2000~2009年肺癌患者临床特征变化和直接医疗费用分析

[目的]分析2000～2009年上海市7 827例新发肺癌患者的临床特征变化以及2009年肺癌患者的直接医疗费用状况,为肺癌综合防治和疾病负担研究提供信息.[方法]采用病历查阅、随访调查和提取收费记录相结合的方法,应用Excel软件建立数据库对数据进行分析.[结果]2000～2009年7 827例肺癌患者平均年龄61.5岁.男、女性别比由2000年的2.7∶1下降至2009年的2.0∶1.病理类型以腺癌为主,占57.0％,且所占比例逐年上升.肺癌Ⅲ～Ⅳ期患者占总病例数的64.2％.2009年新发肺癌患者年人均直接医疗费用57 952.5元,自付费用占41.6％.[结论]应加强对肺癌高危人群的定期筛查、降低疾病经济负担.     

Cost of Treatment for Cancer: Experiences of Patients in Public Hospitals in India

Background: To assess the treatment pattern and expenditure incurred by cancer patients undergoingtreatment at government tertiary hospitals in India. Materials and Methods: A cross-sectional study of 508 cancerpatients randomly selected from tertiary cancer hospitals funded by central/state governments located in majorcities of five states in India, namely Kerala, Maharashtra, Rajasthan, West Bengal and Mizoram, during March- May 2011 was conducted. Information related to direct costs, indirect costs and opportunity costs incurredon investigations and treatment, major source of payment and difficulties faced by patients during the courseof treatment was collected. Results: About 45% of the patients used private health facilities as the first point ofcontact for cancer related diseases as against 32% in public hospitals. About 47% sought private health facilitiesfor cancer investigations, 21% at district/sub-district hospitals, and about 4% contacted primary health carefacilities. A majority of the patients (76%) faced financial problems while undergoing treatment. Conclusions: Theresults highlight the importance of involving the primary health care system in the cancer prevention activities.     

Evaluating Direct Costs of Gastric Cancer Treatment in Iran - Case Study in Kerman City in 2015

Background: Gastrointestinal cancers are common malignancies associated with high mortality rates. Health-care systems are always faced with high costs of treatment of gastrointestinal cancers including stomach cancer. Identification and prioritization of these costs can help determine economic burden and then improve of health planning by policy-makers. This study was performed in 2015 in Kerman City aimed at estimating the direct hospital costs for patients with gastric cancer. Materials and Methods: In this cross-sectional study, the medical records of 160 patients with stomach cancer admitted from 2011 to 2014 to Shafa Hospital were examined, the current stage of the disease and the patients’ health status were identified, and the direct costs related to the type of treatment in the public and private sectors were calculated. SPSS-19 was used for statistical analysis of the data. Results: Of the patients studied, 103 (65%) were men and 57 (35%) were women. The mean age of patients was 65 years. Distribution into four stages of the disease was 5%, 20%, 30%, and 45%, respectively. Direct costs in four stages of the disease were calculated as 2191.07, 2642.93, 2877, and 2674.07 USD (63,045,879, 76,047,934, 82,783,019, and 76,943,800 IRR), respectively. The highest percentage of costs was related to surgery in Stage I and to medication in Stages II, III, and IV. According to the results of direct costs of treatment for stomach cancer in Kerman, the mean total cost of treating a patient in the public sector was estimated at 74,705,158 IRR, of which averages of 60,141,384 IRR and 14,563,774 IRR were the shares of insurance and patients, respectively. Conclusions: The high prevalence and diagnosis of disease in old age and at advanced stages of disease impose great costs on the patients and the health system. Early diagnosis through screening and selecting an appropriate treatment method might largely ameliorate the economic burden of the disease.     

The Burden of Health-Related Out-of-Pocket Cancer Costs in Canada: A Case-Control Study Using Linked Data

Background: The burden of out-of-pocket costs among cancer patients/survivors in Canada is not well understood. The objective of this study was to examine the health-related out-of-pocket cost burden experienced by households with a cancer patient/survivor compared to those without, examine the components of health-related costs and determine who experiences a greater burden. Data and methods: This study used a data linkage between the Survey of Household Spending and the Canadian Cancer Registry to identify households with a cancer patient/survivor (cases) and those without (controls). The out-of-pocket burden (out-of-pocket costs measured relative to household income) and mean costs were described and regression analyses examined the characteristics associated with the household out-of-pocket burden and annual out-of-pocket costs. Results: The health-related out-of-pocket cost burden and annual costs measured in households with a cancer patient/survivor were 3.08% (95% CI: 2.55–3.62%) and CAD 1600 (95% CI: 1456–1759), respectively, compared to a burden of 2.84% (95% CI: 2.31–3.38) and annual costs of CAD 1511 (95% CI: 1377–1659) measured in control households, respectively. Households with a colorectal cancer patient/survivor had a significantly higher out-of-pocket burden compared to controls (mean difference: 1.0%, 95% CI: 0.18, 0.46). Among both cases and controls, the lowest income quintile households experienced the highest health-related out-of-pocket cost burden. Interpretation: Within a universal health care system, it is still relevant to monitor health-related out-of-pocket spending that is not covered by existing insurance mechanisms; however, this is not routinely assessed in Canada. We demonstrate the feasibility of measuring such costs in households with a cancer patient/survivor using routinely collected data. While the burden and annual health-related out-of-pocket costs of households with a cancer patient/survivor were not significantly higher than control households in this study, the routine measurement of out-of-pocket costs in Canada could be systemized, providing a novel, system-level, equity-informed performance indicator, which is relevant for monitoring inequities in the burden of out-of-pocket costs.     

Nutrition Literacy among Cancer Survivors: Feasibility Results from the Healthy Eating and Living Against Breast Cancer (HEAL-BCa) Study: a Pilot Randomized Controlled Trial

Knowledge of nutrition among breast cancer patients is insufficient, despite their motivation to seek valid information about healthy food choices. This study examines the feasibility of nutrition education workshops for cancer survivors, to inform the design of a multi-center intervention. Fifty-nine female English-speaking breast cancer patients, who had completed treatment, were enrolled. Participants were randomized to the intervention or control group. The intervention group attended six nutrition education sessions, and the control group received brochures. Measurements were done at baseline and 3-month follow-up and included the Assessment Instrument for Breast Cancer (NLit-BCa), fruit/vegetable and general health literacy screeners. Height and weight were measured. Changes in nutrition literacy, health literacy, and food intake from baseline to follow-up (within-group change) were calculated for both groups (effect sizes were reported as Cohen’s d). Participants were mostly white, with a mean age of 58 years, BMI of 31.6 kg/m², and had college degrees. Follow-up rates were high (89% = control and 77% = intervention group). At baseline, participants scored high for most NLit-BCa assessment components except food portions in both groups. At the 3-month follow-up, effect sizes (d) on the NLit-BCa ranged from ?0.5 to 0.16. The study met its recruitment goals within 6 months. Focus groups indicated that (a) attending six sessions was acceptable, (b) patients found social/emotional support, (c) improvements should include information for special diets and booster sessions. This pilot study suggests that the intervention was acceptable and that scaling up of this intervention is feasible and could provide benefit to breast cancer survivors.     

Ethnic group and survival from childhood cancer: report from the UK Children's Cancer Study Group

Survival following cancer was analysed in relation to ethnic group among children diagnosed in Britain during 1981-1996 and treated at paediatric oncology centres by members of the UK Children's Cancer Study Group. Survival was analysed for 11 diagnostic groups: acute lymphoblastic leukaemia (ALL), acute non-lymphocytic leukaemia, Hodgkin's disease, non-Hodgkin's lymphoma, astrocytoma, primitive neuroectodermal tumour, neuroblastoma, Wilms' tumour, osteosarcoma, Ewing's sarcoma and rhabdomyosarcoma. There were no significant differences in survival between White and non-White children over the study period as a whole. Among children with ALL, however, the relative risk of death allowing for period of diagnosis, age and white blood count was 1.25 for those of South Asian ethnic origin compared with Whites (P = 0.057).     

A Pilot Study for a Randomized Controlled Trial to Prevent Gastric Cancer in High-risk Japanese Population: Study Design and Feasibility Evaluation

Observational epidemiological studies suggest that some nutrients reduce the risk of gastric cancer and that individuals with atrophic gastritis are at high risk of developing gastric cancer. One possible measure for gastric cancer prevention is therefore nutritional supplementation for the high risk group. Before recommending this strategy for the general public, however, a randomized controlled trial (RCT) is necessary. To evaluate the feasibility of an RCT, the authors conducted a pilot study using recipients of a health check-up program in a general hospital in Japan. The subjects who were asked to participate in the trial had been diagnosed as having atrophic gastritis on the basis of serum pepsinogen I <70 ng/ml and the ratio of pepsinogen I to II <3.0. They were requested to ingest double-blinded capsules containing different levels of vitamin C and β-carotene every day. Out of the 219 subjects (118 males, 101 females) who were eligible for the study and had the required pepsinogen measurement, 90 (41%) met the criteria for atrophic gastritis. Among them, 55 (61%) (35 males, 20 females) gave their informed consent to participate in the RCT. Fifty-four participants completed a 3-month course of supplementation, and all of them agreed to a 5-year supplementation period. The authors concluded that an RCT using double-blinded nutritional supplements and targeting apparently healthy individuals is feasible in an intervention study for cancer prevention in Japan.     

A Self-Help Guided Psychoeducational Intervention for Indonesian Women with Breast Cancer Symptoms: Development and Pilot Feasibility Study

Background: Delay in the diagnosis of breast cancer (BC) may lead to an advanced stage of the disease and apoor prognosis. A psychoeducational intervention can be crucial in helping women with BC symptoms complete theexamination procedures and reduce diagnosis delay of BC. Objective: To develop a psychoeducational interventionto reduce the delay of BC diagnosis among Indonesian women with BC symptoms. Methods: The development ofthe intervention included an inventory of crucial elements in developing psychoeducation through literature review aswell as consultation with BC patients and healthcare providers. Additionally, we developed PERANTARA as the firstpilot version of the self-help guided psychoeducational intervention. PERANTARA is an abbreviation for “PengantarPerawatan Kesehatan Payadura”, which means an introduction to breast health treatment. The pilot feasibility studycombined an expert review and a pilot testing in hospital settings. A semi-structured interview and the client satisfactioninventory were utilized to measure feasibility and acceptability of the intervention for Indonesian women with BCsymptoms. Results: PERANTARA contained an oncologist’s explanation about BC and the BC survivors’ testimonyto reduce the time to diagnosis. The pilot study results showed that most patients were satisfied with and trusted onPERANTARA. Conclusion: PERANTARA was feasible and acceptable for Indonesian patients with BC symptoms.The development framework suggested in this study can be applied to develop psychoeducational packages for otherpatients group, in particular, those interventional packages aimed at reducing diagnosis and treatment delays and nonadherence.     

Risk Factors and Costs of Oral Cancer in a Tertiary Care Hospital in Delhi

The present study conducted with 100 oral cancer patients at a private tertiary care hospital inDelhidemonstrated that stage III cancer was associated with longer use of tobacco and poor oral hygiene. Therewas also statistically significant association (p<.05) between consumption of tobacco and alcohol. More than 60%treatment expenditure was on surgery followed by accommodation (9%) and investigations (8%). The effect oftobacco was well known among patients as 76% of the patients knew that common cancer in tobacco cheweris ‘oral cancer’, 22% of the patients however responded that they did not know which cancer is common intobacco chewers. 58% said that they learnt about ill effects of tobacco from media while 24% said they learntfrom family and friends. Out of 78 tobacco users, 60 (77%) said that they never received help to quit tobaccowhile 18(23%) have received help to quit.     

Association of ABO Blood Group and Risk of Lung Cancer in a Multicenter Study in Turkey

Background: The ABO blood groups and Rh factor may affect the risk of lung cancer. Materials and Methods:We analyzed 2,044 lung cancer patients with serologically confirmed ABO/Rh blood group. A group of 3,022,883healthy blood donors of Turkish Red Crescent was identified as a control group. We compared the distributionsof ABO/Rh blood group between them. Results: The median age was 62 years (range: 17-90). There was a clearmale predominance (84% vs. 16%). Overall distributions of ABO blood groups were significantly differentbetween patients and controls (p=0.01). There were also significant differences between patients and controls withrespect to Rh positive vs. Rh negative (p=0.04) and O vs. non-O (p=0.002). There were no statistically significantdifferences of blood groups with respect to sex, age, or histology. Conclusions: In the study population, ABOblood types were associated with the lung cancer. Having non-O blood type and Rh-negative feature increasedthe risk of lung cancer. However, further prospective studies are necessary to define the mechanisms by whichABO blood type may influence the lung cancer risk.     

Out-of-Pocket Costs and Perceived Financial Burden Associated with Prostate Cancer Treatment in a Quebec Remote Area: A Cross-Sectional Study

Background: In publicly funded healthcare systems, patients do not pay for medical visits but can experience costs stemming from travel or over-the-counter drugs. We lack information about the extent of this burden in Canadian remote regions. This study aimed to: (1) describe prostate cancer-related out-of-pocket costs and perceived financial burden, and (2) identify factors associated with such a perceived burden among prostate cancer patients living in a remote region of the province of Quebec (Canada). Methods: A cross-sectional study was conducted among 171 prostate cancer patients who consulted at the outpatient clinic of the Centre Hospitalier de Rouyn-Noranda. Results: The majority of patients (83%) had incurred out-of-pocket costs for their cancer care. The mean total cost incurred in the last three months was $517 and 22.3% reported a moderate, considerable or unsustainable burden. Multivariable analysis revealed that having incurred higher cancer-related out-of-pocket costs (OR: 1.001; 95%CI: 1.001–1.002) private drug insurance (vs. public, OR: 5.23; 95%CI: 1.13–24.17) was associated with a greater perceived financial burden. Having better physical health-related quality of life (OR: 0.95; 95%CI: 0.913–0.997), a university education (vs. elementary/high school level, OR: 0.03; 95%CI: 0.00–0.79), and an income between $40,000 and $79,999 (vs. ≤ $39,999, OR: 0.15; 95%CI: 0.03–0.69) were associated with a lower perceived burden. Conclusion: Prostate cancer patients incur out-of-pocket costs even if they were diagnosed many years ago and the perceived burden is significant. Greater attention should be paid to the development of services to help patients manage this burden.     

Colorectal Cancer Risk Factors among the Population of South-East Siberia: A Case-Control Study

Colorectal cancer remains one of the most widespread malignancies in the world. However, there is a lackof comprehensive studies considering colorectal cancer risk factors among Russian populations, particularlyin Siberia. The aim of this investigation was to determine the impact of various lifestyle, dietary, family, andsocioeconomical factors on colorectal cancer risk in South-East Siberia. We recruited 185 Russian colorectal cancercases and 210 gender-, age-, and ethnicity-matched asymptomatic controls with no history of any malignant tumor,using a specially designed questionnaire to obtain relevant information. After the statistical analysis, we definedseveral significant factors affecting colorectal cancer risk. Among these were smoking (OR=2.13, 95%CI=1.4-3.24, P=0.0004), being overweight (BMI between 25-30, OR=2.45, 95%CI=1.49-4.03, P=0.0004), alcohol drinking(OR=8.73, 95%CI=5.49-13.87, P<0.0001), beer drinking (OR=9.24, 95%CI=5.14-16.61, P<0.0001), consumptionof hard liquor (OR=9.37, 95%CI=5.92-14.82, P<0.0001), excessive red meat consumption (P<0.0001), excessiveintake of red meat products (P<0.0001), excessive intake of dairy products (P<0.0001), excessive sour cream andcheese consumption (P<0.0001 and 0.0002, respectively), spicy food consumption (OR=2.87, 95%CI=1.9-4.33,P<0.0001), family history of gastrointestinal malignant tumors (OR=3.99, 95%CI=2.09-7.59, P<0.0001), andincome exceeding twice the subsistence minimum (OR=5.34, 95%CI=3.35-8.53, P<0.0001). Certain factors, suchas high concentration of salt in the food and precancerous colonic lesions, demonstrated borderline significance(OR=3.45, 95%CI=1.68-7.1, P=0.0008, and OR=5.25, 95%CI=1.94-14.22, P=0.001, respectively). Some factorswere established as protective, like consumption of rye bread and both rye and wheat bread (OR=0.32,95%CI=0.21-0.5, P<0,0001, and OR=0.07, 95%CI=0.02-0.21, P<0.0001, respectively), and also low concentrationof salt in the food, although this was of borderline significance (OR=0.43, 95%CI=0.26-0.69, P=0.0006). ABOand Rhesus blood antigens were not associated with increased colorectal cancer risk. These results should bedefinitely applied for elaboration of programs of colorectal cancer prevention in Russia, particularly in Siberia.     

Burden of Cancers Related to Smoking among the Indonesian Population: Premature Mortality Costs and Years of Potential Life Lost

Background: As smoking is the leading preventable cause of multiple diseases and premature cancer deaths,estimating the burden of cancer attributable to smoking has become the standard in documenting the adverseimpact of smoking. In Indonesia, there is a dearth of studies assessing the economic costs of cancers related tosmoking. This study aimed to estimate indirect mortality costs of premature cancer deaths and years of potentiallife lost (YPLL) attributable to smoking among the Indonesian population. Materials and Methods: A prevalencebased method was employed. Using national data, we estimated smoking-attributable cancer mortality in 2013.Premature mortality costs and YPLL were estimated by calculating number of cancer deaths, life expectancy,annual income, and workforce participation rate. A human capital approach was used to calculate the presentvalue of lifetime earnings (PVLE). A discount rate of 3% was applied. Results: The study estimated that smokingattributable cancer mortality was 74,440 (30.6% of total cancer deaths), comprised of 95% deaths in men and 5%in women. Cancers attributed to smoking wereresponsible for 1,207,845 YPLL. Cancer mortality costs causedby smoking accounted for USD 1,309 million in 2013. Among all cancers, lung cancer is the leading cause ofdeath and economic burden. Conclusions: Cancers related to smoking pose an enormous economic burden inIndonesia. Therefore, tobacco control efforts need to be prioritized in order to prevent more losses to the nation.The data of this study are important for advocating national tobacco control policy.