Impact of Chemotherapy on Financial Toxicity in African-American Breast Cancer Patients

IF 2.3 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the National Medical Association Pub Date : 2025-09-01 DOI:10.1016/j.jnma.2025.08.075

Maya J. Stephens MS, BS, Nimisha Kasliwal, Ursula J. Burnette MA, Louisa Onyewadume MD, MPH, Chesley W. Cheatham Med, MCHES, Tamika K. Smith AAB, Corey W. Speers MD, PhD, Janice A. Lyons MD, Shearwood McClelland III MD

{"title":"Impact of Chemotherapy on Financial Toxicity in African-American Breast Cancer Patients","authors":"Maya J. Stephens MS, BS, Nimisha Kasliwal, Ursula J. Burnette MA, Louisa Onyewadume MD, MPH, Chesley W. Cheatham Med, MCHES, Tamika K. Smith AAB, Corey W. Speers MD, PhD, Janice A. Lyons MD, Shearwood McClelland III MD","doi":"10.1016/j.jnma.2025.08.075","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>With the rising cost of chemotherapy, the financial toxicity (FT) of systemic therapy can substantially impair patient quality of life. FT is also associated with various socioeconomic factors, one being race. Patients of African American race often bear the worst burden of cancer treatment-related FT, with a 40% increased mortality from breast cancer. The degree to which chemotherapy prior to radiation therapy (RT) impacts FT has yet to be formally quantified. We report early FT findings among African American breast cancer patients prior to receipt of adjuvant RT on the ongoing Navigator-Assisted Hypofractionation (NAVAH) Phase I clinical trial (ClinicalTrials.gov ID: NCT05978232) to assess the impact of chemotherapy on FT.</div></div><div><h3>Methods</h3><div>African-American breast cancer patients undergoing RT were eligible if age 18+ with pathologically confirmed breast cancer following resection. As part of the trial, patients were assisted by a patient navigator during and after treatment. FT was measured using the validated 12-item COmprehensive Score for financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) survey instrument. COST-FACIT scoring was used to find FT in patients before receipt of RT. Values from 26-44 represent Grade 0 FT (none), values from 14-25 represent mild Grade 1 FT (mild), values from 1-13 represent Grade 2 FT (moderate), and values of 0 represent Grade 3 FT (severe). The chi-square test was used to identify statistically significant differences (p <0.05) between patients who received chemotherapy versus no chemotherapy prior to receipt of RT.</div></div><div><h3>Results</h3><div>The first 32 enrolled patients completing the pre-RT COST-FACIT survey were evaluated. 53% of patients underwent chemotherapy before RT. Mild to moderate FT was apparent in 56% of patients. The mean and median COST-FACIT score (range 4.4-39) was 25 (± 10.4). 78% of patients who experienced some level of FT underwent chemotherapy and 22% of patients experiencing FT did not receive chemotherapy (p = 0.0015). Of patients who did not experience FT, 21% received chemotherapy and 79% of patients did not. In total, 82% of patients who underwent chemotherapy before RT reported mild to moderate FT. Grade 3 FT was not observed.</div></div><div><h3>Conclusion</h3><div>The NAVAH study is the first to objectively compare FT among patients receiving chemotherapy before RT for early-stage breast cancer. Our findings indicate that more than 80% of patients who underwent chemotherapy experienced FT. Approximately 1 in 5 patients not experiencing FT received chemotherapy. The findings indicate that chemotherapy plays a significant role in patient quality of life, highlighting a subsection of patients who may benefit from proactive financial assistance to reduce the detrimental effect of FT on their livelihood.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 39-40"},"PeriodicalIF":2.3000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the National Medical Association","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0027968425002718","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}

引用次数: 0

Abstract

Background

With the rising cost of chemotherapy, the financial toxicity (FT) of systemic therapy can substantially impair patient quality of life. FT is also associated with various socioeconomic factors, one being race. Patients of African American race often bear the worst burden of cancer treatment-related FT, with a 40% increased mortality from breast cancer. The degree to which chemotherapy prior to radiation therapy (RT) impacts FT has yet to be formally quantified. We report early FT findings among African American breast cancer patients prior to receipt of adjuvant RT on the ongoing Navigator-Assisted Hypofractionation (NAVAH) Phase I clinical trial (ClinicalTrials.gov ID: NCT05978232) to assess the impact of chemotherapy on FT.

Methods

African-American breast cancer patients undergoing RT were eligible if age 18+ with pathologically confirmed breast cancer following resection. As part of the trial, patients were assisted by a patient navigator during and after treatment. FT was measured using the validated 12-item COmprehensive Score for financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) survey instrument. COST-FACIT scoring was used to find FT in patients before receipt of RT. Values from 26-44 represent Grade 0 FT (none), values from 14-25 represent mild Grade 1 FT (mild), values from 1-13 represent Grade 2 FT (moderate), and values of 0 represent Grade 3 FT (severe). The chi-square test was used to identify statistically significant differences (p <0.05) between patients who received chemotherapy versus no chemotherapy prior to receipt of RT.

Results

The first 32 enrolled patients completing the pre-RT COST-FACIT survey were evaluated. 53% of patients underwent chemotherapy before RT. Mild to moderate FT was apparent in 56% of patients. The mean and median COST-FACIT score (range 4.4-39) was 25 (± 10.4). 78% of patients who experienced some level of FT underwent chemotherapy and 22% of patients experiencing FT did not receive chemotherapy (p = 0.0015). Of patients who did not experience FT, 21% received chemotherapy and 79% of patients did not. In total, 82% of patients who underwent chemotherapy before RT reported mild to moderate FT. Grade 3 FT was not observed.

Conclusion

The NAVAH study is the first to objectively compare FT among patients receiving chemotherapy before RT for early-stage breast cancer. Our findings indicate that more than 80% of patients who underwent chemotherapy experienced FT. Approximately 1 in 5 patients not experiencing FT received chemotherapy. The findings indicate that chemotherapy plays a significant role in patient quality of life, highlighting a subsection of patients who may benefit from proactive financial assistance to reduce the detrimental effect of FT on their livelihood.

查看原文本刊更多论文

化疗对非裔美国乳腺癌患者财务毒性的影响

背景：随着化疗费用的上升，全身治疗的经济毒性（FT）会严重影响患者的生活质量。FT还与各种社会经济因素有关，其中之一就是种族。非裔美国人往往承受着与癌症治疗相关的FT最沉重的负担，乳腺癌死亡率增加了40%。放疗前化疗（RT）对FT的影响程度尚未正式量化。我们报告了在正在进行的导航辅助低分割（NAVAH） I期临床试验（ClinicalTrials.gov ID: NCT05978232）中接受辅助放疗前非洲裔美国乳腺癌患者的早期FT发现，以评估化疗对FT的影响。方法接受RT的非洲裔美国乳腺癌患者，年龄≥18岁，切除后病理证实为乳腺癌。作为试验的一部分，患者在治疗期间和治疗后由患者导航员协助。FT采用经验证的12项综合评分慢性疾病治疗财务毒性-功能评估（COST-FACIT）调查工具进行测量。使用COST-FACIT评分来发现患者接受rt前的FT。26-44表示0级FT（无），14-25表示轻度1级FT（轻度），1-13表示2级FT（中度），0表示3级FT（严重）。采用卡方检验确定接受放疗前接受化疗与未接受化疗的患者之间的差异有统计学意义（p <0.05）。结果对前32名完成放疗前成本- facit调查的入组患者进行评估。53%的患者在放疗前接受了化疗。56%的患者有轻度至中度FT。平均和中位成本- facit评分（范围4.4-39）为25（±10.4）。有一定程度FT的患者中有78%接受了化疗，有22%的FT患者没有接受化疗（p = 0.0015）。在没有经历过FT的患者中，21%接受了化疗，79%的患者没有接受化疗。总的来说，在放疗前接受化疗的患者中有82%报告轻度至中度FT，未观察到3级FT。结论NAVAH研究首次客观比较了早期乳腺癌放疗前化疗患者的FT。我们的研究结果表明，超过80%的接受化疗的患者经历了FT。大约1 / 5的未经历FT的患者接受了化疗。研究结果表明，化疗在患者的生活质量中起着重要作用，强调了一部分患者可能受益于积极的经济援助，以减少化疗对其生活的有害影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of the National Medical Association 医学-医学：内科

CiteScore

4.80

自引率

3.00%

发文量

139

审稿时长

98 days

期刊介绍： Journal of the National Medical Association, the official journal of the National Medical Association, is a peer-reviewed publication whose purpose is to address medical care disparities of persons of African descent. The Journal of the National Medical Association is focused on specialized clinical research activities related to the health problems of African Americans and other minority groups. Special emphasis is placed on the application of medical science to improve the healthcare of underserved populations both in the United States and abroad. The Journal has the following objectives: (1) to expand the base of original peer-reviewed literature and the quality of that research on the topic of minority health; (2) to provide greater dissemination of this research; (3) to offer appropriate and timely recognition of the significant contributions of physicians who serve these populations; and (4) to promote engagement by member and non-member physicians in the overall goals and objectives of the National Medical Association.