'Burden to others' as a public concern in advanced cancer:a comparative survey in seven European countries

Background: Europe faces an enormous public health challenge with aging populations and rising cancer incidence. Little is known about what concerns the public across European countries regarding cancer care towards the end of life. We aimed to compare the level of public concern with different symptoms and problems in advanced cancer across Europe and examine factors influencing this. Methods: Telephone survey with 9,344 individuals aged >= 16 in England, Flanders, Germany, Italy, Netherlands, Portugal and Spain. Participants were asked about nine symptoms and problems, imagining a situation of advanced cancer with less than one year to live. These were ranked and the three top concerns examined in detail. As 'burden to others' showed most variation within and between countries, we determined the relative influence of factors on this concern using GEE and logistic regression. Results: Overall response rate was 21%. Pain was the top concern in all countries, from 34% participants (Italy) to 49% (Flanders). Burden was second in England, Germany, Italy, Portugal, and Spain. Breathlessness was second in Flanders and the Netherlands. Concern with burden was independently associated with age (70+ years, OR 1.50; 95%CI 1.24-1.82), living alone (OR 0.82, 95%CI 0.73-0.93) and preferring quality rather than quantity of life (OR 1.43, 95%CI 1.14-1.80). Conclusions: When imagining a last year of life with cancer, the public is not only concerned about medical problems but also about being a burden. Public education about palliative care and symptom control is needed. Cancer care should include a routine assessment and management of social concerns, particularly for older patients with poor prognosis

Ageing and Long-Term Care: Key Challenges in Long-Term Care Coverage for Public and Private Systems

Ageing populations in developed countries are being driven by strong social and structural demographic movements leading to a significant growth in the over 65 population. In the light of this, long-term care costs will be a major threat to individual assets and public finances over the next 40 years. Existing public schemes covering long-term care exhibit some significant issues, driven by pay-as-you-go designs combined with weak risk definitions. These difficulties will accelerate the need for new financing sources to cover the risk and call for early preparation by both public and private sectors. A new and advantageous public–private partnership has to be invented to meet the ambition of a sustainable and universal coverage. Against this background, key challenges facing the insurers include increasing public awareness of long-term care costs and challenges, risk monitoring and designing innovative and robust solutions for both wealth accumulation and protection products. The Geneva Papers (2009) 34, 24–34. doi:10.1057/gpp.2008.41

Economic Convergence In Ageing Europe

European regions experience accelerating ageing, but the process has substantial regional variation. This paper examines the effect of this variation on regional economic cohesion in Europe. We measure the effect of convergence or divergence in the share of the working age population on convergence or divergence in economies of NUTS 2 regions. The effect of convergence or divergence in ageing on economic convergence or divergence is quite substantial and, in some cases, is bigger than the effect of changes in productivity and labour force participation. Convergence of ageing leads to economic convergence only when the share of the working age population in rich regions exceeds that in poor regions and the former regions experience a substantial decline in the share of the working age population, or the latter regions experience an increase. During 2003–12, an inverse relationship between convergence in ageing and economic convergence was the rule rather than the exception