Subscribe to RSS
DOI: 10.1055/s-0043-1778040
Financial Toxicity in Breast Reconstruction: The Role of the Surgeon-Patient Cost-of-Care Discussion
Funding None.Abstract
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.
Keywords
postmastectomy reconstruction - breast reconstruction - financial toxicity - out-of-pocket expenses - patient-provider communicationPublication History
Article published online:
19 January 2024
© 2024. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Berlin NL, Abrahamse P, Momoh AO. et al. Perceived financial decline related to breast reconstruction following mastectomy in a diverse population-based cohort. Cancer 2022; 128 (06) 1284-1293
- 2 Ehsan AN, Wu CA, Minasian A. et al. Financial toxicity among patients with breast cancer worldwide: a systematic review and meta-analysis. JAMA Netw Open 2023; 6 (02) e2255388
- 3 Jagsi R, Pottow JAE, Griffith KA. et al. Long-term financial burden of breast cancer: experiences of a diverse cohort of survivors identified through population-based registries. J Clin Oncol 2014; 32 (12) 1269-1276
- 4 Zafar SY, Abernethy AP. Financial toxicity, part I: a new name for a growing problem. Oncology (Williston Park) 2013; 27 (02) 80-81 , 149
- 5 Ganesh Kumar N, Berlin NL, Hawley ST, Jagsi R, Momoh AO. Financial toxicity in breast reconstruction: a national survey of women who have undergone breast reconstruction after mastectomy. Ann Surg Oncol 2022; 29 (01) 535-544
- 6 Jagsi R, Ward KC, Abrahamse PH. et al. Unmet need for clinician engagement regarding financial toxicity after diagnosis of breast cancer. Cancer 2018; 124 (18) 3668-3676
- 7 Greenup RA, Rushing C, Fish L. et al. Financial costs and burden related to decisions for breast cancer surgery. J Oncol Pract 2019; 15 (08) e666-e676
- 8 Meropol NJ, Schrag D, Smith TJ. et al; American Society of Clinical Oncology. American Society of Clinical Oncology guidance statement: the cost of cancer care. J Clin Oncol 2009; 27 (23) 3868-3874
- 9 Love Research Army. Dr Susan Love Foundation for Breast Cancer Research. Accessed September 28, 2023 at: https://drsusanloveresearch.org/love-research-army/
- 10 Asaad M, Bailey C, Boukovalas S. et al. Self-reported risk factors for financial distress and attitudes regarding cost discussions in cancer care: a single-institution cross-sectional pilot study of breast reconstruction recipients. Plast Reconstr Surg 2021; 147 (04) 587e-595e
- 11 Roberts A, Baxter N, Camacho X, Lau C, Zhong T. Once is rarely enough: a population-based study of reoperations after postmastectomy breast reconstruction. Ann Surg Oncol 2015; 22 (10) 3302-3307
- 12 Offodile II AC, Asaad M, Boukovalas S. et al. Financial toxicity following surgical treatment for breast cancer: a cross-sectional pilot study. Ann Surg Oncol 2021; 28 (05) 2451-2462
- 13 Shankaran V, Jolly S, Blough D, Ramsey SD. Risk factors for financial hardship in patients receiving adjuvant chemotherapy for colon cancer: a population-based exploratory analysis. J Clin Oncol 2012; 30 (14) 1608-1614
- 14 Narang AK, Nicholas LH. Out-of-pocket spending and financial burden among Medicare beneficiaries with cancer. JAMA Oncol 2017; 3 (06) 757-765
- 15 Davidoff AJ, Erten M, Shaffer T. et al. Out-of-pocket health care expenditure burden for Medicare beneficiaries with cancer. Cancer 2013; 119 (06) 1257-1265
- 16 Out-of-Pocket Costs, Financial Distress, and Underinsurance in Cancer Care | Oncology | JAMA Oncology | JAMA Network. Accessed October 13, 2023 at: https://jamanetwork-com.proxy.lib.umich.edu/journals/jamaoncology/fullarticle/2648318
- 17 Carrera PM, Kantarjian HM, Blinder VS. The financial burden and distress of patients with cancer: understanding and stepping-up action on the financial toxicity of cancer treatment. CA Cancer J Clin 2018; 68 (02) 153-165
- 18 Schrag D, Hanger M. Medical oncologists' views on communicating with patients about chemotherapy costs: a pilot survey. J Clin Oncol 2007; 25 (02) 233-237
- 19 Resnicow K, Patel MR, Mcleod MC, Katz SJ, Jagsi R. Physician attitudes about cost consciousness for breast cancer treatment: differences by cancer sub-specialty. Breast Cancer Res Treat 2019; 173 (01) 31-36
- 20 Cost Consciousness in Patient Care—What Is Medical Education's Responsibility? | NEJM. Accessed October 13, 2023 at: https://www.nejm.org/doi/full/10.1056/nejmp0911502
- 21 Rochlin DH, Rizk NM, Matros E, Wagner TH, Sheckter CC. Commercial price variation for breast reconstruction in the era of price transparency. JAMA Surg 2023; 158 (02) 152-160
- 22 Bailey CM, Selber J, Liu J, Lee CN, Offodile II AC. Current practice and perceptions regarding cost communication in breast cancer reconstruction: survey results of the American Society of Plastic Surgeons. Ann Surg Oncol 2021; 28 (01) 376-385
- 23 Greenup RA, Rushing CN, Fish LJ. et al. Perspectives on the costs of cancer care: a survey of the American Society of Breast Surgeons. Ann Surg Oncol 2019; 26 (10) 3141-3151
- 24 Hunter WG, Zafar SY, Hesson A. et al. Discussing health care expenses in the oncology clinic: analysis of cost conversations in outpatient encounters. J Oncol Pract 2017; 13 (11) e944-e956
- 25 Lane W, Phillips BT, Offodile II AC. Where advocacy meets patient-centered care-cost considerations in breast reconstruction decision-making. Gland Surg 2021; 10 (01) 507-511
- 26 Sherman D, Fessele KL. Financial support models: a case for use of financial navigators in the oncology setting. Clin J Oncol Nurs 2019; 23 (05) 14-18