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

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.