Treatment Decision Making and Financial Toxicity in Women With Metastatic Breast Cancer |
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| Authors: | Clara Wan Courtney P Williams Ryan D Nipp Maria Pisu Andres Azuero Monica S Aswani Stacey A Ingram Jennifer Y Pierce Gabrielle B Rocque |
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| Institution: | 1. University of Alabama School of Medicine, University of Alabama at Birmingham, Birmingham, AL;2. Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL;3. Division of Preventative Medicine, University of Alabama at Birmingham, Birmingham, AL;4. School of Nursing, University of Alabama at Birmingham, Birmingham, AL;5. School of Health Professions, University of Alabama at Birmingham, Birmingham, AL;6. Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA;7. Mitchell Cancer Institute, University of South Alabama, Mobile, AL;1. Department of Surgical Oncology, Max Superspecialty Hospital, Vaishali, India;2. Department of Medical Oncology, Max Superspecialty Hospital, Vaishali, India;3. Department of Radiation Oncology, Max Superspecialty Hospital, Vaishali, India;1. Department of Surgery, Mercy Breast Clinic, Coletta, Oklahoma City, OK;2. Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL;3. Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL;1. Medical Imaging Research Center, Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran;2. Health Behavior Science Research Center, Shiraz University of Medical Sciences, Shiraz, Iran;3. Department of Community Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran;4. Sutter Imaging (SMG)-Sacramento, Department of Nuclear Medicine and Radiology (W.O.S), University of California Davis Medical Center, Sacramento, CA;5. Department of Radiology, University of California San Diego Health, La Jolla, CA;6. Breast Disease Research Center, Shiraz University of Medical Sciences, Shiraz, Iran;1. Department of Oncology, Nottingham University Hospitals, Nottingham, UK;2. Translational Oncology, Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, UK;3. Department of Pathology, School of Medicine, University of Nottingham, Nottingham, UK;1. Allina Health System, Virginia Piper Cancer Institute, Minneapolis, MN;2. Hospital Pathology Associates, Allina Health Laboratories, Minneapolis, MN;3. Research Informatics, Allina Health System, Minneapolis, MN |
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| Abstract: | IntroductionOncologists have increasingly been proponents of shared decision making (SDM) to enhance patient outcomes and reduce unnecessary health care spending. However, its effect on patient out-of-pocket costs is unknown. This study investigated the relationship between patient preferences for SDM and financial toxicity (FT) in patients with metastatic breast cancer (MBC).Patients and MethodsThis cross-sectional study utilized surveys of women aged ≥ 18 with MBC who received care at two academic hospitals in Alabama from 2017 to 2019. Patients self-reported their SDM preference (Control Preferences Scale) and FT (Comprehensive Score for Financial Toxicity COST] tool; 11-item scale, with lower scores indicating worse FT). Effect sizes were calculated using the proportion of variance explained (R2) or Cramer’s V. Differences in FT by SDM preference were estimated using mixed models clustered by site and treating medical oncologist.ResultsIn 95 women with MBC, 44% preferred SDM, 29% preferred provider-driven decision making, and 27% preferred patient-driven decision making. Patients preferring SDM were more often college educated (53% vs. 39%; V = 0.12) with an income greater than $40,000/y (55% vs. 43%; V = 0.18). Overall median COST was 22 (interquartile range, 16-29). After adjusting for patient demographic and clinical characteristics, patients preferring patient-driven decision making trended toward worse FT (COST 17: 95% confidence interval, 12-22) compared to those preferring SDM (COST 19: 95% confidence interval, 15-23) and those preferring provider-driven decision making (COST 22: 95% confidence interval, 17-27).ConclusionPatients preferring more patient-driven decision making reported worse FT, although differences did not reach statistical significance. Further research is needed to understand this relationship. |
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| Keywords: | Control preferences scale COST tool Out-of-pocket costs Patient-driven decision making Provider-driven decision making |
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