Economic outcomes of breast cancer survivorship: CALGB study 79804.
BACKGROUND
Over 80% of women diagnosed with breast cancer will be survivors. We sought to determine the economic consequences of surviving breast cancer.


METHODS
Disease-free survivors who had received adjuvant chemotherapy for stage II breast cancer on CALGB study 8541 participated in a study of long-term outcomes. Survey responses were used to determine the types and frequency of medical resources used in follow-up, annual direct medical costs, and survivor perceptions of the personal economic impact of breast cancer.


RESULTS
245 of 314 (78%) invited breast cancer survivors (median follow-up 12.2 years, range 9.3-16.4) completed the surveys. Eighty-seven percent reported having cancer specialist follow-up in the past year. The following percentages of survivors reported having had, for breast cancer follow-up, at least once in the past year: breast examination 92%, mammogram 88%, bone scan 18%, chest radiograph 59%, tumor marker studies 37%. When follow-up care included a medical oncologist, resources were more likely to be used at least according to published follow-up guidelines, or over-used. Median annual cost of follow-up per survivor was US 630 dollars (range US 0-10,817 dollars) with higher costs associated with medical oncology follow-up, lower income, and younger age. Few women reported a negative impact of breast cancer on employment, but 16% reported being denied life insurance.


CONCLUSIONS
Among long-term breast cancer survivors, patient self-report data suggest that over-use of medical resources for follow-up appears common. When follow-up care included a medical oncologist, resources were more likely to be used appropriately, or over-used. Costs of follow-up are higher with medical oncology follow-up, lower income and among younger survivors. The annual cost of follow-up varies widely and may be driven by over-use of follow-up tests.
Hensley
Martee L
ML
Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. hensleym@mskcc.org
Dowell
Jeannette
J
Herndon
James E
JE
Winer
Eric
E
Stark
Nancy
N
Weeks
Jane C
JC
Paskett
Electra
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001943:Breast Neoplasms / Q000191:economics* / Q000628:therapy; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D004651:Employment; D005260:Female; D005500:Follow-Up Studies; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000191:economics; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000191:economics*; D018709:Statistics, Nonparametric; D017741:Survivors; D014481:United States