{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T12:42:05Z","timestamp":1791636125658,"version":"4.3.4"},"reference-count":48,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"8","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JOP"],"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:sec><jats:title>PURPOSE:<\/jats:title><jats:p> Financial toxicity is a well-recognized adverse effect of cancer care, yet little is known about how women consider treatment costs when facing preference-sensitive decisions for breast cancer surgery or how surgical treatment choice affects financial harm. We sought to determine how financial costs and burden relate to decisions for breast cancer surgery. <\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS:<\/jats:title><jats:p> Women (\u2265 18 years old) with a history of breast cancer were recruited from the Army of Women and Sisters Network to complete an 88-item electronic survey. Descriptive statistics and regression analysis were used to evaluate the impact of costs on surgical decisions and financial harm after breast cancer surgery. <\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS:<\/jats:title><jats:p> A total of 607 women with stage 0 to III breast cancer were included. Most were white (90%), were insured privately (70%) or by Medicare (25%), were college educated (78%), and reported household incomes of more than $74,000 (56%). Forty-three percent underwent breast-conserving surgery, 25% underwent mastectomy, 32% underwent bilateral mastectomy, and 36% underwent breast reconstruction. Twenty-eight percent reported that costs of treatment influenced their surgical decisions, and at incomes of $45,000 per year, costs were prioritized over breast preservation or appearance. Overall, 35% reported financial burden as a result of their cancer treatment, and 78% never discussed costs with their cancer team. When compared with breast-conserving surgery, bilateral mastectomy with or without reconstruction was significantly associated with higher incurred debt, significant to catastrophic financial burden, treatment-related financial hardship, and altered employment. Among the highest incomes, 65% of women were fiscally unprepared, reporting higher-than-expected (26%) treatment costs. <\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSION:<\/jats:title><jats:p> Cancer treatment costs influenced decisions for breast cancer surgery, and comparably effective surgical treatments differed significantly in their risk of patient-reported financial burden, debt, and impact on employment. Cost transparency may inform preference-sensitive surgical decisions and improve patient-centered care. <\/jats:p><\/jats:sec>","DOI":"10.1200\/jop.18.00796","type":"journal-article","created":{"date-parts":[[2019,7,29]],"date-time":"2019-07-29T19:57:18Z","timestamp":1564430238000},"page":"e666-e676","update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":117,"title":["Financial Costs and Burden Related to Decisions for Breast Cancer Surgery"],"prefix":"10.1200","volume":"15","author":[{"given":"Rachel A.","family":"Greenup","sequence":"first","affiliation":[{"name":"Duke University, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christel","family":"Rushing","sequence":"additional","affiliation":[{"name":"Duke University, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Fish","sequence":"additional","affiliation":[{"name":"Duke University, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brittany M.","family":"Campbell","sequence":"additional","affiliation":[{"name":"Duke University, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Tolnitch","sequence":"additional","affiliation":[{"name":"Duke University, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terry","family":"Hyslop","sequence":"additional","affiliation":[{"name":"Duke University, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Peppercorn","sequence":"additional","affiliation":[{"name":"Duke University, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie B.","family":"Wheeler","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. 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