Abstract P6-08-07: Out-of-pocket spending, dermatologic quality of life, and treatment satisfaction in breast cancer radiotherapy patients
Authors: Green S , Montgomery GH , Mattson DMK , Hydeman J , Schnur JB 
Published: August 2014

Abstract
Objective: Skin toxicity is one of the most common acute side effects of breast cancer radiotherapy (RT). Past research has largely neglected non-medical out-of-pocket (OOP) spending associated with this side effect. We therefore developed a Skin Toxicity Costs (STC) questionnaire to assess such spending. The primary goal of the present study was to use the STC to estimate non-medical out-of-pocket spending associated with acute skin toxicity in breast cancer RT patients. Secondary goals included exploration of the associations between the STC, dermatologic quality of life, and satisfaction with RT.
Methods: 185 consecutive female breast cancer RT patients (Stage 0-III) participated in the research from 2008 to 2013. All participants received a course of standard fractionated external beam RT. Demographics: mean age = 55.4; 74% White, 10% African American, 16% Other; and 10% Latina. In regard to employment, 46% reported working full-time, 12% part-time, and 42% were not employed. 68% had at least a college degree and 66% reported a household income of ≥ $60,000/year. On their penultimate day of RT, participants completed the STC, the Dermatologic Life Quality Index (DLQI), and a Patient Satisfaction Questionnaire (PSQ). Patients also completed a demographics questionnaire and an Importance of Appearance Scale (IAPP) at the commencement of RT. Note: all patients were provided with skin creams free of charge through the clinic.
Results: Analyses revealed no differences in the STC, DLQI, or PSQ based on recruitment site (all ps &gt; .45). Results revealed that 83% of the sample reported OOP spending associated with skin toxicity. Mean STC spending was $245.11 (95% CI: 135.34 to 354.87; Median = $75.00). Multiple regression of demographic factors (ethnicity, race, marital status, employment, education, income) and IAPP revealed that IAPP and marital status uniquely predicted STC spending (ps &lt; .02; total model R2 = .24), such that increased STC was associated with increased importance of appearance and being unmarried. Controlling for IAPP and marital status, STC was significantly associated with DLQI (p&lt;.001), such that increased STC was associated with decreased dermatologic quality of life. Lastly, we examined whether the STC was associated with treatment satisfaction controlling for IAPP, marital status, and DLQI. Results revealed that only STC was uniquely associated with patient satisfaction (p&lt;.001; total model R2 = .39), such that patients with higher STC scores were less satisfied with their RT.
Discussion: Results are consistent with recent research suggesting that OOP spending can be considered a “financial toxicity” of cancer treatment, and is associated with lower levels of satisfaction with cancer care. However, the present study is the first to examine this issue with a focus on skin toxicity-related spending in breast cancer patients. The results suggest that OOP spending is linked to patient satisfaction with care. OOP may be a marker of skin toxicity. Future research seeking to manage skin toxicity may have the beneficial downstream consequence of reducing OOP spending and improving overall satisfaction with RT.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-08-07.