Financial cost of lymphedema borne by women with breast cancer

Abstract

ObjectiveOur study examines the financial cost of lymphedema following a diagnosis of breast cancer and addresses a significant knowledge gap regarding the additional impact of lymphedema on breast cancer survivors.MethodsAn online national survey was conducted with 361 women who had either breast cancer without lymphedema (BC) (group 1, n = 209) or breast cancer with lymphedema (BC+LE) (group 2, n = 152). Participant recruitment was supported by the Breast Cancer Network Australia and the Australasian Lymphology Association.ResultsBoth breast cancer and lymphedema result in significant out‐of‐pocket financial costs borne by women. Of patients with BC+LE, 80% indicated that their breast cancer diagnosis had affected them financially compared with 67% in the BC group (P < .020). For patients with lymphedema, over half (56%) indicated that this specific additional diagnosis to their breast cancer affected them financially and that costs increased with lymphedema severity. The cost of compression garments formed a large proportion of these costs (40.1%). The average number of attendances to a therapist each year was 5.8 (range, 0‐45). Twenty‐five patients (16.4%) had an episode of cellulitis in the past year. The incidence of cellulitis was 7.7% in 91 patients with subclinical or mild lymphedema compared with 29.5% of 61 patients with more extensive lymphedema (P < .001). The average out‐of‐pocket financial cost of lymphedema care borne by women was A$977 per annum, ranging from A$207 for subclinical lymphedema to over A$1400 for moderate or severe lymphedema.ConclusionsThis study identifies an additional detrimental effect of lymphedema on women in terms of financial costs.

Diagnosis of Upper-Quadrant Lymphedema Secondary to Cancer: Clinical Practice Guideline From the Oncology Section of APTA

“…The presence of secondary upper-quadrant lymphedema (SUQL) can lead to significant morbidity, activity and participation restrictions, reduced quality of life, and economic hardship 2–6. In 2016 alone, it was estimated that 1.6 million people in the United States had a diagnosis of cancer,7 many involving the upper quadrant, and thus a large number of cancer survivors are at risk of developing SUQL.…”

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

“…Having quality insurance was associated with minimizing burdensome out‐of‐pocket costs, and those with the lowest economic burden believed it was because they had “good insurance.” Patients incur substantial out‐of‐pocket costs and may not know whether such costs could be covered by insurance . This was especially true among those with lymphedema; although the Patient Protection and Affordable Care Act was successful in expanding affordable insurance coverage for cancer‐related care, it did not address the adverse treatment effects of cancer.…”

“…Patients incur substantial outof-pocket costs and may not know whether such costs could be covered by insurance. 45 This was especially true among those with lymphedema; although the Patient Protection and Affordable Care Act was successful in expanding affordable insurance coverage for cancerrelated care, 46 it did not address the adverse treatment effects of cancer. Studies before the 2010 Affordable Care Act reported that financial burden created worry and anger when tools for lymphedema management were not covered by insurance.…”

Breast cancer screening: Impact on care pathways

“…Moreover, according to a US study conducted on the SEER‐Medicare database, mastectomy associated with reconstruction would appear to increase the risk of complications and the cost of treatment compared to breast‐conserving surgery followed by radiotherapy sessions . Further complications, such as the presence of lymphoedema, may have an additional cost …”

“…31 Further complications, such as the presence of lymphoedema, may have an additional cost. 32 Internal controls were performed to take into account coding errors in the SNDS, which was developed for economic and not epidemiological purposes. Some in situ cancers were classified as invasive cancer.…”