By: Jenny Brown
When most people think about side effects of breast cancer treatment, they think about losing their hair during chemotherapy or enduring blistered skin from radiation therapy. What rarely comes to mind is the stress that comes with the costs of treatment—known as the financial toxicity—that often drives critical decisions for patients.
Research shows that low-income women have worse outcomes—lower survival rates—than their affluent counterparts. Samilia Obeng-Gyasi, MD, assistant professor of surgery at IU School of Medicine, wants to know why.
“People make choices based on their resources,” Obeng-Gyasi explains. “Are women refusing to get the recommended course of radiation, for example, because they don’t have ride to the hospital or because they get paid hourly and can’t afford to take so much time off work?”
Too often, she believes, a patient’s decisions about whether or not to get the recommended treatments or adhere to lifestyle adjustments that can help her survive breast cancer are based on where she lives or works, what type of insurance coverage she has, and other economically related factors. These social determinants are driving life-or-death decisions.
With a passion for advocacy, Dr. Obeng-Gyasi’s research is focused on how socioeconomic factors affect an individual’s decisions about breast cancer treatment—and the impact of those decisions on outcomes. For example, if two women, one wealthy and one poor, are diagnosed with the same type of breast cancer, what are the factors that lead to different outcomes?
“When a person is financially stressed about breast cancer treatment—whether its high out-of-pocket costs, unaffordable deductibles, loss of income during FMLA leave or some other related cost—that’s a side effect of treatment,” Obeng-Gyasi points out. “And having to make decisions in that type of environment is difficult. I want to know what women do in that financially toxic situation and why specifically they do it.”
As part of her research on health disparities, she studies health delivery and health policy and how these factors impact health outcomes for women with breast cancer, particularly in Indiana—with the end goal to see the same outcomes all patients with the same disease.
“We can’t change a person’s genetics or the type of tumor she gets,” says Obeng-Gyasi, “but we can work harder to understand the unmet needs of low-income breast cancer patients in Indiana and ensure they get the care they need. Health disparities are actionable.”
The first step, she suggests, is acknowledging that a gap exists in health outcomes, and financial toxicity is a real side effect to breast cancer diagnosis and treatment. At an institutional level, physicians should be tracking financial complications alongside other patient complaints.
“If one of every ten patients I see files for bankruptcy during or after treatment, I should be tracking that,” Obeng-Gyasi suggests. “Or if all my patients with a certain type of insurance avoid certain tests or treatments because it’s not covered, that’s not okay.”