The cost of early-stage breast cancer therapy is a concern that influences treatment decisions for many women, even when they have insurance and higher income than most Americans, a new survey suggests.
The 607 survey participants all had a history of breast cancer or ductal carcinoma in situ (stage 0-III). The majority had private insurance (70%) or Medicare (25%) and a higher annual household income (≥ $74,000) than the general US population.
Despite this relatively empowered socioeconomic status among participants, nearly half (43%) reported considering costs when making treatment decisions. Furthermore, 40% wanted their physicians to think about costs when making medical recommendations.
The survey participants also overwhelmingly reported that they wanted to understand costs before treatment (79%), report the study authors, led by Rachel Adams Greenup, MD, of Duke University Medical Center in Durham, North Carolina.
The study revealed this rarely happened, with 78% of the women saying that costs were never discussed with their caregivers. The new data are due to be presented at the American Society of Clinical Oncology (ASCO) Quality Care Symposium, September 28-29, in Phoenix, Arizona.
"In an era of rising cancer treatment costs, we do not routinely discuss the financial implications of cancer care with women embarking on treatment," said Greenup in a meeting press statement.
Many breast cancer treatment options are comparable in efficacy but have different costs, she said, adding that information about costs could facilitate better decision making.
Details of the Survey
The study participants who were participants in the Army of Women or the Sisters Network, which are national organizations for women after breast cancer completed an 88-question electronic survey. The survey focused on their experiences with breast cancer treatment costs and preferences for cost information.
The group was relatively young (median age at diagnosis, 49.6 years) and median time from diagnosis was 6.7 years. Median reported out-of-pocket (OOP) costs were $3500. However, 25% had OOP costs ≥ $8000, 10% had OOP costs ≥ $18,000, and 5% had OOP costs ≥ $30,000.
The survey also asked women to characterize their financial burden as none, slight, somewhat, significant, and catastrophic. A total of 15.5% chose significant or catastrophic to describe their financial burden.
Given the survey population's demographics (insured, educated, and white), it is likely that other American women have an even greater risk of financial harm, according to ASCO.
In the study, women were more likely to report financial harm if they had bilateral mastectomy vs lumpectomy (odds ratio [OR], 1.9; P = 0.03), greater stage at diagnosis (stage 3 vs 0; OR, 3.9; P < 0.01), and discussed costs during the clinical encounter (OR, 2.3; P < 0.01).
Women who reported discussing costs were more likely to be stage 2 or 3 (56% vs 40%; P = 0.02), less likely to be depressed (24% vs 30%; P = 0.03), and had less insurance coverage (trend P = 0.02) compared with those who did not.