Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, E6650, Baltimore, MD, 21205, USA.
Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Support Care Cancer. 2019 May;27(5):1697-1708. doi: 10.1007/s00520-018-4418-4. Epub 2018 Aug 18.
Financial toxicity after breast cancer may be exacerbated by adverse treatment effects, like breast cancer-related lymphedema. As the first study of long-term out-of-pocket costs for breast cancer survivors in the USA with lymphedema, this mixed methods study compares out-of-pocket costs for breast cancer survivors with and without lymphedema.
In 2015, 129 breast cancer survivors from Pennsylvania and New Jersey completed surveys on demographics, economically burdensome events since cancer diagnosis, cancer treatment factors, insurance, and comorbidities; and prospective monthly out-of-pocket cost diaries over 12 months. Forty participants completed in-person semi-structured interviews. GLM regression predicted annual dollar amount estimates.
46.5% of participants had lymphedema. Mean age was 63 years (SD = 8). Average time since cancer diagnosis was 12 years (SD = 5). Over 98% had insurance. Annual adjusted health-related out-of-pocket costs excluding productivity losses totaled $2306 compared to $1090 (p = 0.006) for those without lymphedema, or including productivity losses, $3325 compared to $2792 (p = 0.55). Interviews suggested that the cascading nature of economic burden on long-term savings and work opportunities, and insufficiency of insurance to cover lymphedema-related needs drove cost differences. Higher costs delayed retirement, reduced employment, and increased inability to access lymphedema care.
Long-term cancer survivors with lymphedema may face up to 112% higher out-of-pocket costs than those without lymphedema, which influences lymphedema management, and has lasting impact on savings and productivity. Findings reinforce the need for actions at policy, provider, and individual patient levels, to reduce lymphedema costs. Future work should explore patient-driven recommendations to reduce economic burden after cancer.
乳腺癌的治疗副作用，如乳腺癌相关淋巴水肿，可能会加重财务毒性。作为美国首例患有淋巴水肿的乳腺癌幸存者长期自付费用的研究，本混合方法研究比较了患有和不患有淋巴水肿的乳腺癌幸存者的自付费用。
2015 年，宾夕法尼亚州和新泽西州的 129 名乳腺癌幸存者完成了关于人口统计学、癌症诊断后经济负担事件、癌症治疗因素、保险和合并症的调查；并在 12 个月内进行了前瞻性每月自付费用日记。40 名参与者完成了面对面的半结构式访谈。GLM 回归预测了年度金额估计。
46.5%的参与者患有淋巴水肿。平均年龄为 63 岁（标准差=8）。平均癌症诊断后时间为 12 年（标准差=5）。超过 98%的人有保险。不包括生产力损失的年度调整后健康相关自付费用总额为 2306 美元，而没有淋巴水肿的自付费用为 1090 美元（p=0.006），包括生产力损失的自付费用为 3325 美元，而没有淋巴水肿的自付费用为 2792 美元（p=0.55）。访谈表明，经济负担对长期储蓄和工作机会的级联性质，以及保险不足以覆盖淋巴水肿相关需求，导致了成本差异。更高的成本延迟了退休，减少了就业，并增加了无法获得淋巴水肿治疗的可能性。
患有淋巴水肿的长期癌症幸存者的自付费用可能比没有淋巴水肿的患者高出 112%，这影响了淋巴水肿的管理，并对储蓄和生产力产生持久影响。研究结果强化了在政策、医疗服务提供者和患者个体层面采取行动的必要性，以降低淋巴水肿的成本。未来的研究应探讨减少癌症后经济负担的患者驱动建议。
