Financial Toxicity Following Surgical Treatment for Breast Cancer: A Cross-sectional Pilot Study

Asaad, Malke; Boukovalas, Stefanos; Bailey, Chad M.; Lin, Yu-Li; Teshome, Mediget; Greenup, Rachel A.; Butler, Charles E.

doi:10.1245/s10434-020-09216-9

Cited by 41 publications

(58 citation statements)

References 36 publications

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“…employment status, a majority having an annual household income > $80,000 and being married or in committed relationships. 21,30 As a result, the economically advantaged status of our study population may be a mediating factor in the relationships between FT and surgical treatment modalities. 38 Factors associated with higher FT in patients with early breast cancer include low credit score, low annual income, no supplemental insurance and a change in employment status.…”

Section: Discussionmentioning

confidence: 97%

“…Our methodology has been previously published. 21 Patients with a diagnosis of early-stage breast cancer (AJCC 8 th edition manual stages 0, I, II) that received surgical treatment within 18 calendar months from the date of initial survey deployment (June 2019) were included in the present analysis. To simplify the analysis, we restricted our cohort to unilateral disease and the receipt of either unilateral BCT, i.e.…”

Section: Study Design and Participantsmentioning

confidence: 99%

“…Our survey entailed two questionnaires that were electronically distributed: the COmprehensive Score for financial Toxicity (COST) and a 30-item questionnaire that leveraged questions from the peer-reviewed literature to highlight the "lived" experience with FT. 30 Domains captured in the later questionnaire include marital status, self-reported race, annual income, primary insurance type (Medicare, Employer-sponsored, self-pay, and individual market), credit score at the time of diagnosis, cancer-related out-of-pocket spending over the antecedent 12 months and any coping strategies used to mitigate FT. 21 Elicited responses to the 30-item questionnaire by the larger study population have also been published elsewhere. 21 The COST questionnaire consists of 11 items and is a validated PRO measure to assess financial burden in cancer patients. 31,32 COST scores range from 0 to 44 with lower scores representing higher financial distress.…”

Section: Surveymentioning

confidence: 99%

“…Coping strategies encompassed decreased spending on basic necessities, depletion of savings, treatment delays, and borrowing money to pay for care. 21…”

Section: Outcome Measuresmentioning

confidence: 99%

“…[6][7][8][9][10][11][12][13][14] Owing to its high prevalence, policy salience and breadth of treatment options, breast cancer has become the archetypal condition for FT. [15][16][17][18][19][20][21] A recently published study identified advanced clinical stage, decreasing household income, low credit score and increased out-ofpocket spending as predisposing factors for FT following surgical treatment of breast cancer. 21 Furthermore, FT has been shown to be significantly associated with a worsening of global and condition-specific quality of life among breast cancer surgical patients. [18][19][20]22 Deepening our understanding of the relationship between FT and breast cancer is especially salient in earlystage disease where surgical treatment is preference-sensitive i.e.…”

Section: Introductionmentioning

confidence: 99%

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Relationship Between Financial Toxicity and Surgical Treatment for Early-Stage Breast Cancer: A Propensity Score-Matched Comparison of Breast-Conserving Therapy and Mastectomy

Boukovalas

Asaad

et al. 2021

Journal of the American College of Surgeons

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Section: Discussionmentioning

confidence: 97%

Section: Study Design and Participantsmentioning

confidence: 99%

Section: Surveymentioning

confidence: 99%

“…Coping strategies encompassed decreased spending on basic necessities, depletion of savings, treatment delays, and borrowing money to pay for care. 21…”

Section: Outcome Measuresmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Relationship Between Financial Toxicity and Surgical Treatment for Early-Stage Breast Cancer: A Propensity Score-Matched Comparison of Breast-Conserving Therapy and Mastectomy

Boukovalas

Asaad

et al. 2021

Journal of the American College of Surgeons

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Financial Toxicity Among Patients With Breast Cancer Worldwide

Ehsan

Minasian

et al. 2023

JAMA Netw Open

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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.

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Perceived financial decline related to breast reconstruction following mastectomy in a diverse population‐based cohort

Berlin

Abrahamse

Momoh

et al. 2021

Cancer

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Background Despite mandated insurance coverage for breast reconstruction following mastectomy, health care costs are increasingly passed on to women through cost‐sharing arrangements and high‐deductible health plans. In this population‐based study, the authors assessed perceived financial and employment declines related to breast reconstruction following mastectomy. Methods Women with early‐stage breast cancer (stages 0‐II) diagnosed between July 2013 and May 2015 who underwent mastectomy were identified through the Surveillance, Epidemiology, and End Results registries of Georgia and Los Angeles and were surveyed. Primary outcome measures included patients' appraisal of their financial and employment status after cancer treatment. Multivariable models evaluated the association between breast reconstruction and primary outcomes. Results Among 883 patients with breast cancer who underwent mastectomy, 44.2% did not undergo breast reconstruction, and 55.8% underwent reconstruction. Overall, 21.9% of the cohort reported being worse off financially since their diagnosis (25.8% with reconstruction vs 16.6% without reconstruction; P = .002). Women who underwent reconstruction reported higher out‐of‐pocket medical expenses (32.1% vs 15.6% with expenses greater than $5000; P < .001). Reconstruction was independently associated with a perceived decline in financial status (odds ratio, 1.92; 95% confidence interval, 1.15‐3.22; P = .013). Among women who were employed at the time of their diagnosis, there was no association between reconstruction and a perceived decline in employment status (P = .927). Conclusions In this diverse cohort of women who underwent mastectomy, those who elected to undergo reconstruction experienced higher out‐of‐pocket medical expenses and self‐reported financial decline. Patients, providers, and policymakers should be aware of the potential financial implications related to reconstruction despite mandatory insurance coverage.

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Financial Toxicity Following Surgical Treatment for Breast Cancer: A Cross-sectional Pilot Study

Cited by 41 publications

References 36 publications

Relationship Between Financial Toxicity and Surgical Treatment for Early-Stage Breast Cancer: A Propensity Score-Matched Comparison of Breast-Conserving Therapy and Mastectomy

Relationship Between Financial Toxicity and Surgical Treatment for Early-Stage Breast Cancer: A Propensity Score-Matched Comparison of Breast-Conserving Therapy and Mastectomy

Financial Toxicity Among Patients With Breast Cancer Worldwide

Perceived financial decline related to breast reconstruction following mastectomy in a diverse population‐based cohort

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