The Faculty of Medicine, Universiti Malaya proudly congratulates Veni Venusha Sakti A/P Indrasathi on the successful completion of her Doctor of Philosophy viva voce held on 12 May 2026. Her thesis, entitled “Validation and Application of the COST Questionnaire for Assessing Financial Toxicity Among People Living with Cancer in an Upper Middle-Income Country with Universal Health Coverage”, represents a timely and significant contribution to cancer care research and public health in Malaysia.
Short Summary of the Thesis
Financial toxicity, the economic burden and financial distress experienced by patients undergoing cancer treatment, has emerged as a major global healthcare concern. Despite Malaysia’s universal health coverage system, many patients with cancer continue to face substantial financial hardship that affects their quality of life and access to care.
In this doctoral research, Veni Venusha Sakti validated the English and Malay versions of the Comprehensive Score for Financial Toxicity (COST) questionnaire for use among Malaysian patients with cancer. Through rigorous psychometric evaluation and longitudinal analyses involving patients from both public and private healthcare institutions across Malaysia, the study demonstrated that the COST questionnaire is a reliable and culturally appropriate tool for assessing financial toxicity in Malaysia’s multiethnic population.
Importantly, the research established a clinically meaningful threshold for identifying high financial toxicity and revealed that approximately one in five patients with cancer experienced significant financial hardship. The study further identified socioeconomic vulnerability, particularly low income, unemployment, and lower educational attainment, as key determinants of financial toxicity. Structural inequities in healthcare delivery and geographical disparities also contributed substantially to patient burden.
The findings underscore the urgent need for routine financial toxicity screening and targeted interventions to support vulnerable patients within Malaysia’s oncology care system.
Highlight of the Candidate’s Achievements
This thesis demonstrates several remarkable scholarly achievements:
- Successful validation of both English and Malay versions of the COST questionnaire for Malaysian clinical settings.
- Development of evidence-based cut-off scores for identifying patients at high risk of financial toxicity.
- Generation of one of the first comprehensive longitudinal datasets examining financial toxicity among people living with cancer in Malaysia.
- Identification of critical socioeconomic and structural determinants influencing financial hardship despite universal health coverage.
- Contribution of locally relevant evidence to support equitable cancer care policies and patient-centred healthcare interventions.
The study reflects methodological rigour, strong analytical capability, and a deep commitment to improving patient outcomes and healthcare equity.
Contribution to Public Health
This research has substantial implications for public health, health economics, and oncology care in Malaysia and other upper middle-income countries with universal health coverage systems.
By demonstrating that financial hardship persists even within subsidised healthcare environments, the study challenges assumptions that universal health coverage alone is sufficient to protect patients from economic burden. The findings provide policymakers, clinicians, and healthcare institutions with actionable evidence to strengthen supportive care services, implement routine financial screening, and design interventions targeting vulnerable populations.
Moreover, the validated COST questionnaire offers healthcare providers a practical and standardised tool for identifying patients at risk of severe financial distress, thereby enabling earlier intervention and more holistic cancer care.
This work contributes meaningfully towards advancing health equity, improving quality of life for patients with cancer, and informing sustainable healthcare policy development in Malaysia and beyond.
Acknowledgement
We wish to acknowledge the invaluable guidance and mentorship provided by Veni Venusha Sakti A/P Indrasathi’s supervisors, Professor Dr. Nirmala Bhoo Pathy and Adjunct Professor Dr. Mahmoud Danaee, whose expertise and support were instrumental in the completion of her thesis.
We extend our sincere gratitude to Professor Dr. John Ele-Ojo Ataguba, University of Manitoba Winnipeg, Canada, and Professor Dr. Mark Cheong Wing Loong, Monash University Malaysia, as External Examiners, as well as Dr. Ainol Haniza Kherul Anuwar, Internal Examiner.
We would also like to thank the Committee of Examiners for their thorough evaluation and insightful feedback, including Professor Dr. Azlina Amir Abbas, Chairperson of the viva voce session; Professor Dr. Victor CW Hoe, Head of Department, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya; and all members of the examination committee for their academic contributions and support throughout the viva voce process.
Congratulations and Future Expectations
Heartiest congratulations to Dr. Veni Venusha Sakti A/P Indrasathi on this outstanding academic accomplishment. The successful completion of this doctoral journey reflects not only scholarly excellence, but also perseverance, dedication, and a strong commitment to addressing real-world healthcare challenges.
Her research stands as an important contribution to cancer care, health equity, and public health policy. It is anticipated that her work will continue to influence future research, clinical practice, and policy initiatives aimed at reducing the financial burden experienced by patients with cancer.
We wish Dr. Veni Venusha Sakti continued success in her future academic, research, and professional endeavours, and look forward to her continued contributions towards advancing equitable healthcare and improving patient well-being locally and globally.
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