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

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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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Funding

This study was funded by a NCI TREC Survivor Center grant U54-CA155850 from the National Institutes of Health. NCI TREC Survivor Center grant U54-CA155850.

Author information

Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Mayo Clinic, First Street SW, Rochester, MN, 55905, USA

    Andrea Cheville, Mary Lynch & Jeffrey Basford

  2. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA

    Minji Lee

  3. Department of Oncology, Mayo Clinic, Rochester, MN, USA

    Timothy Moynihan

  4. Department of Public Health Sciences, Penn State University, Hershey, PA, USA

    Kathryn H. Schmitz

  5. Department of Internal Medicine, University of South Florida, Tampa, FL, USA

    Fabiola Rios De Choudens

  6. Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA

    Lorraine Dean

  7. Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA

    Terry Therneau

Authors
  1. Andrea Cheville
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Corresponding author

Correspondence to Andrea Cheville.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Mayo Clinic Institutional Review Board. The requirement for informed consent was waived for portions of the study that involved retrospective data from clinical records. Informed consent was obtained from surviving cohort members who responded to the survey.

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Cheville, A., Lee, M., Moynihan, T. et al. The impact of arm lymphedema on healthcare utilization during long-term breast cancer survivorship: a population-based cohort study. J Cancer Surviv 14, 347–355 (2020). https://doi.org/10.1007/s11764-019-00851-0

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  • DOI: https://doi.org/10.1007/s11764-019-00851-0

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