Health care utilisation and characteristics of long-term breast cancer survivors: Nationwide survey in Denmark
Introduction
When anticancer treatment is successfully finalised, it is life that matters. However, many cancer survivors are left with mental and physical sequelae,1, 2 functional limitations3, 4 and an increased need of health care5, 6 which often is not met.7 As acute cancer-related symptoms such as pain may change into chronic conditions, and as some sequelae may occur late8, population-based data on long-term sequelae, health, and health care utilisation are of increasing importance to better meet the needs of this population.
Breast cancer is the commonest incident form of malignancy among women in Europe with a 5-year-survival of about 80% in Denmark.9 With one million new cases in the world each year, breast cancer represents a major public health issue,10 and the number of breast cancer survivors (BCS) increases due to improved screening and treatment programmes. However, long-term data on BCS’ health care utilisation beyond 5-years are relatively sparse.
We found previously that long-term BCS frequently reported sequelae such as chronic pain (42%), paraesthesia (47%), swelling of arm/shoulder (25%), phantom pain (19%), and allodynia (15%).1 Interestingly, at the same time this population-based sample of BCS reported a similar to or even slightly better health-related quality of life (HRQOL) compared to the general population data.11
In this study, we aimed at investigating daily activity, employment characteristics, and health care utilisation by BCS using the same nationally representative approach. Some data on BCS could be compared to data from the general population derived from another Danish survey,12 enabling us to identify findings characteristic for BCS.
Section snippets
Study design
Patients diagnosed with breast cancer from 1989 to 1999 were selected from the database of the Danish Breast Cancer Cooperative Group (DBCG) among those who had survived for 5–15 years after primary breast cancer surgery without recurrence or a second cancer. In total, 11,243 women of the DBCG database met the inclusion criteria. The sample design was an age-stratified sample, randomly selecting 500 BCS into each stratum (18–49; 50–59; 60–69; and ⩾70 years). Subsequent analysis led to exclusion
Respondents and non-respondents
Selection of BCS and participation are shown in Fig. 1. Table 1 shows characteristics of responders and non-responders among BCS. High age of participants (⩾70 years) was significantly associated with non-response.
Concerning the data of the general female population sample that we were allowed to access, 7256 women (⩾40 years) were randomly selected, of whom 5208 had completed the interview (72%). The final general population sample included 4865 women, because 343 were excluded due to report
Discussion
Overall, BCS were in contact with the health care system significantly more often than women of the general population, indicating more frequent needs in BCS. The finding that increased health care utilisation is prevalent 5–15 years after breast cancer treatment suggests that breast cancer survival is associated with chronic morbidity. This result is supported by evidence of higher comorbidity in BCS compared to survivors of other cancers2 and compared to women without a cancer history.3, 18
Conclusion
This study identified BCS as a population with chronic morbidity as reflected in the significantly higher prevalence of health care utilisation. While reporting a comparable, high-quality of life, BCS have limitations in daily activities compared to the general women population. Our data suggest that in the long run probably the combination of sociodemographic factors – mainly age, short education, and being single – as well as treatment-related factors – mainly radiotherapy and shorter time
Conflict of interest statement
None declared.
Acknowledgements
The project was financially supported mainly by the Danish Cancer Society. Further funding was also received from the following: ‘Handelsgartner Ove William Buhl Olesen og ægtefælle fru Edith Buhl Olesens’ ‘Mindelegat’, ‘Krista og Viggo Petersens’s Fond’, ‘Beckett– Fonden’, ‘Gangstedfonden’, and ‘Willy og Ingeborg Reinhards Fond’.
References (36)
- et al.
Health profiles of 814 very long-term breast cancer survivors
Clin Breast Cancer
(2006) - et al.
Timescale of evolution of late radiation injury after postoperative radiotherapy of breast cancer patients
Int J Radiat Oncol Biol Phys
(2000) - et al.
Breast cancer
Lancet
(2005) - et al.
Epidemiology of chronic non-malignant pain in Denmark
Pain
(2003) Approximate variance formulas for standardized rate ratios
J Chronic Dis
(1984)- et al.
Comparison of four common stressors across the breast cancer trajectory
J Psychosom Res
(2007) - et al.
Prevalence, characteristics, and impact of postmastectomy pain syndrome: an investigation of women’s experiences
Pain
(1995) - et al.
Pain and other symptoms after different treatment modalities of breast cancer
Ann Oncol
(1995) - et al.
Anxiety and depression in breast cancer patients at low risk of recurrence compared with the general population: a valid comparison?
J Clin Epidemiol
(1999) - et al.
Neuropathic pain following breast cancer surgery: proposed classification and research update
Pain
(2003)
Quality of life among long-term breast cancer survivors: a systematic review
Eur J Cancer
Effect of social class on tumour size at diagnosis and surgical treatment in Danish women with breast cancer
Soc Sci Med
Functional impairment and the economic consequences of female breast cancer
Women Health
Functional limitations in elderly female cancer survivors
J Natl Cancer Inst
Increased health care utilisation among 10-year breast cancer survivors
Support Care Cancer
Breast cancer survivors’ supportive care needs 2–10 years after diagnosis
Support Care Cancer
Cited by (49)
What can a third sector organisation provide for people with breast cancer that public health services cannot? Developing support services in response to service evaluation
2019, European Journal of Integrative MedicineCitation Excerpt :Around one-third of breast cancer survivors report one to five such unmet needs, whilst 17% report at least six concerns [4]. Consequently, long-term breast cancer survivors report significantly more healthcare utilisation than same age controls in the general population [5,6]. This increase in demand for services such as breast care nurse support and oncology outpatient visits is placing increased pressure on the NHS to provide the support needed.
Development of a questionnaire encompassing indicators of distress: A tool for use with women in surgical continuity of care for breast cancer
2015, European Journal of Oncology NursingEducational differences in healthcare use among survivors after breast, prostate, lung, and colon cancer – a SEQUEL cohort study
2023, BMC Health Services ResearchReturn to Work and Work Productivity During the First Year After Cancer Treatment
2022, Frontiers in Psychology