Impact of age and treatment-related adverse events on financial toxicity among patients with breast cancer: a systematic review.

PURPOSE: Increasing incidence of breast cancer among young adults (YA), defined by the National Comprehensive Cancer Network (NCCN) as age < 40 years, has amplified concerns over financial toxicity (FT) in this demographic. This systematic review sought to clarify the association between YA status and FT.

METHODS

We queried bibliographic databases for full-text English language publications between 2010 and 2024 reporting FT using validated patient-reported outcome metrics among patients with stage I-III breast cancer. Two reviewers screened and extracted data between June and September 2024. Variables of interest included age and treatment-related adverse events (secondary outcome of interest).

RESULTS

Of 4023 articles screened, 66 were included for review. Sixty-four were excluded for including in situ or metastatic disease, multiple cancer histologies, or FT as a parameter of a larger scale without validation for stand-alone use. While no studies compared FT using the NCCN YA threshold (i.e., < 40 versus ≥ 40 years), two studies demonstrated that younger age was associated with worse FT. One study compared patients age ≥ 65 to < 65 years using the Comprehensive Score for Financial Toxicity, and the other considered age as a continuous variable using the Psychological Sense of Economic Hardship Scale. The latter also reported treatment-related symptoms were associated with greater FT after adjusting for age.

CONCLUSION

No study identified the multidimensional domain of FT as a primary outcome among YA versus non-YA women with non-metastatic invasive breast cancer. Two studies showed younger age was associated with greater FT.

IMPLICATIONS FOR CANCER SURVIVORS: As FT has been shown to negatively impact patient outcomes, further investigations are needed to support policy efforts and to improve care for younger breast cancer survivors.