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

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.

Medical undergraduates' perceptions on the end of course assessment in Surgery in a developing country in South Asia.

OBJECTIVE: This study reports findings from a feedback assessment conducted among final year medical undergraduates on the end of course assessment in Surgery. A self-administered questionnaire was used among 201 final year medical undergraduates of the Faculty of Medicine Colombo to collect students' perceptions on clinical assessment (i.e. long and short cases), performance of examiners during clinical assessments and student perceptions on different types of undergraduate assessments in Surgery. RESULTS: Approximately 90% of undergraduates perceived that both long and short case assessments were fair in assessing their knowledge and clinical skills. On the overall assessment in Surgery, approximately 90% agreed that tasks reflected those taught, assessment covered a wide area of knowledge and skills in Surgery and time given for assessment was adequate. Most felt long case to be the best method in assessing whether one is a safe doctor with good communication skills and ability to apply knowledge practically. Thus, a majority of students were satisfied with the current assessment system and most perceived the clinical component to be superior to all other components in assessing whether a student is suitable to become a good and a safe doctor.

Assessment of the quality of patient-oriented information over internet on testicular cancer.

BACKGROUND: This study aimed to assess the quality and readability of patient education information available on the internet on testicular cancer. METHODS: Internet searches were performed using the keywords 'testicular cancer', 'testicular tumour', 'testicular tumor', 'testicular malignancy', 'germ cell tumour' and 'germ cell tumor' using Google, Yahoo! And Bing search engines with default settings. The first 50 web links appeared in each search engine were evaluated for their readability by using the validated Flesch Reading Ease Score (FRES) while accessibility, usability and reliability were assessed using the LIDA tool. The quality was assessed using DISCERN instrument. Non-parametric tests were used for statistical analysis. RESULTS: Overall, 900 websites were assessed and 62 websites were included in the analysis. Twenty two (22) websites (35.5%) were certified by Health on the Net Foundation code of conduct (HON code). The majority (n = 57, 91.9%) were non-governmental websites. The median FRES score was 51.6 (range: 28.1-74.1), the overall median LIDA score was 115 (range: 81-147); accessibility 55 (range: 46-61), reliability 22 (range: 8-45) and usability 38.5 (range: 21-50), while the median DISCERN score was 43.5 (range: 16-69). The DISCERN score was significantly associated with the overall LIDA score and usability and reliability components of the LIDA score (p < 0.001). However, no significant associations were observed between readability and accessibility. A significant correlation was noted between usability and reliability components of the LIDA score (Spearman's rho: 0.789, p < 0.001). CONCLUSION: In this study, the readability, reliability and quality scores of most websites were found to be suboptimal and hence, there is potential for improvement. As the internet is expanding rapidly as a readily available source of information to the public, it is essential to implement steps to ensure that highest quality information is provided without any commercial motivation or bias.

Ethnic, socio-demographic and socio-economic differences in surgical treatment of breast cancer in New Zealand.

BACKGROUND: Indigenous Maori are known to experience inferior quality cancer care compared with non-Indigenous Europeans in New Zealand. However, limited data are available on ethnic/socio-economic differences in surgical treatment of breast cancer, or reasons for such variations within the local context. We investigated ethnic/socio-economic differences in rates of mastectomy, sentinel node biopsy (SNB), post-mastectomy breast reconstruction and definitive local therapy for breast cancer in New Zealand. METHODS: A retrospective review of prospective data in the Waikato Breast Cancer Register for women diagnosed during 1999-2012 was performed. Differences in rates of mastectomy (for stage I/II, T1/T2 cancers), SNB (for stage I/II, T1/T2, cN0 cancers), post-mastectomy breast reconstruction (for non-metastatic cancers in women <70 years) and definitive local therapy (for stage I/II cancers) were analysed in univariate and multivariate regression models, adjusting for covariates. RESULTS: Significantly lower mastectomy and higher reconstruction rates were associated with younger age, private compared with public hospital care and screen compared with non-screen detection. Compared with NZ Europeans, Maori (41% versus 33%, P = 0.025) were significantly more likely to undergo mastectomy for cancers, which were potentially amenable for breast conserving surgery, but were significantly less likely to undergo post-mastectomy breast reconstruction (12% versus 35%, P < 0.001). No significant ethnic or socio-economic differences were observed in rates of SNB or definitive local therapy. CONCLUSIONS: This study has demonstrated lower rates of breast conserving surgery and reconstructions in Maori compared with NZ European women, and highlight the need for future research to focus on understanding the reasons behind these findings.