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Mitigating Financial Toxicity in Breast Cancer From Diagnosis to Treatment and Reconstruction

Published:October 03, 2022DOI:https://doi.org/10.1016/j.clbc.2022.09.009

      Clinical Practice Points

      Breast cancer is the most common cancer affecting women in United States with a significant patient and familial financial burden.
      Limited resources offer financial support to patients in the form of cost support for bills, health insurance payments, childcare, and post-treatment recovery.
      Financial resources are often limited to patients of certain geographic regions or low socioeconomic status as determined by the federal poverty level, which may systematically exclude patients in need.

      Keywords

      Introduction

      Breast cancer is the most prevalent cancer and the second leading cause of cancer-related death among women in the United States.
      • Rosenzweig M
      • West M
      • Matthews J
      • et al.
      Financial toxicity among women with metastatic breast cancer.
      Patients with breast cancer encounter challenges including psychosocial stress, side effects of treatment regimens, fertility issues, postprocedural and/or postoperative pain, and financial toxicity.
      • Ruddy KJ
      • Greaney ML
      • Sprunk-Harrild K
      • Meyer ME
      • Emmons KM
      • Partridge AH
      Young women with breast cancer: a focus group study of Unmet Needs.
      Nearly half of the patients receiving a breast cancer diagnosis experience at least moderate financial distress,
      • Irwin B
      • Kimmick G
      • Altomare I
      • et al.
      Patient experience and attitudes toward addressing the cost of breast cancer care.
      which can be further exacerbated by factors such as low socioeconomic status and racial minority status.
      • Politi MC
      • Yen RW
      • Elwyn G
      • et al.
      Women who are young, non-white, and with lower socioeconomic status report higher financial toxicity up to 1 year after breast cancer surgery: a mixed-effects regression analysis.
      Previous research has demonstrated a correlation between financial toxicity of a cancer diagnosis with a worsened quality of life and increased burden of cancer-related distress.
      • Rosenzweig M
      • West M
      • Matthews J
      • et al.
      Financial toxicity among women with metastatic breast cancer.
      Despite these burdens, there are few systems in place to provide support and resources for patients in these areas. Receiving a diagnosis of breast cancer is life-altering, and we believe that supporting the needs of our patients throughout the trajectory of the disease and treatment process, from diagnosis to post-reconstruction, is of the utmost importance and a worthy cause.
      Linking patients to resources that may aid them with covering the expenses of their treatment, as well as expenses of daily living and familial support, may improve health outcomes and decreased cancer-related burden. Despite the apparent need for such resources, a centralized resource of funding opportunities for patients with breast cancer does not currently exist. The aim of the present study was to compile a source of viable, active grants for patients with breast cancer to serve as a reference for clinicians, families, and patients alike.

      Discussion

      The authors identified twelve, independent, active funding opportunities through web-based searches and foundation websites (Table 1). Eligibility is dependent on numerous criteria, including geographic location, status of treatment (active cancer vs. survivor/in remission), and income level. Further criteria for eligibility include stage of cancer, the need for childcare assistance, and age at the time of diagnosis. Several foundations determine financial eligibility based on patient-specific criteria and do not publicly disclose the minimum or maximum awarded funding. Of foundations disclosing a numerical value, awards ranged from $500 to $3000 USD.
      Table 1Scholarships for Breast Cancer Patients and Survivors
      OrganizationAward NameDescriptionAmountGeographic EligibilityOther EligibilityHistorical DeadlineLinkAdditional Information
      Breast Cancer Assistance FundNational Cancer Assistance Foundation FundProvides financial assistance for the nonmedical costs of getting a patient to treatment and other living expensesVaries; up to 60 calendar d of fundingResidents in all 50 US states except AR, IA, MI, ORRollinghttps://breastcanceraf.org/request-assistance/
      Driving Miss Darby Foundation, Inc.General FundingProvides financial support to patients participating in clinical trials for breast cancerVariesRollinghttps://www.drivingmissdarby.org/assistance
      Genevieve's Helping Hands CharityGenevieve Memorial Breast Cancer Recovery GrantOffers financial grants to be used by young breast cancer patients to extend recuperation period after cancer-related surgeries and treatmentVariesA mother first diagnosed with breast cancer at age 40 or younger

      Caring for at least 1 child under the age of 18
      Rollinghttps://www.genshelpinghands.org/Genevieve-memorial-recovery-grant.html
      Hope Chest for Breast Cancer FoundationEmergency Assistive GrantProvides financial assistance for rent, mortgages, car payments, utility bills, daycare costs and provided nutritionVariesMinnesotaIn active treatment for breast cancerRollinghttps://hopechest.com/get-help/
      Patient Advocate FoundationMetastatic Breast Cancer Financial Aid FundProvides financial assistance with expenses related to transportation, housing, utilities, food/nutritional needs, and end of life expensesVariesStage III and IV breast cancer who are in active treatment or will be in active treatment within the next 60 dRollinghttps://financialaid.patientadvocate.org/
      Sisters Network, Inc.Karen E. Jackson Breast Cancer Assistance ProgramNational African-American survivorship organization; helps pay for utilities, rent or mortgage, and medical accessoriesVariesBreast cancer survivorsJuly 15thhttp://www.sistersnetworkinc.org/programs.html
      Susan G. KomenKomen Financial Assistance ProgramFunds may be used for daily living expenses such as rent, utilities, food, transportation, childcareStage IV: $750

      Stage 0-III: $500
      United States or US TerritoryCurrently in treatment for breast cancer or living with Stage IV breast cancer

      Have a current household income below 300% of the FPL
      Rollinghttps://www.komen.org/treatment-assistance-program/
      The Gift of Hope Breast Cancer FoundationGeneral FundingFunds may be used qualifying treatmentsVaries; shall not exceed a period of 4 moFloridaRollinghttps://forthegiftofhope.org/apply-now/
      The Miles of Hope Breast Cancer FoundationMedical Gap Care FundProvides funding for patients who experience life emergencies and/or costs not covered by health insurance while they are undergoing treatment for breast cancerVariesNew York Hudson ValleyRollinghttps://milesofhope.org/programs/financial-assistance/
      The Pink Daisy ProjectGeneral FundingProvides help through gift cards for groceries, restaurants, and gasVariesWomen under age 45 who are within 3 mo of treatment for breast cancer or reconstructionRollinghttps://www.pinkdaisyproject.com/need-help.html
      The Pink FundGeneral FundingProvides direct bill payment for utility bills, mortgage or rent, car or car insurance payment, and health insurance premiumsUp to $3000In active treatment for breast cancer

      Able to demonstrate a loss of working income due to diagnosis

      Have a current household income below 500% of the FPL
      Rollinghttps://pinkfund.org/get-help/Additional funding available for patients awaiting social security disability if eligible (The Mary Jerczog Fund for Metastatic Breast Cancer)
      United Breast Cancer FoundationIndividual GrantProvides financial assistance for medical procedures, prescription medications, COBRA insurance coverage, housing expenses, utilities, therapeutic treatments, transportation, car insurance, nutrition, and housekeepingVariesBreast cancer patient or survivor within 3 y remissionMonthlyhttps://www.ubcf.org/programs-services/individual-grants/Requires a pay-it-forward contribution of $25 or $50
      FPL = Federal Poverty Level.
      Several foundations listed a maximum limit of duration of funding, Eg, “to not exceed 4 months.” Given the average length of treatment for early-stage active treatment of breast cancer is approximately 3 to 6 months, with an even longer treatment duration for patients with more advanced stage disease,

      Chemotherapy for breast cancer. Mayo Clinic. Available at: https://www.mayoclinic.org/tests-procedures/chemotherapy-for-breast-cancer/about/pac-20384931. Accessed May 31, 2022.

      these awards may fail to cover the full duration of the treatment period. Furthermore, following the completion of initial treatment, recovery, postmastectomy breast reconstruction, and potential recurrence are factors that may prolong the need for financial assistance. A 1-time grant of $3000 USD is likely insufficient to ameliorate the financial burden that exists for patients living with both immediate and long-term financial burdens of breast cancer. Additionally, women have demonstrated an average of $1000 to $3300 USD per year in out-of-pocket care expenses for up to 12 years following the initial diagnosis.
      • Dean LT
      • Moss SL
      • Ransome Y
      • et al.
      It still affects our economic situation”: long-term economic burden of breast cancer and lymphedema.
      A dearth of financial support has been similarly described in other patient populations, such as those undergoing transplant surgery
      • Ganji S
      • Ephraim PL
      • Ameling JM
      • Purnell TS
      • Lewis-Boyer LL
      • Boulware LE
      Concerns regarding the financial aspects of kidney transplantation: perspectives of pre-transplant patients and their family members.
      or cleft and craniofacial surgery.
      • Villavisanis DF
      • Folsom N
      • McKenna RA
      • Taylor JA
      Supporting our cleft and craniofacial patients beyond the clinic: scholarships to promote academic achievement.
      While the funding mechanisms presented here are surely not the only methods to receive financial support, the lack of targeted funding highlights a welcome opportunity to support our patients.
      Additionally, targeted financial support is needed for our patients of lower socioeconomic status, who not only suffer from increased financial toxicity but are generally diagnosed with breast cancer at a later stage of disease progression.
      • Farley TA
      • Flannery JT
      Late-stage diagnosis of breast cancer in women of lower socioeconomic status: public health implications.
      While grants requiring household income below 300 to 500% of the federal poverty level (FPL) may certainly aid patients and families who suffer the greatest financial burden, this criterion may unnecessarily exclude patients with significant financial burdens who fall outside of these determined cutoff values.
      The highly individualized nature of breast cancer treatment can include chemotherapy, radiation, surgery, and hormonal therapies.
      • Hortobagyi GN
      Treatment of breast cancer.
      Cost differences among treatment plans for breast cancer patients have been attributed to cancer stage at diagnosis and the need for an adjuvant chemotherapy regimen, which may not be considered by eligibility criteria for foundational financial support.
      • Blumen H
      • Fitch K
      • Polkus V
      Comparison of treatment costs for breast cancer, by tumor stage and type of service.
      For women undergoing mastectomy, breast reconstruction is an increasingly common post-treatment procedure.
      • Lim DW
      • Metcalfe KA
      • Narod SA
      Bilateral mastectomy in women with unilateral breast cancer: a review.
      Between 2000 and 2010, the proportion of women undergoing contralateral mastectomy who also underwent breast reconstruction increased from 18.7 to 46.5%.
      • Lim DW
      • Metcalfe KA
      • Narod SA
      Bilateral mastectomy in women with unilateral breast cancer: a review.
      Reconstruction may further be characterized as delayed or immediate, with delayed procedures potentially incurring greater financial cost.
      • Neyt MJ
      • Blondeel PN
      • Morrison CM
      • Albrecht JA
      Comparing the cost of delayed and immediate autologous breast reconstruction in Belgium.
      Several of the grants identified require “active treatment” for breast cancer; however, the definition of “active treatment” varies among granting programs, and thus planned breast reconstruction may not be considered to fit eligibility criteria. No grants were explicitly found to cover breast reconstruction-associated costs; yet, the time to recover from breast reconstruction can impose a significant financial burden on patients.
      • Ganesh Kumar N
      • Berlin NL
      • Hawley ST
      • Jagsi R
      • Momoh AO
      Financial toxicity in breast reconstruction: a national survey of women who have undergone breast reconstruction after mastectomy.
      Patients have demonstrated low levels of financial discussion with their providers-78% of women reported never discussing financial burden of breast cancer care with their cancer team.
      • Greenup RA
      • Rushing C
      • Fish L
      • et al.
      Financial costs and burden related to decisions for breast cancer surgery.
      Thoughtful discussions with health care teams, as well as structured financial counseling and planning at the time of diagnosis may be 1 strategy to ameliorate the financial burden of breast cancer care. Specific information regarding options for financial support should be available in medical offices for patients that may require it.

      Conclusions

      The present search for sources of financial support for the over 3.8 million women that suffer from breast cancer in the United States

      Key statistics for breast cancer. American Cancer Society. Available at: https://www.cancer.org/cancer/breast-cancer/about/how-common-is-breast-cancer.html. Accessed May 31, 2022.

      has generated only a handful of currently active grants. Breast cancer incurs a great cost to a patient and their care associates; however, there is an apparent lack of resources readily available to assist these patients. Identifying and centralizing the existing financial programs and developing fundraising initiatives that provide more targeted funding is 1 important first step to supporting our breast cancer patients from diagnosis to treatment and remission.

      Author Contributions

      NR identified the existing funding opportunities, created the table, and constructed the manuscript. DFV conceptualized the study, assisted in assessing the eligibility of the identified studies, and assisted NR with drafting the manuscript. PJT provided supervision and guidance on all aspects of the research process and assisted NR with manuscript finalization.

      Disclosure

      DFV is a fellow to Artis Ventures, LP.

      References

        • Rosenzweig M
        • West M
        • Matthews J
        • et al.
        Financial toxicity among women with metastatic breast cancer.
        Oncol Nurs Forum. 2019; 46: 83-91https://doi.org/10.1188/19.ONF.83-91
        • Ruddy KJ
        • Greaney ML
        • Sprunk-Harrild K
        • Meyer ME
        • Emmons KM
        • Partridge AH
        Young women with breast cancer: a focus group study of Unmet Needs.
        J Adolesc Young Adult Oncol. 2013; 2: 153-160https://doi.org/10.1089/jayao.2013.0014
        • Irwin B
        • Kimmick G
        • Altomare I
        • et al.
        Patient experience and attitudes toward addressing the cost of breast cancer care.
        Oncologist. 2014; 19: 1135-1140https://doi.org/10.1634/theoncologist.2014-0117
        • Politi MC
        • Yen RW
        • Elwyn G
        • et al.
        Women who are young, non-white, and with lower socioeconomic status report higher financial toxicity up to 1 year after breast cancer surgery: a mixed-effects regression analysis.
        Oncologist (Dayton, Ohio). 2021; 26: e142-e152https://doi.org/10.1002/onco.13544
        • Dean LT
        • Moss SL
        • Ransome Y
        • et al.
        It still affects our economic situation”: long-term economic burden of breast cancer and lymphedema.
        Supportive Care Cancer. 2019; 27: 1697-1708https://doi.org/10.1007/s00520-018-4418-4
        • Ganji S
        • Ephraim PL
        • Ameling JM
        • Purnell TS
        • Lewis-Boyer LL
        • Boulware LE
        Concerns regarding the financial aspects of kidney transplantation: perspectives of pre-transplant patients and their family members.
        Clin Transplant. 2014; 28: 1121-1130https://doi.org/10.1111/ctr.12428
        • Villavisanis DF
        • Folsom N
        • McKenna RA
        • Taylor JA
        Supporting our cleft and craniofacial patients beyond the clinic: scholarships to promote academic achievement.
        Cleft Palate-Craniofac J. 2022; 10556656221089154https://doi.org/10.1177/10556656221089154
        • Farley TA
        • Flannery JT
        Late-stage diagnosis of breast cancer in women of lower socioeconomic status: public health implications.
        Am J Public Health. 1989; 79: 1508-1512https://doi.org/10.2105/ajph.79.11.1508
        • Hortobagyi GN
        Treatment of breast cancer.
        N Engl J Med. 1998; 339: 974-984https://doi.org/10.1056/NEJM199810013391407
        • Blumen H
        • Fitch K
        • Polkus V
        Comparison of treatment costs for breast cancer, by tumor stage and type of service.
        Am Health Drug Benefits. 2016; 9: 23-32
        • Lim DW
        • Metcalfe KA
        • Narod SA
        Bilateral mastectomy in women with unilateral breast cancer: a review.
        JAMA Surg. 2021; 156: 569-576https://doi.org/10.1001/jamasurg.2020.6664
        • Neyt MJ
        • Blondeel PN
        • Morrison CM
        • Albrecht JA
        Comparing the cost of delayed and immediate autologous breast reconstruction in Belgium.
        Br J Plast Surg. 2005; 58: 493-497https://doi.org/10.1016/j.bjps.2004.12.002
        • Ganesh Kumar N
        • Berlin NL
        • Hawley ST
        • Jagsi R
        • Momoh AO
        Financial toxicity in breast reconstruction: a national survey of women who have undergone breast reconstruction after mastectomy.
        Ann Surg Oncol. 2022; 29: 535-544https://doi.org/10.1245/s10434-021-10708-5
        • Greenup RA
        • Rushing C
        • Fish L
        • et al.
        Financial costs and burden related to decisions for breast cancer surgery.
        J Oncol Pract. 2019; 15: e666-e676https://doi.org/10.1200/jop.18.00796
      1. Chemotherapy for breast cancer. Mayo Clinic. Available at: https://www.mayoclinic.org/tests-procedures/chemotherapy-for-breast-cancer/about/pac-20384931. Accessed May 31, 2022.

      2. Key statistics for breast cancer. American Cancer Society. Available at: https://www.cancer.org/cancer/breast-cancer/about/how-common-is-breast-cancer.html. Accessed May 31, 2022.