From the Departments of Plastic and Reconstructive Surgery and Health Services Research, University of Texas M. D. Anderson Cancer Center; private practice; and the Baker Institute for Public Policy, Rice University.
Plast Reconstr Surg. 2021 Apr 1;147(4):587e-595e. doi: 10.1097/PRS.0000000000007703.
High treatment costs associated with breast cancer are a substantial burden to patients and society. Despite mounting awareness, patient perspectives about the value of cost discussions in breast reconstruction and risk factors for financial distress are unknown.
The authors performed a single-institution, cross-sectional survey of all women who underwent breast reconstruction following mastectomy or lumpectomy for breast cancer or risk reduction. Questions were derived from previously published survey items, and the authors leveraged regression analysis to identify patient-level risk factors for major financial distress.
A total of 647 of 2293 patients returned the survey questionnaires (28.2 percent response rate). From the 647 respondents, 399 (62 percent) underwent breast reconstruction, and of these, 140 (35 percent) reported that total treatment expenses were higher than expected. One hundred twenty-nine breast reconstruction patients (32 percent) paid over $5000 in out-of-pocket costs. Two hundred eighty-four (71 percent) felt that surgeons should explain the estimated out-of-pocket costs when choosing a type of breast reconstruction and 205 (51 percent) believed that a financial consultation should be scheduled with every new cancer diagnosis. However, only 52 patients (13 percent) reported having had cost discussions with the treatment team. The incidence of major financial distress was n = 70 (18 percent), and following regression analysis, higher credit score and annual income were associated with a 66 percent and 69 percent risk reduction, respectively.
Recipients of breast reconstruction demonstrate unanticipated and unplanned financial strain related to out-of-pocket expenses and believe that cost-consciousness should impact treatment decisions. Lower income and credit score are associated with financial distress. Cost discussions may optimize decision-making in preference sensitive conditions.
乳腺癌相关的高治疗费用给患者和社会带来了沉重的负担。尽管人们的认识不断提高，但患者对成本讨论在乳房重建中的价值以及导致财务困境的风险因素的看法尚不清楚。
作者对所有因乳腺癌或降低风险而接受乳房切除术或保乳手术后行乳房重建的女性进行了单机构、横断面调查。问题来自先前发表的调查项目，作者利用回归分析确定了导致主要财务困境的患者个体风险因素。
共有 2293 名患者中的 647 名（28.2%的应答率）返回了调查问卷。在 647 名应答者中，399 名（62%）接受了乳房重建，其中 140 名（35%）报告总治疗费用高于预期。129 名乳房重建患者（32%）自付费用超过 5000 美元。284 名患者（71%）认为外科医生在选择乳房重建类型时应解释预计自付费用，205 名患者（51%）认为应在每次新的癌症诊断时安排财务咨询。然而，只有 52 名患者（13%）报告与治疗团队进行了成本讨论。重大财务困境的发生率为 n = 70（18%），回归分析后发现，较高的信用评分和年收入分别使风险降低 66%和 69%。
乳房重建的接受者表现出与自付费用相关的意外和无计划的财务压力，并认为成本意识应影响治疗决策。较低的收入和信用评分与财务困境相关。成本讨论可能会优化偏好敏感情况下的决策。
