INSURANCE coverage influences quality of life outcomes for women with early-stage estrogen receptor positive breast cancer. In a large Brazilian cohort of patients receiving adjuvant endocrine therapy, treatment within the public system was associated with consistently worse symptom and functioning scores than care delivered in private institutions.
Insurance Coverage And Quality Of Life
Researchers conducted a cross-sectional study among women with early-stage estrogen receptor positive invasive breast carcinoma who had completed locoregional treatment and were receiving adjuvant endocrine therapy for more than six months. Patients were approached in person during routine clinic visits across 14 institutions. Quality of life for breast cancer patients was assessed using the EORTC QLQ C30 and the breast specific QLQ BR23 questionnaires, both widely used tools for capturing patient reported outcomes in oncology.
Between June 2021 and March 2024, the team contacted 774 eligible women, with 347 treated in private institutions. The mean age was 56.5 years and the median duration of endocrine therapy use was 3.2 years. Multivariate regression analyses explored how type of insurance coverage and clinical or social characteristics related to quality-of-life domains.
Key Predictors Of Poor Quality Of Life
After adjustment for potential confounders, treatment in the public sector emerged as a significant predictor of worse symptom burden. Women treated in public institutions reported higher scores for nausea and vomiting, pain, arm symptoms and breast symptoms. They also reported greater financial difficulty, suggesting that public insurance coverage may be associated with both physical and economic toxicity in this setting.
The analysis also identified clinical and demographic factors that contributed to poorer quality of life. Younger age under 60 years, the presence of comorbidities and the use of ovarian suppression alongside endocrine therapy were all linked with lower quality of life scores. These findings underline that even within a population with hormone receptor positive early-stage breast cancer receiving standard adjuvant endocrine therapy, certain subgroups carry a disproportionate symptom and financial burden.
Clinical Implications For Breast Cancer Care
For clinicians, these data emphasize the importance of routinely assessing quality of life in breast cancer survivorship, particularly for patients treated in public systems and for younger women or those with comorbidities receiving ovarian suppression. Proactive symptom control, financial counselling and tailored supportive interventions may help mitigate the disparities seen between public and private care. The authors suggest that recognizing how insurance coverage intersects with clinical factors can inform future interventions aimed at improving patient reported outcomes for women with early breast cancer in Brazil.
Reference: Laperche-Santos D et al. Impact of public vs. private insurance coverage on quality of life of women with early-stage estrogen receptor-positive breast cancer. Breast Cancer Res Treat. 2025;215(1):26.
