Understanding the Relationship between Breast Reconstruction Subtype and Risk of Financial Toxicity: A Single-Institution Pilot Study

Bailey, Chad M.; Asaad, Malke; Boukovalas, Stefanos; Lin, Yu Li; Kothamasu, Venkata S.; Kapur, Sahil K.; Villa, Mark Timothy; Butler, Charles E.

doi:10.1097/prs.0000000000008015

Cited by 16 publications

(10 citation statements)

References 41 publications

(81 reference statements)

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“…16 Also included was a 27-item composite survey derived from published literature, which assessed patient socioeconomic and financial data and evaluated how patients coped with the costs of cancer care. [7][8][9][17][18][19][20] Baseline demographic, clinicopathologic, and operative characteristics were obtained from our prospectively maintained departmental database. Also, collected was the receipt of preoperative therapy, Zubrod performance status, and clinical stage based on the eighth edition of the American Joint Commission on Cancer staging system.…”

Section: Data Sources and Patient Populationmentioning

confidence: 99%

“…In addition, FT can be affected by a variety of clinicopathologic and treatment-related factors. In breast cancer patients, FT was associated with baseline financial well-being and insurance status, employment stability, disease stage, and surgical approach 6–9 . Further, breast cancer survivors who experience FT often experience a worse quality of life and decrease their spending on leisure activities, such as vacations or movies, as well as basic needs including food and clothing 4,10,11 …”

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confidence: 99%

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Financial Toxicity in Patients with Resected Lung Cancer

et al. 2023

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Objectives: To describe financial toxicity (FT) in patients with resected lung cancer and identify risk factors in this population. Background: FT describes the financial burden associated with cancer care and its impact on the quality of survivorship. Few prior studies have examined FT in patients with lung cancer. Methods: Patients who underwent lung cancer resection at our institution between January 1, 2016 and December 31, 2021, were surveyed to gather demographic information and evaluate FT using a validated questionnaire. A multivariable model was built to identify risk factors for FT. Results: Of the total, 1477 patients were contacted, of whom 463 responded (31.3%). Most patients were stage I (n = 349, 75.4%) and lobectomy was performed often (n = 290, 62.8%). There were 196 patients (42.3%) who experienced FT. Upon multivariable analyses, divorced marital status [odds ratio (OR)

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Section: Data Sources and Patient Populationmentioning

confidence: 99%

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confidence: 99%

Financial Toxicity in Patients with Resected Lung Cancer

et al. 2023

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“…These results echo findings by Bailey et al that demonstrated no differences in out-of-pocket costs according to breast reconstruction subtype, possibly due to most financial exposure being accepted by the insurer regardless of the reconstructive modality; however, future studies are needed to further examine the potential financial toxicity attributed to staged free-flap procedures. 31 …”

Section: Discussionmentioning

confidence: 99%

Complications, Costs, and Healthcare Resource Utilization After Staged, Delayed, and Immediate Free-Flap Breast Reconstruction: A Longitudinal, Claims-Based Analysis

et al. 2022

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Background There is a lack of consensus detailing the optimal approach to free-flap breast reconstruction when considering immediate, delayed, or staged techniques. This study compared costs, complications, and healthcare resource utilization (HCRU) across staged, delayed, and immediate free-flap breast reconstruction. Patients and Methods Retrospective study using MarketScan databases to identify women who underwent mastectomies and free-flap reconstructions between 2014 and 2018. Complications, costs, and HCRU [readmission, reoperation, emergency department (ED) visits] occurring 90 days after mastectomy and 90 days after free flap were compared across immediate, delayed, and staged reconstruction. Results Of 3310 women identified, 69.8% underwent immediate, 11.7% underwent delayed, and 18.5% underwent staged free-flap reconstruction. Staged reconstruction was associated with the highest rate (57.8% staged, 42.3% delayed, 32.0% immediate; p < 0.001) and adjusted relative risk [67% higher than immediate (95% CI: 49–87%; p < 0.001)] of surgical complications. Staged displayed the highest HCRU (staged 47.9%, delayed, 38.4%, immediate 25.2%; p < 0.001), with 16.5%, 30.7%, and 26.5% of staged patients experiencing readmission, reoperation, or ED visit, respectively. The adjusted probability of HCRU was 206% higher (95% CI: 156–266%; p < 0.001) for staged compared with immediate. Staged had the highest mean total cost (staged $106,443, delayed $80,667, immediate $76,756; p < 0.001) with regression demonstrating the adjusted mean cost for staged is 31% higher (95% CI: 23–39%; p < 0.001) when compared with immediate. Conclusions Staged free-flap reconstruction is associated with increased complications, costs, and HCRU, while immediate demonstrated the lowest. The potential esthetic benefits of a staged approach should be balanced with the increased risk for adverse events after surgery. Supplementary Information The online version contains supplementary material available at 10.1245/s10434-022-12896-0.

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“…Given the significant cost associated with the use of ADM, the increased cost burden on patients undergoing breast reconstruction, and the similarity in surgical outcomes, it is important for surgeons to consider cost differences among ADMs when choosing the type of ADM for IBR. 25,[33][34][35][36] It is evident that the difference in product price could significantly affect the overall cost of the procedure. 25 Other studies have shown that AlloDerm has a higher cost than SurgiMend and Dermacell.…”

Section: Ementioning

confidence: 99%

No Differences in Surgical and Patient-reported Outcomes Between Alloderm, Surgimend, and Dermacell for Prepectoral Implant-based Breast Reconstruction

Asaad

Morris

Selber

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Prepectoral implant–based breast reconstruction (IBR) has become the standard of care for many reconstructive surgeons and is often supplemented with coverage using acellular dermal matrix (ADM). However, more clinical data examining the use of ADM in breast reconstruction are needed. The current study compares complications and patient-reported outcomes (PROs) among three different types of ADM used in IBR. Methods: The authors performed a retrospective review of consecutive patients who underwent immediate prepectoral IBR from January of 2018 through December of 2019. Surgical outcomes and PROs (using the BREAST-Q) were compared among the AlloDerm, SurgiMend, and Dermacell ADMs. Results: Overall, 557 breasts (383 patients) were included (78.6% AlloDerm, 14% SurgiMend, 7.4% Dermacell). Patients in the Dermacell group were older (P = 0.001) and more likely to have diabetes (P = 0.001) compared with AlloDerm and SurgiMend patients. Other patient characteristics were similar among the three groups. The overall complication rate was equivalent among the three ADM groups (AlloDerm 27% vs SurgiMend 33% vs Dermacell 39%; P = 0.209). Multivariable frailty models demonstrated that the type of ADM was not significantly associated with overall complications, infection, major complications, or device explantation. BREAST-Q satisfaction with breasts, psychosocial well-being, and sexual well-being were also similar among the three ADM groups (P = 0.109, P = 0.439, P = 0.152, respectively). Conclusions: Three of the most commonly used ADMs in the United States have similar surgical outcomes and PROs when used for prepectoral IBR. No significant differences in infection, overall complications, or device removal rates were identified among AlloDerm, SurgiMend, and Dermacell. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

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Understanding the Relationship between Breast Reconstruction Subtype and Risk of Financial Toxicity: A Single-Institution Pilot Study

Cited by 16 publications

References 41 publications

Financial Toxicity in Patients with Resected Lung Cancer

Financial Toxicity in Patients with Resected Lung Cancer

Complications, Costs, and Healthcare Resource Utilization After Staged, Delayed, and Immediate Free-Flap Breast Reconstruction: A Longitudinal, Claims-Based Analysis

No Differences in Surgical and Patient-reported Outcomes Between Alloderm, Surgimend, and Dermacell for Prepectoral Implant-based Breast Reconstruction

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