Post-treatment survivorship has not been empirically studied to a large degree. The BCEI is one of the few interventions demonstrating effectiveness among survivors after primary treatment, suggesting that oncology nurses may be uniquely positioned to provide safe passage using education and support.

Goals Economic burden is emerging as a crucial dimension in our understanding of adjustment to cancer during treatment. Yet, economic burden is rarely examined in cancer survivorship. The goal of this paper is to describe the effect of economic hardship and burden among women with breast cancer. Methods We examined baseline and follow-up (3 and 6 month) data reported by 132 stage I and II breast cancer survivors assigned to the Wait Control arm of the Breast Cancer Education Intervention (BCEI), a clinical trial of education and support interventions. Repeated measures models fitted with linear mixed models were used to examine relationships between aspects of economic burden and overall quality of life (QOL) scores. Structural equation models (SEM) were used to examine the relationship between overall economic burden and QOL. Results Nineteen economic events were reported. The proportion of survivors who reported increase in insurance premiums increased in the 6-month study period (p=.022). The proportion of survivors reporting change in motivation (p=.016), productivity (p=.002), quality of work (p=.01), days missed from work (p<.001) and sacrificing other things (p=.001) declined. An increase in economic events was significantly associated with poorer quality of life at each of the study time points. Conclusion Economic burden of breast cancer extends into post-treatment survivorship. Better understanding of economic impact and managing economic burden may help maintain QOL.

Introduction Out of pocket (OOP) costs add to the burden facing breast cancer survivors but remain an understudied area of costs. Current turbulent economic climate increases the urgency to better understand this burden. Few studies or systematic reviews focus on OOP costs. Methods PubMed search was conducted for articles in English containing: (1) MESH terms breast neoplasms and economics, and (2) words “breast cancer” and “cost” or “costs,” “expenditure,” or “out of pocket.” Limits included: publication dates from January 1, 1980 to December 16, 2009, and populations aged≥45 years old. Articles were excluded based on title, abstract, and full text reviews. Citation searches and searches of reference lists were also conducted. Three articles were selected for this review. Results Medical direct OOP costs (e.g., for physician fees) ranged from $300 to $1,180 per month during active treatment, and were about $500 per month 1 year post diagnosis. Non-medical direct OOP costs (e.g., for transportation to doctor’s office, parking etc.) ranged from $137 to $174 per month in the year post diagnosis; and $200–$509 per month 1 year or more after diagnosis. Different types of costs were identified. Conclusion OOP costs represent a significant burden for survivors even after initial treatment. The nature and extent of OOP costs need further evaluation. Implications for cancer survivors OOP costs are rarely considered. However, as OOP costs affect the well being of cancer survivors, they should be understood more fully and possibly addressed in interventions aimed at improving quality of life.

The purpose of this article is to: (1) describe out of pocket (OOP) costs among minority and Caucasian participants in the BCEI, the Breast Cancer Education Intervention, a randomized clinical trial of psychoeducational quality of life interventions for breast cancer survivors (BCS); and (2) examine the OOP burden, as measured by the proportion of income spent OOP, between the two racial/ethnic groups. We examined baseline OOP costs reported by 261 early-stage I and II breast cancer survivors who participated in the BCEI trial. Data were collected using the Breast Cancer Finances Survey and the Breast Cancer Sociodemographic and Treatment Tool. OOP costs averaged $316 per month since diagnosis. Direct medical costs were $281, and direct non-medical were $66. There were no significant differences in total OOP costs or direct medical and nonmedical OOP costs between minority and Caucasian BCS. Minority BCS with incomes of $40,000 or less spent a greater proportion of income in total OOP and direct medical OOP costs (31.4 and 27% for BCS with incomes ≤$20,000; 19.5 and 18.8% for BCS with incomes $20,001-40,0000) compared to their Caucasian counterparts (12.6 and 9.2% for BCS with incomes ≤$20,000; 8.7 and 8.2% for BCS with incomes $20,001-40,0000). OOP costs can be a considerable burden for breast cancer survivors representing as much as 31% of monthly income depending on BCS' income levels. Future studies can investigate how this burden affects the quality of life of breast cancer survivors, especially minorities.

Telephone-based Latina Breast Cancer Survivorship Intervention reached Latina breast cancer survivors for survivorship education and support. Self-management of pain and fatigue showed improvement over time.