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Financial Toxicity in Breast Reconstruction: A National Survey of Women Who have Undergone Breast Reconstruction After Mastectomy

  • Reconstructive Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

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.

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Acknowledgments

The authors would like to thank the members of the Love Research Army who volunteered their time to complete our survey and who contributed financial information regarding their cancer care.

Funding

The University of Michigan Section of Plastic Surgery MacNguyen Fund was used to support collaboration with the Susan Love Research Foundation Love Research Army.

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Authors and Affiliations

  1. Department of Surgery, Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA

    Nishant Ganesh Kumar MD, Nicholas L. Berlin MD, MPH & Adeyiza O. Momoh MD

  2. National Clinician Scholars Program, University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA

    Nicholas L. Berlin MD, MPH

  3. Department of Internal Medicine and Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA

    Sarah T. Hawley PhD, MPH

  4. Department of Radiation Oncology, Center for Bioethics and Social Science in Medicine, University of Michigan, Ann Arbor, USA

    Reshma Jagsi MD, DPhil

Authors
  1. Nishant Ganesh Kumar MD
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  2. Nicholas L. Berlin MD, MPH
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  3. Sarah T. Hawley PhD, MPH
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  4. Reshma Jagsi MD, DPhil
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  5. Adeyiza O. Momoh MD
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Contributions

Nishant Ganesh Kumar and Nicholas L. Berlin contributed equally as co-first authors. Adeyiza O. Momoh is the senior/last author. All authors and co-authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship.

Corresponding author

Correspondence to Adeyiza O. Momoh MD.

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Disclosures

Nishant Ganesh Kumar, Nicholas L. Berlin, Sarah T. Hawley, Reshma Jagsi, and Adeyiza O. Momoh report no financial conflicts of interests or relevant disclosures in relation to this study.

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Ganesh Kumar, N., Berlin, N.L., Hawley, S.T. et al. Financial Toxicity in Breast Reconstruction: A National Survey of Women Who have Undergone Breast Reconstruction After Mastectomy. Ann Surg Oncol 29, 535–544 (2022). https://doi.org/10.1245/s10434-021-10708-5

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  • DOI: https://doi.org/10.1245/s10434-021-10708-5

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