Financial Costs and Burden Related to Decisions for Breast Cancer Surgery
Financial Costs and Burden Related to Decisions for Breast Cancer Surgery
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DOI：
10.1200/jop.18.00796
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发表时间：
2019-08-01
影响因子：
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通讯作者：
Hwang, E. Shelley
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作者：
Greenup, Rachel A.;Rushing, Christel;Hwang, E. Shelley
财务毒性是癌症护理的一个公认的不良影响，但很少有人知道女性如何考虑治疗费用时，面对乳腺癌手术的偏好敏感的决定或手术治疗的选择如何影响经济伤害。我们试图确定如何财务成本和负担与乳腺癌surgery.METHODS的决定妇女（>= 18岁）与乳腺癌的历史被招募从军队的妇女和姐妹篇网络完成88项电子调查。描述性统计和回归分析被用来评估成本的影响，对手术的决定和财务损害后，乳腺癌surgery.RESULTS，共607名妇女与0至III期乳腺癌。大多数是白色人（90%），有私人保险（70%）或医疗保险（25%），受过大学教育（78%），家庭收入超过74，000美元（56%）。43%的患者接受了保乳手术，25%接受了乳房切除术，32%接受了双侧乳房切除术，36%接受了乳房再造术。28%的人报告说，治疗费用影响了他们的手术决定，在每年45,000美元的收入下，费用优先于乳房保留或外观。总体而言，35%的人报告了癌症治疗带来的经济负担，78%的人从未与癌症团队讨论过费用问题。与保乳手术相比，双侧乳房切除术伴或不伴乳房再造与更高的债务、严重到灾难性的经济负担、治疗相关的经济困难和就业改变显著相关。在最高的收入，65%的妇女是prevailly准备，报告高于预期（26%）治疗costs.CONCLUSION癌症治疗费用影响乳腺癌手术的决定，和有效的手术治疗显着不同的风险，病人报告的经济负担，债务，并对就业的影响。成本透明度可以为偏好敏感的手术决策提供信息，并改善以患者为中心的护理。(C)2019年美国临床肿瘤学会
PURPOSE Financial toxicity is a well-recognized adverse effect of cancer care, yet little is known about how women consider treatment costs when facing preference-sensitive decisions for breast cancer surgery or how surgical treatment choice affects financial harm. We sought to determine how financial costs and burden relate to decisions for breast cancer surgery.METHODS Women (>= 18 years old) with a history of breast cancer were recruited from the Army of Women and Sisters Network to complete an 88-item electronic survey. Descriptive statistics and regression analysis were used to evaluate the impact of costs on surgical decisions and financial harm after breast cancer surgery.RESULTS A total of 607 women with stage 0 to III breast cancer were included. Most were white (90%), were insured privately (70%) or by Medicare (25%), were college educated (78%), and reported household incomes of more than $74,000 (56%). Forty-three percent underwent breast-conserving surgery, 25% underwent mastectomy, 32% underwent bilateral mastectomy, and 36% underwent breast reconstruction. Twenty-eight percent reported that costs of treatment influenced their surgical decisions, and at incomes of $45,000 per year, costs were prioritized over breast preservation or appearance. Overall, 35% reported financial burden as a result of their cancer treatment, and 78% never discussed costs with their cancer team. When compared with breast-conserving surgery, bilateral mastectomy with or without reconstruction was significantly associated with higher incurred debt, significant to catastrophic financial burden, treatment-related financial hardship, and altered employment. Among the highest incomes, 65% of women were fiscally unprepared, reporting higher-than-expected (26%) treatment costs.CONCLUSION 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. (C) 2019 by American Society of Clinical Oncology