Financial and employment toxicity related to breast reconstruction following mastectomy in a diverse population-based cohort.

78 Background: Despite mandated private insurance coverage for breast reconstruction following mastectomy, health care costs are increasingly passed onto women who seek these procedures through cost-sharing arrangements and high-deductible health plans. In this population-based study, we sought to characterize financial and employment toxicities related to pursuing breast reconstruction following mastectomy. Methods: Women (white, African American, and Latina-English and Spanish speaking) with early stage breast cancer (stages 0-II) diagnosed between July 2013 to September 2014 and who underwent mastectomy were identified through the Georgia and Los Angeles Surveillance, Epidemiology, and End Results (SEER) registries and surveyed. Primary outcome measures included patient-reported appraisal of financial toxicity and employment status following breast cancer treatment using previously developed measures. Multivariable models evaluated the association between breast reconstruction and self-reported financial and employment status. Results: Among 868 breast cancer patients who underwent mastectomy, 43.5% (n = 378) did not undergo breast reconstruction and 56.5% (n = 490) underwent reconstruction. 43.4% of the cohort reported being worse off financially since their diagnosis (49.4% with reconstruction vs. 35.0% without reconstruction, P< .001). Among women who were employed at time of breast cancer diagnosis (n = 535), 70.2% who underwent reconstruction reported being worse off regarding employment status compared to 51.1% who did not undergo reconstruction ( P< .001). Receipt of reconstruction was independently associated with a self-reported decline in financial status (Odds Ratio (OR) 2.1, 95% Confidence Interval (CI) 1.4-3.4, P= .001). Similarly, reports of being worse off regarding employment status were also higher in those who underwent reconstruction vs. not (OR 2.2, 95% CI 1.2-3.8, P= .006). Spanish-speaking Latina women more often reported being worse off regarding employment status (OR 4.3, 95% CI 2.1-9.0, P< .001) than white women. Conclusions: In this diverse cohort of women who underwent mastectomy for early stage breast cancer, women who elected to undergo reconstruction experienced more self-reported financial and employment toxicities. Patients should be counseled regarding the potential costs related to these procedures. Policy-makers should be aware of the financial barriers for women who undergo reconstruction despite mandatory insurance coverage in the United States.

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Community-Based Use of Chemotherapy and Hormonal Therapy for Early-Stage Breast Cancer: 1987-2000

Journal of Clinical Oncology ◽

10.1200/jco.2005.03.5840 ◽

2006 ◽

Vol 24 (6) ◽

pp. 872-877 ◽

Cited By ~ 57

Author(s):

Linda C. Harlan ◽

Limin X. Clegg ◽

Jeffrey Abrams ◽

Jennifer L. Stevens ◽

Rachel Ballard-Barbash

Keyword(s):

Breast Cancer ◽

Adjuvant Therapy ◽

Hormonal Therapy ◽

Early Stage ◽

The United States ◽

Population Based ◽

Early Stage Breast Cancer ◽

Community Based ◽

Node Negative ◽

Er Positive

Purpose We describe trends in the use of chemotherapy and hormonal therapy by nodal and estrogen receptor (ER) status in women with early-stage breast cancer. Methods Cases were randomly sampled from the population-based Surveillance, Epidemiology and End Results (SEER) program and physician verified treatment was examined. A total of 9,481 women, aged 20 years and older, diagnosed with early-stage breast cancer in 1987 to 1991, 1995, and 2000 were included in the study. Results The use of chemotherapy plus tamoxifen increased between 1995 and 2000 for women with node-negative, ER-positive breast cancer ≥ 1 cm (8% to 21%). Nearly 23% of women with node-negative and ER-positive tumors ≥ 1 cm received no adjuvant therapy. The use of chemotherapy alone increased to nearly 60% in women with node-negative, ER-negative tumors ≥ 1 cm (48% to 59%). However, in 2000, 16% of women with node-positive and ER-negative tumors received no adjuvant therapy and an additional 6% received tamoxifen alone. The influence of age can clearly be seen. Chemotherapy is given much less often in women 70 years or older. Conclusion The results from SEER areas across the United States suggest that physicians quickly responded to publications and guidelines regarding breast cancer therapy. The lack of definitive findings from clinical trials on the use of adjuvant therapy in women 70 years and older may explain the lower use in this group of women.

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Increasing Mastectomy Rates for Early-Stage Breast Cancer? Population-Based Trends From California

Journal of Clinical Oncology ◽

10.1200/jco.2009.26.1032 ◽

2010 ◽

Vol 28 (10) ◽

pp. e155-e157 ◽

Cited By ~ 43

Author(s):

Scarlett Lin Gomez ◽

Daphne Lichtensztajn ◽

Allison W. Kurian ◽

Melinda L. Telli ◽

Ellen T. Chang ◽

...

Keyword(s):

Breast Cancer ◽

Early Stage ◽

Population Based ◽

Early Stage Breast Cancer

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Adherence and persistence to adjuvant hormonal therapy in early stage breast cancer patients: A population-based retrospective cohort study in Israel.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e12051 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e12051-e12051

Author(s):

Tal Sella ◽

Gabriel Chodick

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Hormonal Therapy ◽

Breast Cancer Survivors ◽

Early Stage ◽

Population Based ◽

Early Stage Breast Cancer ◽

Adjuvant Hormonal Therapy ◽

Breast Cancer Patients ◽

Suboptimal Adherence

e12051 Background: Adjuvant hormonal therapy has been consistently proven to improve multiple outcomes in early breast cancer. Nonetheless, data on rates of adherence and persistence with therapy outside West Europe and North America are scarce. We assessed the adherence and persistence with adjuvant hormonal in a retrospective population based cohort of breast cancer survivors in Maccabi Health Services (MHS), Israel. Methods: We identified women who were diagnosed with breast cancer and initiated adjuvant hormonal therapy between January 2000 and November 2008. Subjects were followed retrospectively from first dispensed tamoxifen or aromatase inhibitor (AI) and up to the earliest of the following events: disease recurrence (indicated by surgery, radiotherapy, chemotherapy or other related therapies), leaving MHS, death, or completion of 5 years of treatment. Discontinuation of therapy was defined as a 180-day or longer treatment gap. Adherence with therapy was assessed using proportion of days covered (PDC) during follow-up period. Survival analysis was used to determine the effect of adherence on all-cause mortality. Results: A total of 4178 women with breast cancer were followed for a median 7.8 years. Over 90% of patients received tamoxifen as the initial hormonal agent. Mean PDC was 84% with lower rates associated with younger age, smoking status, comorbidities and year of diagnosis. Residential area did not affect adherence. Differences were not found. Discontinuation of therapy occurred in 23% of study patients. Among persistent patients, 70% were optimally adherent with therapy (PDC>=80%). Association between adherence with therapy and survival is investigated. Conclusions: Adherence to adjuvant hormonal therapy among Israeli breast cancer patients with national health insurance is high in comparison to international reports. Nevertheless, suboptimal adherence was identified among younger (<45y) patients. Because of the efficacy of hormonal therapy in preventing recurrence and death in women with early-stage breast cancer, interventions are necessary to identify and prevent suboptimal adherence among high risk subgroups.

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Characteristics and Outcomes of Women Developing Heart Failure After Early Stage Breast Cancer Chemotherapy: A Population-Based Matched Cohort Study

Circulation Heart Failure ◽

10.1161/circheartfailure.120.008110 ◽

2021 ◽

Author(s):

Husam Abdel-Qadir ◽

Felicia Tai ◽

Ruth Croxford ◽

Peter C. Austin ◽

Eitan Amir ◽

...

Keyword(s):

Breast Cancer ◽

Heart Failure ◽

Early Stage ◽

Sequential Therapy ◽

Cardiovascular Death ◽

Population Based ◽

Emergency Department Visits ◽

Early Stage Breast Cancer ◽

Administrative Databases ◽

Breast Cancer Chemotherapy

Background: The prognosis of heart failure (HF) after early stage breast cancer (EBC) treatment with anthracyclines or trastuzumab is not well-characterized. Methods: Using administrative databases, women diagnosed with HF after receiving anthracyclines or trastuzumab for EBC in Ontario during 2007 to 2017 (the EBC-HF cohort) were categorized by cardiotoxic exposure (anthracycline alone, trastuzumab alone, sequential therapy with both agents) and matched on age with ≤3 cancer-free HF controls to compare baseline characteristics. To study prognosis after HF onset, we conducted a second match on age plus important HF prognostic factors. The cumulative incidence function was used to describe risk of hospitalization or emergency department visits (hospital presentations) for HF and cardiovascular death. Results: A total of 804 women with EBC developed HF after anthracyclines (n=312), trastuzumab (n=112), or sequential therapy (n=380); they had significantly fewer comorbidities than 2411 age-matched HF controls. After the second match, the anthracycline-HF cohort had a similar 5-year incidence of HF hospital presentations (16.5% [95% CI, 12.0%–21.7%]) as controls (17.1% [95% CI, 14.4%–20.1%]); the 5-year incidence was lower than matched controls for the trastuzumab-HF (9.7% [95% CI, 4.7%–16.9%]; controls 16.4% [95% CI, 12.1%–21.3%]; P =0.03) and sequential-HF cohorts (2.7% [95% CI, 1.4%–4.8%]; controls 10.8% [95% CI, 8.9%–13.0%]; P <0.001). At 5 years, the incidence of cardiovascular death was 2.9% (95% CI, 1.2%–5.9%) in the anthracycline-HF cohort vs. 9.5% (95% CI, 6.9%–12.6%) in controls, and 1.7% (0.6%–3.7%) for women developing HF after trastuzumab vs. 4.3% (95% CI, 3.1–5.8%) for controls. Conclusions: Women developing HF after cardiotoxic EBC chemotherapy have fewer comorbidities than cancer-free women with HF; trastuzumab-treated women who develop HF have better prognosis than matched HF controls.

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