Navigating costs of care in women with breast cancer: Examining racial differences in non-treatment costs and financial toxicity in under-resourced populations struggling to afford medical care.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 156-156
Author(s):  
Kathleen D. Gallagher ◽  
Brittnee Barris ◽  
Eric Anderson ◽  
Katie Deehr ◽  
Shonta Chambers ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Medical Care ◽  
Cancer Patients ◽  
Racial Differences ◽  
Financial Distress ◽  
Healthcare Costs ◽  
Treatment Costs ◽  
Categorical Variables ◽  
Financial Toxicity ◽  
Breast Cancer Patients

156 Background: Patients with cancer struggle to afford needed medical care alongside daily financial obligations due to rising healthcare costs. This may be more pronounced among minorities who are less likely to seek resources to mitigate their financial distress. This study sought to identify racial differences in non-treatment costs for under-resourced women with breast cancer who sought assistance from Patient Advocate Foundation (PAF). Methods: This cross-sectional study utilized secondary survey data collected from breast cancer patients receiving case management services from PAF in 2018. Respondents answered questions describing their financial distress and COmprehensive Score for financial Toxicity (COST) tool (0-44 with lower scores indicating worse toxicity). Descriptive statistics were calculated using means and standard deviations (SD) for continuous variables and frequencies for categorical variables. Two sample t-tests were used for bivariate comparisons between racial groups. Results: Of 267 breast cancer patients surveyed, 54% were Caucasian, 29% were African American (AA), and 83% indicated a household income of < $48,000. Cohorts expressed strong dissatisfaction with their financial situation with AA impacted more acutely (78% vs 56%) and acknowledged inability to pay for treatment costs (83% vs 58%). Compared to Caucasians, AAs were more often concerned with transportation costs (33% vs 16%) and with day-to-day living expenses (83% vs 59%). Younger (≤55 years) AA respondents were twice as often unable to meet monthly expenses (60% vs. 27%). Older AA respondents ( > 55 years) reported greater distress than older Caucasians (74% vs 57%), while younger Caucasians reported greater distress than their AA counterparts (72% vs 65%). COST scores differed significantly between Caucasians (mean 13, SD 9) and AAs (mean 11, SD 8; p = 0.04). Conclusions: While the impacts of medical care costs were felt by all survey respondents, under-resourced AA breast cancer patients may be at higher risk for household material hardships as financial resources are diverted toward essential healthcare costs.

Abstract B024: Racial differences in financial toxicity among metastatic breast cancer patients

2020 ◽  
Author(s):  
Cleo A. Samuel ◽  
Jennifer C. Spencer ◽  
Michelle L. Manning ◽  
Donald L. Rosenstein ◽  
Katherine E. Reeder-Hayes ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Cancer Patients ◽  
Racial Differences ◽  
Metastatic Breast ◽  
Financial Toxicity ◽  
Breast Cancer Patients

Abstract PR07: Racial differences in financial toxicity among metastatic breast cancer patients

2020 ◽  
Author(s):  
Cleo A. Samuel ◽  
Jennifer C. Spencer ◽  
Michelle L. Manning ◽  
Donald L. Rosenstein ◽  
Katherine E. Reeder-Hayes ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Cancer Patients ◽  
Racial Differences ◽  
Metastatic Breast ◽  
Financial Toxicity ◽  
Breast Cancer Patients

scholarly journals MEDICAL CARE FOR BREAST CANCER PATIENTS IN THE AMUR REGION FOR THE PERIOD 1999–2014

2017 ◽  
Vol 16 (3) ◽  
pp. 12-18 ◽  
Author(s):  
Lyubov F. Pisareva ◽  
Irina O. Spivakova ◽  
Nina P. Lyakhova ◽  
Irina N. Odintsova ◽  
Tatyana N. Korobkova ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Medical Care ◽  
Cancer Patients ◽  
Amur Region ◽  
Breast Cancer Patients

scholarly journals Breast Cancer: Reimbursement Policies and Adoption of New Therapeutic Agents by National Health Systems

Breast Care ◽  
2019 ◽  
Vol 14 (6) ◽  
pp. 373-381 ◽  
Author(s):  
Dario Trapani ◽  
Giuseppe Curigliano ◽  
Alexandru Eniu
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Priority Setting ◽  
Financial Distress ◽  
Quality Care ◽  
Premature Death ◽  
Health Coverage ◽  
Breast Cancer Patients ◽  
Middle Income ◽  
Timely Access

Background: Breast cancer is a cause of morbidity for more than half a million of patients in Europe, resulting in broad societal impacts that affect patients, families, and societies from a human, emotional, economic, and financial perspective. Expenditure for cancer medicines represents one of the principal driving costs of healthcare. The aim of this review is to describe the European policy and regulatory landscape of innovation uptake in breast oncology – with emphasis on value in cancer healthcare. Summary: In Europe, several reimbursement models or policy tools have been developed by countries to compose their benefit packages. The most commonly applied scheme is the product-specific eligibility model, prioritizing selected medicines and their indications. Mixed models are commonly developed, addressing the protection of more vulnerable people, ensuring protection from impoverishment caused by cancer and containing disparities. However, the risk to incur significant out-of-pocket expenses for essential or newer medicines for cancer is still substantial in Europe, especially in low- and middle-income countries, determining greater financial distress and poorer outcome for patients. Value-based priority setting is an essential mechanism to ensure timely access to the most valuable medicines for breast cancer patients. Estimations of the value of medicines can be provided within health technology assessment services and networks and informed by benefit scales and tools. Key Messages: There is ample room for reciprocal support across the diverse cultural and legal realities in Europe. The aim is common: save cancer patients from premature death by ensuring the timely access to the best care, protecting from financial hardships and distress to leave no cancer patient behind in poverty. Steps are to be taken to promote value-based priority setting, paving the way toward universal health coverage in Europe, where health of people is protected, and affordable best quality care is the only standard pursued and acceptable.

Race and clinical outcome in breast cancer in a series with long-term follow-up evaluation.

1997 ◽  
Vol 15 (6) ◽  
pp. 2329-2337 ◽  
Author(s):  
R Heimann ◽  
D Ferguson ◽  
C Powers ◽  
D Suri ◽  
R R Weichselbaum ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Racial Differences ◽  
Multivariable Analysis ◽  
Disease Free Survival ◽  
Similar Proportion ◽  
Significant Variable ◽  
Breast Cancer Patients ◽  
Node Negative

PURPOSE To compare the outcome of African American (AA) and Caucasian (C) breast cancer patients who had equivalent disease extent and were similarly treated. PATIENTS AND METHODS We compared prognostic characteristics, treatment, and outcome of 1,037 C and 481 AA breast cancer patients treated with mastectomy between 1946 and 1987. The median follow-up duration was 15.6 years. RESULTS During the study period, there was a successive increase in the percent of patients who presented with early breast cancer. Between 1980 and 1987, 35.1% AA versus 47.6% C patients had < or = 2-cm tumors and 50.0% AA versus 61.9% C patients were node-negative, while between 1946 and 1959, 27.7% AA and 31.3% C had < or = 2-cm tumors and 41.5% AA versus 40.4% C patients were node-negative. The treatments were similar during the study period. The 20-year disease-free survival (DFS) rate of AA compared with C patients with node-negative < or = 2-cm, 2.1- to 4-cm, and greater than 4-cm tumors and of patients with one to three and > or = four positive nodes was not significantly different. Equal-size tumors had similar proportion of positive axillary nodes in AA compared with C patients. The DFS for AA patients compared with C patients was similar in the periods 1946 to 1959, 1960 to 1969, and 1970 to 1979, but was lower between 1980 and 1987 (P = .02). In multivariable analysis, race was not a significant variable. CONCLUSION In this large group of uniformly treated breast cancer patients, race was not an independent factor that influenced outcome. The racial differences seen between 1980 and 1987 are likely because of a larger percent of greater than 2-cm and node-positive tumors in AA patients. Education and access to early diagnosis should reduce or eliminate the racial differences seen.

Association of baseline cardiovascular risk factors and health care utilization and costs in elderly breast cancer patients enrolled in SWOG clinical trials.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11508-11508
Author(s):  
Dawn L. Hershman ◽  
Cathee Till ◽  
Jason Dennis Wright ◽  
Melissa Kate Accordino ◽  
Riha Vaidya ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Clinical Trials ◽  
Cancer Patients ◽  
Healthcare Costs ◽  
Disease Risk ◽  
Breast Cancer Patients ◽  
Increased Risk ◽  
Clinical Records ◽  
The Impact

11508 Background: Cardiovascular-disease risk factors (CVD-RFs) increase the risk of cardiac events in women undergoing chemotherapy. Less is known about the impact of CVD-RFs on healthcare utilization and costs. Methods: We examined breast cancer patients treated uniformly on SWOG clinical trials from 1999-2011. We identified baseline diabetes, hypertension, hypercholesterolemia, and coronary artery disease (CAD) by linking trial records to Medicare claims; obesity was identified using clinical records. The outcomes were emergency room visits (ER), hospitalizations and costs. Multivariable logistic and linear regression were used. Results: Among the 708 patients included in the analysis, 160 (22.6%) experienced 234 separate hospitalizations, and 193 (27.3%) experienced 311 separate ER visits. Diabetes, hypertension, hypercholesterolemia, and CAD were all associated with increased risk of hospitalizations and ER visit. Hypertension had the strongest association, with more than a threefold risk of hospitalization for those with hypertension compared to those without (OR [95% CI], 3.16 [1.85-5.40], p<0.001). For those with ≥3 CVD-RFs, the risk of hospitalization was greater compared to 0 or 1 CVD-RFs (OR [95% CI], 2.74 [1.71-4.38], p<0.001). Similar results were seen for ER visits. In the first 12 months after trial registration, patients with diabetes ($38,324 vs $30,923, 23.9% increase, p=0.05), hypercholesterolemia ($34,168 vs $30,661, 11.4% increase, p=0.02), and CAD ($37,781 vs $31,698, 19.2% increase, p=0.04) had statistically significantly higher total healthcare costs. Additionally, those with 2 significant CVD-RFs ($35,353 vs. $28,899, 22.3% increase, p=.005) had higher total healthcare costs. Conclusions: Our study demonstrates that the presence of both CVD-RFs and ER visits and hospitalizations are frequent among elderly BC patients. The risk of ER visits and hospitalizations is higher among patients with CVD-RFs, and increases with the number of RFs. Better management of CVD-RFs and more aggressive symptom management may be required to reduce both physical and financial toxicities to elderly patients undergoing BC therapy.

scholarly journals Evaluation of Pentosidine as Bone Quality Marker in Postmenopausal Breast Cancer Patients Receiving Aromatase Inhibitors

2020 ◽  
Author(s):  
Hideo Shigematsu ◽  
Tomoyuki Yoshiyama ◽  
Daisuke Yasui ◽  
Shinji Ozaki
Keyword(s):  
Breast Cancer ◽  
Bone Turnover ◽  
Cancer Patients ◽  
Bone Quality ◽  
Bone Turnover Markers ◽  
Postmenopausal Breast Cancer ◽  
Categorical Variables ◽  
Breast Cancer Patients ◽  
Average Change ◽  
Turnover Markers

Abstract Background: Osteoporosis and fractures are important aromatase inhibitor (AI) related adverse events in postmenopausal women with hormone receptor positive breast cancer. An incremental increase of pentosidine is associated with a deterioration of bone quality. In this study, pentosidine was evaluated in postmenopausal breast cancer patients receiving AIs.Methods: Fifty Japanese postmenopausal breast cancer patients receiving AIs were retrospectively evaluated. Sixteen patients were given a bone modifying agent (BMA) concomitant with AIs. Changes of pentosidine, bone turnover markers and bone mineral density (BMD) before and after 12 months of AI therapy were compared between BMA administered patients (BMA group) and a non-BMA group. These factors were assessed by BMA groups using chi-square of categorical variables and t-test for continuous variables.Results: The median age of the subjects was 67 years, and 21, 23 and 6 subjects were classified as normal, bone loss and osteoporosis, respectively. There was no significant difference between pentosidine low and high groups in regard to age, height, weight, BMD of femoral neck and lumbar spine, and bone turnover markers including TRACP-5b and BAP. In the non-BMA group, pentosidine was increased in 18 cases (53%), and the average change of pentosidine was 21.5% (95%CI; 0.23 to 42.7%, p=0.048). In the BMA group, pentosidine was increased only in 2 cases (13%), and the average change of pentosidine was -16.6% (95%CI; -30.6 to -2.6%, p=0.023). There was a significantly lower proportion of pentosidine-increased cases (p=0.0065) and decrease of pentosidine (p=0.021) in the BMA group compared to those in the non-BMA group.Conclusions: Pentosidine was increased with AI, however, BMA inhibits an AI-induced increase of pentosidine in postmenopausal breast cancer patients.

Racial differences in weight perception among breast cancer patients.

2015 ◽  
Vol 33 (15_suppl) ◽  
pp. e12623-e12623
Author(s):  
Jenny J Lin ◽  
Kezhen Fei ◽  
Rebeca Franco ◽  
Emily Gallagher ◽  
Derek Leroith ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Racial Differences ◽  
Weight Perception ◽  
Breast Cancer Patients

Radiation and cardiotoxicity: A retrospective analysis of a midwest population.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e12616-e12616
Author(s):  
Nitin Tandan ◽  
Cameron Koester ◽  
Priyanka Parajuli ◽  
Odalys Estefania Lara Garcia ◽  
Manjari Rani Regmi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Cancer Patients ◽  
Large Scale ◽  
Categorical Variables ◽  
Rank Test ◽  
Continuous Variables ◽  
Breast Cancer Patients ◽  
Cardiac Events ◽  
Coronary Syndrome

e12616 Background: The most common female malignancy diagnosed in the US is breast cancer. Early breast cancer therapy is often treated with radiation therapy; one of the unfortunate side effects of radiotherapy in the past has been cardiotoxicity, especially coronary artery disease. Recent usage of dose reduction techniques have helped reduce these effects. Here, we present our analysis of breast cancer patients that received radiation therapy and the likelihood of cardiotoxicity. Methods: An IRB-approved retrospective study was performed utilizing ICD codes to analyze patients diagnosed with biopsy-confirmed breast cancer between January 1, 2014 and December 31, 2017. 478 of 1618 de-identified patients qualified for this study. Statistical analysis was performed with SAS v9.4. Descriptive statistics were computed for all study variables. Continuous variables were described with measures of central tendency (mean, median) and dispersion (range, standard deviation). Categorical variables were summarized as frequencies and percentages. Comparisons between categorical variables were compared with the Chi-Square test (or Fisher’s Exact) where appropriate. Survival curves were estimated using Kaplan-Meier methodology and analyzed with a log rank test. Predictors of survival were assessed with Cox proportional hazards regression analyses. All significance is assumed at the p < 0.05 level. Results: Of the 478 eligible patients, heart failure (HF), HF hospitalizations, acute coronary syndrome and overall cardiac events were compared among breast cancer patients. Patients who received radiation experienced HF 6.02% compared to 4.61% without radiation (p = 0.574). HF hospitalization was recorded as 2.27% in radiotherapy compared to 1.23% in non-radiotherapy patients (p = 0.686). Patients who radiation experienced ACS 2.27% of the time as compared to 1.21% in patients who were not treated with radiation. Of note, 9.25% receiving radiation experienced cardiac events compared to 4.24% in patients without radiation (p = 0.068). While results were not statistically significant, the trend of elevated cardiac events in breast cancer patients receiving radiation is noteworthy. Conclusions: Per our study, although statistically insignificant, radiation therapy may result in higher incidence of cardiac events in breast cancer patients. Further large-scale, prospective studies should be performed to confirm the aforementioned trends with respect to survival outcomes in urban and rural populations.

Association between obesity and the clinical stage of newly diagnosed breast cancer: Experience with 2212 patients.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e12602-e12602
Author(s):  
Bader I Alshamsan ◽  
Kausar Suleman ◽  
Naela Agha ◽  
Marwa Ismail Abdelgawad ◽  
Mashari J Alzahrani ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Confidence Interval ◽  
Cancer Patients ◽  
Clinical Stage ◽  
Locally Advanced ◽  
Overweight And Obesity ◽  
Categorical Variables ◽  
Newly Diagnosed ◽  
Breast Cancer Patients ◽  
Time Of Presentation

e12602 Background: Excess weight is currently recognized as a risk factor for several cancer types, including breast cancer. The primary goal of this study was to evaluate the impact of overweight and obesity in newly diagnosed breast cancer patients at the time of presentation. Methods: A retrospective analysis of breast cancer from a prospective database of all newly diagnosed non-metastatic breast cancer patients seen at King Faisal Specialist Hospital and Research Center between 2002 and 2014 was performed. The clinical stages were divided into early stage breast cancer and locally advanced breast cancer. The body mass index (BMI) groups were underweight, normal, overweight, and obese based on the World Health Organization classifications of BMI. The patient characteristics are presented as medians with interquartile ranges (IQRs) and frequencies for continuous and categorical variables, respectively. The association between BMI groups and clinical stage at presentation was evaluated using the logistic regression model. Survival probabilities were calculated using the Kaplan-Meier estimator. Results: In total, 2212 patients were eligible for the study. The median age at diagnosis was 45 (IQR = 39-52) years; 62% patients were pre-menopausal, and 31% were post-menopausal. The median BMI was 30 (IQR = 26-34) kg/m2. In this population, 53% patients were obese; 31%, overweight; and 14.7%, in the normal range at diagnosis. Regression analysis revealed a significant association between clinical stage and BMI at the time of presentation (p = 0.006). Obese patients showed a 40% higher chance of having locally advanced presentation than the normal BMI group (OR = 1.41, 95% confidence interval = 1.06-1.86, p = 0.02). However, overweight had no significant association with clinical stage (OR = 1.03, 95% confidence interval = 0.76-1.8). The median follow-up duration was 39 (IQR = 22-66.6) months. Overall survival showed no significant association with different BMI groups and breast cancer subtypes. Conclusions: The prevalence of overweight and obesity was found to be high (85%) in newly diagnosed breast cancer patients in Saudi Arabia. Obesity is associated with a more advanced clinical stage at the time of diagnosis of breast cancer and may be a contributing factor for more locally advanced presentations in the region.

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