Unmet need for clinician engagement regarding financial toxicity after diagnosis of breast cancer

• Type of Material: Article
• Authors: Reshma Jagsi, University of Michigan; Kevin C. Ward, Emory University; Paul Abrahamse, University of Michigan; Lauren P. Wallner, University of Michigan; Allison W. Kurian, Stanford University; Ann S. Hamilton, University of Southern California; Steven J. Katz, University of Michigan; Sarah T. Hawley, University of Michigan
• Language: English
• Date: 2018-09-15
• Publisher: Wiley: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 American Cancer Society
• Final Published Version (URL): http://dx.doi.org/10.1002/cncr.31532
• Title of Journal or Parent Work: Cancer
• ISSN: 0008-543X
• Volume: 124
• Issue: 18
• Start Page: 3668
• End Page: 3676
• Grant/Funding Information: Cancer incidence data collection was supported by the California Department of Public Health pursuant to California Health and Safety Code Section 103885; Centers for Disease Control and Prevention’s (CDC) National Program of Cancer Registries, under cooperative agreement 5NU58DP003862–04/DP003862; the NCI’s Surveillance, Epidemiology and End Results Program under contract HHSN261201000140C awarded to the Cancer Prevention Institute of California; contract HHSN261201000035C awarded to the University of Southern California; and contract HHSN261201000034C awarded to the Public Health Institute.; Funded by grant P01CA163233 to the University of Michigan from the National Cancer Institute; and supported by the University of Michigan Cancer Center Biostatistics, Analytics and Bioinformatics shared resource (P30CA46592).; Cancer incidence data collection in Georgia was supported by contract HHSN261201300015I; Task Order HHSN26100006 from the NCI; and cooperative agreement 5NU58DP003875–04-00 from the CDC.
• Keywords: breast cancer; Aged; Cost of Illness; Surveys and Questionnaires; patient-provider communication; Female; cost; Health Care Costs; Health Services Needs and Demand; United States; Adult; Humans; finances; Young Adult; Attitude of Health Personnel; Physician-Patient Relations; financial toxicity; SEER Program; Breast Neoplasms; Counseling; Practice Patterns, Physicians'; Decision Making; Middle Aged; Communication; Oncologists
• Research Categories: Health Sciences, Oncology; Health Sciences, Epidemiology

Abstract

BACKGROUND: Little is known regarding whether growing awareness of the financial toxicity of a cancer diagnosis and its treatment has increased clinician engagement or changed the needs of current patients. METHODS: The authors surveyed patients with early-stage breast cancer who were identified through population-based sampling from 2 Surveillance, Epidemiology, and End Results (SEER) regions and their physicians. The authors described responses from approximately 73% of surgeons (370 surgeons), 61% of medical oncologists (306 medical oncologists), 67% of radiation oncologists (169 radiation oncologists), and 68% of patients (2502 patients). RESULTS: Approximately one-half (50.9%) of responding medical oncologists reported that someone in their practice often or always discusses financial burden with patients, as did 15.6% of surgeons and 43.2% of radiation oncologists. Patients indicated that financial toxicity remains common: 21.5% of white patients and 22.5% of Asian patients had to cut down spending on food, as did 45.2% of black and 35.8% of Latina patients. Many patients desired to talk to providers about the financial impact of cancer (15.2% of whites, 31.1% of blacks, 30.3% of Latinas, and 25.4% of Asians). Unmet patient needs for engagement with physicians about financial concerns were common. Of 945 women who worried about finances, 679 (72.8%) indicated that physicians and their staff did not help. Of 523 women who desired to talk to providers regarding the impact of breast cancer on employment or finances, 283 (55.4%) reported no relevant discussion. CONCLUSIONS: Many patients report inadequate clinician engagement in the management of financial toxicity, even though many providers believe that they make services available. Clinician assessment and communication regarding financial toxicity must improve; cure at the cost of financial ruin is unacceptable.