Introduction: Breast cancer is on rise and cervix cancer is on declining mode according to the cancer registry data in India. The major mode of financing treatment is out-of-pocket (OOP) and this can push 25% of the cancer affected households below the poverty line. Materials and Methods: A cross-sectional descriptive study with a household perspective was done in the state of Punjab. By using probability proportional to the size method and systematic random sampling, the sample was drawn from every district of Punjab. A face-to-face semi-structured interview schedule was administered to 221 patients. Results: The direct cost contributed 79% toward the total cost-of-illness. The cost of drugs (36.23%) followed by cost of hospitalization (27.05%) and productivity loss (13.44%) were the main contributors toward the total cost of illness. The contribution of indirect cost is 21 per cent of the total cost. The cost of treatment depends upon type of facility used (more in private as compared to the public), stage of cancer (stage above first stage cost more than the first stage), and age at the time of diagnosis aged above sixty incurred more expenditure as compared to the aged below sixty. The 84% of the households had experienced the catastrophic health expenditure (CHE) and 51% of the households had faced distress financing (DF). The main financial coping strategies*(*multiple strategies) used were saving (74%), borrowing at low rate of interest (88%), social nets (55%), and selling financial assets (30%).

The comparative studies on grading in subarachnoid hemorrhage (SAH) had several limitations such as the unclear grading of Glasgow Coma Scale 15 with neurological deficits in World Federation of Neurosurgical Societies (WFNS), and the inclusion of systemic disease in Hunt and Hess (H&H) scales. Their differential incremental impacts and optimum cut-off values for unfavourable outcome are unsettled. This is a prospective comparison of prognostic impacts of grading schemes to address these issues. SAH patients were assessed using WFNS, H&H (including systemic disease), modified H&H (sans systemic disease) and followed up with Glasgow Outcome Score (GOS) at 3 months. Their performance characteristics were analysed as incremental ordinal variables and different grading scale dichotomies using rank-order correlation, sensitivity, specificity, positive predictive value, negative predictive value, Youden's J and multivariate analyses. A total of 1016 patients were studied. As univariate incremental variable, H&H sans systemic disease had the best negative rank-order correlation coefficient (-0.453) with respect to lower GOS (p < 0.001). As univariate dichotomized category, WFNS grades 3-5 had the best performance index of 0.39 to suggest unfavourable GOS with a specificity of 89% and sensitivity of 51%. In multivariate incremental analysis, H&H sans systemic disease had the greatest adjusted incremental impact of 0.72 (95% confidence interval (CI) 0.54-0.91) against a lower GOS as compared to 0.6 (95% CI 0.45-0.74) and 0.55 (95% CI 0.42-0.68) for H&H and WFNS grades, respectively. In multivariate categorical analysis, H&H grades 4-5 sans systemic disease had the greatest impact on unfavourable GOS with an adjusted odds ratio of 6.06 (95% CI 3.94-9.32). To conclude, H&H grading sans systemic disease had the greatest impact on unfavourable GOS. Though systemic disease is an important prognostic factor, it should be considered distinctly from grading. Appropriate cut-off values suggesting unfavourable outcome for H&H and WFNS were 4-5 and 3-5, respectively, indicating the importance of neurological deficits in addition to level of consciousness.

Serum albumin levels following SAH can be useful to predict development of NND, while its further weekly decrease correlates independently with unfavourable outcome at 3 months. Albumin assessment being readily available may serve as more than a mere nutritional parameter in SAH.

No abstract

No abstract