For some, breast cancer treatment is a balance between affordability and independence


Women with breast cancer who were receiving financial assistance through a national charity prioritized either affordability or maintaining functional independence when making treatment decisions.

Researchers surveyed 220 breast cancer patients receiving assistance through the Patient Advocate Foundation and found that three-quarters of patients prioritized cost, and the remaining patients prioritized functional independence, such as the ability to work.

Courtney Williams, DrPH, of the National Cancer Institute in Rockville, Md., described this research in a presentation at the 2020 American Society of Clinical Oncology Quality Care Symposium.

Although “oncologists routinely emphasize the importance of efficacy in treatment decision-making, patients may be prioritizing other factors,” Dr. Williams noted.

This research “highlights the importance of engaging women with breast cancer in discussions about the financial cost and cost on quality of life with various treatment options,” said Marjory Charlot, MD, of the University of North Carolina at Chapel Hill, who was the moderator for Dr. Williams’s presentation.

Understanding and “communicating what matters most to women with breast cancer will help them in making informed decisions with less decisional regret,” Dr. Charlot added.

Dr. Courtney Williams

Dr. Marjory Charlot

Courtesy Rhoda Baer/National Cancer Institute

Courtesy Daniel Sone/National Cancer Institute

Study details

The investigators decided to survey 220 patients receiving charitable assistance because there’s little data on treatment preferences among the financially stressed.

Most patients (91%) had stage I-III breast cancer, 38% had recurrent cancer, and 61% were on active treatment. The patients had a median age of 58 years, 60% had household incomes below $40,000, 72% were White, and 42% were employed.

The patients were all under “severe financial burden,” Dr. Williams said, as indicated by scores of around 10 on the Comprehensive Score for Financial Toxicity questionnaire.

The patients were asked to choose between competing treatment scenarios that traded one benefit for another; for instance, between an expensive treatment option with minimal side effects that preserved the patient’s fertility and an option that was affordable but with moderate side effects and fertility loss.

“After sampling many patients, we [could] then understand the most valued preferences within our sample,” Dr. Williams said.

Results and applicability

Two subgroups of patients emerged in the data. One group, which consisted of 75% of patients, prioritized cost. They were most concerned about affordability, impact on activities of daily living, and being a burden on family and friends.

The other group, 25% of patients, prioritized functional independence. These patients were most concerned about their ability to keep working, side effects, impact on daily activities, and interference with important life events.

The cost-prioritizing respondents, when compared with the group prioritizing functional independence, more often had early-stage cancer (88% vs. 78%), were White (78% vs. 56%), and were privately insured (45% vs. 36%).

Patients in the group prioritizing functional independence more often had household incomes less than $40,000 a year (76% vs. 54%), identified as Hispanic (20% vs. 9%), and had Medicaid (15% vs. 7%).

Courtesy Rhoda Baer/National Cancer Institute
Overall, the ability to be in a clinical trial or receive a newly approved medication fell about midrange in terms of importance to the patients. 

There was no difference in financial toxicity scores between the groups.

“I don’t think one can generalize from this sample to the general population of women with breast cancer,” said Patricia Ganz, MD, of the University of California, Los Angeles, when asked for comment.

She noted that patients in this study were all getting help with drug costs through the charity and were therefore especially concerned about affordability.

“Efficacy usually plays the most prominent role rather than cost in the broader population,” Dr. Ganz said. “Certainly, all issues should be discussed with patients when starting a therapy, including cost/affordability.”

Dr. Patricia Ganz
This research was funded by the Breast Cancer Research Foundation of Alabama. Study investigators disclosed relationships with LIM Innovations, Genentech/Roche, Pfizer, and Carevive Systems. Dr. Charlot and Dr. Ganz had no relevant disclosures.