title: Adverse breast cancer treatment effects: the economic case for making rehabilitative programs standard of care.
abstract: OBJECTIVE
  The purpose of this work was to evaluate the patient-borne financial cost of common, adverse breast cancer treatment-associated effects, comparing cost across women with or without these side effects.
  
  
  METHODS
  Two hundred eighty-seven Australian women diagnosed with early-stage breast cancer were prospectively followed starting at 6 months post-surgery for 12 months, with three monthly assessments of detailed treatment-related side effects and their direct and indirect patient costs attributable to breast cancer. Bootstrapping statistics were used to analyze cost data, and adjusted logistic regression was used to evaluate the association between costs and adverse events from breast cancer. Costs were inflated and converted from 2002 Australian to 2014 US dollars.
  
  
  RESULTS
  More than 90 % of women experienced at least one adverse effect (i.e., post-surgical issue, reaction to radiotherapy, upper-body symptoms or reduced function, lymphedema, fatigue, or weight gain). On average, women paid $5,636 (95 % confidence interval (CI), $4,694, $6,577) in total costs. Women with any one of the following symptoms (fatigue, reduced upper-body function, upper-body symptoms) or women who report ≥4 adverse treatment-related effects, have 1.5 to nearly 4 times the odds of having higher healthcare costs than women who do not report these complaints (p < 0.05).
  
  
  CONCLUSIONS
  Women face substantial economic burden due to a range of treatment-related health problems, which may persist beyond the treatment period. Improving breast cancer care by incorporating prospective surveillance of treatment-related side effects and strategies for prevention and treatment of concerns (e.g., exercise) has real potential for reducing patient-borne costs.
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Kathryn H
authors.initials: KH
authors.lastname: Schmitz
authors.forename: Tracey
authors.initials: T
authors.lastname: DiSipio
authors.forename: Louisa G
authors.initials: LG
authors.lastname: Gordon
authors.forename: Sandra C
authors.initials: SC
authors.lastname: Hayes
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000191:economics* / Q000627:therapeutic use; D001315:Australia; D001943:Breast Neoplasms / Q000191:economics / Q000628:therapy*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000191:economics*; D015444:Exercise; D005221:Fatigue / Q000453:epidemiology; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008209:Lymphedema / Q000453:epidemiology; D008875:Middle Aged; D011446:Prospective Studies; D059039:Standard of Care; D011795:Surveys and Questionnaires; D015430:Weight Gain
chemical_list: D000970:Antineoplastic Agents