Incidence, Treatment Costs, and Complications of Lymphedema After Breast Cancer Among Women of Working Age: A 2-Year Follow-Up Study
Incidence, Treatment Costs, and Complications of Lymphedema After Breast Cancer Among Women of Working Age: A 2-Year Follow-Up Study
复制标题
DOI：
10.1200/jco.2008.18.3517
复制
发表时间：
2009-04-20
影响因子：
45.3
通讯作者：
Elting, Linda S.
中科院分区：
文献类型：
--
作者：
Shih, Ya-Chen Tina;Xu, Ying;Elting, Linda S.
PurposeThis study estimates the economic burden of breast cancer related lymphedema（BCRL）among working-age women，the incidence of lymphedema，and associated risk factors.MethodsWe used claims data to study a incident cohort of breast cancer patients for the 2 years after starting of cancer treatment. Logistic回归模型用于确定与水肿相关的因素。我们比较了BCRL女性患者和对照组患者的医疗费用和可能与水肿相关的感染率。我们进行了非参数bootstrapping比较未调整的成本差异，估计调整后的成本差异回归analysis. ResultsAbout 10%的1,877例患者的索赔表明治疗水肿。预测因素包括腋窝淋巴结清扫术（OR = 6.3，P <0.001）和化疗（OR = 1.6，P = 0.01）。观察到的地理差异;居住在西部的妇女更有可能比那些在东北部（OR = 2.05，P = 0.01）有水肿索赔。匹配队列分析表明，BCRL组的医疗费用显著较高（14，877美元至23，167美元），患淋巴管炎或蜂窝织炎的可能性是其两倍（OR = 2.02，P = .009）。门诊护理，特别是精神卫生服务，诊断成像，并访问中度或高度复杂性，占大多数的difference.ConclusionAlthough使用索赔数据可能低估了真正的发病率，水肿，妇女BCRL感染的风险更大，并产生更高的医疗费用。这里记录的大量成本表明，应进一步努力阐明减少和预防BCRL的战略。J Clin Oncol 27：2007-2014. (C)2009年美国临床肿瘤学会
PurposeThis study estimated the economic burden of breast cancer-related lymphedema (BCRL) among working-age women, the incidence of lymphedema, and associated risk factors.MethodsWe 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.ResultsApproximately 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.ConclusionAlthough 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. J Clin Oncol 27: 2007-2014. (C) 2009 by American Society of Clinical Oncology