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Semin Plast Surg 2024; 38(01): 039-047
DOI: 10.1055/s-0043-1778040
Review Article

Financial Toxicity in Breast Reconstruction: The Role of the Surgeon-Patient Cost-of-Care Discussion

Brigit D. Baglien
1   Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
,
Nishant Ganesh Kumar
1   Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
,
Nicholas L. Berlin
1   Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
,
Sarah T. Hawley
2   Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
3   Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan
4   Ann Arbor VA Center for Clinical Management Research, Ann Arbor, Michigan
,
Reshma Jagsi
5   Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia
,
Adeyiza O. Momoh
1   Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
› Author Affiliations Funding None.
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Abstract

The financial burden of breast cancer treatment and reconstruction is a significant concern for patients. Patient desire for preoperative cost-of-care counseling while navigating the reconstructive process remains unknown. A cross-sectional survey of women from the Love Research Army was conducted. An electronic survey was distributed to women over 18 years of age and at least 1 year after postmastectomy breast reconstruction. Descriptive statistics and multivariable modeling were used to determine desire for and occurrence of cost-of-care discussions, and factors associated with preference for such discussions. Secondary outcomes included the association of financial toxicity with desire for cost discussions. Among 839 women who responded, 620 women (74.1%) did not speak to their plastic surgeon and 480 (57.4%) did not speak to a staff member regarding costs of breast reconstruction. Of the 550 women who reported it would have been helpful to discuss costs, 315 (57.3%) were not engaged in a financial conversation initiated by a health care provider. A greater proportion of women who reported financial toxicity, compared to those who did not, would have preferred to discuss costs with their plastic surgeon (65.2% vs. 43.5%, p < 0.001) or a staff member (75.5% vs. 59.3%, p < 0.001). Among women with financial toxicity, those who had some form of insurance (private, Medicaid, Medicare, “other”) were significantly more likely to prefer a cost-of-care discussion (p < 0.001, p = 0.02, p = 0.05, p = 0.01). Financial discussions about the potential costs of breast reconstruction seldom occurred in this national cohort. Given the reported preference and unmet need for financial discussions by a majority of women, better cost transparency and communication is needed.

Keywords

postmastectomy reconstruction - breast reconstruction - financial toxicity - out-of-pocket expenses - patient-provider communication


Publication History

Article published online:
19 January 2024

© 2024. Thieme. All rights reserved.

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