Impact of age and treatment-related adverse events on financial toxicity among patients with breast cancer: a systematic review.

PURPOSE

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.

METHODS

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).

RESULTS

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.

CONCLUSION

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.

IMPLICATIONS FOR CANCER SURVIVORS

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.