Search

Background: Despite mandated insurance coverage for breast reconstruction following mastectomy, health care costs are increasingly passed on to women through cost‐sharing arrangements and high‐deductible health plans. In this population‐based study, the authors assessed perceived financial and employment declines related to breast reconstruction following mastectomy. Methods: Women with early‐stage breast cancer (stages 0‐II) diagnosed between July 2013 and May 2015 who underwent mastectomy were identified through the Surveillance, Epidemiology, and End Results registries of Georgia and Los Angeles and were surveyed. Primary outcome measures included patients' appraisal of their financial and employment status after cancer treatment. Multivariable models evaluated the association between breast reconstruction and primary outcomes. Results: Among 883 patients with breast cancer who underwent mastectomy, 44.2% did not undergo breast reconstruction, and 55.8% underwent reconstruction. Overall, 21.9% of the cohort reported being worse off financially since their diagnosis (25.8% with reconstruction vs 16.6% without reconstruction; P =.002). Women who underwent reconstruction reported higher out‐of‐pocket medical expenses (32.1% vs 15.6% with expenses greater than $5000; P <.001). Reconstruction was independently associated with a perceived decline in financial status (odds ratio, 1.92; 95% confidence interval, 1.15‐3.22; P =.013). Among women who were employed at the time of their diagnosis, there was no association between reconstruction and a perceived decline in employment status (P =.927). Conclusions: In this diverse cohort of women who underwent mastectomy, those who elected to undergo reconstruction experienced higher out‐of‐pocket medical expenses and self‐reported financial decline. Patients, providers, and policymakers should be aware of the potential financial implications related to reconstruction despite mandatory insurance coverage. Among 883 patients with breast cancer who underwent mastectomy, women who underwent reconstruction reported higher out‐of‐pocket medical expenses and were independently more likely to report a perceived decline in their financial status. Patients, providers, and policymakers should be aware of the potential financial implications related to reconstruction despite mandatory insurance coverage. [ABSTRACT FROM AUTHOR]

Background: Treatment decisions for patients with early‐stage breast cancer often involve discussions with multiple oncology providers. However, the extent to which primary care providers (PCPs) are involved in initial treatment decisions remains unknown. Methods: A stratified random sample of PCPs identified by newly diagnosed patients with early‐stage breast cancer from the Georgia and Los Angeles Surveillance, Epidemiology, and End Results registries were surveyed (n = 517; a 61% response rate). PCPs were asked how frequently they discussed surgery, radiation, and chemotherapy options with patients; how comfortable they were with these discussions; whether they had the necessary knowledge to participate in decision making; and what their confidence was in their ability to help (on 5‐item Likert‐type scales). Multivariate logistic regression was used to identify PCP‐reported attitudes associated with more PCP participation in each treatment decision. Results: In this sample, 34% of PCPs reported that they discussed surgery, 23% discussed radiation, and 22% discussed chemotherapy options with their patients. Of those who reported more involvement in surgical decisions, 22% reported that they were not comfortable having a discussion, and 17% did not feel that they had the necessary knowledge to participate in treatment decision making. PCPs who positively appraised their ability to participate were more likely to participate in all 3 decisions (odds ratio [OR] for surgery, 6.01; 95% confidence interval [CI], 4.16‐8.68; OR for radiation, 8.37; 95% CI, 5.16‐13.58; OR for chemotherapy, 6.56; 95% CI, 4.23‐10.17). Conclusions: A third of PCPs reported participating in breast cancer treatment decisions, yet gaps in their knowledge about decision making and in their confidence in their ability to help exist. Efforts to increase PCPs' knowledge about breast cancer treatment options may be warranted. The extent to which primary care providers are involved in their patients' multimodal breast cancer treatment decisions across surgery, radiation, and chemotherapy options is assessed in this study. Although a third of primary care providers report participating in these decisions, a notable proportion report gaps in their knowledge of treatment options and a lack of confidence in their ability to help with decision making. [ABSTRACT FROM AUTHOR]