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Asogwa OA, Quansah DY, Boakye D, Ezewuiro ON, Boateng D. Prevalence, patterns, and determinants of multimorbidity among childhood and adult cancer survivors: A systematic review. Crit Rev Oncol Hematol 2023; 192:104147. [PMID: 37778707 DOI: 10.1016/j.critrevonc.2023.104147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 09/15/2023] [Accepted: 09/26/2023] [Indexed: 10/03/2023] Open
Abstract
Development of multimorbidity is common among cancer survivors due to their previous cancer, treatments, or changes in lifestyle. We summarized evidence on the prevalence, patterns, and determinants of multimorbidity among childhood and adult cancer survivors. We searched PubMed and EMBASE databases for articles reporting prevalence, patterns, and determinants of multimorbidity in cancer survivors. Finally, 23/500 articles were included. There was a large variation in the prevalence of multimorbidity (13-89%) among cancer survivors. Bone marrow transplantation, radiation, female sex, lower level of physical activity, increasing age, minority ethnicity, low-income, and low-education were associated with a higher prevalence of multimorbidity. Patterns of multimorbidity were both concordant and discordant. In conclusion, multimorbidity is highly prevalent and a major concern among cancer survivors. A personalized care plan that takes into account the identified risk may be beneficial to reduce the burden of multimorbidity and improve the quality of life among cancer survivors.
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Affiliation(s)
- Ogechukwu A Asogwa
- Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands.
| | - Dan Yedu Quansah
- Obstetric Service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne Switzerland Avenue de la Sallaz, CH-1011 Lausanne, Switzerland; Canadian Women Heart Health Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Daniel Boakye
- School of Health & Life Sciences, University of the West of Scotland, Glasgow PA1 2BE, UK
| | | | - Daniel Boateng
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre, Utrecht, the Netherlands; Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Abdalla T, Walwyn T, White D, Choong CS, Bulsara M, Preen DB, Ohan JL. Hospitalizations and Cost of Inpatient Care for Physical Diseases in Survivors of Childhood Cancer in Western Australia: A Longitudinal Matched Cohort Study. Cancer Epidemiol Biomarkers Prev 2023; 32:1249-1259. [PMID: 37409970 DOI: 10.1158/1055-9965.epi-22-1313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/28/2023] [Accepted: 06/21/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND The long-term effects of childhood cancer are unclear in the Australian context. We examined hospitalization trends for physical diseases and estimated the associated inpatient care costs in all 5-year childhood cancer survivors (CCS) diagnosed in Western Australia (WA) from 1982 to 2014. METHODS Hospitalization records for 2,938 CCS and 24,792 comparisons were extracted from 1987 to 2019 (median follow-up = 12 years, min = 1, max = 32). The adjusted hazard ratio (aHR) of hospitalization with 95% confidence intervals (CI) was estimated using the Andersen-Gill model for recurrent events. The cumulative burden of hospitalizations over time was assessed using the mean cumulative count method. The adjusted mean cost of hospitalization was estimated using the generalized linear models. RESULTS We identified a higher risk of hospitalization for all-cause (aHR, 2.0; 95% CI, 1.8-2.2) physical disease in CCS than comparisons, with the highest risk for subsequent malignant neoplasms (aHR, 15.0; 95% CI, 11.3-19.8) and blood diseases (aHR, 6.9; 95% CI, 2.6-18.2). Characteristics associated with higher hospitalization rates included female gender, diagnosis with bone tumors, cancer diagnosis age between 5 and 9 years, multiple childhood cancer diagnoses, multiple comorbidities, higher deprivation, increased remoteness, and Indigenous status. The difference in the mean total hospitalization costs for any disease was significantly higher in survivors than comparisons (publicly funded $11,483 United States Dollar, P < 0.05). CONCLUSIONS The CCS population faces a significantly higher risk of physical morbidity and higher cost of hospital-based care than the comparisons. IMPACT Our study highlights the need for long-term follow-up healthcare services to prevent disease progression and mitigate the burden of physical morbidity on CCS and hospital services.
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Affiliation(s)
- Tasnim Abdalla
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Thomas Walwyn
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
- Department of Paediatric and Adolescent Oncology and Hematology, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Daniel White
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Catherine S Choong
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Max Bulsara
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - David B Preen
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
| | - Jeneva L Ohan
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
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Deng P, Fu Y, Chen M, Si L. Factors associated with health care utilization and catastrophic health expenditure among cancer patients in China: Evidence from the China health and retirement longitudinal study. Front Public Health 2022; 10:943271. [PMID: 36438282 PMCID: PMC9684646 DOI: 10.3389/fpubh.2022.943271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022] Open
Abstract
Background Cancer, the leading cause of mortality in China, is a significant burden on patients, their families, the medical system, and society at large. However, there is minimal data on health service utilization and catastrophic health expenditure (CHE) among cancer patients in China. The objective of this study was to identify factors associated with health care utilization and CHE in Chinese cancer patients. Methods The 2018 wave of a nationally representative dataset, the China Health and Retirement Longitudinal Study, was used in our study. Of 18,968 respondents recruited for the analysis, 388 were clinically diagnosed with cancer. CHE was defined as household health expenditure that exceeded 40% of non-food household expenses. A binary logistic regression model was used to identify the risks of cancer exposure among all participants, along with the likelihood of CHE in households with cancer patients at the 40% threshold. A negative binomial regression model was used to identify determinants of health service utilization among cancer patients. Results Contracting a family physician (incidence rate ratio IRR: 2.38, 1.18-4.77), Urban Employee Basic Medical Insurance (IRR: 4.02, 1.91-8.46, compared to the uninsured), Urban and Rural Resident Basic Medical Insurance (IRR: 3.08, 1.46-6.49, compared to the uninsured), and higher per-capita household consumption were positively associated with inpatient service utilization. Patients with a college education and above reported a greater number of outpatient visits (IRR: 5.78, 2.56-13.02) but fewer inpatient hospital days (IRR: 0.37, 0.20-0.67). Being diagnosed with a non-cancer chronic non-communicable disease was associated with an increased number of outpatient visits (IRR: 1.20, 1.10-1.31). Of the 388 participants, 50.1% of households had CHE, which was negatively correlated with a larger household size (odds ratio OR: 0.52, 0.32-0.86) and lower socioeconomic status [for quintile 5 (lowest group) OR: 0.32, 0.14-0.72]. Conclusions The socioeconomic characteristics of cancer patients had a considerable impact on their healthcare utilization. Individualized and targeted strategies for cancer management should be implemented to identify high-risk populations and trace the utilization of care among Chinese cancer patients. Strategic purchasing models in cancer care and social health insurance with expanded benefits packages for cancer patients are crucial to tackling the cancer burden in China.
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Affiliation(s)
- Penghong Deng
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Yu Fu
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Mingsheng Chen
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China,Center for Global Health, Nanjing Medical University, Nanjing, China,*Correspondence: Mingsheng Chen
| | - Lei Si
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia,The George Institute for Global Health, University of New South Wales, Kensington, NSW, Australia
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Steineck A, Chow EJ, Doody DR, Mueller BA. Hospitalization and mortality outcomes in the first 5 years after a childhood cancer diagnosis: a population-based study. Cancer Causes Control 2021; 32:739-752. [PMID: 33835282 PMCID: PMC8215887 DOI: 10.1007/s10552-021-01425-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 03/25/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Children with cancer are frequently hospitalized. However, hospitalization and death by disease category are not well defined < 5 years from diagnosis. METHODS We conducted a retrospective cohort study using linked cancer registry-hospital discharge-vital records to identify cancer cases < 20 years at diagnosis during 1987-2012 (n = 4,567) and comparison children without cancer, matched on birth year and sex (n = 45,582). Data linkage identified serious morbidities resulting in cancer- and non-cancer-related hospitalizations or deaths < 5 years from diagnosis. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated to compare relative hospitalization and mortality by disease category and after excluding cancer-related outcomes. Among cancer cases, relative risks of these outcomes for children with solid tumors compared with children with leukemia/lymphoma were also estimated. RESULTS Greater rates of all-cause hospitalization (281.5/1,000 vs. 6.2/1,000 person years) and death (40.7/1,000 vs. 0.15/1,000 person years) were observed in childhood cancer cases than comparators and across all diagnosis categories. Increased hospitalization (31.0/1,000 vs. 6.2/1,000 person years; HR 5.0, 95% CI 4.5-5.5) and death (1.0/1,000 vs. 0.15/1,000 person years; HR 10.4, 95% CI 5.6-19.1) rates remained when cancer-related outcomes were excluded. Although HRs for hospitalization and death did not differ greatly by treatment era, absolute rates of hospitalization were greater (1987-1999: 233.3/1,000; 2000-2012: 320.0/1,000 person years) and death were lesser (1987-1999: 46.3/1,000; 2000-2012: 36.8/1,000 person years) in the later treatment era among cases. Children with solid tumors were less likely to have a cancer-related hospitalization than were those with leukemia/lymphoma (RR 0.91, 95% CI 0.84-0.98). CONCLUSION Even after excluding cancer-related diagnoses, children with cancer experience greater rates of hospitalization and death in all disease categories. Results may guide future toxicity mitigation initiatives and inform anticipatory guidance for families of children with cancer.
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Affiliation(s)
- Angela Steineck
- Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, WA, USA.
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
- Center for Clinical and Translational Research, Seattle Children's Research Institute, 1900 9t h Ave, MS JMB 10-C, Seattle, WA, 98101, USA.
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA, USA.
| | - Eric J Chow
- Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, WA, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - David R Doody
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Beth A Mueller
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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Health and Housing Energy Expenditures: A Two-Part Model Approach. Processes (Basel) 2021. [DOI: 10.3390/pr9060943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Interest in the interaction between energy and health within the built environment has been increasing in recent years, in the context of sustainable development. However, in order to promote health and wellbeing across all ages it is necessary to have a better understanding of the association between health and energy at household level. This study contributes to this debate by addressing the case of Portugal using data from the Household Budget Survey (HBS) microdata database. A two-part model is applied to estimate health expenditures based on energy-related expenditures, as well as socioeconomic variables. Additional statistical methods are used to enhance the perception of relevant predictors for health expenditures. Our findings suggest that given the high significance and coefficient value, energy expenditure is a relevant explanatory variable for health expenditures. This result is further validated by a dominance analysis ranking. Moreover, the results show that health gains and medical cost reductions can be a key factor to consider on the assessment of the economic viability of energy efficiency projects in buildings. This is particularly relevant for the older and low-income segments of the population.
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