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Understanding Financial Toxicity in Breast Reconstruction: Patient Perspectives on Economic Burden and Access to Resources
Jenny Chen
*1, Jaime L. Gilliland
2, Ayana K. Cole-Price
1, Kyeong Tae-Lee
1, Jonas Nelson
1, Evan Matros
1, Danielle Rochlin
11Plastic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; 2Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
Background: Financial toxicity (FT)"”the excessive economic burden associated with cancer care"”significantly impacts many women with breast cancer. This study explores the lived experiences of patients undergoing breast reconstruction to better understand financial challenges, including effects on treatment decisions, emotional well-being, and long-term financial stability.
Methods: We conducted semi-structured virtual interviews with patients who experienced FT and underwent breast reconstruction at Memorial Sloan Kettering Cancer Center from 2022-2023. FT was defined as a Comprehensive Score for Financial Toxicity (COST) score <20 at the time of mastectomy. Interviews explored direct and indirect costs, decision-making, and access to resources. Two independent reviewers conducted inductive thematic analysis of transcripts.
Results: Interviews with 22 patients identified five major themes. (1) Breast cancer treatment significantly impacted long-term financial health. While short-term effects involved lifestyle adjustments, many patients faced direct financial hardship, including debt, missed bills, and use of savings. (2) Despite financial strain, treatment decisions"”including reconstruction"”were driven primarily by physician guidance and logistics rather than cost. (3) FT added substantial emotional distress, compounding cancer-related stress. (4) Insurance often covered major costs, but high deductibles, out-of-pocket expenses, unclear policies, and job disruptions created ongoing burdens. Some patients worked through treatment to keep coverage; others could not return to work post-treatment. (5) Lack of cost transparency and limited access to financial support worsened FT. Patients expressed a need for clearer insurance guidance and more accessible aid programs.
Conclusion: FT in breast reconstruction extends beyond direct costs, affecting emotional and financial stability. To address this, improved cost transparency, insurance navigation support, and expanded financial assistance resources are essential for mitigating the economic burden of breast cancer care.
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