Shih YC, Xu Y, Cormier JN, Giordano S, Ridner SH, Buchholz TA, Perkins GH, Elting LS, et al.
Journal of clinical oncology : official journal of the American Society of Clinical Oncology. Date of publication 2009 Apr 20;volume 27(12):2007-14.
1. J Clin Oncol. 2009 Apr 20;27(12):2007-14. doi: 10.1200/JCO.2008.18.3517. Epub
2009 Mar 16.
Incidence, treatment costs, and complications of lymphedema after breast cancer
among women of working age: a 2-year follow-up study.
Shih YC(1), Xu Y, Cormier JN, Giordano S, Ridner SH, Buchholz TA, Perkins GH,
Elting LS.
Author information:
(1)Section of Health Services Research, Department of Biostatistics, Division of
Quantitative Sciences, The University of Texas M. D. Anderson Cancer Center, PO
Box 301402, Houston, TX 77230-1402, USA. yashih@mdanderson.org
PURPOSE: This study estimated the economic burden of breast cancer-related
lymphedema (BCRL) among working-age women, the incidence of lymphedema, and
associated risk factors.
METHODS: We used claims data to study an incident cohort of breast cancer
patients for the 2 years after the initiation of cancer treatment. A logistic
regression model was used to ascertain factors associated with lymphedema. We
compared the medical costs and rate of infections likely associated with
lymphedema between a woman with BCRL and a matched control. We performed
nonparametric bootstrapping to compare the unadjusted cost differences and
estimated the adjusted cost differences in regression analysis.
RESULTS: Approximately 10% of the 1,877 patients had claims indicating treatment
of lymphedema. Predictors included treatment with full axillary node dissection
(odds ratio [OR] = 6.3, P < .001) and chemotherapy (OR = 1.6, P = .01). A
geographic variation was observed; women who resided in the West were more likely
to have lymphedema claims than those in the Northeast (OR = 2.05, P = .01). The
matched cohort analysis demonstrated that the BCRL group had significantly higher
medical costs ($14,877 to $23,167) and was twice as likely to have lymphangitis
or cellulitis (OR = 2.02, P = .009). Outpatient care, especially mental health
services, diagnostic imaging, and visits with moderate or high complexity,
accounted for the majority of the difference.
CONCLUSION: Although the use of claims data may underestimate the true incidence
of lymphedema, women with BCRL had a greater risk of infections and incurred
higher medical costs. The substantial costs documented here suggest that further
efforts should be made to elucidate reduction and prevention strategies for BCRL.
DOI: 10.1200/JCO.2008.18.3517
PMID: 19289624 [Indexed for MEDLINE]
