Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany.
Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany.
J Cancer Surviv. 2023 Dec;17(6):1639-1659. doi: 10.1007/s11764-022-01293-x. Epub 2022 Dec 2.
This study aims to examine the magnitude of out of pocket (OOP) payments and income loss, as well as to identify socioeconomic and clinical factors among long-term breast cancer (BC) survivors in Germany.
We examine data from 2654 long-term BC survivors in Germany that participated in the "CAncEr Survivorship - A multi-Regional population-based study" (CAESAR) and who were at least 5 years post diagnosis. BC-related OOP payments and income loss both within the 12 months prior to the survey were analyzed. Two-part regression models were performed to identify socioeconomic and clinical factors.
OOP payments were incurred by 51.9% of survivors with a total mean spending of 566 euros. Income loss was present among 9.6% of survivors and averaged 5463 euros among those reporting such. Socioeconomic and clinical factors associated with higher OOP payments (p ≤ 0.05) included age at time of diagnosis (65-79 years), education (10-11 years), (early) retirement, stage of diagnosis (stage III), time from diagnosis (more than 10 years), comorbidities (at least 1), and the use of rehabilitation services. Regarding income loss, age at time of diagnosis (50-59 years), (early) retirement, stage of diagnosis (stage II), time from diagnosis (5-7 years), comorbidities (at least 1), and receiving chemotherapy treatment were associated with higher losses.
For some survivors in Germany, financial burden can be considerably high despite comprehensive healthcare and support from social security.
OOP payments related to domestic help and nursing staff as well as to outpatient care are most frequent.
本研究旨在考察德国长期乳腺癌（BC）幸存者的自付费用（OOP）支出和收入损失的程度，并确定其社会经济和临床因素。
我们分析了德国参加“癌症生存-多区域基于人群的研究”（CAESAR）且至少在诊断后 5 年的 2654 名长期 BC 幸存者的数据。分析了调查前 12 个月内与 BC 相关的 OOP 支出和收入损失。采用两部分回归模型来确定社会经济和临床因素。
51.9%的幸存者发生了 OOP 支出，总平均支出为 566 欧元。9.6%的幸存者存在收入损失，报告收入损失的幸存者平均损失为 5463 欧元。与 OOP 支出较高相关的社会经济和临床因素（p≤0.05）包括诊断时的年龄（65-79 岁）、教育程度（10-11 年）、（提前）退休、诊断分期（III 期）、诊断后时间（超过 10 年）、合并症（至少 1 种）和康复服务的使用。关于收入损失，诊断时的年龄（50-59 岁）、（提前）退休、诊断分期（II 期）、诊断后时间（5-7 年）、合并症（至少 1 种）和接受化疗治疗与较高的损失相关。
尽管有全面的医疗保健和社会保障，一些德国幸存者的经济负担可能仍然相当沉重。
与家庭帮助和护理人员以及门诊护理相关的 OOP 支出最为频繁。
