Financial Toxicity in Breast Reconstruction: A National Survey of Women Who have Undergone Breast Reconstruction After Mastectomy
Financial Toxicity in Breast Reconstruction: A National Survey of Women Who have Undergone Breast Reconstruction After Mastectomy
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DOI：
10.1245/s10434-021-10708-5
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发表时间：
2021-09-03
影响因子：
3.7
通讯作者：
Momoh, Adeyiza O.
中科院分区：
文献类型：
--
作者：
Kumar, Nishant Ganesh;Berlin, Nicholas L.;Momoh, Adeyiza O.
背景尽管人们已经意识到乳腺癌治疗的经济毒性，但对乳房再造相关的经济压力却知之甚少。本研究旨在描述经济毒性，并确定与追求乳房切除术后乳房重建的女性经济毒性独立相关的因素。方法采用33个项目的电子调查表对爱研军成员进行问卷调查。邀请18岁以上且乳房切除术后乳房重建至少1年的女性参加。关注的主要结局是自我报告的乳房再造引起的经济毒性，而关注的次要结局是患者报告的自付费用和经济毒性对手术决策的影响。结果共纳入922名女性（平均年龄58.6岁，标准差10.3岁）; 216名女性（23.8%）报告了重建的财务毒性。这些女性的自付医疗费用明显更高。与没有经历过财务毒性的女性相比，那些经历过财务毒性的女性更有可能因重建而负债（50.9%对3.2%，p < 0.001）。年龄较小、家庭年收入较低、自付费用较高和术后重大并发症与财务毒性风险增加独立相关。如果面临同样的决定，与没有经历金融毒性的女性相比，经历金融毒性的女性更有可能决定反对重建（p < 0.001）。结论：近四分之一的女性经历过乳房再造的经济毒性。报告财务毒性水平较高的女性更有可能改变手术决定。确定的预测财务毒性的因素可以指导术前讨论，以告知减轻不希望的财务下降的决策。
Background Despite awareness regarding financial toxicity in breast cancer care, little is known about the financial strain associated with breast reconstruction. This study aims to describe financial toxicity and identify factors independently associated with financial toxicity for women pursuing post-mastectomy breast reconstruction. Methods A 33-item electronic survey was distributed to members of the Love Research Army. Women over 18 years of age and at least 1 year after post-mastectomy breast reconstruction were invited to participate. The primary outcome of interest was self-reported financial toxicity due to breast reconstruction, while secondary outcomes of interest were patient-reported out-of-pocket expenses and impact of financial toxicity on surgical decision making. Results In total, 922 women were included (mean age 58.6 years, standard deviation 10.3 years); 216 women (23.8%) reported financial toxicity from reconstruction. These women had significantly greater out-of-pocket medical expenses. When compared with women who did not experience financial toxicity, those who did were more likely to have debt due to reconstruction (50.9% vs. 3.2%, p < 0.001). Younger age, lower annual household income, greater out-of-pocket expenses, and a postoperative major complication were independently associated with an increased risk for financial toxicity. If faced with the same decision, women experiencing financial toxicity were more likely to decide against reconstruction (p < 0.001) compared with women not experiencing financial toxicity. Conclusions Nearly one in four women experienced financial toxicity from breast reconstruction. Women who reported higher levels of financial toxicity were more likely to change their decisions about surgery. Identified factors predictive of financial toxicity could guide preoperative discussions to inform decision making that mitigates undesired financial decline.