Risk Factors, Outcomes of Financial Toxicity Related to Breast Cancer Identified in Review

Researchers explored risk factors and outcomes related to financial toxicity in patients with breast cancer in a scoping review. They reported their findings in the journal Cancer Nursing.

Advances in treatment and diagnostics related to breast cancer can impart substantial financial burden for patients, and that financial toxicity can have profound impacts on patients. “Financial toxicity can cause material loss, result in coping behaviors, and lead to impaired health-related quality of life,” the researchers reported in their study.

They conducted a search of PubMed/MEDLINE, Web of Science, MEDLINE (Ovid), CINAHL, EMBASE, ProQuest, and China National Knowledge Infrastructure databases for published studies related to breast cancer, financial toxicity, and a variety of similar terms. Based on this information, they aimed to identify risk factors and outcomes related to financial toxicity in patients with breast cancer.

The analysis included 31 studies, with research conducted across multiple countries and including 13,832 patients with breast cancer overall. Risk factors for financial toxicity were addressed in 29 of the studies; outcomes of financial toxicity were addressed in 13 studies.

Financial toxicity risks comprised a broad array of factors. Socioeconomic factors were primarily related to household income, household savings, insurance status, and employment status. These factors affected patients’ ability to manage out-of-pocket medical costs, exacerbated weak social adaptability, and limited access to support resources, the researchers reported.

Demographic factors included age, race, education level, and marriage and residence status. For example, among patients with breast cancer, younger age associated with more aggressive types of cancer, less savings, and potential loss of work, making these patients more vulnerable to financial burden.

Disease and treatment factors associated with stage and type of breast cancer, treatment, physical health status, and symptom burden. Advanced cancer stage is a strong predictor of financial toxicity. Treatments such as radiotherapy, adjuvant and neoadjuvant chemotherapy, and targeted therapy also associated with higher risk of financial toxicity.

Type of surgery also affected financial status. For example, axillary lymph node dissection, bilateral mastectomy, lumpectomy, and autologous reconstruction was associated with financial toxicity, whereas prophylactic mastectomy was not.

Financial toxicity was affected by psychological and cognitive factors, including lower level of psychological resilience. Limited health financial literacy (eg, ability for long-term financial planning) was a risk factor, but limited health insurance literacy was not a risk factor.

Impacts of financial toxicity also were wide ranging. Material loss caused by reductions to income and increased debt could lead to efforts to limit costs. These coping behaviors can include self-reducing medications, delaying treatment, using savings or borrowing money, and reducing spending on food and other basics.

Cost-saving measures may have a negative impact on health status and health-related quality of life. The resulting overall distress can manifest as worse symptom burden, depression, anxiety, and worse perceived health.

Financial toxicity can result from direct and indirect costs related to treatment and can be associated with maladaptive behaviors affecting patient well-being and health, the researchers found. “Therefore, providers should proactively carry out financial toxicity assessment and screening, identify high-risk groups early, and conduct effective interventions to reduce the adverse outcomes associated with financial toxicity,” the researchers concluded.

Reference

Kuang Y, Yuan X, Zhu Z, Xing W. Financial toxicity among breast cancer patients: a scoping review of risk factors and outcomes. Cancer Nurs. Published online July 11, 2023. doi:10.1097/NCC.0000000000001262