Myers Sara P, Morton Claire R, Bain Paul A, Obeng-Gyasi Samilia, Paskett Electra D, McAlearney Ann S, Greenup Rachel A, Minami Christina A, Mittendorf Elizabeth A, King Tari A
Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.
J Cancer Surviv. 2025 Aug 30. doi: 10.1007/s11764-025-01881-7.
Increasing incidence of breast cancer among young adults (YA), defined by the National Comprehensive Cancer Network (NCCN) as age < 40 years, has amplified concerns over financial toxicity (FT) in this demographic. This systematic review sought to clarify the association between YA status and FT.
We queried bibliographic databases for full-text English language publications between 2010 and 2024 reporting FT using validated patient-reported outcome metrics among patients with stage I-III breast cancer. Two reviewers screened and extracted data between June and September 2024. Variables of interest included age and treatment-related adverse events (secondary outcome of interest).
Of 4023 articles screened, 66 were included for review. Sixty-four were excluded for including in situ or metastatic disease, multiple cancer histologies, or FT as a parameter of a larger scale without validation for stand-alone use. While no studies compared FT using the NCCN YA threshold (i.e., < 40 versus ≥ 40 years), two studies demonstrated that younger age was associated with worse FT. One study compared patients age ≥ 65 to < 65 years using the Comprehensive Score for Financial Toxicity, and the other considered age as a continuous variable using the Psychological Sense of Economic Hardship Scale. The latter also reported treatment-related symptoms were associated with greater FT after adjusting for age.
No study identified the multidimensional domain of FT as a primary outcome among YA versus non-YA women with non-metastatic invasive breast cancer. Two studies showed younger age was associated with greater FT.
As FT has been shown to negatively impact patient outcomes, further investigations are needed to support policy efforts and to improve care for younger breast cancer survivors.
青年成人（YA）乳腺癌发病率不断上升，美国国立综合癌症网络（NCCN）将其定义为年龄小于40岁，这加剧了人们对该人群经济毒性（FT）的担忧。本系统评价旨在阐明青年成人状态与经济毒性之间的关联。
我们检索了文献数据库，以查找2010年至2024年间使用经过验证的患者报告结局指标报告I-III期乳腺癌患者经济毒性的英文全文出版物。两名评审员在2024年6月至9月期间筛选并提取数据。感兴趣的变量包括年龄和与治疗相关的不良事件（感兴趣的次要结局）。
在筛选的4023篇文章中，66篇被纳入综述。64篇因纳入原位癌或转移性疾病、多种癌症组织学类型，或因将经济毒性作为更大规模研究的一个参数而未单独验证而被排除。虽然没有研究使用NCCN青年成人阈值（即<40岁与≥40岁）比较经济毒性，但有两项研究表明年龄较小与更严重的经济毒性相关。一项研究使用经济毒性综合评分比较了年龄≥65岁与<65岁的患者，另一项研究使用经济困难心理感受量表将年龄视为连续变量。后者还报告说，在调整年龄后，与治疗相关的症状与更严重的经济毒性相关。
没有研究将经济毒性的多维度领域确定为非转移性浸润性乳腺癌青年成人与非青年成人女性的主要结局。两项研究表明年龄较小与更严重的经济毒性相关。
由于经济毒性已被证明会对患者结局产生负面影响，因此需要进一步研究以支持政策努力并改善对年轻乳腺癌幸存者的护理。
