Direct Economic Burden of Post-Cancer Treatment Pain Among Cancer Survivors in the United States: A Population-Based Retrospective Longitudinal Study.

Abstract

Purpose: Post-cancer treatment pain (PCTP) is prevalent among cancer survivors but remains understudied. It is critical to quantify PCTP prevalence over time and to estimate the resulting short and long-term incremental healthcare expenditures (total, third-party, and out-of-pocket) and out-of-pocket burden among cancer survivors.

Methods: A longitudinal retrospective cohort design was used. To identify cancer survivors (≥ 18 years) with PCTP, the Medical Expenditure Panel Survey (MEPS) and its supplementary Cancer Self-Administered Questionnaire (CSAQ)were used. Recycled predictions from generalised linear models (GLM) with log-link and gamma distribution were used to estimate annual incremental healthcare expenditures at different PCTP gradations over time. To account for covariate imbalance, sensitivity analysis using inverse probability weighting was conducted.

Results: 2125 cancer survivors had PCTP. Post-cancer treatment, 10.5%-24.2% of survivors experienced some form of chronic PCTP, whereas between 21.9%-5.1% experienced acute PCTP. Across the survivorship journey, the adjusted total annual incremental healthcare expenditures were the highest among cancer survivors with moderate chronic PCTP (< 1-year post-cancer treatment), and severe chronic PCTP, (≥ 5 years post-cancer treatment) compared to survivors with no pain, reaching respectively, $27.3 and $40.2 billion nationally. There was a significant high out-of-pocket burden among cancer survivors with severe chronic PCTP compared to those with no pain.

Conclusion: These findings highlight the persistent financial burden of PCTP but also the critical need for effective pain management alongside the use of patient-reported outcomes for pain among cancer survivors.