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The Role of Cryoablation in Breast Cancer Beyond the Oncologic Control: COST and Breast-Q Patient-Reported Outcomes

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Cryoablation has been established as a minimally invasive alternative to resection of early-stage breast cancer; however, there are no data on the cost and impact on patients’ financial, psychosocial, sexual, physical, and cosmetic outcomes utilizing this approach. This study compares cost-effectiveness and patient-reported quality-of-life factors in cryoablation versus resection.

Methods

Women with early-stage, low-risk infiltrating ductal carcinomas ≤ 1.5 cm underwent cryoablation or resection. Adjuvant therapy was provided according to tumor board recommendations. Direct and indirect costs were tracked for both groups. Financial toxicity and well-being outcome were measured by administering the Comprehensive Score of Financial Toxicity (COST) and BREAST-Q surveys, respectively, at 6-month follow-up.

Results

Of the 34 eligible patients, 14 (41.1%) consented for cryoablation and 20 (58.8%) underwent resection. The median (centile) (range) follow-up was 35.0 (21.3) (15-50) months for cryoablation vs. 25 (20.8) (17-50) months for resection [p = 0.6479]. Mean (standard deviation) cost of care for cryoablation versus resection was $2221.70 (615.70) versus $16,896.50 (1332.40) [p < 0.0001], and median financial well-being scores for the cryoablation versus resection groups were 38.0 (34.5, 40.0) versus 10 (5.3, 14.0) [p < 0.0001]. Poor financial well-being was directly correlated with the cost of care [p < 0.0001]. Median psychosocial well-being scores were similar across both groups, however the cryoablation group had higher scores for physical [100 (100, 100) vs. 89 (79, 100); p = 0.0141], sexual [100 (91, 100) vs. 91 (87.5, 91); p = 0.0079], and cosmetic [100 (100, 100) vs. 88 (88, 100); p = 0.0171] outcomes.

Conclusion

Cryoablation offers a cost-effective and quality-of-life advantage compared with resection for early-stage, low-risk breast cancer.

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References

  1. National Comprehensive Cancer Network. Breast cancer (version 2.2022). 2022. https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed 22 Mar 2022.

  2. Curigliano G, et al. De-escalating and escalating treatments for early-stage breast cancer: the St. Gallen International Expert Consensus Conference on the Primary Therapy of Early Breast Cancer 2017. Ann Oncol. 2017;28(8):1700–12.

    Article  CAS  Google Scholar 

  3. Roubidoux MA, et al. Small (< 2.0-cm) breast cancers: mammographic and US findings at US-guided cryoablation—initial experience. Radiology. 2004;233(3):857–67.

    Article  Google Scholar 

  4. Habrawi Z, et al. Cryoablation: a promising non-operative therapy for low-risk breast cancer. Am J Surg. 2021;221(1):127–33.

    Article  Google Scholar 

  5. Fine RE, et al. Cryoablation without excision for low-risk early-stage breast cancer: 3-year interim analysis of ipsilateral breast tumor recurrence in the ICE3 trial. Ann Surg Oncol. 2021;28(10):5525–34.

    Article  Google Scholar 

  6. Soni A. Trends in the five most costly conditions among the U.S. Civilian institutionalized population, 2002 and 2012. In: Statistical Brief (Medical Expenditure Panel Survey (US)). Statistical Brief #470. Rockville: Agency for Healthcare Research and Quality (US); 2021.

  7. Guy GP Jr, et al. Economic burden of cancer survivorship among adults in the United States. J Clin Oncol. 2013;31(30):3749–57.

    Article  Google Scholar 

  8. PDQ® Adult Treatment Editorial Board. PDQ financial toxicity and cancer treatment. Bethesda: National Cancer Institute. Updated 03/04/2022. https://www.cancer.gov/about-cancer/managing-care/track-care-costs/financial-toxicity-hp-pdq. Accessed 30 Mar 2022.

  9. de Souza JA, Wong YN. Financial distress in cancer patients. J Med Person. 2013;11(2):73–7.

    Article  Google Scholar 

  10. Zafar SY. Financial toxicity of cancer care: it’s time to intervene. J Natl Cancer Inst. 2016;108(5):djv370.

    Article  Google Scholar 

  11. Tucker-Seeley RD, Yabroff KR. Minimizing the “financial toxicity” associated with cancer care: advancing the research agenda. J Natl Cancer Inst. 2016;108(5):djv410.

    Article  Google Scholar 

  12. Zafar SY, et al. Population-based assessment of cancer survivors’ financial burden and quality of life: a prospective cohort study. J Oncol Pract. 2015;11(2):145–50.

    Article  Google Scholar 

  13. Lathan CS, et al. Association of financial strain with symptom burden and quality of life for patients with lung or colorectal cancer. J Clin Oncol. 2016;34(15):1732–40.

    Article  CAS  Google Scholar 

  14. Neugut AI, et al. Association between prescription co-payment amount and compliance with adjuvant hormonal therapy in women with early-stage breast cancer. J Clin Oncol. 2011;29(18):2534–42.

    Article  Google Scholar 

  15. Ramsey SD, et al. Financial insolvency as a risk factor for early mortality among patients with cancer. J Clin Oncol. 2016;34(9):980–6.

    Article  CAS  Google Scholar 

  16. Chang A, Abbott DE. Cost-effectiveness analysis in cancer care. Cancer Treat Res. 2016;168:377–91.

    Article  Google Scholar 

  17. Mock V. Body image in women treated for breast cancer. Nurs Res. 1993;42:153–7.

    Article  CAS  Google Scholar 

  18. Simmons RM, et al. A phase II trial exploring the success of cryoablation therapy in the treatment of invasive breast carcinoma: results from ACOSOG (Alliance) Z1072. Ann Surg Oncol. 2016;23(8):2438–45.

    Article  Google Scholar 

  19. de Souza JA, et al. The development of a financial toxicity patient-reported outcome in cancer: the COST measure. Cancer. 2014;120(20):3245–53.

    Article  Google Scholar 

  20. Pusic AL, et al. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg. 2009;124(2):345–53.

    Article  CAS  Google Scholar 

  21. Hollander M, Wolfe DA. Nonparametric statistical methods. 2nd edn. New York: Wiley; 1999.

    Google Scholar 

  22. Weisberg S. Applied linear regression. New York: Wiley; 1980.

    Google Scholar 

  23. Belsley DA, Kuh E, Welsch RE. Regression diagnostics: identifying influential data and sources of collinearity. New York: Wiley; 1980.

    Book  Google Scholar 

  24. Kaiser WA, Pfleiderer SO, Baltzer PA. MRI-guided interventions of the breast. J Magn Reson Imaging. 2008;27(2):347–55.

    Article  Google Scholar 

  25. Littrup PJ, et al. CT-guided percutaneous cryotherapy of renal masses. J Vasc Interv Radiol. 2007;18(3):383–92.

    Article  Google Scholar 

  26. Permpongkosol S, et al. Thermal maps around two adjacent cryoprobes creating overlapping ablations in porcine liver, lung, and kidney. J Vasc Interv Radiol. 2007;18(2):283–7.

    Article  Google Scholar 

  27. Vitez TS. Principles of cost analysis. J Clin Anesth. 1994;6(5):357–63.

    Article  CAS  Google Scholar 

  28. Yabroff KR, et al. Burden of illness in cancer survivors: findings from a population-based national sample. J Natl Cancer Inst. 2004;96(17):1322–30.

    Article  Google Scholar 

  29. Gordon LG, et al. A systematic review of financial toxicity among cancer survivors: we can’t pay the co-pay. Patient. 2017;10(3):295–309.

    Article  Google Scholar 

  30. Gilligan AM, et al. Death or debt? National estimates of financial toxicity in persons with newly-diagnosed cancer. Am J Med. 2018;131(10):1187-1199.e5.

    Article  Google Scholar 

  31. Boing L, et al. Factors associated with depression symptoms in women after breast cancer. Rev Saude Publica. 2019;53:30.

    Article  Google Scholar 

  32. Spiegel D, et al. Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet. 1989;2(8668):888–91.

    Article  CAS  Google Scholar 

  33. Giese-Davis J, et al. Decrease in depression symptoms is associated with longer survival in patients with metastatic breast cancer: a secondary analysis. J Clin Oncol. 2011;29(4):413–20.

    Article  Google Scholar 

  34. Safi S, Thiessen T, Schmailzl KJ. Acceptance and resistance of new digital technologies in medicine: qualitative study. JMIR Res Protoc. 2018;7(12):e11072.

    Article  Google Scholar 

  35. Mytton OT, et al. Introducing new technology safely. Qual Saf Health Care. 2010;19(Suppl 2):i9-14.

    Article  Google Scholar 

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Acknowledgment

The authors would like to thank the women who participated in this study and the dedicated nurses and clinical staff who provided medical care to the patients and collected the data. The authors also thank the CH Foundation and ASCO Equipment Endowment for Excellence in Women’s Health for their support.

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Authors and Affiliations

  1. Department of Surgery, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA

    Sonia Y. Khan BS, Annie Snitman MD, Zaina Habrawi MD, Michael W. Melkus PhD & Rakhshanda Layeequr Rahman MD

  2. Breast Center of Excellence, Texas Tech University Health Sciences Center, Lubbock, TX, USA

    Sonia Y. Khan BS, Zaina Habrawi MD, Michael W. Melkus PhD & Rakhshanda Layeequr Rahman MD

  3. Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA

    Sybil Crawford PhD

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  1. Sonia Y. Khan BS
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Correspondence to Rakhshanda Layeequr Rahman MD.

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Disclosure

Sonia Y. Khan, Annie Snitman, Zaina Habrawi, Sybil Crawford, Michael W. Melkus, and Rakhshanda Layeequr Rahman have no conflicts of interest to declare.

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Khan, S.Y., Snitman, A., Habrawi, Z. et al. The Role of Cryoablation in Breast Cancer Beyond the Oncologic Control: COST and Breast-Q Patient-Reported Outcomes. Ann Surg Oncol 30, 1029–1037 (2023). https://doi.org/10.1245/s10434-022-12570-5

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