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The "True Cost" of Lymphedema: A Prospective Cohort Study Assessing Financial Toxicity in Extremity Lymphedema Patients
Nerone Douglas MSc; Shayan Sarrami MD; Carolyn De La Cruz MD
University
2024-01-22
Presenter: Nerone Douglas
Affidavit:
Nerone Douglas
Director Name: Vu T. Nguyen
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background: Despite numerous studies exploring the monetary costs of lymphedema care, there remains a gap in our understanding of treatment-induced distress, or "financial toxicity" (FT), in lymphedema patients. This study aims to (1) quantify FT in our cohort, (2) evaluate disparities in lymphedema care, and (3) identify the association between FT and lymphedema disease progression.
Methods: This is a prospective survey of adult patients with diagnosed chronic lymphedema undergoing clinical evaluation at a single-provider multi-disciplinary lymphedema clinic. FT was measured using the comprehensive 11-item COST-FACIT instrument. Surveys were distributed through RedCap, patients were anonymized and given a unique identifier to link responses for later analyses.
Results: 29 patients were interviewed and 24 met inclusion criteria and were included in the final analysis. 5 (21%) patients were male, and 24 (79%) were female. 18 (75%) patients had government-based insurance such as Medicare/Medicaid, and 6 (25%) patients had private insurance. 15 patients (63%) had lower-extremity lymphedema and the remaining 38% had upper-extremity lymphedema; all patients with upper-extremity lymphedema were more specifically breast-cancer-related lymphedema. Higher lymphedema disease stages were associated with lower observed FT scores (less financial well-being). Patients with lower-extremity lymphedema had an observed higher FT score (more financial well-being) compared to patients with upper-extremity lymphedema (25.7 vs 19.8). Patients with private insurance had an observed higher FT score compared to patients with government-based insurance (24 vs 20.9).
Conclusions: Solely evaluating the monetary aspect of lymphedema care fails to unveil the "true cost" burden of this chronically debilitating disease for patients.
