Financial toxicity in breast cancer patients receiving regional nodal irradiation: Variation by cancer subtype
Grace L. Smith,
Benjamin D. Smith,
Chi-Fang Wu,
Simona F. Shaitelman,
Mariana Chavez-MacGregor,
Rashmi Murthy,
Kelsey Kaiser,
Kimberly S. Ku,
Julia J. Shi,
Sanjay S. Shete,
Ying-Shiuan Chen,
Robert J. Volk,
Sharon H. Giordano,
Ya-Chen T. Shih,
Karen E. Hoffman
Affiliations
Grace L. Smith
Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA
Benjamin D. Smith
Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA
Chi-Fang Wu
Department of Health Services Research, The University of Texas MD Anderson Cancer Center, USA
Simona F. Shaitelman
Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA
Mariana Chavez-MacGregor
Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, USA
Rashmi Murthy
Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, USA
Kelsey Kaiser
Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA
Kimberly S. Ku
Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA
Julia J. Shi
Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA
Sanjay S. Shete
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, USA
Ying-Shiuan Chen
Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA
Robert J. Volk
Department of Health Services Research, The University of Texas MD Anderson Cancer Center, USA
Sharon H. Giordano
Department of Health Services Research, The University of Texas MD Anderson Cancer Center, USA; Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, USA
Ya-Chen T. Shih
Department of Radiation Oncology, University of California Los Angeles School of Medicine, USA
Karen E. Hoffman
Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA
Background: We evaluated sociodemographic and clinical predictors of financial toxicity (FT) among patients with breast cancer with higher risk clinical factors warranting regional nodal irradiation (RNI). Methods: Among 183 participants in a clinical trial of conventional vs. hypofractionated treatment with RNI, 125 (68 %) completed a pilot survey of FT measured using the validated Economic Strain and Resilience in Cancer (ENRICh) instrument, scored from 0 (minimal) to 10 (severe) FT. Associations with predictors were evaluated using Pearson correlation coefficients and Kruskal Wallis, Mann-Whitney U, and Jonckheere-Terpstra tests. Predictors of severe FT (ENRICh≥5) were tested using multivariable logistic regression with odds ratios converted to relative risks (RR). Results: Of the sample, all received RNI, 92 % chemotherapy, 67 % axillary dissection, 26 % mastectomy without reconstruction, and 32 % mastectomy with reconstruction. At a median follow up of 1.48 years, median FT score was 2.13 (IQR 0.93–4.6), with 20.8 % of patients experiencing severe FT. Unadjusted worse FT score was associated with younger age (P = 0.003), Hispanic ethnicity (P = 0.006), lower income (P = 0.02), shorter interval from diagnosis to FT assessment (P = 0.02), and chemotherapy receipt (P = 0.05), but not with breast surgery type (P = 0.42), axillary surgery type (P = 0.33), or pathologic T (P = 0.68) or N stage (P = 0.47). In multivariable analysis, triple negative subtype was the sole clinical factor predicting severe FT (RR = 3.38; 95 % CI 1.48–4.99; P = 0.01). Conclusion: Among patients with breast cancer receiving RNI, triple negative subtype was associated with severe FT, suggesting that tumor receptor subtype may help identify a key breast cancer subpopulation for early FT intervention.
