Impact of Chemotherapy on Financial Toxicity in African American Breast Cancer Patients

Objectives: With the rising cost of chemotherapy, the financial toxicity (FT) of systemic therapy can substantially impair patient quality of life. FT is also associated with various socioeconomic factors, one being race. Patients of African American race often bear the worst burden of cancer treatment-related FT, with a 40% increased mortality from breast cancer. The degree to which chemotherapy before radiation therapy (RT) impacts FT has yet to be formally quantified. We report early FT findings among African American breast cancer patients before receipt of adjuvant RT on the ongoing Navigator-Assisted Hypofractionation (NAVAH) phase I clinical trial to assess the impact of chemotherapy on FT. Methods: African American breast cancer patients undergoing RT were eligible if age 18+ with pathologically confirmed breast cancer following resection. FT was measured using the validated 12-item COmprehensive Score for financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) survey instrument. Values from 26 to 44 represent grade 0 FT (none), 14 to 25 grade 1 FT (mild), 1 to 13 grade 2 FT (moderate), and 0 represents grade 3 FT (severe). The χ 2 test assessed statistically significant differences ( P < 0.05) between patients who received chemotherapy versus no chemotherapy before RT receipt. Results: Mean COST-FACIT score was 25 (±10.4); 61% experienced mild to severe FT. Of the 38 patients, 53% underwent chemotherapy before RT. Patients with prior chemotherapy treatment reported 16% grade 0 FT, 53% grade 1 FT, 26% grade 2 FT, and 5% grade 3 FT. The relationship between adjuvant chemotherapy and FT was statistically significant ( P = 0.0028). Conclusions: Over 60% of participants in this study experienced some degree of meaningful FT. These results from an ongoing phase I clinical trial indicate a subsection of patients may benefit from proactive financial assistance to reduce the detrimental effect of FT on their breast cancer treatment, highlighting patients requiring chemotherapy before RT being more likely to experience FT.