title: Acute skin toxicity-related, out-of-pocket expenses in patients with breast cancer treated with external beam radiotherapy: a descriptive, exploratory study.
abstract: OBJECTIVE
  Acute skin toxicity is one of the most common side effects of breast cancer radiotherapy. To date, no one has estimated the nonmedical out-of-pocket expenses associated with this side effect. The primary aim of the present descriptive, exploratory study was to assess the feasibility of a newly developed skin toxicity costs questionnaire. The secondary aims were to: (1) estimate nonmedical out-of-pocket costs, (2) examine the nature of the costs, (3) explore potential background predictors of costs, and (4) explore the relationship between patient-reported dermatologic quality of life and expenditures.
  
  
  METHODS
  A total of 50 patients (mean age = 54.88, Stage 0-III) undergoing external beam radiotherapy completed a demographics/medical history questionnaire as well as a seven-item Skin Toxicity Costs (STC) questionnaire and the Skindex-16 in week 5 of treatment.
  
  
  RESULTS
  Mean skin toxicity costs were $131.64 (standard error [SE] = $23.68). Most frequently incurred expenditures were new undergarments and products to manage toxicity. Education was a significant unique predictor of spending, with more educated women spending more money. Greater functioning impairment was associated with greater costs. The STC proved to be a practical, brief measure which successfully indicated specific areas of patient expenditures and need.
  
  
  CONCLUSIONS
  Results reveal the nonmedical, out-of-pocket costs associated with acute skin toxicity in the context of breast cancer radiotherapy. To our knowledge, this study is the first to quantify individual costs associated with this treatment side effect, as well as the first to present a scale specifically designed to assess such costs.
  
  
  CONCLUSIONS
  In future research, the STC could be used as an outcome variable in skin toxicity prevention and control research, as a behavioral indicator of symptom burden, or as part of a needs assessment.
authors.affiliation: Department of Oncological Sciences, Integrative Behavioral Medicine Program, Mount Sinai School of Medicine, 1425 Madison Avenue, Box 1130, New York, NY 10029, USA. julie.schnur@mssm.edu
authors.forename: Julie B
authors.initials: JB
authors.lastname: Schnur
authors.forename: Joshua
authors.initials: J
authors.lastname: Graff Zivin
authors.forename: David M K
authors.initials: DM
authors.lastname: Mattson
authors.forename: Sheryl
authors.initials: S
authors.lastname: Green
authors.forename: Lina H
authors.initials: LH
authors.lastname: Jandorf
authors.forename: A Gabriella
authors.initials: AG
authors.lastname: Wernicke
authors.forename: Guy H
authors.initials: GH
authors.lastname: Montgomery
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000191:economics / Q000532:radiotherapy*; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D011788:Quality of Life; D011832:Radiation Injuries / Q000191:economics* / Q000209:etiology; D011878:Radiotherapy / Q000009:adverse effects* / Q000191:economics; D012189:Retrospective Studies; D012867:Skin / Q000293:injuries*; D011795:Surveys and Questionnaires