Financial Toxicity of Lower Extremity Amputation: Providing Supportive Services as Part of a Multidisciplinary Care Model.

In the United States, roughly 150,000 people undergo lower extremity (LE) amputation each year, contributing billions to health care costs.1 Thus, it is crucial to consider the hidden financial consequences, or financial toxicity (FT), of LE amputation. The term FT can be applied to chronic conditions with high health care utilization, such as LE amputation, and is defined as the economic burden a patient encounters because of an illness, which can lead to negative health outcomes owing to treatment nonadherence or other psychosocial repercussions of financial stress.2 Factors contributing to FT are identifiable, such as demographic characteristics, insurance, socioeconomic status, type of disease, and cost of treatment.2 Studies have shown that FT causes a variety of material, psychosocial, and physical consequences, which include employment disruption, debt, depression, and worsened physical health.2 Specific to LE amputees, hidden direct and indirect out-of-pocket costs include prostheses, physical therapy, home and car modifications, and caregiver support, on top of the significant psychological impact of losing a limb. The sum of these factors can lead to increasing financial hardships and poor health outcomes, such as deconditioning, risk of higher-level amputation, disease morbidity, and death. Despite these negative outcomes, many providers do not screen for FT or have services available to prevent or mitigate the economic burden of treatment.3 However, screening for the aforementioned risk factors allows providers to assess the level of FT among patients and identify those at risk. Screening has previously been done by psychosocial distress screening and/or surveys of patient-reported predictive factors.4 Previous studies in patients with cancer found that these surveys are sensitive and capture most of the financial hardship patients may encounter; however, additional studies are warranted to elucidate survey accuracy across different populations, such as people undergoing amputation.4 We can also increase awareness of FT through improving cost transparency by incorporating cost-effectiveness data for treatment modalities into patient counseling discussions. Ganesh Kumar et al.5 examined FT in 922 patients with postmastectomy breast reconstruction and found that patients who experienced FT were less satisfied with the amount of information they received preoperatively. This study highlights the importance of patient education and counseling on what to expect postoperatively, including cost and out-of-pocket expenses. Successful care of patients who undergo LE amputation is interdisciplinary in nature. Streamlining care reduces the number of patient visits and may eliminate redundancies in clinical care, which has proven to be cost-effective for patients.4 Patient navigators or social workers may be included in the interdisciplinary care team and can provide resources to assist patients financially, alleviating FT at various levels of care.4 However, larger efforts to mitigate FT must focus on legislative policies to support patients and health care networks and address disparities in care.3 The FT of LE amputation has many negative physical and mental consequences that directly affect patient care and outcomes. As a result, it is critical for reconstructive surgeons to consider the direct and indirect financial costs of amputation, incorporate these considerations into patient communication, and focus efforts on preventing and mitigating financial burden. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.