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Updated: Jan 20, 2026
Ultrasonographic Evaluation of Breast Cancer-related Lymphedema
Published on: January 12, 2017
Drivers of cost differences between US breast cancer survivors with or without lymphedema
Lorraine T Dean1,2, Yusuf Ransome3, Livia Frasso-Jaramillo4
1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, E6650, Baltimore, MD, 21205, USA. ldean9@jhu.edu.
Insights
Breast cancer survivors with lymphedema face significantly higher healthcare costs beyond lymphedema treatment itself. Socioeconomic factors also contribute to these persistent financial disparities.
Area of Science:
- Oncology
- Health Economics
- Public Health
Background:
- Breast cancer-related lymphedema affects nearly 30% of US survivors.
- Previous studies indicated higher out-of-pocket costs for survivors with lymphedema, but the full extent of cost drivers was unclear.
Purpose of the Study:
- To investigate the factors contributing to elevated healthcare costs for breast cancer survivors with lymphedema, beyond the direct costs of lymphedema treatment.
- To identify specific cost categories and underlying socioeconomic influences on financial disparities.
Main Methods:
- A mixed-methods study involving 129 breast cancer survivors (BCS) completing 12 monthly cost diaries.
- Statistical analysis (Cohen's d, multivariable analysis) comparing 13 cost categories by lymphedema status.
- Qualitative data collection through in-person interviews with 40 participants.
Main Results:
- BCS with lymphedema reported 122% higher mean monthly direct costs ($355 vs. $160) compared to those without.
- Significantly higher co-pays, medication, and other out-of-pocket expenses were observed in BCS with lymphedema.
- Socioeconomic factors influenced expenditure differences in lotions and medications, highlighting disparities in ability to pay.
Conclusions:
- Elevated patient costs for BCS with lymphedema extend beyond the condition itself, indicating that lymphedema treatment coverage alone may not resolve cost disparities.
- Addressing economic challenges requires comprehensive solutions, including expanded insurance coverage and financial assistance for all BCS, considering socioeconomic diversity.
Purpose:
Breast cancer-related lymphedema is an adverse effect of breast cancer surgery affecting nearly 30% of US breast cancer survivors (BCS). Our previous analysis showed that, even 12 years after cancer treatment, out-of-pocket healthcare costs for BCS with lymphedema remained higher than for BCS without lymphedema; however, only half of the cost difference was lymphedema-related. This follow-up analysis examines what, above and beyond lymphedema, contributes to cost differences.
Methods:
This mixed methods study included 129 BCS who completed 12 monthly cost diaries in 2015. Using Cohen's d and multivariable analysis, we compared self-reported costs across 13 cost categories by lymphedema status. We elicited quotes about specific cost categories from in-person interviews with 40 survey participants.
Results:
Compared with BCS without lymphedema, BCS with lymphedema faced 122% higher mean overall monthly direct costs ($355 vs $160); had significantly higher co-pay, medication, and other out-of-pocket costs, lower lotion costs; and reported inadequate insurance coverage and higher costs that persisted over time. Lotion and medication expenditure differences were driven by BCS' socioeconomic differences in ability to pay.
Conclusions:
Elevated patient costs for BCS with lymphedema are for more than lymphedema itself, suggesting that financial coverage for lymphedema treatment alone may not eliminate cost disparities.
Implications For Cancer Survivors:
The economic challenges examined in this paper have long been a concern of BCS and advocates, with only recent attention by policy makers, researchers, and providers. BCS identified potential policy and programmatic solutions, including expanding insurance coverage and financial assistance for BCS across socioeconomic levels.
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