“It still affects our economic situation”: long-term economic burden of breast cancer and lymphedema

Dean, Lorraine T.; Moss, Shadiya L.; Ransome, Yusuf; Frasso-Jaramillo, Livia; Zhang, Yuehan; Visvanathan, Kala; Nicholas, Lauren Hersch; Schmitz, Kathryn H.

doi:10.1007/s00520-018-4418-4

Cited by 90 publications

(110 citation statements)

References 46 publications

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“…We can confirm that income loss is a major cause of high short‐term or long‐term financial decline, as found in other studies (Arozullah et al, ; Bradley et al, ; Dean et al, ; Lauzier et al, ; Pearce et al, ). However, high medical costs, especially non‐refundable costs, can increase the financial impact of a cancer diagnosis.…”

Section: Discussionsupporting

confidence: 90%

‘It was a big monetary cut’—A qualitative study on financial toxicity analysing patients’ experiences with cancer costs in Germany

Lueckmann

Schumann

Hoffmann

et al. 2020

Health Soc Care Community

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Receiving information about expected costs promptly after a cancer diagnosis through psycho‐oncology care or social counselling is crucial for patients to be prepared for the financial impact. Nevertheless, less is known about financial impacts for cancer patients in countries with statutory health insurance. This study aims to explore the full scope of costs that constitute the financial impact of a cancer diagnosis in Germany and to identify the reasons for high financial decline. Semistructured interviews with 39 cancer patients were conducted between May 2017 and April 2018. Narratives were analysed via qualitative content analysis. Several factors influenced cancer patients’ indirect costs and direct medical and non‐medical costs. For many patients, these changes resulted in higher indirect costs caused by income losses, especially when surcharges for shift work, travel expenses or company benefits ceased and were not reimbursed. Higher direct medical costs were caused by co‐payments and additional non‐refundable costs. Non‐medical costs were reported to increase for some patients and to decrease for others, as for example, leisure activity costs either increasing because of pampering oneself to cope with the diagnosis and undergoing therapy or decreasing because of not being able to participate in leisure activities during therapy. When analysing the financial impacts of individuals' total costs, we found that some patients experienced no financial decline or an overall financial increase. Most patients experienced overall higher costs, and income loss was the main driver of a high financial decline. Nevertheless, decreased non‐medical costs due to lower work‐related and leisure activity costs could compensate for these higher costs. Cancer patients are confronted with a variety of changes in their financial situations, even in countries with statutory health insurance. Screening for cancer patients with a high risk of financial decline should consider any effects on indirect costs and direct medical and nonmedical costs.

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Section: Discussionsupporting

confidence: 90%

‘It was a big monetary cut’—A qualitative study on financial toxicity analysing patients’ experiences with cancer costs in Germany

Lueckmann

Schumann

Hoffmann

et al. 2020

Health Soc Care Community

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“…Breast cancer related lymphedema (BCRL) is a chronic lifelong condition that affects approximately one‐third of women who receive breast cancer treatment 1 . Traditional conservative management of BCRL often fails to alleviate morbidity resulting in worse quality of life among lymphedema patients and substantial direct and indirect costs to patients, payers, and employers 2,3 . In 1998, the Women's Health and Cancer Rights Act required payers to provide coverage for breast reconstruction and treatment of physical complications after mastectomy, including lymphedema 4 .…”

Section: Introductionmentioning

confidence: 99%

An economic analysis of prophylactic lymphovenous anastomosis among breast cancer patients receiving mastectomy with axillary lymph node dissection

Squitieri

Rasmussen

Patel

2020

Journal of Surgical Oncology

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Background and Objectives: Prophylactic lymphovenous anastomosis (LVA) has been shown to decrease the incidence of postoperative lymphedema among patients receiving mastectomy with axillary lymph node dissection (ALND). However, the economic impact of this intervention on overall healthcare costs has not been adequately studied and insurance reimbursement for lymphedema treatment is limited resulting in substantial out-of-pocket patient expenses. Methods:We performed a cost-minimization decision analysis from the societal perspective to assess two different patient scenarios: (a) mastectomy with ALND alone, (b) mastectomy with ALND and prophylactic LVA. Results: The annual cost of lymphedema-related care is estimated to be $5,691.88 ($3,160.52 direct, $2,531.36 indirect). If all patients undergoing mastectomy with ALND undergo prophylactic LVA, the average expected lifetime cost per patient in the entire population (whether or not they develop lymphedema) is approximately $6,295.61, compared to $13,942.26 if no patients in the same population receive prophylactic LVA. Conclusions: Prophylactic LVA is economically preferred over mastectomy and ALND alone from a cost minimization perspective, and results in an average of $7,646.65 (45.2%) cost saving per patient over the course of their lifetime. K E Y W O R D S breast cancer, cost minimization, economic analysis, lymphedema, lymphovenous bypass

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“…The economic burden after cancer may be further exacerbated for patients who are managing adverse treatment effects, such as breast cancer‐related lymphedema, which is one of the most common and costly breast cancer‐related adverse treatment effects, affecting nearly 35% of breast cancer survivors in the United States and resulting in an estimated $14,877 in out‐of‐pocket costs in the first 2 years of a diagnosis . Even up to 10 years after diagnosis, out‐of‐pocket health costs for women who have breast cancer‐related lymphedema are more than double the costs for those without breast cancer‐related lymphedema . The associated economic burden is so significant that it even affects the insured .…”

Section: Introductionmentioning

confidence: 99%

“…15 Even up to 10 years after diagnosis, outof-pocket health costs for women who have breast cancer-related lymphedema are more than double the costs for those without breast cancer-related lymphedema. 19 The associated economic burden is so significant that it even affects the insured. 5,[20][21][22][23][24] Cancer survivors with public insurance experience even greater economic burden than those with private insurance, 24,25 which is exacerbated for those who have lymphedema, because many public insurance plans do not cover compression bandages or garments for self-management of lymphedema.…”

Section: Introductionmentioning

confidence: 99%

Patient recommendations for reducing long‐lasting economic burden after breast cancer

Dean

Moss

Rollinson

et al. 2019

Cancer

Self Cite

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Background In the United States, patients who have breast cancer experience significant economic burden compared with those who have other types of cancers. Cancer‐related economic burden is exacerbated by adverse treatment effects. Strategies to resolve the economic burden caused by breast cancer and its adverse treatment effects have stemmed from the perspectives of health care providers, oncology navigators, and other subject‐matter experts. For the current study, patient‐driven recommendations were elicited to reduce economic burden after 1) breast cancer and 2) breast cancer‐related lymphedema, which is a common, persistent adverse effect of breast cancer. Methods Qualitative interviews were conducted with 40 long‐term breast cancer survivors who were residents of Pennsylvania or New Jersey in 2015 and were enrolled in a 6‐month observational study. Purposive sampling ensured equal representation by age, socioeconomic position, and lymphedema diagnosis. Semistructured interviews addressed economic challenges, supports used, and patient recommendations for reducing financial challenges. Interviews were coded, and representative quotes from the patient recommendations were analyzed and reported to illustrate key findings. Results Of 40 interviewees (mean age, 64 years; mean time since diagnosis, 12 years), 27 offered recommendations to reduce the economic burden caused by cancer and its adverse treatment effects. Nine recommendations emerged across 4 major themes: expanding affordable insurance and insurance‐covered items, especially for lymphedema treatment (among the 60% who reported lymphedema); supportive domestic help; financial assistance from diagnosis through treatment; and employment‐preserving policies. Conclusions The current study yielded 9 actionable, patient‐driven recommendations—changes to insurance, supportive services, financial assistance, and protective policies—to reduce breast cancer‐related economic burden. These recommendations should be tested through policy and programmatic interventions.

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“It still affects our economic situation”: long-term economic burden of breast cancer and lymphedema

Cited by 90 publications

References 46 publications

‘It was a big monetary cut’—A qualitative study on financial toxicity analysing patients’ experiences with cancer costs in Germany

‘It was a big monetary cut’—A qualitative study on financial toxicity analysing patients’ experiences with cancer costs in Germany

An economic analysis of prophylactic lymphovenous anastomosis among breast cancer patients receiving mastectomy with axillary lymph node dissection

Patient recommendations for reducing long‐lasting economic burden after breast cancer

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