Abstract
The purpose of this article was to provide a literature-based extensive overview of the quality-of-life and cost issues posed by the management of breast cancer.
Incidence and mortality rates vary widely in different countries. Breast cancer accounts approximately for one-fifth of all deaths in women aged 40–50 years. The 1994–1998 incidence rate in the US population was on average 114.3 per 100 000 women.
Treatment options include surgery, radiotherapy and drug therapy (cytotoxic and endocrine drugs). All treatment options affect patients’ health-related quality of life (HR-QOL) in various ways. The use of cytotoxic agents has a particularly large HR-QOL impact. HR-QOL questionnaires are complex tools, not routinely used in breast cancer trials.
Worldwide, around 10 million individuals develop cancer each year; this figure is expected to increase to 15 million in 2020. For all cancers, the total economic burden of this disease worldwide was projected by the authors to be in the range of $US300–400 billion in 2001 (about $US100–140 billion as direct costs and the remainder as indirect costs [morbidity and mortality]). According to the National Institute of Health (NIH), the total cost of cancer was estimated at $US156.7 billion in 2001 in US ($US56.4 billion as direct costs, $US15.6 as indirect morbidity costs, and $US84.7 billion as indirect mortality costs). Based on limited information, in the US, breast cancer can be projected to account for about one-fifth/one-fourth of the total cost of cancer. Breast cancer treatment costs are higher in the US than in other developed countries. Both direct and indirect costs are dependent on disease stage. The per-patient costs for initial care in 1992 were estimated at $US10 813, for continuing care at $US1084 and for terminal care at $US17 886. Stage-specific costs provide information for cost-effectiveness analyses of cancer-control initiatives, such as screening programmes. Economic studies on breast cancer are heterogeneous, and the cost estimates made are not easily generalisable. The cost of treatment for breast cancer in developing countries is ≤5% of that in developed regions.
Similar content being viewed by others
Notes
The use of tradenames is for product identification purposes only and does not imply endorsement.
References
Ferlay J, Bray F, Pisani P, et al. Globocan/Eucan 2000: Cancer incidence, mortality and prevalence worldwide. Available from URL: http://www-dep.iare.fr/dataava/infodata.htm [Accessed 2003 Jan 31]
Eucan cancer incidence, mortality and prevalence in the European Union. Available from URL: http://www-dep.iare.fr/eucan/eucan.htm [Accessed 2003 Feb 19]
American Cancer Society (ACS). Cancer facts and figures 2002. Available from URL: http://www.cancer.org [Accessed 2003 Feb 7]
Greenlee RT, Hill-Harmon MB, Thun M. ACS cancer statistics 2001. CA Cancer J Clin 2001; 51: 15–36
Hartmann LC, Schaid DJ, Woods JE, et al. Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. N Engl J Med 1999; 340: 77–84
Fisher B, Constantino JP, Wickerman DL, et al. Tamoxifen for prevention of breast cancer. Report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Just 1998; 16:1371–88
Cummings SR, Eckert S, Krueger KA, et al. The effect of raloxifene on risk of breast cancer in postmenopausal women: results from MORE randomized trial. 10-Multiple Outcomes of Raloxifene Evaluation. JAMA 1999; 281(23):2189–97
The effect of raloxifene on risk of breast cancer in postmenopausal women: results from the MORE randomized trial. Multiple Outcomes of Raloxifene Evaluation. JAMA 1999; 281 (23): 2189–97
Henderson MM, Kushi LH, Thompson DJ, et al. Feasibility of a randomized trial of a low-fat diet for the prevention of breast cancer: dietary compliance in the Women’s Health Trial Vanguard Study. Prev Med 1990; 19 (2): 115–33
USPSTF. Chemoprevention of breast cancer: recommendations and rationale. Ann Intern Med 2002 Jul 2; 137 (1): 56–69
ASCO update on breast cancer chemoprevention. Inpharma 2002 Feb 16; 1325: 1–14
Goss PE, Strasser K. Chemoprevention with aromarase inhibitors-trial strategies. J Steroid Biochem Mol Biol 2001 Dec; 79 (1–5): 143–9
Veronesi U, Saccozzi R, Del Vecchio M, et al. Comparing radical mastectomy with quadrantectomy, axillary dissection, and radiotherapy in patients with small cancers of the breast. N Engl J Med 1981; 305: 6–11
Sarrazin D, Le MG, Fontaine MF, et al. Conservative treatment versus mastectomy in TI or small T2 breast cancer: a randomized trial. In: Hams JR, Hellman S, Silver W, editors. Conservative management of breast cancer: new surgical and miotherapeutic techniques. Philadelphia (PA): J.B. Lipencott, 1983:101–11
Fisher B, Redmond C, Fisher ER, et al. Ten-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation. N Engl J Med 1985; 312: 674–81
van Dongen E. Breast conserving therapy in operable breast cancer. EORTC Working Conference on Breast Cancer; 1987 Jul 1-3; London
Lichter AS, Lippman ME, Danforth DN, et al. Mastectomy versus breast-conserving therapy in the treatment of stage I and II carcinoma of the breast: a randomized trial at the National Cancer Institute. J Clin Oncol 1992; 10: 976–83
Perez EA, Hortobagyi GN. Ongoing and planned adjuvant trials with trastuzumab. Semin Oncol 2000 Dec; 27 (6 Suppl. 1): 26–32
Lonning PE. Aromatase inhibitors and inactivators in breast cancer. BMJ 2001 Oct 20; 323 (7318): 880–1
Buzdar AU. A summary of second-line randomized studies of aromarase inhibitors J Steroid Bio & Mol Biol 2001; 79 (201): 109–14
Fisher B, Costantino J, Redmond C. A randomized clinical trial evaluating tamoxifen in the treatment of patients with node-negative breast cancer who have estrogen-receptor-sensitive tumours. N Engl J Med 1989; 320: 478–84
Twombly R. Upstaging tamoxifen? New classes of drugs emerging for breast cancer. J Natl Cancer Inst 2002 Apr 3; 94 (7): 474–5
Howell A, Howell SJ, Clarke R, et al. Where do selective estrogen receptor modulators (SERMs) and aromatase inhibitors (AIs) now fit into breast cancer treatment algorithm? J Steroid Biochem Mol Biol 2001; 79 (1–5): 227–37
Lonning PE. Aromarase inhibitors and inactivators for breast cancer therapy. Drugs Aging 2002; 19 (4): 277–98
Ragaz J. Adjuvant trials of aromarase inhibitors: determining the future landscape of adjuvant endocrine therapy. J Steroid Biochem Biol 2001 Dec; 79 (1–5): 133–41
Gelber RD, Cole BF, Gelber S, et al. The Q-TWiST method: quality of life and pharmacoeconomics in clinical trials. 2nd ed. Philadelphia (PA): Lippincott-Raven Publishers, 1996
Radice D, Redaelli A. Non-parametric Q-TWiST analysis of intensive CEF versus standard CMF as adjuvant therapy for breast carcinoma in pre-menopausal patients with histologically involved axillary nodes. Qual Life Res 2000; 9 (9): 1065–6
Efficace F, Bottomley A, Collins GS. Quality of life in breast cancer: measurement issues in cancer clinical trials. Expert Rev Pharmacoeconomics Outcomes Res 2002; 2 (1): 57–65
Hurny C, Bernhard J, Coates AS, et al. Impact of adjuvant therapy on quality of life in women with node positive operable breast cancer. Lancet 1996; 347: 1279–84
Selby PJ, Campbell JE, Chapman JA, et al. Measurement of the quality of life in patients with breast cancer. Rev Endocr Related Cancer 1984; 14: 245–7
Priestman TJ, Baum M. Evaluation of quality in patients receiving treatment for advanced breast cancer. Lancet 1976; 24: 899–900
Priestman TJ. Quality of life after cytotoxic chemotherapy: discussion paper. J R Soc Med 1984; 77: 492–5
Padilla GV, Preasant C, Grant MM, et al. Quality of life index for patients with cancer. Res Nuts Health 1983; 6: 117–26
Stiggelbout AM, Jansen SIT, De Haes JCJM, et al. Adjuvant chemotherapy in breast cancer: do ratings of side effects explain differences in preferences? [poster]. ASCO Conference; 1999 May 15–18; Atlanta (GA)
Bernhard J, Castiglione-Gertsch M, Schmitz SF, et al. Quality of life in postmenopausal patients with breast cancer after failure of tamoxifen: formestane versus megestrol acetate as second-line hormonal treatment. Eur J Cancer 1999; 35: 913–20
Hurny C, Berhard J, Gelber RD, et al. Quality of life measures for patients receiving adjuvant therapy for breast cancer: an international trial. Eur J Cancer 1992; 18 (1): 118–24
Coates A, Gebski V, Signorini D, et al. Prognostic value of quality of life scores during chemotherapy for advanced breast cancer. J Clin Oncol 1992; 10 (12): 1833–8
Shimozuma K, Sonoo H, Ichihra K, et al. The prognostic value of quality of life scores: preliminary results of an analysis of patients with breast cancer. Surg Today 2000; 30: 255–61
Macquart-Moulin G, Viens P, Genre D, et al. Concomitant chemoradiotherapy for patients with nonmetastatic breast carcinoma: side effects, quality of life and daily organization. Cancer 1999; 85: 2190–9
Wyatt G, Kurtz ME, Liken M. Breast cancer survivors: an exploration of quality of life issues. Cancer Nuts 1993; 16: 440–8
Mor V, Malin M, Allen S. Age differences in the psychosocial problems encountered by breast cancer patients. J Natl Cancer Inst Monogr 1994; 16: 191–7
Edlund B, Sneed NV. Emotional responses to the diagnosis of cancer: age-related comparisons. Oncol Nuts Forum 1989; 16: 691–7
Schagen SB, Booger W, Muller MJ, et al. Cognitive impairment as late effect of adjuvant chemotherapy for breast cancer. O-N-E 2000; 1 (9): 48–51
McPherson K, Steel CM, Dixon JM. ABC of breast diseases. Breast cancer: epidemiology, risk factors and genetics. BMJ 1994; 309: 1003–6
Brown ML, Hodgson TA, Rice DP. Economic impact of cancer in the United States. NCI 1994; 13: 255–66
Thom TJ. Economic costs of neoplasms, arteriosclerosis, and diabetes in the United States. In Vivo 1996; 10: 255–60
Brown HL, Fintor L. The economic burden of cancer. NCI 1990; 5: 69–81
White E, Urban N, Taylor V. Mammography utilization, public health impact on cost-effectiveness in the United States. Annu Rev Public Health 1993; 14: 605–33
Shapiro S, Venet W, Strax P, et al. Ten-to-fourteen year effect of screening on breast cancer mortality. J Natl Cancer Inst 1982; 326: 653–7
Greenberg ER, Chute CG, Stukel T, et al. Social and economic factors in the choice of lung cancer treatment: a population based study in two states. N Engl J Med 1988; 313: 612–7
Lazovich DA, White E, Thomas DB, et al. Underutilization of breast-conserving surgery and radiation therapy among women with stage I or II breast cancer. JAMA 1991; 266: 3433–8
Newcomp PA, Carbone PP. Cancer treatment and age: patient perspectives. J Natl Cancer Inst 1993; 85: 1580–4
Taplin SH, Barlow W, Urban N, et al. Stage, age, comorbidity and direct costs of colon, prostate and breast cancer care. J Natl Cancer Inst 1995; 87 (6): 417–26
Baker MS, Kessler LG, Urban N, et al. Estimating the treatment costs of breast and lung cancer. Med Care 1991; 29: 40–9
Von Korff M, Wagner EH, Saunders K. A chronic disease score from automated pharmacy data. J Clin Epidemiol 1992; 45: 197–203
Will BP, Le Petit C, Berthelot JM, et al. Diagnostic and therapeutic approaches for non metastatic breast cancer in Canada, and their associated costs. Br J Cancer 1999; 79 (10): 1428–36
Will BP, Berthelot JM, Le Petit C, et al. Estimates of the lifetime costs of breast cancer treatment in Canada. Eur J Cancer 2000; 36: 724–35
Riley GF, Potosky AL, Lubitz JD, et al. Medicare payments from diagnosis to death for elderly patients by stage at diagnosis. Med Care 1995; 33: 828–41
Wolstenhome JL, Smith SJ, Whynes DK. The cost of treating breast cancer in the United Kingdom: implications for screening. Int J Technol Assess Health Care 1998; 14: 277–89
Berkowitz N, Gupta S, Silberman G. Estimates of the lifetime direct costs of treatment for metastatic breast cancer. Value Health 2000; 3 (1): 23–30
Clark GM. Prognostic and predictive factors. In: Jarris JR, Lippman ME, Morrow M, et al. (editors). Diseases of the breast. Philadelphia (PA): Lippincott-Raven Publishers, 1996: 461–85
McPherson K, Steel CM, Dixon JM. ABC of breast diseases. Breast cancer — epidemiology, risk factors and genetics. BMJ 1994; 309: 1003–6
Acknowledgements
The authors are employees of Pharmacia Corporation which has funded the literature search for the preparation of this manuscript. No potential conflicts of interest relevant to the contents of the manuscript are anticipated by the two authors to the best of their knowledge.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Radice, D., Redaelli, A. Breast Cancer Management. Pharmacoeconomics 21, 383–396 (2003). https://doi.org/10.2165/00019053-200321060-00003
Published:
Issue Date:
DOI: https://doi.org/10.2165/00019053-200321060-00003