Originally published as JCO Early Release 10.1200/JCO.2008.18.3517 on March 16 2009

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Incidence, Treatment Costs, and Complications of Lymphedema After Breast Cancer Among Women of Working Age: A 2-Year Follow-Up Study

From the Section of Health Services Research, Department of Biostatistics, Division of Quantitative Sciences; Department of Surgical Oncology; Department of Breast Medical Oncology, Division of Cancer Medicine; and Department of Radiation Oncology, Division of Radiation Oncology, Breast Service, The University of Texas M. D. Anderson Cancer Center, Houston, TX; and Vanderbilt University School of Nursing, Nashville, TN.

Corresponding author: Ya-Chen Tina Shih, PhD, Section of Health Services Research, Department of Biostatistics, Division of Quantitative Sciences, The University of Texas M. D. Anderson Cancer Center, PO Box 301402, Houston, TX 77230-1402; e-mail: yashih{at}mdanderson.org.

Purpose This study estimated the economic burden of breast cancer–related lymphedema (BCRL) among working-age women, the incidence of lymphedema, and associated risk factors.

Methods We 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.

Results Approximately 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.

Conclusion Although 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.

Supported by Research Scholar Grant No. RSGTL-05-093-01-CPHPS from the American Cancer Society.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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