The financial toxicity of breast cancer: a systematic mapping of the literature and identification of research challenges

FIGURE 1.

FIGURE 2.

FIGURE 3.

A list of authors with at least 4 published papers in the investigated set of literature

Authors	Articles	Articles Fractionalized*	No of documents (in % of all)
HAWLEY ST31–33	7	0.919	4.2
OFFODILE AC10,34,35	7	0.774	4.2
WHEELER SB36,38	7	0.868	4.2
BRADLEY CJ29,39,40	6	1.569	3.6
JAGSI R31,32,41	6	0.701	3.6
ASAAD M10,34,35	5	0.549	3
BOUKOVALAS S10,34,35	5	0.549	3
KATZ SJ31–33	5	0.576	3
AZUERO A46	4	0.522	2.4
CHAN A64–67	4	0.342	2.4
COOPER B64–67	4	0.342	2.4
GORDON L45	4	0.501	2.4
HAMILTON AS31,32	4	0.476	2.4
KOCZWARA B64–67	4	0.342	2.4
MIASKOWSKI C64–67	4	0.342	2.4

A list of 10 most cited papers in the investigated set of literature (only the first author is listed in case of multiple authors)*

Paper	DOI/PMID	Total citations	TC per year	Normalized TC
Jagsi et al., 2014, J Clin Oncol31	10.1200/JCO.2013.53.0956	206	18.73	4.73
Arozullah et al., 2004, J Support Oncol28	PMID: 15328826	161	7.67	1.00
Bradley et al., 2002, J Health Econ29	10.1016/S0167-6296(02)00059-0	137	5.96	1.00
Bradley et al., 2007, Cancer Invest39	10.1080/07357900601130664	117	6.50	1.12
Lauzier et al., 2008, J Natl Cancer Inst44	10.1093/jnci/djn028	111	6.53	1.51
Jagsi et al., 2018, Cancer32	10.1002/cncr.31532	104	14.86	2.82
Meneses et al., 2012, Gynecol Oncol46	10.1016/j.ygyno.2011.11.038	94	7.23	2.40
Gordon L et al, 2007, Psycho-Oncology45	10.1002/pon.1182	92	5.11	0.88
Greenup et al, 2019, J Oncol Pract37	10.1200/JOP.18.00796	81	13.50	4.12
Wheeler et al., 2018, J Clin Oncol36	10.1200/JCO.2017.77.6310	81	11.57	2.20

A systematization of (financial) toxicity of breast cancer at the level of the individual (left column) and research gap (right column)

Type of financial burden/burden	Coverage in the literature and research gap
1. Medical costs	Weaker coverage, survey based, depends on social security system, more relevant for private-insurance based system (e.g. US)
Treatment expenses
Hospitalization costs
2. Non-medical costs	Weaker coverage, survey based, depends on social security system, more relevant for private-insurance based system (e.g. US)
Travel expenses
Accommodation costs
Other
3. Out-of-pocket costs	Weak coverage, survey based
Deductibles and co-payments
Prescription drug costs*
4. Loss of income	Well-documented employment impacts, income impacts, less focus on occupational change
Changed work hours
Job loss
Change in occupation
Loss/change in income
5. Insurance-related costs	Weak coverage, depends on social security system, but has broader relevance for other non-medical insurances (life, travel, etc.)
6. Impact on finances and assets:	Weak coverage
Debt accumulation
Asset depletion
7. Psychosocial impact: Stress and anxiety	Well-documented, focus on stress, anxiety, less focus on quality of life as a whole
Stress and anxiety
Quality of life
8. Long-term financial consequences	Increasing interest on recurrence, screening
Survivorship costs
Cancer recurrence
9. Geographical coverage	Vast body of evidence for the US, poorer coverage for EU/European context
US
Europe

Thematic map of (financial) toxicity of breast cancer with most common author keywords for each of the themes and selected references

	Key term(s)	Other key terms*	Selected papers (No. of reference)
	T1: Breast cancer (neoplasms), employment, financial toxicity	Quality of life, return to work, (cancer) survivor(ship), treatment, financial burden / stress, fatigue, chemotherapy, mental health, caregivers, social support, disability, occupation, burnout complaints	29, 33, 39
Motor themes	T2: Metastatic breast cancer	Prevalence, healthcare use, healthcare utilization, healthcare costs, advanced breast cancer, adverse effects, administrative claims, breast cancer costs	48, 49
	T3: COVID-19	Depression, job loss, access to healthcare, breast cancer survivors, cognition, anxiety, autonomy	50, 51
Basic themes	T1 Economic burden	Cost(s), oncology, lymphedema, rehabilitation, breast neoplasm, cost-effectiveness, recurrence, screening, cost of illness, cancer, resource utilization, healthcare use	52–54
Emerging or declining themes	T1: Coping strategies	Breast cancer, healthcare, costs, regional, ethnic differences	55, 56
Niche themes	T1: Reasonable accommodations	Sick leave, assessment and planning	57, 58