TY - JOUR
T1 - Drivers of cost differences between US breast cancer survivors with or without lymphedema
AU - Dean, Lorraine T.
AU - Ransome, Yusuf
AU - Frasso-Jaramillo, Livia
AU - Moss, Shadiya L.
AU - Zhang, Yuehan
AU - Ashing, Kimlin
AU - Denis, Gerald V.
AU - Frick, Kevin D.
AU - Visvanathan, Kala
AU - Schmitz, Kathryn H.
N1 - Funding Information:
This work was supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health through grant 1UL1TR001079 (statistical consultation); the National Cancer Institute grant K01CA184288 (Lorraine T. Dean); the National Institute of Mental Health grant R25MH083620 (Lorraine T. Dean, Yusuf Ransome); the Sidney Kimmel Cancer Center grant P30CA006973 (Lorraine T. Dean, Kala Visvanathan, Yuehan Zhang, Livia Frasso-Jaramillo); Johns Hopkins University Center for AIDS Research grant P30AI094189 (Lorraine T. Dean); the National Institute on Drug Abuse grant T32DA031099 (Shadiya L. Moss), National Institutes of Mental Health K01MH111374 (Yusuf Ransome); and the National Cancer Institute grants R01CA106851 and 1U54CA155850–01 (Kathryn H. Schmitz).
Publisher Copyright:
© 2019, The Author(s).
PY - 2019/10/1
Y1 - 2019/10/1
N2 - Purpose: 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. Methods: 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. Results: 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. Conclusions: 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. Implications for Cancer Survivors: 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.
AB - Purpose: 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. Methods: 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. Results: 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. Conclusions: 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. Implications for Cancer Survivors: 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.
KW - Breast cancer
KW - Economic burden
KW - Financial toxicity
KW - Lymphedema
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U2 - 10.1007/s11764-019-00799-1
DO - 10.1007/s11764-019-00799-1
M3 - Article
C2 - 31446591
AN - SCOPUS:85071416556
SN - 1932-2259
VL - 13
SP - 804
EP - 814
JO - Journal of Cancer Survivorship
JF - Journal of Cancer Survivorship
IS - 5
ER -