Out-of-Pocket Costs From Breast Cancer Treatment Have Long-Lasting Impact

The cumulative economic toll that breast cancer treatment has on survivors and their families carries long-term financial implications, according to a recent study in the Journal of Supportive Care and Cancer.

In particular, patients who experience lymphedema, a common adverse event associated with breast cancer treatment, were estimated to have out-of-pocket costs approximately 112% higher than those without lymphedema. The average annual out-of-pocket costs for patients with lymphedema were found to be $2306 compared with $1090 for those without the condition.

When the researchers factored in productivity, patients with lymphedema were found to have annual out-of-pocket costs of $3325 compared with $2792 for those without lymphedema.

"That extra $2000 or so may not break the bank in 1 year," study leader Lorraine T. Dean, ScD, assistant professor in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health, said in a press release. "But it can take away discretionary spending or whittle away retirement savings. If it's a recurring burden each year, how can you ever rebuild? That extra $2000 in spending can cripple people over the long term."

The current study provides additional evidence that shows the significant economic burden caused by cancer treatment, according to the authors. Existing research into the financial challenges caused by breast cancer primarily focused on short-term costs using insurance claims, which the authors of the current study said falls short of capturing the actual health care spending by patients with the disease.

The economic burden of cancer therapy can affect mental health and increase the risk for negative health outcomes, including mortality rates, the study noted. The researchers used a variety of methods to evaluate total cancer-related costs in 129 breast cancer survivors who had an average of 12 years since their diagnosis and had a mean age of 63 years. Nearly half of these patients had lymphedema and were insured by public or private health care providers.

The patients recorded direct and indirect costs related to their overall health over a 6-month period, including physician and emergency department visits, medications, and gym memberships. Patients with lymphedema also had additional health care costs related to that condition, such as compression garments and bandages, according to the study.

The loss of productivity at work and home was defined as instances in which patients were unable to participate in usual activities or required assistance in performing usual day-to-day tasks.

Many patients in the study were forced to use their personal savings, obtain loans, or had plunged into debt to cover their medical costs, which grew to the level of having an adverse effect on their ability to cover basic living expenses.

The researchers found a long-term cumulative socioeconomic effect, which inhibited the ability of patients to help family members, contribute to their children's education, or retire. The medical costs of patients with lymphedema also had a negative impact on their ability to manage the condition.

The snowball effect of annual health care costs for cancer survivors can have a long-lasting impact, even among those with insurance coverage, according to the study authors. The researchers said that systemic health care changes are needed that require insurers to relieve some of the burden on patients, such as fully covering the health care costs for lymphedema, for example.

They pointed to proposed legislation in Congress that would mandate Medicare cover needed items, such as compression garments, under durable medical equipment.

"The US is too resource-rich for people to have to make decisions between their health and their wealth," Dean said. "By making some important changes in coverage, we can help breast cancer survivors who continue to struggle with economic burdens long after their cancers are considered cured."