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

  • Health Services Research and Global Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Despite growing national attention, there is limited understanding of the patient- and treatment-level characteristics related to treatment cost-associated distress (“financial toxicity”) in breast cancer patients. Our aim is to identify risk factors for financial toxicity amongst breast cancer patients undergoing surgical treatment.

Methods

This is a single-institution cross-sectional survey of adult female breast cancer patients who underwent lumpectomy or mastectomy between January 2018 and June 2019. Financial toxicity was measured via the 11-item comprehensive score for financial toxicity (COST) instrument. Responses were linked with data on patient demographics and clinical history abstracted from the corresponding medical record. Multivariate regression was used to identify patient- and treatment-level factors associated with worsening financial toxicity. Secondary outcome measures included self-reported coping strategies for high treatment costs.

Results

A total of 571 patients were included; overall, these individuals were mostly white (76.0%), in-state residents (72.3%), and married (73.0%). Following multivariate analysis, lower financial distress was associated with the use of supplemental insurance, increasing annual household income, and a higher credit score (score > 740). Conversely, work reduction or cessation, increased out-of-pocket spending, advanced tumor stage, and being employed at the time of diagnosis were associated with increased financial distress. Patients with higher reported financial distress were more likely to decrease their spending on food, clothing, and leisure activities.

Conclusions

Financial toxicity was associated with baseline demographic, disease, and treatment characteristics in our cohort of insured patients. These characteristics may be critical opportunities for interventions related to financial navigation along the treatment continuum.

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Acknowledgement

The authors would like to thank Ann Sutton in the Department of Scientific Publications at MD Anderson for editing this manuscript.

Funding

This research was generously supported by funds from the University Cancer Foundation via the Sister Institution Network Fund at The University of Texas MD Anderson Cancer Center.

Author information

Authors and Affiliations

  1. Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Anaeze C. Offodile II MD, MPH, Malke Asaad MD, Stefanos Boukovalas MD & Charles Butler MD, FACS

  2. Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Anaeze C. Offodile II MD, MPH & Yu-Li Lin MS

  3. Baker Institute for Public Policy, Rice University, Houston, TX, USA

    Anaeze C. Offodile II MD, MPH

  4. Institute for Cancer Care Innovation, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Anaeze C. Offodile II MD, MPH

  5. Plastic and Reconstructive Surgeons, Renton, WA, USA

    Chad Bailey MD

  6. Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Mediget Teshome MD, MPH

  7. Departments of Surgery and Population Health Sciences, Duke University School of Medicine, Durham, NC, USA

    Rachel A. Greenup MD, MPH

Authors
  1. Anaeze C. Offodile II MD, MPH
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  2. Malke Asaad MD
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  3. Stefanos Boukovalas MD
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  4. Chad Bailey MD
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  5. Yu-Li Lin MS
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  6. Mediget Teshome MD, MPH
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  7. Rachel A. Greenup MD, MPH
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  8. Charles Butler MD, FACS
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Corresponding author

Correspondence to Anaeze C. Offodile II MD, MPH.

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Disclosure

The lead author (ACO) has received research funding from the Blue Cross Blue Shield Affordability Cures Consortium and National Academy of Medicine that are unrelated to the submitted work. He is also a board member of the Patient Advocate Foundation.

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Offodile, A.C., Asaad, M., Boukovalas, S. et al. Financial Toxicity Following Surgical Treatment for Breast Cancer: A Cross-sectional Pilot Study. Ann Surg Oncol 28, 2451–2462 (2021). https://doi.org/10.1245/s10434-020-09216-9

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  • DOI: https://doi.org/10.1245/s10434-020-09216-9

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