{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T03:46:36Z","timestamp":1791863196899,"version":"4.3.4"},"reference-count":56,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,5,17]],"date-time":"2026-05-17T00:00:00Z","timestamp":1778976000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,17]],"date-time":"2026-05-17T00:00:00Z","timestamp":1778976000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Objectives<\/jats:title>\n                    <jats:p>Out\u2010of\u2010pocket (OOP) costs and healthcare utilization remain unknown for women facing breast conservation and mastectomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Women aged 18\u201364 who underwent upfront breast cancer surgery were identified from the IBM MarketScan Commercial Claims Database (2014\u20132017). Surgical groups included lumpectomy+radiation; unilateral mastectomy\u2009+\u2009\/\u2010reconstruction, and bilateral mastectomy\u2009+\u2009\/\u2010reconstruction. Cumulative OOP payments were assessed at 12\u2010month intervals over 4 years postoperatively and adjusted to 2017 USD$. Multivariable regression identified factors associated with increased OOP costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, 23,159 underwent lumpectomy with radiation (60%), unilateral mastectomy with (15%) and without (6%) reconstruction, and bilateral mastectomy with (17%) and without (2.6%) reconstruction. Women undergoing bilateral mastectomy+reconstruction were younger than other surgical groups (median age 49 vs. 50\u201355). In the first year after diagnosis, 1.24 million outpatient visits occurred, 27% of enrollees had inpatient admissions, 23% visited an E.R., and median OOP costs were $5669 (range $0 to $132\u2009125). Cumulative costs were significantly higher in women &lt;\u200945 yo and for those with greater comorbidities. Median OOP costs declined over time (0\u201312\u2009months: $3661 vs 48\u2009months: $486). OOP costs were 12% higher (8.9%\u201315.1%) with mastectomy+reconstruction than lumpectomy+radiation ($6529 vs $5333).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Out\u2010of\u2010pocket costs and healthcare utilization differ between equally effective surgical treatment options; mastectomy\u2009+\u2009reconstruction is costlier for patients than breast conservation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jso.70281","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T05:31:51Z","timestamp":1779082311000},"page":"185-196","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Patient Out\u2010of\u2010Pocket Costs and Healthcare Utilization Related to Mastectomy vs Breast Conservation: A Claims\u2010Based Study"],"prefix":"10.1002","volume":"134","author":[{"given":"Ellie M.","family":"Proussaloglou","sequence":"first","affiliation":[{"name":"Department of Surgery Yale University School of Medicine New Haven Connecticut USA"},{"name":"Smilow Cancer Center, Yale New Haven Health System New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Ren","sequence":"additional","affiliation":[{"name":"Artera Inc Los Altos California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oluwadamilola M.","family":"Fayanju","sequence":"additional","affiliation":[{"name":"Department of Surgery, Perelman School of Medicine The University of Pennsylvania Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel C.","family":"Blitzblau","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Duke University School of Medicine Durham North Carolina USA"},{"name":"Duke Cancer Institute Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth R.","family":"Berger","sequence":"additional","affiliation":[{"name":"Department of Surgery Yale University School of Medicine New Haven Connecticut USA"},{"name":"Smilow Cancer Center, Yale New Haven Health System New Haven Connecticut USA"},{"name":"Cancer Outcomes, Public Policy, and Effectiveness Research Center Yale University School of Medicine New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Valero","sequence":"additional","affiliation":[{"name":"Department of Surgery Yale University School of Medicine New Haven Connecticut USA"},{"name":"Smilow Cancer Center, Yale New Haven Health System New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Shelley Hwang","sequence":"additional","affiliation":[{"name":"Duke Cancer Institute Durham North Carolina USA"},{"name":"Department of Surgery Duke School of Medicine Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie B.","family":"Wheeler","sequence":"additional","affiliation":[{"name":"UNC Gillings School of Global Public Health. Lineberger Cancer Center Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel A.","family":"Greenup","sequence":"additional","affiliation":[{"name":"Department of Surgery Yale University School of Medicine New Haven Connecticut USA"},{"name":"Smilow Cancer Center, Yale New Haven Health System New Haven Connecticut USA"},{"name":"Cancer Outcomes, Public Policy, and Effectiveness Research Center Yale University School of Medicine New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,17]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21708"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198503143121102"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198503143121101"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa040587"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2012.45.2615"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2015.03.033"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2008.20.1681"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/sla.0000000000001698"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-016-5443-5"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-016-5648-7"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-024-15360-3"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2008.16.6215"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2011.09.017"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2012-0279"},{"key":"e_1_2_9_16_1","unstructured":"K.F. Foundation.Healthcare Debt Survey.2022."},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2016.4865"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2012.1263"},{"issue":"80","key":"e_1_2_9_19_1","first-page":"149","article-title":"Financial Toxicity, Part I: A New Name for a Growing Problem","volume":"27","author":"Zafar S. Y.","year":"2013","journal-title":"Oncology (Williston Park, NY)"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djv410"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2015.64.6620"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.29808"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.21.02810"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1093\/oncolo\/oyae016"},{"key":"e_1_2_9_25_1","unstructured":"IBM. MarketScan Research Database for Life Sciences Researchers: A White Paper."},{"key":"e_1_2_9_26_1","first-page":"188","article-title":"Charlson Comorbidity Index: ICD\u20109 Update and ICD\u201010 Translation","volume":"12","author":"Glasheen W. P.","year":"2019","journal-title":"American Health & Drug Benefits"},{"key":"e_1_2_9_27_1","unstructured":"NIH Surveillance Epidemiology and End Results (SEER) Program Cancer Statistics Review. 2022 [cited 2022 December 15]https:\/\/seer.cancer.gov\/statistics-network."},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2016.34.15_suppl.e18268"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.34220"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2024.2212"},{"key":"e_1_2_9_31_1","unstructured":"C.W.\u2010A.S.o.B. Surgeons. Double Mastectomies.https:\/\/www.choosingwisely.org\/clinician-lists\/breast-surgeons-mastectomies-for-single-breast-cancer-patients\/."},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djw178"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-015-4628-7"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-014-3687-5"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1097\/prs.0000000000004272"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1097\/sla.0000000000001840"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-014-3759-6"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.46091"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.28812"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-024-15895-5"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1093\/jncics\/pkae093"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1200\/jop.18.00796"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djac141"},{"key":"e_1_2_9_44_1","unstructured":"Women's Health and Cancer Rights Act of 1998. (1998). H.R. 4328 105th Congress https:\/\/www.congress.gov\/bill\/105th-congress\/house-bill\/4328."},{"key":"e_1_2_9_45_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-019-05449-9"},{"key":"e_1_2_9_46_1","doi-asserted-by":"publisher","DOI":"10.1097\/sla.0000000000003629"},{"key":"e_1_2_9_47_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11764-025-01881-7"},{"key":"e_1_2_9_48_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2017.77.6310"},{"key":"e_1_2_9_49_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-022-08016-z"},{"key":"e_1_2_9_50_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2015.62.0468"},{"key":"e_1_2_9_51_1","unstructured":"U.S. Bureau of Labor Statistics.High Deductible Health Plans and Health Savings Accounts Published (April 2024) https:\/\/www.bls.gov\/ebs\/factsheets\/high-deductible-health-plans-and-health-savings-accounts.htm."},{"key":"e_1_2_9_52_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2017.75.2501"},{"key":"e_1_2_9_53_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1910549"},{"key":"e_1_2_9_54_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1814017"},{"key":"e_1_2_9_55_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-017-6217-4"},{"key":"e_1_2_9_56_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000000924"},{"key":"e_1_2_9_57_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11764-019-00764-y"}],"container-title":["Journal of Surgical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jso.70281","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jso.70281","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jso.70281","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T03:06:08Z","timestamp":1791860768000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jso.70281"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,17]]},"references-count":56,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1002\/jso.70281"],"URL":"https:\/\/doi.org\/10.1002\/jso.70281","archive":["Portico"],"relation":{},"ISSN":["0022-4790","1096-9098"],"issn-type":[{"value":"0022-4790","type":"print"},{"value":"1096-9098","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,17]]},"assertion":[{"value":"2026-01-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-24","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-17","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}