Exploring Unmet Needs from an Online Metastatic Breast Cancer Support Group: A Qualitative Study.

Background and Objective: Despite the increasing treatment options for patients with metastatic breast cancer (MBC), unmet needs remain common, especially in low and middle-income countries where resources are limited and MBC patients face many challenges. They often join support groups to cope with their unmet needs. Currently, many MBC patients connect with each other via online support group in view of the constant availability of support and rapid information exchange. The objective of this study is to determine the unmet needs of women with MBC from an online support group. Material and Methods: Messages in an online support group of twenty-two MBC patients over a period of three years from August 2016 till August 2019 were thematically analyzed. Results: Three themes were generated, (1) unmet information needs (2) unmet financial needs (3) unmet support needs. Women needed information on side effects of treatment, new treatment options and availability of clinical trials. Although Malaysia has universal health care coverage, access to treatment remains a major challenge. When treatment was not available in the public hospitals, or waiting lists were too long, women were forced to seek treatment in private hospitals, incurring financial catastrophe. Insufficient private insurance and inadequate social security payments force many women to consider stopping treatment. Women felt that they were not getting support from their clinicians in the public sector, who were quick to stop active treatment and advise palliation. On the other hand, clinicians in the private sector advise expensive treatment beyond the financial capability of the patients. Women with families also face the challenge of managing their family and household in addition to coping with their illness. Conclusions: There is a need for healthcare professionals, policy makers, and civil society to better address the needs of MBC patients through patient-centered, multidisciplinary and multi-organizational collaboration.

Paraduodenal hernia with situs inversus abdominalis: A case report.

INTRODUCTION & IMPORTANCE: Situs Inversus Abdominalis (SIA) & Paraduodenal Hernias (PDH) are extremely rare causes acute surgical emergencies among adults. We present a case of an adult patient with intestinal obstruction secondary to PDH through the fossa of Landzert with concurrent SIA. PRESENTATION OF CASE: A thirteen-year-old Southeast Asian female with situs inversus abdominalis due to Kartagener syndrome presented with bowel obstruction. The patient failed conservative management and required surgical intervention. A diagnostic laparoscopy was done followed by laparotomy. Intraoperatively, there was a paraduodenal mesentery defect at the duodenojejunal junction with internal herniation of the terminal ileum and caecum. Successful reduction of bowels and closure of the mesentery defect was done without any bowel resection. DISCUSSION: Only three cases of bowel obstruction secondary to SIA have been documented in literature. This is the fourth and the only case to have concurrent paraduodenal hernia. Surgical repair of PDH is mandatory to avoid the increased risk of incarceration or strangulation however pre-operative diagnosis of PDH resembles a diagnostic challenge especially among patients with intestinal anomalies. CONCLUSION: Intestinal malrotation is known to be the most common cause of intestinal obstruction in patients with intestinal anomalies. However, clinicians should maintain a high index of suspicion of intestinal herniation and adhesions as the cause of intestinal obstruction in such cases. Further imaging such as computed tomography (CT) scan and diagnostic laparoscopy may be beneficial provided patients have no overt signs of acute bowel ischaemia.