Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2026 Feb;20(1):20-27.
doi: 10.1007/s11764-024-01628-w. Epub 2024 Jun 19.

Arm morbidity and financial difficulty in breast cancer survivors

Sara P Myers  1   2   3 , Alison Laws  4   5   6   7 , Laura S Dominici  4   5   6 , Mirelle Lagendijk  8 , Samantha Grossmith  4 , Elizabeth A Mittendorf  4   5   6 , Tari A King  4   5   6
Affiliations

Arm morbidity and financial difficulty in breast cancer survivors

Sara P Myers et al. J Cancer Surviv. 2026 Feb.

Abstract

Purpose: Long-term upper extremity symptoms after breast cancer treatment may impact patient-reported financial difficulty. In this cross-sectional investigation, we hypothesized that severity of arm symptoms would be associated with greater financial difficulty.

Methods: Stage 0-III breast cancer patients treated at our institution from 2002 to 2012 were recruited for a 2018 survey study appraising disease-specific patient-centered outcomes using EORTC-QLQ-BR23 and EORTC-QLQ-C30 questionnaires. The association between Arm Symptom (AS) score and Financial Impact (FI) score was assessed, adjusting for clinically relevant variables.

Results: Of 1126 interested participants, 882 (78%) responded to surveys. Three hundred fourteen (36%) with incomplete responses were excluded. Median time from surgery was 9 years; 181 (32%) and 117 (21%) had mastectomy with or without reconstruction, 126 (22%) received postmastectomy radiation (PMRT), and 221 (39%) underwent axillary lymph node dissection. 76 (13%) reported some degree of financial difficulty; 10 (2%) the highest degree of difficulty. Of 217 (38%) patients experiencing arm symptoms, 60 (28%) had severe symptoms. Seven (70%) of those with highest degree of financial difficulty had severe arm symptoms. Younger age at surgery (p = .029), mastectomy with reconstruction (p = 0.003), Hispanic ethnicity (p < 0.001), PMRT (p = 0.027), recurrence (p < 0.001), and higher AS score (p < 0.001) were associated with greater financial difficulty. On multivariable analysis, AS score, younger age, Hispanic ethnicity, and recurrence remained associated with financial difficulty.

Conclusion: In this study, younger age, Hispanic ethnicity, and arm morbidity were associated with increased risk for financial difficulty. Clarifying how treatment-related adverse events such as arm morbidity increase financial hardship may guide interventions to mitigate this burden.

Keywords: Arm; Breast cancer; Financial difficulty; Lymphedema; Morbidity.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval/consent to participate: This study was performed in line with the principles of the Declaration of Helsinki. Approval for this study was given by the Dana-Farber Cancer Institute research ethics review board (Study 18–214). Participants were all English-speaking adult patients with stage 0-III breast cancer treated between 2002–2012 who participated in the institutional cancer registry and consented in writing to further contact for research purposes. Competing interests: EAM reports compensated service on scientific advisory boards for AstraZeneca, BioNTech, Merck, and Moderna; uncompensated service on steering committees for Bristol Myers Squibb and Roche/Genentech; speakers honoraria and travel support from Merck Sharp & Dohme; and institutional research support from Roche/Genentech (via SU2C grant) and Gilead. EAM also reports research funding from Susan Komen for the Cure for which she serves as a Scientific Advisor, and uncompensated participation as a member of the American Society of Clinical Oncology Board of Directors. TAK reports compensated service on advisory board and speakers honoraria from Exact Sciences, and compensated service as faculty for PrecisCa cancer information service. All other authors declare no competing interests.

References

    1. Financial burden of cancer care. Cancer Trends Progress Report. Updated August 2023. National Cancer Institute, NIH, DHHS, Bethesda, MD, July 2021. Accessed March 25, 2024. https://progressreport.cancer.gov/after/economic_burden .
    1. American Cancer Society. Out-of-pocket spending limits are crucial for cancer patients & survivors. January 4, 2022. Available at: https://www.fightcancer.org/policy-resources/out-pocket-spending-limits-... . Accessed March 25, 2024.
    1. Smith GL, Banegas MP, Acquati C, Chang S, Chino F, Conti RM, et al. Navigating financial toxicity in patients with cancer: a multidisciplinary management approach. CA Cancer J Clin. 2022;72(5):437–53. https://doi.org/10.3322/caac.21730 . - DOI - PubMed
    1. Giaquinto AN, Sung H, Miller KD, Kramer JL, Newman LA, Minihan A, et al. Breast cancer statistics, 2022. CA Cancer J Clin. 2022;72(6):524–41. https://doi.org/10.3322/caac.21754 . - DOI - PubMed
    1. Howlader N, Noone AM, Krapcho M, Miller D, Brest A, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975–2017, National Cancer Institute. Bethesda, MD. https://seer.cancer.gov/csr/1975_2017/ , based on November 2019 SEER data submission, posted to the SEER web site, April 2020. Accessed March 25, 2024.

LinkOut - more resources