News
Article
Financial Difficulty Persists Through Early Breast Cancer Survivorship for Some Patients
Author(s):
Key Takeaways
- Financial hardship in young breast cancer patients is influenced by race, ethnicity, and clinical characteristics, with three distinct financial trajectories identified.
- Hispanic ethnicity, unemployment, and arm symptoms are associated with increased odds of severe financial difficulty.
The authors suggest that targeted interventions to mitigate financial toxicity should be implemented to better support patients.
Authors of research published in JAMA Network Open evaluated patterns of financial hardship over time while characterizing factors that may be associated with sustained or increased financial burden. The investigators identified these to help design customized interventions that were aimed to alleviate cancer care-associated economic distress.
Image credit: LStockStudio | stock.adobe.com
The study used data from a multi-institutional, prospective, cohort study that enrolled women 40 years and younger with newly diagnosed breast cancer between 2006 and 2016. The enrolled women were asked to complete surveys at baseline, biannually for the first 3 years following their diagnosis, and then annually. Additionally, women who were diagnosed with stage 0 to III breast cancer were included in the study.
Patient, disease, and treatment information was obtained from serially collected surveys and medical record review when indicated. Additionally, demographic variables of interest included age at diagnosis, self-reported race (including Hispanic or Latino ethnicity), partner status at baseline, parity at baseline, and highest education attained at the time of diagnosis.
The study authors believes race and ethnicity to be important covariates that could influence financial toxicity. In addition, prior research showed variation of financial hardship among young adults. In the current study, age was categorized as follows: 18 to 25 years and 26 to 39 years. Additionally, clinical characteristics of interest included stage at diagnosis, hormone receptor positivity, and ERBB2 status.
A total of 1008 patients with breast cancer and a median age at diagnosis 36 years (IQR: 33-39) were enrolled in the study. Most of the patients were college graduates (n = 840; 83.3%), had a partner at baseline (n = 764; 75.8%), nulliparous (n = 649; 64.4%), and were without comorbidities at enrollment (n = 908; 90.1%). Additionally, approximately 87.7% (n = 884) of the patients were White, and the remaining were Asian (n = 60; 6.0%), Black (n = 35; 3.5%), Hispanic (n = 47; 4.7%).
Further, the majority of patients’ tumors were stage I through II (n = 778; 77.2%), estrogen receptor/progesterone receptor–positive (n = 754; 74.8%), and ERBB2-negative (n = 686; 68.1%). Additionally, patients were more frequently treated with a mastectomy instead of breast conservation (n = 771, 76.5% vs n = 297, 29.5%; P < .001), but many patients also received radiation therapy (n = 627; 62.2%), chemotherapy (n = 760; 75.4%), and endocrine therapy (n = 610; 60.6%).
The investigators observed approximately 72.1% (n = 727) reported arm symptoms within 2 years of surgery. Three trajectories of experiences with finances emerged: approximately 54.7% (n = 551) of patients experienced low financial difficulty (trajectory 1); 29.1% (n = 293) had mild difficulty that improved (trajectory 2); and 16.3% (n = 164) had moderate to severe difficulty that peaked several years after diagnosis prior to improving (trajectory 3). Hispanic patients (OR, 3.71; 95% CI, 1.47-9.36), unemployment at baseline and 1 year (OR, 2.66; 95% CI, 1.63-4.33), as well as arm symptoms (OR, 1.77; 95% CI, 1.06-2.96) were observed to be associated with increased odds of experiencing trajectory 3. Further, having a college degree (OR, 0.20; 95% CI, 0.12-0.34) or having a partner (OR, 0.24; 95% CI, 0.15-0.38) were associated with increased odds of experiencing trajectory 1.
The most notable limitation, according to the authors, was the homogeneity of the enrolled cohort (regarding race, ethnicity, and education level), which likely influenced the generalizability of the findings. Other limitations included the lack of indicators that financial hardship was directly attributed to cancer treatment and all premorbid treatment-related adverse events were not assessed. The authors also observed that association between arm morbidity and financial difficulty; however, some factors (eg, swelling, functional limitations) were self-reported by patients and may be inaccurate or missing.
