Longitudinal Impact of Adjuvant Radiation Therapy on Financial Toxicity in African-American Breast Cancer Patients: Early Findings From the Navigator-Assisted Hypofractionation (NAVAH) Program Phase I Clinical Trial

TL;DR

This study finds that financial strain worsens for most African-American breast cancer patients after radiation therapy, despite some improvements in a minority.

Contribution

The study is the first to longitudinally assess financial toxicity in African-American breast cancer patients undergoing radiation therapy.

Findings

60% of patients experienced financial toxicity before radiation therapy, and 62% after treatment.

54% of patients reported worsening financial strain one month after completing radiation therapy.

No significant difference in financial toxicity was found between patients receiving one versus three or more weeks of radiation therapy.

Abstract

Purpose/objectives

Breast cancer remains the most prevalent cancer among women, with African Americans experiencing the highest rates of mortality/morbidity. In this context, our current study examines financial toxicity (FT) among African American breast cancer patients before and one month after undergoing adjuvant radiation therapy (RT), aiming to assess the impact of RT on quality of life. This IRB-approved cohort study is part of an ongoing phase I clinical trial evaluating the role of patient navigation during RT as part of the Navigator-Assisted Hypofractionation (NAVAH) program.

Methods

Adults of African American race with a pathologically confirmed diagnosis of early-stage breast cancer following lumpectomy were recruited for enrollment before receipt of adjuvant RT. As part of the NAVAH clinical trial, each participant was paired with a trained patient navigator for support throughout and following RT. FT was assessed using the 12-item COmprehensive Score for financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) questionnaire. This validated instrument was administered (in person or via telephone) at two time points: prior to RT initiation and at one month following completion. Composite COST-FACIT scores were calculated. Paired comparisons of pre- and post-treatment scores were conducted to evaluate FT changes over time.

Results

A total of 40/40 (100%) participants completed the pre-RT COST-FACIT assessment (score range: 4.4-39). At one-month follow-up, post-treatment data was available for 26/40 (65%) participants (score range: 6-38). Prior to starting RT, 24/40 (60%) of participants reported experiencing FT, compared to 16/26 (62%) following treatment (p<0.05). Among those who completed both time points, 9/26 (35%) demonstrated an improvement in FT scores, while 3/26 (11.5%) reported none. However, 14/26 (54%) of participants experienced FT worsening. Comparison revealed no significant difference in FT for one versus three or more weeks of RT at one-month post-treatment (p>0.05).

Conclusion

These findings from the first study longitudinally assessing FT in breast cancer patients receiving RT highlight the dynamic nature of FT among this patient population. While a subset of patients experienced improvements in financial well-being following treatment, more than half reported worsening financial strain. Noteworthy is that there was no significant difference in FT onset following RT completion. These results emphasize the persistent and evolving burden of financial toxicity for people with cancer, especially this population, reinforcing the need for early, sustained, and culturally responsive interventions. Continued investigation through the NAVAH program will further elucidate the role of patient navigation in mitigating financial hardship and optimizing cancer care delivery for all patients.