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.
J Cancer Surviv. 2019 Oct;13(5):804-814. doi: 10.1007/s11764-019-00799-1. Epub 2019 Aug 24.
Breast cancer-related lymphedema is an adverse effect of breast cancer surgery affecting nearly 30% of US breast cancer survivors (BCS). Our previous analysis showed that, even 12 years after cancer treatment, out-of-pocket healthcare costs for BCS with lymphedema remained higher than for BCS without lymphedema; however, only half of the cost difference was lymphedema-related. This follow-up analysis examines what, above and beyond lymphedema, contributes to cost differences.
This mixed methods study included 129 BCS who completed 12 monthly cost diaries in 2015. Using Cohen's d and multivariable analysis, we compared self-reported costs across 13 cost categories by lymphedema status. We elicited quotes about specific cost categories from in-person interviews with 40 survey participants.
Compared with BCS without lymphedema, BCS with lymphedema faced 122% higher mean overall monthly direct costs ($355 vs $160); had significantly higher co-pay, medication, and other out-of-pocket costs, lower lotion costs; and reported inadequate insurance coverage and higher costs that persisted over time. Lotion and medication expenditure differences were driven by BCS' socioeconomic differences in ability to pay.
Elevated patient costs for BCS with lymphedema are for more than lymphedema itself, suggesting that financial coverage for lymphedema treatment alone may not eliminate cost disparities.
The economic challenges examined in this paper have long been a concern of BCS and advocates, with only recent attention by policy makers, researchers, and providers. BCS identified potential policy and programmatic solutions, including expanding insurance coverage and financial assistance for BCS across socioeconomic levels.
乳腺癌相关淋巴水肿是乳腺癌手术的一种不良反应，影响了近 30%的美国乳腺癌幸存者（BCS）。我们之前的分析表明，即使在癌症治疗 12 年后，患有淋巴水肿的 BCS 的自付医疗保健费用仍然高于没有淋巴水肿的 BCS；然而，成本差异只有一半与淋巴水肿有关。这项后续分析探讨了除了淋巴水肿之外，还有什么因素导致了成本差异。
这项混合方法研究包括 129 名 BCS，他们在 2015 年完成了 12 个月的成本日记。使用 Cohen's d 和多变量分析，我们比较了淋巴水肿状况下 13 个成本类别中的自我报告成本。我们从 40 名调查参与者的面对面访谈中引出了关于特定成本类别的报价。
与没有淋巴水肿的 BCS 相比，患有淋巴水肿的 BCS 的总月直接成本高 122%（355 美元对 160 美元）；自付额、药物和其他自付费用显著较高，乳液费用较低；并报告保险覆盖不足和随着时间的推移成本持续增加。乳液和药物支出差异是由 BCS 支付能力的社会经济差异驱动的。
患有淋巴水肿的 BCS 患者的成本升高不仅仅是因为淋巴水肿本身，这表明仅为淋巴水肿治疗提供财务覆盖可能无法消除成本差距。
本文研究的经济挑战长期以来一直是 BCS 和倡导者关注的问题，最近才引起政策制定者、研究人员和提供者的关注。BCS 确定了潜在的政策和计划解决方案，包括扩大保险覆盖范围和为各社会经济水平的 BCS 提供财务援助。
