How Treatment Costs Affect Decisions for Breast Cancer Surgery
In a study reported in the Journal of Oncology Practice, Greenup et al found that cancer treatment costs influenced women’s decisions on breast cancer surgery. Researchers reported many women, even at the highest income levels, said that costs were higher than expected, and that most women never discussed costs with their cancer treatment team.
Study Details
The study involved data from an 88-item electronic survey completed by 607 women with a history of stage 0 to III breast cancer from January 2017 to June 2017. Most patients were white (90%); had private insurance (70%) or Medicare (25%); were college educated (78%); and reported household incomes of more than $74,000 (56%). Overall, 43% underwent breast-conserving surgery, 25% underwent mastectomy, 32% underwent bilateral mastectomy, and 36% underwent breast reconstruction.
Key Findings
Twenty-eight percent of patients reported that costs of treatment influenced surgical decisions.
Cost increased in importance with decreasing household income—eg, 16% of participants with income of more $125,000 per year reported costs as somewhat to extremely important, vs 41% of those with income of $74,000 per year or less (P < .01). Patients with household income of $45,000 per year or less reported that cost had more influence on decisions for breast cancer surgery than loss of sensation, breast preservation or appearance, need for long-term surveillance, and avoiding radiation.
Thirty-five percent of patients reported financial burden as a result of cancer treatment. Thirty-four percent reported costs were higher than expected, including 26% of those in the highest household income brackets. Seventy-eight percent of patients never discussed costs with their cancer team.
Compared with breast-conserving surgery (BCS), bilateral mastectomy with reconstruction (BMR) or without reconstruction (BM) were significantly associated with higher incurred debt (more than $5,000 for 12% for BCS vs 27% for BMR [P < .01] and 25% for BM [P = .04]; significant to catastrophic financial burden (12% for BCS vs 23% for BMR [P = .02] and 30% for BM [P < .01]; higher rates of cancer-induced financial hardship (14% for BCS vs 27% for BMR [P < .01] and 33% for BM [P < .01]; and higher rates of altered or reduced employment (46% for BCS vs 70% for BMR [P < .01] and 67% for BM [P = .02]).
The investigators concluded, “Cancer treatment costs influenced decisions for breast cancer surgery, and comparably effective surgical treatments differed significantly in their risk of patient-reported financial burden, debt, and impact on employment. Cost transparency may inform preference-sensitive surgical decisions and improve patient-centered care.”
Rachel A. Greenup, MD, MPH, of Duke University, is the corresponding author for the Journal of Oncology Practice article.
Disclosure: The study was supported by a National Institutes of Health Building Interdisciplinary Research Careers in Women’s Health Career Development Award and the National Cancer Institute. For full disclosures of the study authors, visit jop.ascopubs.org.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
