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Journal of Cancer Survivorship
Published in: Journal of Cancer Survivorship 3/2020

01-06-2020 | Breast Cancer

The impact of arm lymphedema on healthcare utilization during long-term breast cancer survivorship: a population-based cohort study

Authors: Andrea Cheville, Minji Lee, Timothy Moynihan, Kathryn H. Schmitz, Mary Lynch, Fabiola Rios De Choudens, Lorraine Dean, Jeffrey Basford, Terry Therneau

Published in: Journal of Cancer Survivorship | Issue 3/2020

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Abstract

Purpose

Cancer treatment–related late effects degrade survivors’ quality of life, independence, and societal integration, yet may be ameliorated, or even reversed, with effective care. Unfortunately, survivors inconsistently receive this care and the impact on their healthcare utilization is unknown. We sought to estimate differences in utilization between breast cancer (BC) survivors with and without upper extremity lymphedema; a common, remediable late effect.

Methods

We conducted a population-based, retrospective longitudinal cohort study of survivors with incident BC diagnosed from January 1, 1990, through December 31, 2010. HC utilization was characterized using the Berenson-Eggers Type of Service (BETOS) categories. Outcomes included overall healthcare utilization as well as its compartmentalization into the BETOS categories of (1) Evaluation and management, (2) Procedures, (3) Imaging, (4) Tests, (5) Durable medical equipment, (6) Physical/occupational therapy, (7) Other, and (8) Exceptions/Unclassified.

Results

The cohort included 1906 subjects of which 94% (1800) had records meeting the inclusion criteria. Mean follow-up per survivor was 12.8 years (mean, 11, range 1–25 years). Analysis revealed that (1) survivors with BC-associated lymphedema used > 30% more services annually; (2) their increased utilization lessened but persisted for at least 10 years after diagnosis; and (3) this finding of increased utilization extends across all BETOS categories, is further amplified as BMI increases, and cannot be explained solely by lymphedema-directed care.

Conclusions

BC-related lymphedema appears to be an important driver of survivors’ healthcare utilization and guideline-concordant activities to reduce its incidence and severity may be cost neutral or saving.

Implications for Cancer Survivors

Early detection and effective management of cancer-related late effects like lymphedema may reduce survivors’ healthcare needs in the decades that follow their cancer treatment.
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Metadata
Title
The impact of arm lymphedema on healthcare utilization during long-term breast cancer survivorship: a population-based cohort study
Authors
Andrea Cheville
Minji Lee
Timothy Moynihan
Kathryn H. Schmitz
Mary Lynch
Fabiola Rios De Choudens
Lorraine Dean
Jeffrey Basford
Terry Therneau
Publication date
01-06-2020
Publisher
Springer US
Published in
Journal of Cancer Survivorship / Issue 3/2020
Print ISSN: 1932-2259
Electronic ISSN: 1932-2267
DOI
https://doi.org/10.1007/s11764-019-00851-0

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