Grants Funded

Abstract

Project Summary: Breast cancer care economics have recently been in the spotlight due to rapidly rising prices, higher patient cost-sharing, and disproportionate rates of bankruptcy among breast cancer patients. Collectively, studies suggest that approximately 25-35% of patients experience excessive financial burden related to breast cancer treatment. Breast reconstruction adds another layer of complexity to cost considerations due to its preference-sensitive nature with various cost profiles. Though there are many retrospective, cross-sectional studies that identify associations of demographic and clinical factors with risk of financial hardship, there are no prospective, longitudinal studies that evaluate the arc of financial well-being from diagnosis to completion of breast reconstruction. Furthermore, there are no widely-implemented predictive models to prioritize high-risk patients for financial interventions. This objective of this study is to understand the bidirectional relationship between financial hardship and breast reconstruction. Specifically, we seek to understand if financial considerations influence choice of reconstructive method and/or timing, particularly in the setting of a healthcare system with poor price transparency. In addition, we seek to understand how reconstructive choice affects downstream financial burden. This study builds upon a quality improvement (QI) project at our institution, in which patients with a new cancer diagnosis are administered the COmprehensive Score for financial Toxicity (COST) survey at initiation of care and at 4-month intervals thereafter. Specific Aims include: (1) to use QI data for breast cancer patients to understand baseline patient financial differences, (2) to determine the change in financial well-being over time, and (3) to develop a preoperative model that predicts financial hardship with minimal patient-reported data. The first two aims seek to enhance our understanding of how cost may be a driver of disparities in breast reconstruction. The third aim operationalizes this knowledge by using it to formulate a predictive model that can identify at risk patients, and ultimately screen patients for intervention. Findings from this study will inform future efforts to determine how health systems can facilitate reconstructive decision-making to optimize satisfaction with breast reconstruction, taking into account baseline cost considerations and institutional resources available to equalize economic outcomes.

Impact Statement: Financial toxicity is a common sequelae of breast cancer treatment that lacks a predictive framework to identify at-risk women. Our historical inability to formulate a predictive model largely reflects our lack of understanding of how financial hardship varies throughout the course of breast cancer treatment, specifically for women undergoing delayed breast reconstruction whose payments span multiple fiscal cycles. Improving our understanding of financial considerations in breast reconstruction will enhance our ability to provide patient-centered care. In addition, risk stratification and prioritization will allow for more efficient expense of time and financial resources on those with the greatest need.

Biography
Danielle Rochlin is currently a microsurgery fellow at Memorial Sloan Kettering Cancer Center (MSK). She completed plastic and reconstructive surgery residency at Stanford University and spent a year as a craniofacial fellow at New York University prior to her current position at MSK. She additionally has a background in healthcare economics and public policy, having graduated from Princeton University summa cum laude with a minor in this topic and spent a research year as a health systems design fellow at Stanford’s Clinical Excellence Research Center. For the past four years, she has served as the American Society of Plastic Surgeons delegate to the Resident and Fellows’ Section of the American Medical Association, where she has represented the interests of plastic surgery trainees and patients to the larger medical community. She has a keen interest in health services and clinical research; to date, she has authored nearly 80 peer-reviewed papers, including 37 as first or senior author. Her particular research interests include price transparency, affordability, and cost considerations in the value-based care of the plastic surgery patient. She intends to pursue a career in academic medicine with a continued strong emphasis on health systems research and a clinical practice with a focus on breast reconstruction.