Treatment Decision Making and Financial Toxicity in Women With Metastatic Breast Cancer

Wan, Clara; Williams, Courtney; Nipp, Ryan David; Pisu, Maria; Azuero, Andres; Aswani, Monica S.; Ingram, Stacey A.; Pierce, Jennifer Young; Rocque, Gabrielle Betty

doi:10.1016/j.clbc.2020.07.002

Cited by 19 publications

(24 citation statements)

References 49 publications

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“…The median COST score was a little lower in this study than the score of 22 in the previous study [ 25 ], which may be attributed to the inclusion of patients with stage IV breast cancer in this study (stage IV: 18.50%, median COST score: 17). The median COST score reported in a study of financial toxicity in patients with breast cancer who underwent lumpectomy or mastectomy in the USA was 30 and the median COST score reported in patients with metastatic breast cancer was 22, which are higher than in our study [ 16 , 38 ]. The comparatively higher level of financial toxicity among Chinese patients might be attributed to inadequate coverage of medical insurance for cancer treatment cost and the low affordability of advanced drugs and procedures given that China is still a middle-income country with a big population.…”

Section: Discussioncontrasting

confidence: 83%

Financial toxicity in female patients with breast cancer: a national cross-sectional study in China

Liu

Han

et al. 2022

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Purpose To quantify financial toxicity of female patients with breast cancer in China and investigate its factors and patients’ coping strategies. Methods The Comprehensive Score for Financial Toxicity (COST) is defined by using a structured questionnaire containing 12 items measuring perceived affordability of healthcare services, with the range of scoring of which being from 0 to 44 (higher score indicates lower financial toxicity). From January to March 2021, a total of 664 female patients diagnosed with stage 0–IV breast cancer were recruited from 33 public tertiary cancer hospitals located in 31 provinces of China. Multivariate linear regression models were used. Results The median age of patients was 48 years (range: 26–84 years), and 62.04% lived in urban areas. The median COST score was 21.00 (interquartile range: 15–26). Older age, higher household income, and better self-reported health status were associated with lower financial toxicity, while a bigger household size, being retired or unemployed, stage IV cancer, and a history of targeted therapy were associated with higher financial toxicity (all P < 0.05). Nearly half of the patients reported using at least one coping strategy, including considering quitting treatment, delaying treatment, and failing to take medicine or attend medical visits as instructed. The people with increased financial toxicity seem to adopt more coping strategies. Conclusions Financial toxicity and coping strategies are common among Chinese women with breast cancer. An understanding of the factors regarding financial toxicity may help oncologists and policy-makers identify at-risk patients and develop targeted interventions.

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Section: Discussioncontrasting

confidence: 83%

Financial toxicity in female patients with breast cancer: a national cross-sectional study in China

Liu

Han

et al. 2022

Support Care Cancer

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“…The median COST score was a little lower in this study than the score of 22 in the previous study [23] , which may be attributed to the inclusion of patients with stage IV breast cancer in this study (stage IV: 18.50%, median COST score : 17). The median COST score reported in a study of nancial toxicity in patients with breast cancer who underwent lumpectomy or mastectomy in the United States was 30 and the median COST score reported in patients with metastatic breast cancer was 22, which are higher than in our study [14,34] . Besides, in the United States, median scores of nancial toxicity among cancer cancer survivors were mostly between 23 and 29, and nancial toxicity of patients with breast cancer was relatively lower than patients with other types of cancer, such as multiple myeloma and lung cancer [19,21,25] .…”

Section: The Level Of Nancial Toxicity Of Patients With Breast Cancer In Chinacontrasting

confidence: 78%

Financial Toxicity in Female Patients with Breast Cancer: A National Cross-Sectional Study in China

Liu

Han

et al. 2022

Preprint

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Purpose: To quantify financial toxicity of female patients with breast cancer in China and investigate its factors and patients’ coping strategies.Methods: The Comprehensive Score for Financial Toxicity (COST) is defined by using a structured questionnaire containing 12 items measuring perceived affordability of healthcare services, with the range of scoring of which being from 0 to 44 (higher score indicates lower financial toxicity). From January to March 2021, a total of 664 female patients diagnosed with stage 0-Ⅳ breast cancer were recruited from 33 public tertiary cancer hospitals located in 31 provinces of China. Multivariate linear regression models were used.Results: The median age of patients was 48 years (range: 26-84 years), and 62.04% lived in urban areas. The median COST score was 21.00 (Interquartile Range: 15-26). Older age, higher household income, and better self-reported health status were associated with lower financial toxicity, while a bigger household size, being retired or unemployed, stage Ⅳ cancer, and a history of targeted therapy were associated with higher financial toxicity (all P<0.05). Nearly half of the patients reported using at least one coping strategy, including considering quitting treatment, delaying treatment, failing to take medicine or attend medical visits as instructed. The people with increased financial toxicity seem to adopt more coping strategies.Conclusion: Financial toxicity and coping strategies are common among Chinese women with breast cancer. An understanding of the factors regarding financial toxicity may help identify at-risk patients and develop targeted interventions.

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“…Quantitative methods included rate of patients experiencing FT (18 studies). 4 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 Qualitative methods included validated patient-reported outcome measures (PROM; 10 studies), 23 , 24 , 25 , 26 , 29 , 30 , 31 , 32 , 33 , 34 patient-reported severity of FT rated by the patient on a 3-point or 5-point scale (7 studies), 26 , 27 , 35 , 36 , 37 , 38 , 39 qualitative interviews (4 studies), 28 , 40 , 41 , 42 and other (2 studies). 43 , 44 A study falling into multiple categories was analyzed in all categories.…”

Section: Methodsmentioning

confidence: 99%

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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Treatment Decision Making and Financial Toxicity in Women With Metastatic Breast Cancer

Cited by 19 publications

References 49 publications

Financial toxicity in female patients with breast cancer: a national cross-sectional study in China

Financial toxicity in female patients with breast cancer: a national cross-sectional study in China

Financial Toxicity in Female Patients with Breast Cancer: A National Cross-Sectional Study in China

Financial Toxicity Among Patients With Breast Cancer Worldwide

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