Abstract P6-11-18: Medical, financial and insurance related concerns of metastatic breast cancer patients
Authors: Geske Savannah Joy , Ambrosier Katie , Pluard Timothy J. 
Published: March 2020

Abstract
Background: The medical, financial and insurance concerns of patients throughout the cancer trajectory are well documented. Over a quarter of patients report at least one financial problem. Due to the financial burden of cancer care, patients report that they delay filling prescriptions, have difficulty making ends meet, are concerned about their household’s financial situation and skip doses of medication. These are significant findings as consistent use of medication is necessary for treatment and those with increased financial problems also have lower scores on physical and mental health quality of life measures. While most providers agree that the burden of metastatic breast cancer (MBC) is also significant, little information is known about the specific medical, financial and insurance needs of those with MBC. Methods: Saint Luke’s Cancer Institute (SLCI) employs providers in the fields of medical and surgical oncology, gynecologic oncology, hematology and radiation oncology who subspecialize in every type of cancer. In October of 2016, the Koontz Center for Advanced Breast Cancer was established within the Saint Luke’s Cancer Institute. This center focuses exclusively on patients with MBC with a dual focus of improving outcomes and quality of life of those with MBC. In addition to a robust therapeutic research program, genomics, and immunotherapy, a comprehensive supportive/integrative team, including social worker, is imbedded in the center. Social workers see patients throughout the entirety of SLCI and the Koontz Center for Advanced Breast Cancer. As part of their patient interactions, social workers document the date of intervention, patients’ name, concern addressed, and length of every interaction. The following data compares the reported needs of those with MBC in the Koontz Center for Advanced Breast Cancer to the non-MBC patients within the SLCI population from September 1st of 2017 to August 31st of 2018. Results: In total, there were 2,072 interactions with non-MBC patients during this period. The top three reported concerns were medication assistance (n=335, 16.15%), being uninsured (n=298, 14.37%) and transportation (n=284, 13.69%). For those with MBC, there were a total of 476 interactions within the same time frame and the top three reported concerns were medication assistance (n=166, 34.87%), insurance issues (n=75, 15.76%) and financial distress (n=66, 13.87%). About 55% of non-MBC patients (n=334, 55.95%) have repeat appointments and meet with social work on average 5 times. Of MBC patients, 60.67% (n=54) have repeat appointments and meet with social work on average 7 times. For one time encounters with social work, those with non-MBC patients lasted 21 minutes and 9 seconds and encounters with MBC patients lasted 24 minutes and 34 seconds. Conclusion: Results indicate differences and similarities for MBC patients compared to non-MBC patients. This could be explained by the fact that both populations share several concerns such as financial barriers to medications, high insurance premiums and decreased ability to work. However, due to the nature of MBC, patients with MBC often deal with these concerns for longer periods of time and are often required to utilize expensive specialty medication. The top three concerns of MBC patients including medication assistance, insurance issues, and financial distress, are closely related to one another as it relates to gaps in healthcare coverage. The high cost of treatment for advanced disease, coupled with the specific and unique needs of those living with MBC, can directly impact patients’ ability to access necessary care. These potential causes, as well as how the Koontz Center for Advanced Breast Cancer works to mitigate these issues, will be addressed in further detail.
Citation Format: Savannah Joy Geske, Katie Ambrosier, Timothy J. Pluard. Medical, financial and insurance related concerns of metastatic breast cancer patients [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-11-18.