Improvements in survival and early retirement rates – real-world evidence for Danish breast cancer patients 2004-2018

Background: Historically, Denmark has had poor survival for cancer patients relative to other western countries with comparable healthcare systems. The associated adverse outcomes may have been attributed to lifestyle factors or healthcare system weaknesses. In this study, we examine the long-term cancer impact of a nationwide reform addressing all cancer diagnostics, implemented in 2006. Our analyses include patients diagnosed with breast cancer and their spouses (informal caregivers). Patients and their spouses diagnosed before and after the reform was compared. Focus is on the potential impact on overall survival, early retirement, sick leave, unemployment as well as earnings (income). Methods: In a nationwide retrospective cohort study of real-world data utilizing the Danish National Patient Register we identified 77,474 breast cancer patients between 1 st January 2002 and 31 st December 2018. Data was merged with the National Cancer Register, the Central Person Register, the Education Register, the DREAM Register and the Income Register using citizens’ personal identification number. Spouses of patients were identified through the Central Person Register. Propensity score matching was applied to match populations before and after the reform. Analyses on matched and unmatched populations were performed. Results: In a matched sample of cases diagnosed before and after the reform, we found a 15% reduction in risk of mortality for breast cancer patients after the reform. Moreover, there was a 15% reduced risk of early retirement. The patients diagnosed after the reform had reduced income three to five years after diagnosis relative to those diagnosed before the reform, likely due to survival bias and labour market conditions, such as the financial crisis (2008– 2009). In an unmatched sample of patients diagnosed two years before or after the reform, we found a 7% reduction in mortality. Conclusion: Implementation of the nationwide cancer reform together with advancement in new cancer treatments had a positive impact on the survival of breast cancer patients. The patients diagnosed after the reform also had reduced risk of early retirement, indicating reduced burden of disease relative to those diagnosed before the reform. The results from our study are reassuring that relevant healthcare reforms improve cancer outcome.