Financial toxicity and contralateral prophylactic mastectomy: an analysis using propensity score methods
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EPIDEMIOLOGY
Financial toxicity and contralateral prophylactic mastectomy: an analysis using propensity score methods Malke Asaad1 · Stefanos Boukovalas1 · Carrie K. Chu1 · Yu‑Li Lin2 · Cristina M. Checka3 · Mark W. Clemens1 · Rachel A. Greenup4 · Anaeze C. Offodile II1,2,5 Received: 29 May 2020 / Accepted: 11 July 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Contralateral prophylactic mastectomy (CPM) is increasingly performed in average-risk patients despite the lack of survival benefit. In an era of heightened awareness of healthcare costs, we sought to determine the impact of CPM on financial toxicity in breast cancer. Methods A single-institution propensity-matched analysis of female patients who underwent unilateral mastectomy (UM) with or without CPM for breast cancer over an 18-month period. Patients with a history of genetic predisposition or bilateral cancer were excluded. The validated Comprehensive Score for financial Toxicity (COST) evaluated financial toxicity among participants. Multivariable regression analysis evaluated the relationship between CPM and financial toxicity. Relevant domains of the Breast Q and SF12 instruments were examined as secondary outcomes. Sensitivity analysis was performed using propensity-weighting to examine robustness of results and increase our sample size. Results Overall, 104 patients were identified, equally distributed across UM and CPM. CPM was not associated with financial toxicity, as evidenced by comparable COST scores (adjusted difference, 1.53 [− 3.24 to 6.29]). Minor complications were significantly lower in UM patients (UM, 8%; CPM, 31%). CPM was associated with significantly higher Breast Q psychosocial well-being score (adjusted difference, 10.58 [1.34 to 19.83]). BREAST Q surgeon satisfaction, SF12 mental and physical component scores were comparable. Similar results were noted on sensitivity analysis involving 194 patients. Conclusions Choice for CPM was associated with higher minor complications, but led to improved psychosocial well-being without a higher degree of patient-reported financial toxicity. Prospective studies are needed to discern the influence of CPM on the incidence and trajectory of financial toxicity. Keywords Breast reconstruction · Financial toxicity · Cost · Surgery · Contralateral prophylactic mastectomy · Breast cancer
Introduction * Anaeze C. Offodile II [email protected] 1
Department of Plastic & Reconstructive Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
2
Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
3
Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
4
Department of Surgical Oncology, Duke University School of Medicine, Durham, NC, USA
5
Baker Institute for Public Policy, Rice University, Houston, TX, USA
Contralateral prophylactic mastectomy (CPM) refers to surgical resection of the unaffected breast in patien
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