New research by the University of North Carolina at Chapel Hill shows much higher costs for treating metastatic breast cancer patients than for earlier-stage cancer patients or those without cancer.
The findings, published in the journal Breast Cancer Research and Treatment, revealed the largest expected costs were among women age 18-44 (2020; https://doi.org/10.1007/s10549-020-05654-x). Breast cancer in younger women is typically diagnosed at more advanced stages, more aggressive, and less responsive to treatment.
"Our results highlight the tremendous cost burden associated with metastatic breast cancer among working-age women, particularly during the years after initial treatment of metastatic disease as well as at the end of life," said study co-author Stephanie Wheeler, PhD, MPH, Professor of Health Policy and Management at the Gillings School of Global Public Health and researcher at the Center for Health Promotion and Disease Prevention.
For example, among women aged 18-44, the incremental average monthly cost of treating metastatic breast cancer were $4,463 compared to monthly costs of $2,418 for treating stage I cancer. Among other age groups the treatment costs for advanced cancer were not statistically different.
Women living in North Carolina and treated for breast cancer between 2003 and 2014 were included in the study that was funded by the U.S. Centers for Disease Control and Prevention.
In the study group, 4,806 had metastatic breast cancer, meaning their cancer had spread to other parts of the body, and 21,772 had non-metastatic cancer. The patient data was collected in a cancer registry coordinated by the Lineberger Comprehensive Cancer Center.
Using statistical modeling based on insurance claims data, researchers estimated medical costs for patients with metastatic breast cancer.
For comparison, they also estimated costs for patients with earlier-stage breast cancer and 109,631 women with no cancer who were in the same age group, from the same county of residence, and who had the same type of health insurance.
For women with metastatic breast cancer where the five-year survival rate is only 26.3 percent compared to 98.8 percent for localized cancer, treatment continues for longer, and it includes end-of-life care. These factors contribute to the high medical costs associated with metastatic breast cancer, which can be a financial burden for women and their families.
The finding that medical costs are higher for younger and middle age women may reflect their desire for more aggressive treatment and willingness to pay for additional months of life, researchers said, or it may reflect breakdowns in shared decision-making between patients and practitioners, leading to treatments with minimal financial and health benefits for patients.
"Our results suggest that we spend nearly twice as much in the last year of life for women that die of breast cancer compared to other causes of death," said study lead author Justin Trogdon, PhD, Professor of Health Policy and Management at Gillings School of Global Public Health and researcher at the Center for Health Promotion and Disease Prevention.
"We should work to ensure that end-of-life spending for metastatic breast cancer represents women's preferences and is of high value," said Trogdon, a health economist.
By identifying the age groups and phases of care where medical costs are the highest, the results of this study may inform decision makers about where to invest resources, for example, which groups of patients may be in need of extra financial or psychological support.
The study can also inform future research into how to improve metastatic breast cancer treatment for populations or treatment phases that are currently associated with the highest medical costs.