Out-of-pocket payments and loss of income among long-term breast cancer survivors in Germany: a multi-regional population-based study

Abstract

Purpose: This study aims to examine the magnitude of out of pocket (OOP) payments and income loss, as well as to identify socioeconomic and clinical factors among long-term breast cancer (BC) survivors in Germany. Methods: We examine data from 2654 long-term BC survivors in Germany that participated in the “CAncEr Survivorship – A multi-Regional population-based study” (CAESAR) and who were at least 5 years post diagnosis. BC-related OOP payments and income loss both within the 12 months prior to the survey were analyzed. Two-part regression models were performed to identify socioeconomic and clinical factors. Results: OOP payments were incurred by 51.9% of survivors with a total mean spending of 566 euros. Income loss was present among 9.6% of survivors and averaged 5463 euros among those reporting such. Socioeconomic and clinical factors associated with higher OOP payments (p ≤ 0.05) included age at time of diagnosis (65–79 years), education (10–11 years), (early) retirement, stage of diagnosis (stage III), time from diagnosis (more than 10 years), comorbidities (at least 1), and the use of rehabilitation services. Regarding income loss, age at time of diagnosis (50–59 years), (early) retirement, stage of diagnosis (stage II), time from diagnosis (5–7 years), comorbidities (at least 1), and receiving chemotherapy treatment were associated with higher losses. Conclusions: For some survivors in Germany, financial burden can be considerably high despite comprehensive healthcare and support from social security. Implications for Cancer Survivors: OOP payments related to domestic help and nursing staff as well as to outpatient care are most frequent.