{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T10:40:51Z","timestamp":1790851251016,"version":"4.1.0"},"reference-count":52,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCO"],"published-print":{"date-parts":[[2009,4,20]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This study estimated the economic burden of breast cancer\u2013related lymphedema (BCRL) among working-age women, the incidence of lymphedema, and associated risk factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used claims data to study an incident cohort of breast cancer patients for the 2 years after the initiation of cancer treatment. A logistic regression model was used to ascertain factors associated with lymphedema. We compared the medical costs and rate of infections likely associated with lymphedema between a woman with BCRL and a matched control. We performed nonparametric bootstrapping to compare the unadjusted cost differences and estimated the adjusted cost differences in regression analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Approximately 10% of the 1,877 patients had claims indicating treatment of lymphedema. Predictors included treatment with full axillary node dissection (odds ratio [OR] = 6.3, P &lt; .001) and chemotherapy (OR = 1.6, P = .01). A geographic variation was observed; women who resided in the West were more likely to have lymphedema claims than those in the Northeast (OR = 2.05, P = .01). The matched cohort analysis demonstrated that the BCRL group had significantly higher medical costs ($14,877 to $23,167) and was twice as likely to have lymphangitis or cellulitis (OR = 2.02, P = .009). Outpatient care, especially mental health services, diagnostic imaging, and visits with moderate or high complexity, accounted for the majority of the difference.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Although the use of claims data may underestimate the true incidence of lymphedema, women with BCRL had a greater risk of infections and incurred higher medical costs. The substantial costs documented here suggest that further efforts should be made to elucidate reduction and prevention strategies for BCRL.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1200\/jco.2008.18.3517","type":"journal-article","created":{"date-parts":[[2009,3,16]],"date-time":"2009-03-16T21:33:21Z","timestamp":1237239201000},"page":"2007-2014","source":"Crossref","is-referenced-by-count":383,"title":["Incidence, Treatment Costs, and Complications of Lymphedema After Breast Cancer Among Women of Working Age: A 2-Year Follow-Up Study"],"prefix":"10.1200","volume":"27","author":[{"given":"Ya-Chen Tina","family":"Shih","sequence":"first","affiliation":[{"name":"From the Section of Health Services Research, Department of Biostatistics, Division of Quantitative Sciences; Department of Surgical Oncology; Department of Breast Medical Oncology, Division of Cancer Medicine; and Department of Radiation Oncology, Division of Radiation Oncology, Breast Service, The University of Texas M. D. Anderson Cancer Center, Houston, TX; and Vanderbilt University School of Nursing, Nashville, TN."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Xu","sequence":"additional","affiliation":[{"name":"From the Section of Health Services Research, Department of Biostatistics, Division of Quantitative Sciences; Department of Surgical Oncology; Department of Breast Medical Oncology, Division of Cancer Medicine; and Department of Radiation Oncology, Division of Radiation Oncology, Breast Service, The University of Texas M. D. Anderson Cancer Center, Houston, TX; and Vanderbilt University School of Nursing, Nashville, TN."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janice N.","family":"Cormier","sequence":"additional","affiliation":[{"name":"From the Section of Health Services Research, Department of Biostatistics, Division of Quantitative Sciences; Department of Surgical Oncology; Department of Breast Medical Oncology, Division of Cancer Medicine; and Department of Radiation Oncology, Division of Radiation Oncology, Breast Service, The University of Texas M. D. Anderson Cancer Center, Houston, TX; and Vanderbilt University School of Nursing, Nashville, TN."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon","family":"Giordano","sequence":"additional","affiliation":[{"name":"From the Section of Health Services Research, Department of Biostatistics, Division of Quantitative Sciences; Department of Surgical Oncology; Department of Breast Medical Oncology, Division of Cancer Medicine; and Department of Radiation Oncology, Division of Radiation Oncology, Breast Service, The University of Texas M. D. Anderson Cancer Center, Houston, TX; and Vanderbilt University School of Nursing, Nashville, TN."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheila H.","family":"Ridner","sequence":"additional","affiliation":[{"name":"From the Section of Health Services Research, Department of Biostatistics, Division of Quantitative Sciences; Department of Surgical Oncology; Department of Breast Medical Oncology, Division of Cancer Medicine; and Department of Radiation Oncology, Division of Radiation Oncology, Breast Service, The University of Texas M. D. Anderson Cancer Center, Houston, TX; and Vanderbilt University School of Nursing, Nashville, TN."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas A.","family":"Buchholz","sequence":"additional","affiliation":[{"name":"From the Section of Health Services Research, Department of Biostatistics, Division of Quantitative Sciences; Department of Surgical Oncology; Department of Breast Medical Oncology, Division of Cancer Medicine; and Department of Radiation Oncology, Division of Radiation Oncology, Breast Service, The University of Texas M. D. Anderson Cancer Center, Houston, TX; and Vanderbilt University School of Nursing, Nashville, TN."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George H.","family":"Perkins","sequence":"additional","affiliation":[{"name":"From the Section of Health Services Research, Department of Biostatistics, Division of Quantitative Sciences; Department of Surgical Oncology; Department of Breast Medical Oncology, Division of Cancer Medicine; and Department of Radiation Oncology, Division of Radiation Oncology, Breast Service, The University of Texas M. D. Anderson Cancer Center, Houston, TX; and Vanderbilt University School of Nursing, Nashville, TN."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda S.","family":"Elting","sequence":"additional","affiliation":[{"name":"From the Section of Health Services Research, Department of Biostatistics, Division of Quantitative Sciences; Department of Surgical Oncology; Department of Breast Medical Oncology, Division of Cancer Medicine; and Department of Radiation Oncology, Division of Radiation Oncology, Breast Service, The University of Texas M. D. Anderson Cancer Center, Houston, TX; and Vanderbilt University School of Nursing, Nashville, TN."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2007.14.4899"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3322\/canjclin.50.5.292"},{"key":"B3","first-page":"208","volume":"35","author":"Armer JM","year":"2002","journal-title":"Lymphology"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.137.11.1253"},{"key":"B5","first-page":"177","volume":"40","author":"Heiney SP","year":"2007","journal-title":"Lymphology"},{"key":"B6","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1177\/000313489906501021","volume":"65","author":"Kakuda JT","year":"1999","journal-title":"Am Surg"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.21195"},{"key":"B8","first-page":"185","volume":"39","author":"Pyszel A","year":"2006","journal-title":"Lymphology"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.4010"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1017\/S1478951506060068"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/S0360-3016(02)04273-6"},{"key":"B12","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1177\/000313480306900306","volume":"69","author":"Golshan M","year":"2003","journal-title":"Am Surg"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(20011001)92:7<1783::AID-CNCR1694>3.0.CO;2-G"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1006\/jsre.2000.6021"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1007\/BF02573889"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-06-0168"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1053\/ejso.2002.1385"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0142(20000201)88:3<608::AID-CNCR17>3.0.CO;2-K"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(20010815)92:4<748::AID-CNCR1378>3.0.CO;2-V"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1080\/028418600750013177"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1081\/CNV-48707"},{"key":"B22","first-page":"18","volume":"41","author":"Hayes S","year":"2008","journal-title":"Lymphology"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1191\/0269216305pm1020oa"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/93.2.96"},{"key":"B25","first-page":"59","volume":"35","author":"Johansson K","year":"2002","journal-title":"Lymphology"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1080\/028418600750013168"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2002.12.003"},{"key":"B28","first-page":"381","volume":"4","author":"Golshan M","year":"2006","journal-title":"J Support Oncol"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djj158"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1016\/j.suronc.2006.11.003"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-4741.2006.00342.x"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1089\/154099903770948159"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1245\/ASO.2004.04.017"},{"key":"B34","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1111\/j.1742-1241.2002.tb11206.x","volume":"56","author":"Sparaco A","year":"2002","journal-title":"Int J Clin Pract"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000245472.47748.ec"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2006.07.4062"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdl182"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1097\/01.sap.0000257149.42922.7e"},{"key":"B39","first-page":"270","volume":"268","author":"Mason W","year":"2000","journal-title":"Int J Palliat Nurs 6:265-"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1097\/00006199-200311000-00004"},{"key":"B41","volume-title":"User Guide and Database Dictionary","author":"Medstat: 1997-2001 MarketScan Health and Productivity Management Databases","year":"2003"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1111\/j.1475-6773.2004.00315.x"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1046\/j.1440-1622.2000.01839.x"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1016\/S0895-4356(00)00256-0"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a113476"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.2307\/2530417"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-4733.2006.00122.x"},{"key":"B49","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1080\/07350015.1983.10509330","volume":"1","author":"Duan N","year":"1983","journal-title":"J Business Econ Stat"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.1016\/S0167-6296(98)00025-3"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.1007\/s11414-006-9028-0"},{"key":"B52","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djj205"},{"key":"B55","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcg126"}],"container-title":["Journal of Clinical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ascopubs.org\/doi\/pdfdirect\/10.1200\/JCO.2008.18.3517","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,8]],"date-time":"2025-02-08T07:50:48Z","timestamp":1739001048000},"score":1,"resource":{"primary":{"URL":"https:\/\/ascopubs.org\/doi\/10.1200\/JCO.2008.18.3517"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,4,20]]},"references-count":52,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2009,4,20]]}},"alternative-id":["10.1200\/JCO.2008.18.3517"],"URL":"https:\/\/doi.org\/10.1200\/jco.2008.18.3517","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.1158900.620154","asserted-by":"object"}]},"ISSN":["0732-183X","1527-7755"],"issn-type":[{"value":"0732-183X","type":"print"},{"value":"1527-7755","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,4,20]]}}}