Where advocacy meets patient-centered care—cost considerations in breast reconstruction decision-making

Abstract

Cancer care in the United States is unquestionably expensive. In 2017, annual costs related to cancer-related treatment reached $180 billion. There is clear evidence that the increased cost of cancer care translates to financial hardship. This hardship is widespread, impacting as many as 75% of patients and their families with associated adverse sequelae. Growing recognition of the negative impact of cancer-related treatment costs on patients and their families led to the creation of the term "financial toxicity". The present editorial is borne out of the need to bring this problem to the attention of practicing surgeons, as to the best of our knowledge is still underreported in our specialties.

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

“…Increasing awareness and professional guidelines are necessary but not sufficient to promote discussions with patients about costs of care. Multilevel strategies are needed that also consider the clinical workflow, organizational commitment, price transparency, and timing of conversations as well as provider education and training 33‐36 …”

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

“…Social workers and financial counselors have a role but are rarely seen preemptively to avoid financial harm. 25 Interviews of medical, radiation, and surgical oncologists found medical oncologists are more likely to have someone in their practice who routinely addresses financial concerns. 6 Oncologic clinics have piloted financial navigators who combat financial toxicity by optimizing a patient's insurance coverage and counsel patients on the implications of treatment plan options.…”

“…These programs have been shown to reduce rates of financial toxicity by proactively guiding patients through available health insurance options, optimizing their coverage, and informing patients about implications of treatment plans on cost. 25,26 If in-clinic personnel are not possible, plastic surgeons should identify financial tools, counselors, and navigators to refer their patients to. Furthermore, providers should strive to be knowledgeable about the costs of interventions and eliminate low-value practices.…”