Abstract P6-09-06: Family Members' Burden in Patients with Metastatic and Early Stage Breast Cancer
Authors: Wan Y , Gao X , Mehta S , Zhang Z , Faria C , Schwartzberg L 
Published: August 2014

Abstract
BACKROUND: No previous studies have assessed the indirect costs attributable to family members of patients with metastatic breast cancer (MBC). This retrospective database study compared productivity loss and cost associated with family members of patients with MBC vs. early-stage breast cancer (EBC).
METHODS: The Thomson Reuters MarketScan Health and Productivity Management (HPM) data (2005–2009) were used. MBC and EBC patients with no other tumors and 12-month continuous enrollment in medical insurance after the index diagnosis date were identified. Adult working family members of these MBC/EBC patients were identified based on their enrollee ID numbers since the enrollees from the same family were assigned the same ID except for the last two digits. The patients' working family members who were eligible for absenteeism and did not have any cancer diagnosis were included and used as a proxy for “caregivers”. The reasons for absenteeism included sickness, personal leave, disability, recreation, Family and Medical Leave Act (FMLA) and others. The productivity loss was measured as the leave days taken under FMLA or personal leave by the family members during a 12-month follow-up period. Associated indirect costs were estimated by multiplying leave days with daily wages obtained from the 2011 Bureau of Labor Statistics. Descriptive analyses and a generalized linear model with log link and gamma distribution were conducted.
RESULTS: A total of 209 MBC/1,166 EBC patients' family members were eligible for absenteeism, with a mean age of 50/51 years. 1,373 out of the 1,375 family members were male. Majority of the family members (52%) worked in manufacturing industry, followed by transportation/communication/utilities (28%) and oil gas extraction/mining industry (15%). 52% of the family members had PPO health insurance. Family members of MBC and EBC patients had similar clinical and demographic characteristics. Similar proportions of MBC and EBC patients' family members had overall and individual type of absenteeism. However, MBC patients' family members had more FMLA/personal leave days and higher costs vs. EBC patients (overall mean: 2.8±6.1 vs. 2.1±4.8; $2,366±5,095 vs. $1,741±3,995, both p = .047). Among those who had non-zero FMLA/personal leave days (MBC vs. BC: N=92/44% vs. 502/43%), mean FMLA/personal leave days and costs were 6.4±7.8 vs. 4.8±6.3; $5,375±6,556 vs. $4,043±5,272 respectively, both p = .033. After adjusting for covariates, MBC patients' family members incurred 40% (p = .06) more absenteeism-related costs due to FMLA/personal leave vs. EBC patients' family members. Additionally, occupation in oil/gas extraction/mining (vs. manufacturing non-durable goods industry, p &lt; .001) and Northeast and South regions (vs. West, p &lt; .001) were associated with higher FMLA/personal leave costs.
CONCLUSIONS: Productivity loss in MBC patients' family members was substantial and higher than family members of EBC patients, which is expected with the differing goals, type and length of treatment for MBC and EBC. The patients' family members were used as a proxy of the “caregivers” with limitations that prevent generating accurate estimates on caregiver costs. Nevertheless the findings showed that the productivity loss in MBC patients' family members was considerable.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-09-06.