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. This article describes financial toxicity in a nonfee-levying healthcare system in South Asia to better enable care providers to be sensitive to the implications of their prescribed therapy and provide patient-centred care.

Automated summary

Financial toxicity refers to the excessive financial burden caused by a cancer diagnosis, which affects the well-being of patients, families, and society. This study investigated the prevalence and effects of financial toxicity in a lower- to middle-income country with predominantly public nonfee-levying healthcare. The results showed that financial toxicity was highly prevalent, leading to significant compromises in daily life. Despite the availability of public nonfee-levying healthcare, many patients still chose to seek care in fee-levying private healthcare sector.