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Financial toxicity and contralateral prophylactic mastectomy: an analysis using propensity score methods

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Contralateral prophylactic mastectomy (CPM) is increasingly performed in average-risk patients despite the lack of survival benefit. In an era of heightened awareness of healthcare costs, we sought to determine the impact of CPM on financial toxicity in breast cancer.

Methods

A single-institution propensity-matched analysis of female patients who underwent unilateral mastectomy (UM) with or without CPM for breast cancer over an 18-month period. Patients with a history of genetic predisposition or bilateral cancer were excluded. The validated Comprehensive Score for financial Toxicity (COST) evaluated financial toxicity among participants. Multivariable regression analysis evaluated the relationship between CPM and financial toxicity. Relevant domains of the Breast Q and SF12 instruments were examined as secondary outcomes. Sensitivity analysis was performed using propensity-weighting to examine robustness of results and increase our sample size.

Results

Overall, 104 patients were identified, equally distributed across UM and CPM. CPM was not associated with financial toxicity, as evidenced by comparable COST scores (adjusted difference, 1.53 [− 3.24 to 6.29]). Minor complications were significantly lower in UM patients (UM, 8%; CPM, 31%). CPM was associated with significantly higher Breast Q psychosocial well-being score (adjusted difference, 10.58 [1.34 to 19.83]). BREAST Q surgeon satisfaction, SF12 mental and physical component scores were comparable. Similar results were noted on sensitivity analysis involving 194 patients.

Conclusions

Choice for CPM was associated with higher minor complications, but led to improved psychosocial well-being without a higher degree of patient-reported financial toxicity. Prospective studies are needed to discern the influence of CPM on the incidence and trajectory of financial toxicity.

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Funding

This research was supported by funds from the University Cancer Foundation via the Sister Institution Network Fund (SINF) at the University of Texas MD Anderson Cancer Center. The senior author (ACO) has received research funding from Blue Cross Blue Shield Affordability Cures Research Consortium and National Academy of Medicine, both are unrelated to the submitted work. The senior author is also a board member of the Patient Advocate Foundation. All other authors report no financial conflicts of interest.

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Authors and Affiliations

  1. Department of Plastic & Reconstructive Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Malke Asaad, Stefanos Boukovalas, Carrie K. Chu, Mark W. Clemens & Anaeze C. Offodile II

  2. Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Yu-Li Lin & Anaeze C. Offodile II

  3. Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Cristina M. Checka

  4. Department of Surgical Oncology, Duke University School of Medicine, Durham, NC, USA

    Rachel A. Greenup

  5. Baker Institute for Public Policy, Rice University, Houston, TX, USA

    Anaeze C. Offodile II

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  1. Malke Asaad
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  2. Stefanos Boukovalas
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  3. Carrie K. Chu
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  4. Yu-Li Lin
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  5. Cristina M. Checka
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  6. Mark W. Clemens
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  7. Rachel A. Greenup
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  8. Anaeze C. Offodile II
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Correspondence to Anaeze C. Offodile II.

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Conflict of interest

Senior author (ACO) has received competitive research funding from the Blue Cross Blue Shield Affordability Cures Research Consortium and National Academy of Medicine, both are unrelated to the submitted work.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Asaad, M., Boukovalas, S., Chu, C.K. et al. Financial toxicity and contralateral prophylactic mastectomy: an analysis using propensity score methods. Breast Cancer Res Treat 183, 649–659 (2020). https://doi.org/10.1007/s10549-020-05805-0

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