• Christopher J Coroneos, Yu-Li Lin, Chris Sidey-Gibbons, Malke Asaad, Brian Chin, Stefanos Boukovalas, Margaret S Roubaud, Makesha Miggins, Donald P Baumann, and Anaeze C Offodile.
• Division of Plastic Surgery, Department of Surgery, McMaster University, Ontario, CA; Department of Health Research Methods, Evidence and Impact, McMaster University, Ontario, CA.
• J. Am. Coll. Surg. 2021 Mar 1; 232 (3): 253-263.

BackgroundThe relationship between treatment-related, cost-associated distress "financial toxicity" (FT) and quality-of life (QOL) in breast cancer patients remains poorly characterized. This study leverages validated patient-reported outcomes measures (PROMs) to analyze the association between FT and QOL and satisfaction among women undergoing ablative breast cancer surgery.Study DesignThis is a single-institution cross-sectional survey of all female breast cancer patients (>18 years old) who underwent lumpectomy or mastectomy between January 2018 and June 2019. FT was measured via the 11-item COmprehensive Score for financial Toxicity (COST) instrument. The BREAST-Q and SF-12 were used to asses condition-specific and global QOL, respectively. Responses were linked with demographic and clinical data. Pearson correlation coefficient and multivariable regression were used to examine associations.ResultsOur analytical sample consisted of 532 patients; mean age 58, mostly white (76.7%), employed (63.7%), married/committed (73.7%), with 64.3% undergoing reconstruction. Median household income was $80,000 to $120,000/year, and mean COST score was 28.0. After multivariable adjustment, a positive relationship for all outcomes was noted; lower COST (greater cost-associated distress) was associated with lower BREAST-Q and SF-12 scores. This relationship was strongest for BREAST-Q psychosocial well-being, for which we observed a 0.89 (95% CI 0.76-1.03) change per unit change in COST score.ConclusionsFinancial toxicity captured in this study correlates with statistically significant and clinically important differences in BREAST-Q psychosocial well-being, patient satisfaction with reconstructed breasts, and SF-12 global mental and physical quality of life. Treatment costs should be included in the shared decision-making for breast cancer surgery. Future prospective outcomes research should integrate COST.Copyright © 2020 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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