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

Berlin, Nicholas L.; Abrahamse, Paul; Momoh, Adeyiza O.; Jagsi, Reshma; Hamilton, Ann S.; Ward, Kevin C.; Hawley, Sarah T.

doi:10.1002/cncr.34048

Cited by 7 publications

(5 citation statements)

References 35 publications

(46 reference statements)

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“…That CHE and employment outcomes are affected by annual household income is consistent with previous studies on FT among BC patients ( 2 , 27 , 36 , 37 ). Other studies have even demonstrated an association between income and survival after treatment for cancer ( 38 ).…”

Section: Discussionsupporting

confidence: 90%

Catastrophic health expenditures, insurance churn, and non-employment among women with breast cancer

Berlin,

Albright,

Moss

et al. 2024

JNCI Cancer Spectrum

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Background Breast cancer treatment and survivorship entails a complex and expensive continuum of subspecialty care. Our objectives were to assess catastrophic health expenditures, insurance churn, and non-employment among women younger than 65 years who reported a diagnosis of breast cancer. We also evaluated changes in these outcomes related to implementation of the Affordable Care Act. Methods The data source for this study was the Medical Expenditure Panel Survey (2005-2019), which is a national annual cross-sectional survey of families, providers, and insurers in the United States. To assess the impact of breast cancer, comparisons were made with a matched cohort of women without cancer. We estimated predicted marginal probabilities to quantify the effects of covariates in models for catastrophic health expenditures, insurance churn, and non-employment. Results We identified 1,490 respondents younger than 65 years who received care related to breast cancer during the study period, representing a weight-adjusted annual mean of 1,062,129 patients. Approximately 31.8% of women with breast cancer reported health expenditures in excess of 10% of their annual income. In models, the proportion of women with breast cancer who experienced catastrophic health expenditures and non-employment was inversely related to increasing income. During ACA implementation, mean number of months of uninsurance decreased and expenditures increased among breast cancer patients. Conclusions Our study underscores the impact of breast cancer on financial security and opportunities for patients and their families. A multi-level understanding of these issues is needed to design effective and equitable strategies to improve quality of life and survivorship.

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Section: Discussionsupporting

confidence: 90%

Catastrophic health expenditures, insurance churn, and non-employment among women with breast cancer

Berlin,

Albright,

Moss

et al. 2024

JNCI Cancer Spectrum

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“…Outof-pocket costs are higher after breast reconstruction than after mastectomy alone, and reconstruction has been found to be independently associated with a perceived decline in financial status. 1 This decline in financial status was attributed in part to the cumulative financial and time burden of procedures and postoperative complications as 1 in 10 women undergo more than three major operative procedures directly related to breast reconstruction. 11 Breast reconstruction is a highly personalized process which takes into consideration a multitude of patient factors and values in the process of shared decision making.…”

Section: Discussionmentioning

confidence: 99%

“…In practice, many barriers to surgeoninitiated cost-of-care discussions have been cited, including surgeons believing it is not their role, insufficient knowledge or resources, a perceived inability to help with costs, inadequate time, and specific to plastic surgeons, some concern that discussing costs may impact the treatment recommendations and outcomes that patients receive. 1,22,23 Though many of these concerns may be unfounded (discussions of health care expenses in the oncology clinic have been found to have a median duration of 33 seconds), plastic surgeons may not be the optimal team member to engage in these discussions. 24 Moreover, the results of this study indicate that a greater percentage of women would prefer discussions about the potential costs of breast reconstruction from a member of the surgical team rather than the plastic surgeon.…”

Section: Discussionmentioning

confidence: 99%

“…

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.

…”

mentioning

confidence: 99%

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

Baglien,

Ganesh Kumar,

Berlin

et al. 2024

Semin Plast Surg

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The financial burden of breast cancer treatment and reconstruction is a significant concern for patients. Patient desire for preoperative cost-of-care counseling while navigating the reconstructive process remains unknown. A cross-sectional survey of women from the Love Research Army was conducted. An electronic survey was distributed to women over 18 years of age and at least 1 year after postmastectomy breast reconstruction. Descriptive statistics and multivariable modeling were used to determine desire for and occurrence of cost-of-care discussions, and factors associated with preference for such discussions. Secondary outcomes included the association of financial toxicity with desire for cost discussions. Among 839 women who responded, 620 women (74.1%) did not speak to their plastic surgeon and 480 (57.4%) did not speak to a staff member regarding costs of breast reconstruction. Of the 550 women who reported it would have been helpful to discuss costs, 315 (57.3%) were not engaged in a financial conversation initiated by a health care provider. A greater proportion of women who reported financial toxicity, compared to those who did not, would have preferred to discuss costs with their plastic surgeon (65.2% vs. 43.5%, p < 0.001) or a staff member (75.5% vs. 59.3%, p < 0.001). Among women with financial toxicity, those who had some form of insurance (private, Medicaid, Medicare, “other”) were significantly more likely to prefer a cost-of-care discussion (p < 0.001, p = 0.02, p = 0.05, p = 0.01). Financial discussions about the potential costs of breast reconstruction seldom occurred in this national cohort. Given the reported preference and unmet need for financial discussions by a majority of women, better cost transparency and communication is needed.

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“…A survey of breast cancer patients that had or had not undergone reconstruction reported significantly higher out-of-pocket costs and financial stress in reconstructed patients. 18 Complications during breast reconstruction add to the burden. Patients undergoing a second attempt after failure have higher complication rates and repeated failures.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Early Cultures and Dual-port Expanders on Two-stage, Prepectoral Breast Reconstruction: The 25/25 Study

Moyer,

Sisson

2024

Plastic and Reconstructive Surgery - Global Open

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Background: Two-stage tissue expander to implant surgery remains the predominant technique for breast reconstruction. Unfortunately, there is a high incidence of reconstruction failure which portends a financial and emotional burden. Most failures are related to postmastectomy skin flap necrosis and infection. Recently, a dual-port tissue expander was introduced to the market, and the authors hypothesize that early cultures from the peri-implant fluid will guide antibiotic treatment and decrease reconstruction failure. Methods: This is a cohort study of 50 consecutive patients treated for breast cancer or genetic susceptibility via a two-stage, prepectoral technique. The first 25 patients (46 breasts) were treated with a variety of tissue expanders, and the subsequent 25 patients (47 breasts) received a dual-port expander. Routine cultures from the drain port were taken from the dual-port group at the second postoperative visit, and cultures were taken in the control group only when signs of infection were present. All other procedures and interventions were similar. Results: Fifty patients, totaling 93 breasts, completed the study with a mean follow-up of 145 days. There were no statistically significant demographic or pathologic differences between groups. Fifteen tissue expanders were explanted in the control group and five in the dual-port cohort (32.6% versus 10.6%, P = 0.012). All bacteria in the control group failures were either methicillin-resistant Staphylococcus aureus or Staphylococcus epidermidis, whereas failures in the dual-port group varied. Conclusion: Treatment of routine, early cultures from a dual-port expander led to a statistically significant decrease in tissue expander explantation.

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

Cited by 7 publications

References 35 publications

Catastrophic health expenditures, insurance churn, and non-employment among women with breast cancer

Catastrophic health expenditures, insurance churn, and non-employment among women with breast cancer

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

The Effect of Early Cultures and Dual-port Expanders on Two-stage, Prepectoral Breast Reconstruction: The 25/25 Study

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