Disparities in supportive care access and financial burden associated with chemotherapy-induced alopecia in women with breast cancer.

Abstract

e13748 Background: Chemotherapy-induced alopecia (CIA) remains one of the most visible and psychologically distressing toxicities of breast cancer therapy. Despite its high prevalence and impact on treatment experience, CIA management is inconsistently integrated into oncology supportive care pathways, and access to mitigation strategies may vary across demographic and treatment-related factors. Methods: A cross-sectional survey was administered between July and October 2025 to women with breast cancer who received chemotherapy or endocrine therapy at two academic centers in the United States. Data collected included demographic characteristics, chemotherapy regimen, hair loss severity and management strategies, out-of-pocket costs, treatment avoidance, and perceived healthcare support. Outcomes were analyzed by Fitzpatrick skin phototype, chemotherapy regimen, hair texture, and household income. Results: Among 63 respondents (mean age 57.1 years), 43% received-taxane based chemotherapy. Nearly all participants reported chemotherapy-associated hair loss; however, only 11.1% had dermatologic involvement in management. Patients with Fitzpatrick skin types IV-VI were significantly more likely to delay or forgo CIA treatment due to cost compared with those with types I-III (68.4% vs. 34.2%; RR = 2.00; p = 0.023). Patients receiving taxane-based chemotherapy reported greater financial burden related to CIA management compared with non-taxane regimens (64.0% vs 45.5%; RR = 1.41) and were less likely to feel adequately supported by the healthcare team (7.4% vs 27.8%; p = 0.055). Cost-related treatment avoidance was highest among middle-income patients ($25,000-$74,999; 56.0%) compared with both lower- and higher-income groups, consistent with a supportive-care coverage gap. Hair texture was not significantly associated with treatment-seeking behavior or access. Conclusions: CIA represents a clinically meaningful toxicity with disproportionate financial and supportive-care burden among patients receiving taxane-based therapy and those with darker skin phototypes. These findings suggest that disparities in CIA management are driven by structural gaps in oncology supportive care. Improved integration of alopecia prevention counseling, referral pathways, and equitable access strategies is warranted within comprehensive breast cancer care.