Breast Cancer-Related Financial Toxicity in Sri Lanka: Insights From a Lower Middle-Income Country With Free Universal Public Healthcare

Author:

Ranawaka Sarith1ORCID,Gunarathna Sathika1,Gunasekera Sanjeeva2,Booth Christopher M34,Jalink Matthew45,Carson Laura M4,Berry Scott3,Gyawali Bishal34ORCID,Seneviratne Sanjeewa1ORCID,Wijeratne Don Thiwanka46

Affiliation:

1. Department of Surgery, Faculty of Medicine, University of Colombo , Colombo , Sri Lanka

2. National Cancer Institute , Maharagama , Sri Lanka

3. Department of Oncology, Queen’s University , Kingston, Ontario , Canada

4. Division of Cancer Care and Epidemiology, Queen’s University Cancer Research Institute , Kingston, Ontario , Canada

5. Department of Public Health Sciences, Queen’s University , Kingston, Ontario , Canada

6. Department of Medicine, Queen’s University , Kingston, Ontario , Canada

Abstract

Abstract Financial toxicity (FT) describes either objective or perceived excess financial strain due to a cancer diagnosis on the well-being of patients, families, and society. The consequences of FT have been shown to span countries of varied economic tiers and diverse healthcare models. This study attempts to describe FT and its effects in a lower- to middle-income country delivering predominantly public nonfee-levying healthcare. This was a cross-sectional study involving 210 patients with breast cancer of any stage (I to IV), interviewed between 6 and 18 months from the date of diagnosis. Financial toxicity was highly prevalent with 81% reporting 3 or more on a scale of 1 to 5. Costs incurred for travelling (94%), out-of-hospital investigations (87%), and consultation fees outside the public system (81%) were the most common contributors to FT. Daily compromises for food and education were made by 30% and 20%, respectively, with loss of work seen in over one-third. Greater FT was seen with advanced cancer stage and increasing distance to the nearest radiotherapy unit (P = .008 and .01, respectively). Family and relatives were the most common form of financial support (77.6%). In conclusion, FT is substantial in our group, with many having to make daily compromises for basic needs. Many opt to visit the fee-levying private sector for at least some part of their care, despite the availability of an established public nonfee-levying healthcare.

Publisher

Oxford University Press (OUP)

Subject

Cancer Research,Oncology

Reference24 articles.

1. Financial toxicity in cancer care: prevalence, causes, consequences, and reduction strategies;Lentz,2019

2. A systematic review of financial toxicity among cancer survivors: we can’t pay the co-pay;Gordon,2017

3. Financial toxicity among women with metastatic breast cancer;Rosenzweig;Oncol Nurs Forum,2019

4. Financial toxicity of cancer treatment: moving the discussion from acknowledgement of the problem to identifying solutions;Desai,2020

5. Measuring financial toxicity as a clinically relevant patient-reported outcome: the validation of the COmprehensive Score for financial Toxicity (COST);Souza;Cancer,2017

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