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Breast Cancer Treatment Is Associated With Financial Toxicity Worldwide, Study Finds


The findings emphasize a need for policies that may offset the impact of direct and indirect costs for patients with breast cancer.

Breast cancer treatment is associated with substantial financial toxicity worldwide, according to a systematic review and meta-analysis published in JAMA Network Open. The findings emphasize a need for policies that may offset the impact of direct and indirect costs for patients with breast cancer.

Financial toxicity, or the negative impact of health care costs on patients’ financial well-being, fiscal security, and health, is a persistent issue in cancer treatment overall, the study authors noted. Contributors to financial toxicity include direct medical costs, such as hospitalizations, pharmaceutical costs, and outpatient treatment, and nondirect medical and indirect costs that are typically not covered by insurance, such as transportation to appointments, food and lodging, employment loss related to a patient’s disease, and other expenses.

Nondirect medical and indirect costs are significant contributors to out-of-pocket costs (OOPCs) for cancer patients, including those with breast cancer. Extremely high OOPCs can have a negative impact on patients’ medical care and psychosocial wellness.

“Compared with other chronic conditions, patients with cancer are at risk for higher OOPCs,” the authors wrote. “Breast cancer care in particular may be associated with high financial toxicity given the need for screening and diagnosis, multidisciplinary care, and longitudinal follow-up; notably, gender also affects financial security.”

The systematic review and meta-analysis aimed to characterize the rate of financial toxicity in patients with breast cancer and identify national and international populations that may be especially vulnerable. The main outcome was financial toxicity and was determined by quantitative measures, such as the rate of patients experiencing financial toxicity, as well as qualitative outcomes, including patient-reported effects of financial toxicity.

A total of 462 articles from 4 databases underwent full-text review, and 34 were included in the review. The studies ranged in size, and most of the studies (n = 24) were conducted in high-income countries (HICs), while the remainder (n = 10) were from middle- and low-income countries (LMICs).

The definition of financial toxicity varied between studies, and 18 studies were included in the meta-analysis. Of those studies, 14 were from HICs and 4 were conducted in LMICs. Overall, the rate of financial toxicity was 35.3% among patients with breast cancer in HICs compared with 78.8% among patients in LMICs.

The results demonstrate substantially higher financial toxicity in LMICs vs in HICs. These rates are also significantly higher than typical rates of financial toxicity across all health conditions in LMICs, which usually range 6% to 12%, the authors noted. They added that breast cancer carries an even greater financial burden than other cancer types in regard to OOPCs, which are higher in breast cancer than in colorectal, lung, and prostate cancers combined.

The causes of increased costs and financial toxicity in breast cancer are yet to be determined, but the authors speculate that novel and expensive interventions, overutilization of services, varying insurance coverage, and patient willingness to pay are all factors in HICs. In LMICs, limited access to screening and diagnostic services cause delays in care and higher rates of late-stage diagnoses that warrant extensive treatment, and patients typically have lower baseline income and limited insurance coverage, and must travel greater distances to receive specialist care, the authors noted.

“Further efforts, ideally led by transnational organizations, are required to thoroughly characterize financial toxicity burden in a standardized fashion across different settings,” the authors concluded. “Policy interventions to improve breast cancer education, expand health care coverage, enhance patient support for nonmedical costs, and invest in health care infrastructure could improve both financial and health outcomes among patients with breast cancer at risk for financial toxicity.”


Ehsan AN, Wu CA, Minasian A, et al. Financial toxicity among patients with breast cancer worldwide. JAMA Netw Open. 2023;6(2):e2255388. doi:10.1001/jamanetworkopen.2022.55388

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