Financial Toxicity Among Patients With Breast Cancer Worldwide

Abstract

ImportanceFinancial toxicity (FT) is the negative impact of cost of care on financial well-being. Patients with breast cancer are at risk for incurring high out-of-pocket costs given the long-term need for multidisciplinary care and expensive treatments.ObjectiveTo quantify the FT rate of patients with breast cancer and identify particularly vulnerable patient populations nationally and internationally.Data SourcesA systematic review and meta-analysis were conducted. Four databases—Embase, PubMed, Global Index Medicus, and Global Health (EBSCO)—were queried from inception to February 2021. Data analysis was performed from March to December 2022.Study SelectionA comprehensive database search was performed for full-text, English-language articles reporting FT among patients with breast cancer. Two independent reviewers conducted study screening and selection; 462 articles underwent full-text review.Data Extraction and SynthesisA standardized data extraction tool was developed and validated by 2 independent authors; study quality was also assessed. Variables assessed included race, income, insurance status, education status, employment, urban or rural status, and cancer stage and treatment. Pooled estimates of FT rates and their 95% CIs were obtained using the random-effects model.Main Outcomes and MeasuresFT was the primary outcome and was evaluated using quantitative FT measures, including rate of patients experiencing FT, and qualitative FT measures, including patient-reported outcome measures or patient-reported severity and interviews. The rates of patients in high-income, middle-income, and low-income countries who incurred FT according to out-of-pocket cost, income, or patient-reported impact of expenditures during breast cancer diagnosis and treatment were reported as a meta-analysis.ResultsOf the 11 086 articles retrieved, 34 were included in the study. Most studies were from high-income countries (24 studies), and the rest were from low- and middle-income countries (10 studies). The sample size of included studies ranged from 5 to 2445 people. There was significant heterogeneity in the definition of FT. FT rate was pooled from 18 articles. The pooled FT rate was 35.3% (95% CI, 27.3%-44.4%) in high-income countries and 78.8% (95% CI, 60.4%-90.0%) in low- and middle-income countries.Conclusions and RelevanceSubstantial FT is associated with breast cancer treatment worldwide. Although the FT rate was higher in low- and middle-income countries, more than 30% of patients in high-income countries also incurred FT. Policies designed to offset the burden of direct medical and nonmedical costs are required to improve the financial health of vulnerable patients with breast cancer.

Assessment of Medical and Public Assistance Expenditures and Employment Among US Adults With Cancer Diagnoses

“…However, we did not observe a statistically significant association between cancer history and earnings in the short term (<1 year) or long term. Finally, a number of studies have documented the financial toxicity associated with cancer treatment . Our study extends this result by showing that this financial burden may persist for years after cancer diagnosis.…”

Nine-Week Versus One-Year Trastuzumab for Early Human Epidermal Growth Factor Receptor 2–Positive Breast Cancer: 10-Year Update of the ShortHER Phase III Randomized Trial

“…In Western countries, a proportion of patients has to stop trastuzumab before 1 year for a variety of reasons (up to 15% of the patients in pivotal trials) or cannot start the treatment for financial reasons. 16 The figure is even more dismal if we look worldwide: according to a recently published survey on essential anticancer drugs aimed to finalize the WHO Essential Medicine List, trastuzumab is available for only 15% of the patients living in low-middle-income countries, while access to the drug would imply catastrophic expenses for 68% of the patients. 17 In conclusion, at a median follow-up of 9 years, 9 weeks of trastuzumab can guarantee 10-year DFS and OS rates of 78% and 88%, respectively, which, statistically, cannot be claimed as noninferior to the 77% DFS and 89% OS of 1-year trastuzumab.…”

Financial Toxicity in Breast Reconstruction: The Role of the Surgeon-Patient Cost-of-Care Discussion

“…4 Studies have found the incidence of financial toxicity after breast cancer treatment and reconstruction to be as high as 35.3 and 23%, respectively. 2 5…”

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The financial burden of breast cancer treatment and reconstruction has become a significant concern for patients. [1][2][3] Increasing insurance premiums combined with cost sharing in the form of coinsurance and copays can generate high outof-pocket expenditures for patients. This has created a phenomenon known as financial toxicity, defined as the negative impact high out of pocket costs can have on financial well-being, quality of life, and receipt of the highest quality care.

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