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A breast prosthesis, a limb prosthesis, a compression garment, a voice valve, a dental implant and a hearing aid are each the difference between a function working and not working, and each is funded differently. In the United States a federal law requires plans that cover mastectomy to cover prostheses and lymphoedema treatment.
Rehabilitation after cancer runs on devices as much as on therapy. This record collects them, with what is known about how well they work and who pays, and names the places where the funding picture could not be established from a primary source.
Breast prostheses and reconstruction. In the United States the Women's Health and Cancer Rights Act of 1998 is the relevant law. The Department of Labor's own guidance states what it requires: "Under WHCRA, group health plans and health insurance companies offering mastectomy coverage also must provide coverage for certain services relating to the mastectomy in a manner determined in consultation with your attending physician and you. This required coverage includes all stages of reconstruction of the breast on which the mastectomy was performed, surgery and reconstruction of the other breast to produce a symmetrical appearance, prostheses and treatment of physical complications of the mastectomy, including lymphedema." It applies to plans that cover mastectomy, and deductibles and coinsurance may be applied if they are consistent with the plan's other benefits. Church plans and governmental plans may not be subject to it. The protection follows the patient to a new employer's plan. In the United Kingdom, breast prostheses and reconstruction are provided by the health service; the corpus holds separate records on wigs and head coverings, which have a different and nation-dependent charging rule.
Limb prostheses. Fitting, socket replacement and gait training are the practical content of amputation rehabilitation and are covered in the limb record here. Sockets need remaking as the stump changes shape, which happens most in the first year and again whenever weight changes, and children need successive prostheses as they grow.
Compression garments for lymphoedema. The garment is the element of decongestive therapy with the most consistent effect, as the wave one lymphoedema record sets out, and it is a consumable: garments lose compression with washing and wear and need replacing on a schedule. Funding varies by country and by indication within a country.
Voice prostheses. A one-way silicone valve after laryngectomy is replaced when it leaks, which is driven by biofilm growth rather than by a fixed schedule. The abandonment study in the voice record here found that insurance coverage of supplies was not a significant predictor of giving up the device, while housing instability and distance from the hospital were, which argues that access to the clinic matters more than the cost of the valve.
Dental implants after jaw surgery and radiotherapy. The question is whether implants hold in irradiated bone. An umbrella review of 11 systematic reviews covering 73,674 implants found survival of 81.52 per cent in irradiated bone against 94.64 per cent in non-irradiated bone, with the difference supported by 11 separate meta-analyses, and the included reviews were of critically low methodological quality. A narrower systematic review and meta-analysis of 2,602 implants in 660 patients, 425 of whom received radiotherapy, found survival of 97 per cent in non-irradiated patients after an average 37.7 months and 91.9 per cent in irradiated patients after 39.8 months, and osteoradionecrosis in 11 cases, an incidence of 3 per cent. A third meta-analysis of 4,838 implants reported success of 82.47 per cent in irradiated and 89.37 per cent in non-irradiated jaws, with 70.4 per cent in maxillary bone against 94.5 per cent in mandibular bone, and better survival with delayed rather than primary placement (87.7 against 75.5 per cent). The consistent findings across all three are that irradiated bone fails more, the upper jaw fails more than the lower, and osteoradionecrosis is uncommon but serious.
Hearing aids and implants. Platinum chemotherapy and radiotherapy involving the ear cause permanent hearing loss, which the wave one hearing record covers. The device answer is hearing aids for most, and bone-anchored or cochlear implants for a minority. Funding is the sharpest contrast between systems here and it is also where the public sources were least accessible from a script. What can be said from the primary source checked: the Women's Health and Cancer Rights Act covers prostheses after mastectomy and says nothing about hearing. A reader should check their own plan or national rules rather than take a figure from this page.
What could not be verified. The current charging rules for wigs, fabric supports and prescriptions across the four United Kingdom nations, and the detail of Medicare prosthetic and orthotic coverage, could not be read from their primary sources during this work because the pages refused automated access. They are not stated here, rather than stated approximately.
A device substitutes for a structure that is gone. Its value therefore depends on three things that have nothing to do with the device: whether it fits, whether someone taught its use, and whether it is replaced when it wears out. Funding rules act on the third, which is why coverage shows up in the outcome literature as abandonment rather than as dissatisfaction.
Query for this technology: (TITLE:"The devices that do the restoring, and who pays for them" OR ABSTRACT:"The devices that do the restoring, and who pays for them") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about The devices that do the restoring, and who pays for them, not a curated reading list.
Shares Limb salvage, amputation, and the rehabilitation that follows either, Breast reconstruction: implant and autologous, immediate and delayed, and what women report afterwards, Head and neck reconstruction: the free flap, and what it gives back, Compression, decongestive therapy and exercise for lymphoedema and the tags rejuvenation, survivorship, rehabilitation.
Shares Voice after the larynx is removed, Facial reconstruction and facial prostheses: ears, orbits and noses, Limb salvage, amputation, and the rehabilitation that follows either, Breast reconstruction: implant and autologous, immediate and delayed, and what women report afterwards and the tags rejuvenation, survivorship, rehabilitation.
Shares Where rehabilitation is commissioned, and who misses out, Financial toxicity and financial navigation, Patients lack understanding, navigation and agency, Quality of life and the tags rejuvenation, survivorship, rehabilitation.
Shares Where rehabilitation is commissioned, and who misses out, Compression, decongestive therapy and exercise for lymphoedema, Quality of life, Late effects and survivorship toxicity and the tags rejuvenation, survivorship, rehabilitation.
Shares Hearing and tinnitus after platinum chemotherapy, Where rehabilitation is commissioned, and who misses out, Quality of life, Late effects and survivorship toxicity and the tags rejuvenation, survivorship, rehabilitation.
Shares Compression, decongestive therapy and exercise for lymphoedema, Patients lack understanding, navigation and agency, Quality of life, Late effects and survivorship toxicity and the tags rejuvenation, survivorship, rehabilitation.
Shares Voice after the larynx is removed, Head and neck reconstruction: the free flap, and what it gives back, Dry mouth, teeth and taste after head and neck radiotherapy, Laryngeal and hypopharyngeal cancer and the tags rejuvenation, survivorship, rehabilitation.
Shares Quality of life, Late effects and survivorship toxicity, Survivorship and late effects are neglected and the tags rejuvenation, survivorship, rehabilitation.