title: Older women with localized breast cancer: costs and survival rates increased across two time periods.
abstract: Significant national attention has been paid to the rising costs of cancer care. However, few studies have evaluated the association between trends in costs and survival outcomes. We used the Surveillance, Epidemiology, and End Results (SEER) Program-Medicare linked database to compare changes in costs and survival rates over time, among women ages 67-94 who were diagnosed with stage II or III breast cancer in 1994-96 or 2004-06. We found that median cancer-related costs increased from $12,335 to $17,396 among women with stage II disease, and from $18,107 to $32,598 among women with stage III disease. Although the median cost of breast surgery declined between the two study periods, the median cost of chemo- and radiation therapy increased substantially, leading to an overall rise in cancer-related costs. Meanwhile, adjusted overall five-year survival improved, from 67.8 percent to 72.5 percent for women with stage II disease and from 38.5 percent to 51.9 percent for those with stage III disease. These findings suggest that increases in cancer care costs have been accompanied by improved outcomes. Future work should identify opportunities to optimize efficiency in cancer care.
authors.affiliation: Aaron J. Feinstein is a resident in head and neck surgery at the University of California, Los Angeles, and a researcher at the Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University School of Medicine, in New Haven, Connecticut.
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Feinstein
authors.affiliation: Jessica Long is a researcher at the COPPER Center.
authors.forename: Jessica
authors.initials: J
authors.lastname: Long
authors.affiliation: Pamela R. Soulos is a researcher at the COPPER Center.
authors.forename: Pamela R
authors.initials: PR
authors.lastname: Soulos
authors.affiliation: Xiaomei Ma is an associate professor of epidemiology at the Yale University School of Public Health.
authors.forename: Xiaomei
authors.initials: X
authors.lastname: Ma
authors.affiliation: Jeph Herrin is an assistant professor of medicine (cardiology) at the Yale University School of Medicine.
authors.forename: Jeph
authors.initials: J
authors.lastname: Herrin
authors.affiliation: Kevin D. Frick is a professor and vice dean for education at the Johns Hopkins Carey Business School, in Baltimore, Maryland.
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Frick
authors.affiliation: Anees B. Chagpar is an associate professor of surgery at the Yale University School of Medicine.
authors.forename: Anees B
authors.initials: AB
authors.lastname: Chagpar
authors.affiliation: Harlan M. Krumholz is the Harold H. Hines Jr. Professor of Medicine and Epidemiology and Public Health at the Yale University School of Medicine.
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
authors.affiliation: James B. Yu is an assistant professor of therapeutic radiology at the Yale University School of Medicine.
authors.forename: James B
authors.initials: JB
authors.lastname: Yu
authors.affiliation: Joseph S. Ross is an associate professor of internal medicine at the Yale University School of Medicine.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Ross
authors.affiliation: Cary P. Gross (cary.gross@yale.edu) is a professor of medicine at the Yale University School of Medicine.
authors.forename: Cary P
authors.initials: CP
authors.lastname: Gross
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000191:economics* / Q000453:epidemiology / Q000401:mortality*; D005260:Female; D017048:Health Care Costs / Q000639:trends*; D006801:Humans; D053208:Kaplan-Meier Estimate; D006278:Medicare / Q000191:economics; D009367:Neoplasm Staging; D018426:SEER Program; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
keywords: Cost of Health Care; Elderly; Medicare