.
Standard Deviation. This statistical treatment will be used to
determine the relationship of the variables with are the socioeconomic
standing of respondents such as the lower class, middle and upper
class to the disease management process such as the medical,
naturopathic, mixed or no management regimen respondents
undergone to.

METHODOLOGY
Limitations of the Study
The study will tackle about socio-economic
standing of respondents and their disease
management process but will be limited to
respondents residing within the 3 Barangay
identified and diagnosed with a metastatic
type of cancer. The data collection would
last a week and will be conducted on the
last week of August 2016

References
Cancer Health Disparities. National Cancer Institute. July 2016:
http://www.cancer.gov/research/areas/disparities
Cancer patient survival by socioeconomic status in The Netherlands: a review for six common cancer sites Schrijvers C Mackenbach J Journal of
Epidemiology and Community HealthJ7 Epidemiol Community Health 1994 vol: 4848
http://search.proquest.com/openview/861a6e11b07ab85b1dc74e0943498396/1.pdf?pq-origsite=gscholar
Impact of socioeconomic status in etiology and management of urinary stone disease. Ansari M Gupta N
Urologia internationalis 2003 vol: 70 (4) pp: 255-61 www.ncbi.nlm.nih.gov/pubmed/12776701
The Relationship between Socioeconomic Status and Health: A Review of the Literature. Feinstein J. The Milbank Quarterly 1993 vol: 71 (2) pp:
279 www.jstor.org/stable/3350401?origin=crossref
Economic hardship associated with managing chronic illness: a qualitative inquiry Jeon Y Essue B Jan S Wells R Whitworth J et. al. BMC Health
Services Research 2009 vol: 9 (1) pp: 182 bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-9-182
Influence of patients' socioeconomic status on clinical management decisions: a qualitative study. Bernheim S Ross J Krumholz H Bradley E
Annals of family medicine 2008 vol: 6 (1) pp: 53-9.
www.ncbi.nlm.nih.gov/pubmed/18195315
http://www.cdc.gov/cancer/healthdisparities/basic_info/challenges.htm
Distribution of Families by Income Class, by Main Source of Income and by Region. Philippine Statistics Authority. December 2013:
http://psa.gov.ph/content/2012-fies-statistical-tables
Journal of Translational Medicine. The effect of socioeconomic status on health-care delay and treatment of esophageal cancer. Wang et al., 2015
http://www.ncbi.nlm.nih.gov/pubmed/2072149