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Yang YH. Current advances of oral cancer in Taiwan. Oral Dis 2024. [PMID: 39072913 DOI: 10.1111/odi.15076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 07/01/2024] [Accepted: 07/08/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVES To provide updated statistics of oral cancer incidence and mortality in Taiwan, and to describe recent developments for oral cancer control to reduce oral cancer incidence and mortality. METHODS The Taiwan Cancer Registry Annual Report 2023, the Taiwan Cancer Registry Online Interactive Search System, and the 2023 Health Promotion Administration Annual Report are consulted and summarized. A literature search using PubMed was also conducted to identify Taiwan oral cancer control-related studies. RESULTS Taiwan, with a long history of areca/betel quid chewing, has battled with oral cancer for decades. In 2021, the male lip and oral cavity cancer incidence is 29.77 (per 100,000 persons) and mortality is 11.25. Over these years, the male chewing prevalence was reduced to 6.2% in 2018. Taiwan has a sustained national oral cancer screening programme provided to high-risk groups biennially. CONCLUSIONS Although the age-standardized incidence rates have been slowly decreasing since 2009, due to Taiwan's ageing population, the actual oral cancer burden is still stringent. The collaboration of multi-ministries and agencies on promoting areca nut and betel quid control, improving oral cancer awareness, and delivering cancer care remains essential to prevent oral cancer and reduce oral cancer deaths.
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Affiliation(s)
- Yi-Hsin Yang
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
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2
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Lo WC, Hu TH, Shih CY, Lin HH, Hwang JS. Impact of Healthy Lifestyle Factors on Life Expectancy and Lifetime Health Care Expenditure: Nationwide Cohort Study. JMIR Public Health Surveill 2024; 10:e57045. [PMID: 39018094 PMCID: PMC11292159 DOI: 10.2196/57045] [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: 02/03/2024] [Revised: 03/20/2024] [Accepted: 05/17/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND The association between lifestyle risk factors and the risk of mortality and chronic diseases has been established, while limited research has explored the impact of healthy lifestyle factors on lifetime health care expenditure using longitudinal individual data. OBJECTIVE We aimed to determine the individual and combined effects of 5 healthy lifestyle factors on life expectancy and lifetime health care expenditure in Taiwan. METHODS Using data from the National Health Interview Survey cohort, 5 healthy lifestyle behaviors were defined and analyzed: nonsmoking, avoiding excessive alcohol consumption, engaging in sufficient physical activity, ensuring sufficient fruit and vegetable intake, and maintaining a normal weight. We used a rolling extrapolation algorithm that incorporated inverse probability of treatment weighting to estimate the life expectancy and lifetime health care expenditure of the study populations with and without healthy lifestyle factors. RESULTS A total of 19,893 participants aged ≥30 (mean age 48.8, SD 13.4) years were included, with 3815 deaths recorded during a median follow-up period of 15.6 years. The life expectancy and per capita estimated lifetime health care expenditures for the overall study population were 35.32 years and US $58,560, respectively. Multivariable-adjusted hazard ratios for all-cause mortality in participants adhering to all 5 healthy lifestyle factors, compared with those adhering to none, were 0.37 (95% CI 0.27-0.49). We found significant increases in life expectancy for nonsmokers (2.31 years; 95% CI 0.04-5.13; P=.03), those with sufficient physical activity (1.85 years; 95% CI 0.25-4.34; P=.02), and those with adequate fruit and vegetable intake (3.25 years; 95% CI 1.29-6.81; P=.01). In addition, nonsmokers experienced a significant reduction in annual health care expenditure (-9.78%; 95% CI -46.53% to -1.45%; P=.03), as did individuals maintaining optimal body weight (-18.36%; 95% CI -29.66% to -8.57%; P=.01). Overall, participants adhering to all 5 healthy lifestyle behaviors exhibited a life gain of 7.13 years (95% CI 1.33-11.11; P=.02) compared with those adhering to one or none, with a life expectancy of 29.19 years (95% CI 25.45-33.62). Furthermore, individuals adopting all 5 healthy lifestyle factors experienced an average annual health care expenditure reduction of 28.12% (95% CI 4.43%-57.61%; P=.02) compared with those adopting one or none. CONCLUSIONS Adopting a healthy lifestyle is associated with a longer life expectancy and a reduction of health care expenditure in Taiwanese adults. This contributes to a more comprehensive understanding of the impact of healthy lifestyle factors on the overall health and economic burden.
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Affiliation(s)
- Wei-Cheng Lo
- Master Program in Applied Epidemiology, College of Public Health, Taipei Medical University, New Taipei, Taiwan
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Tsuey-Hwa Hu
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Cheng-Yu Shih
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Hsien-Ho Lin
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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3
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Wang JD, Lai WW, Yang SC, Huang WY, Hwang JS. Estimating Taiwan's QALY league table for catastrophic illnesses: Providing real-world evidence to integrate prevention with treatment for resources allocation. J Formos Med Assoc 2024:S0929-6646(24)00247-X. [PMID: 38772804 DOI: 10.1016/j.jfma.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 04/21/2024] [Accepted: 05/14/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND/PURPOSE Curative technologies improve patient's survival and/or quality of life but increase financial burdens. Effective prevention benefits all three. We summarize estimation methods and provide examples of how much money is spent per quality-adjusted life year (QALY) or life year (LY) on treating a catastrophic illness under a lifetime horizon and how many QALYs/LYs and lifetime medical costs (LMC) could be potentially saved by prevention. METHODS We established cohorts by interlinkages of Taiwan's nation-wide databases including National Health Insurance. We developed methods to estimate lifetime survival functions, which were multiplied with the medical costs and/or quality of life and summed up to estimate LMC, quality-adjusted life expectancy (QALE) and lifetime average cost per QALY/LY for catastrophic illnesses. By comparing with the age-, sex-, and calendar year-matched referents simulated from vital statistics, we obtained the loss-of-QALE and loss-of-life expectancy (LE). RESULTS The lifetime cost-effectiveness ratios of ventilator-dependent comatose patients, dialysis, spinal cord injury, major trauma, and cancers were US$ 96,800, 16,200-20,000, 5500-5,900, 3400-3,600, and 2900-11,900 per QALY or LY, respectively. The successful prevention of lung, liver, oral, esophagus, stomach, nasopharynx, or ovary cancer would potentially save US$ 28,000-97,000 and > 10 QALYs; whereas those for end-stage kidney disease, stroke, spinal injury, or major trauma would be US$ 55,000-300,000 and 10-14 QALYs. Loss-of-QALE and loss-of-LE were less confounded indicators for comparing the lifetime health benefits of different technologies estimated from real-world data. CONCLUSIONS Integration of prevention with treatment for resources allocation seems feasible and would improve equity and efficiency.
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Affiliation(s)
- Jung-Der Wang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
| | - Wu-Wei Lai
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Surgery, An Nan Hospital, China Medical University, Tainan, Taiwan
| | - Szu-Chun Yang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wen-Yen Huang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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4
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Su CH, Hsu PS, Lin CS. Impact of the COVID-19 pandemic on population-based cancer screening, a nationwide retrospective study in Taiwan. BMC Health Serv Res 2023; 23:878. [PMID: 37605162 PMCID: PMC10440859 DOI: 10.1186/s12913-023-09901-x] [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: 08/20/2022] [Accepted: 08/10/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND The Coronavirus disease 2019 (COVID-19) pandemic has placed a great burden on Taiwan's health care system. It has also had a great impact on other public health issues, including cancer screening. Delayed cancer screening was also noticed in the U.S. during the pandemic, which may have led to both delayed diagnosis and poor prognosis. In Taiwan, population-based cancer screening for breast cancer, oral cancer, colon cancer and cervical cancer has been executed and ongoing for years. METHOD In this study we have analyzed the change in screening numbers for cancer during the period of the 2019 to 2021 COVID-19 outbreak in Taiwan. RESULTS Through our results we found that total cancer screening numbers decreased from 307,547 to 103,289 (a 66% decrease) from the years 2020 to 2021. Specifically, a 63%, 79%, 65% and 71% decrease in screening cases was seen for colon cancer, oral cancer, cervical cancer and breast cancer, respectively, during that period. A similar condition was noticed when comparing 2019 to 2021 when the disclosed total cancer screening numbers decreased by 70% (2019-2021); 65%, 83%, 70% and 76% in colon cancer, oral cancer, cervical cancer and breast cancer, respectively. Among these various cancer screenings, oral cancer screening showed the greatest reduction rate (a drop of 83% compared to 2019 and 79% compared to 2020). We also compared the reduction rates taken from different regions in Taiwan. It was in Taipei, where most COVID-19 cases were noted, that the greatest reduction rate of cancer screening numbers occurred (a drop of76% compared to 2019 and 74% compared to 2020). A proportional decrease of screening cases was also noticed in all areas when confirmed COVID-19 cases rose. CONCLUSIONS Screening for cancers dropped significantly due to the pandemic and its effect on long-term health needs to be evaluated. Additionally, efforts should be taken to address these cancer screening number deficits which have taken place during the COVID-19 pandemic.
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Affiliation(s)
- Chih-Hsuan Su
- Department of Family Medicine, Da-Chien Hospital, Miaoli, 36052, Taiwan
- Department of Environment and Occupational Medicine, Taichung Veterans General Hospital, Taichung, 407219, Taiwan
| | - Pi-Shan Hsu
- Department of Family Medicine, Taichung Veterans General Hospital, 407219, Taichung, Taiwan
- Graduate Institute of Microbiology and Public Health, College of Veterinary Medicine, National Chung-Hsing University, Taichung, Taiwan
| | - Chu-Sheng Lin
- Department of Family Medicine, Taichung Veterans General Hospital, 407219, Taichung, Taiwan.
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
- Center for Geriatrics & Gerontology, Taichung Veterans General Hospital, Taichung, 407219, Taiwan.
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5
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Lin SM, Yang SC, Wu TI, Wang JD, Liu LF. Estimation of disability free life expectancy in non small cell lung cancer based on real world data. Sci Rep 2023; 13:13318. [PMID: 37587142 PMCID: PMC10432474 DOI: 10.1038/s41598-023-40117-5] [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: 03/06/2023] [Accepted: 08/04/2023] [Indexed: 08/18/2023] Open
Abstract
To quantify the societal impact of disability in patients with non-small cell lung cancer (NSCLC), this study estimated the disability-free life expectancy (DFLE), loss-of-DFLE and explored their associations with quality-adjusted life expectancy (QALE) and loss-of-QALE. We interlinked national databases and applied a rolling-over algorithm to estimate the lifetime survival function for patients with NSCLC. Using the EuroQOL-5 Dimension (EQ-5D) and Barthel index (BI), we repeatedly measured the quality-of-life and disability functions of NSCLC patients who visited our hospital from 2011 to 2020. Age-, sex-matched referents were simulated from lifetables of the same calendar year of diagnosis. We categorized BI scores ≤ 70 as in need of long-term care and constructed linear mixed models to estimate the utility values and disability scores. We collected 960 cases and 3088 measurements. The proportions of measurements without disability at age 50-64 and in stage I-IIIa, 50-64 and stage IIIb-IV, 65-89 and stage I-IIIa and 65-89 and stage IIIb-IV were 97.3%, 89.3%, 94.8%,78.3%, corresponding to DFLEs of 15.3, 2.4, 6.8, 1.2 years and losses-of-DFLE of 8.1, 20.7, 4.0, 8.6 years, respectively, indicating that advanced stage had a stronger effect than old age. Survivors in advanced stages showed increased demands for assistance in almost all subitems. The DFLEs seemed to be approximate to the QALEs and the latter were shorter than the former due to discomfort and depression. From a societal perspective, future health technology assessment should consider the impact of lifetime duration of functional disability. Early diagnosis of NSCLC may decrease the burden of long-term care.
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Affiliation(s)
- Shin-Mao Lin
- Department of Environmental and Occupational Medicine, National Cheng Kung University Hospital, College of Medicine, Tainan, Taiwan
| | - Szu-Chun Yang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tzu-I Wu
- Department of Environmental and Occupational Medicine, National Cheng Kung University Hospital, College of Medicine, Tainan, Taiwan
| | - Jung-Der Wang
- Department of Environmental and Occupational Medicine, National Cheng Kung University Hospital, College of Medicine, Tainan, Taiwan
- Department of Environmental and Occupational Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Li-Fan Liu
- Department of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- Department of Geriatric, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng-Li Road, Tainan, 70428, Taiwan.
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6
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Lin C, Chen W, Shia B, Wu S. Statin use and its association with decreased risk of esophageal squamous cell carcinoma in betel nut chewers. Thorac Cancer 2023; 14:2241-2250. [PMID: 37395565 PMCID: PMC10423659 DOI: 10.1111/1759-7714.15009] [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: 05/26/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND Betel nut chewing involves the chewing of areca nuts or betel quid (areca nuts wrapped in betel leaves), which is associated with an increased risk of esophageal squamous cell carcinoma (ESCC). Statins have anticancer properties. We investigated the association between statin use and ESCC risk in betel nut chewers. METHODS The study included 105 387 betel nut chewers matched statin users and nonusers. Statin use was defined as the use of ≥28 cumulative defined daily doses (cDDDs) of statin. The primary outcome was incidence of ESCC. RESULTS The incidence rate of ESCC was significantly lower in statin users than in nonusers (2.03 vs. 3.02 per 100 000 person-years). Statin users had a lower incidence rate ratio of 0.66 for ESCC (95% confidence interval [CI]: 0.43-0.85) relative to nonusers. After potential confounders were adjusted for, statin use was determined to be associated with a reduced risk of ESCC (adjusted hazard ratio [aHR], 0.68; 95% CI: 0.51-0.91). A dose-response relationship was observed between statin use and ESCC risk; the aHRs for statin use at 28-182 cDDDs, 183-488 cDDDs, 489-1043 cDDDs, and > 1043 cDDDs were 0.92, 0.89, 0.66, and 0.64, respectively. CONCLUSION Statin use was revealed to be associated with a reduced risk of ESCC in betel nut chewers.
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Affiliation(s)
- Chih‐Lang Lin
- Liver Research Center, Department of Gastroenterology and HepatologyKeelung Chang Gung Memorial HospitalKeelungTaiwan
- Community Medicine Research CenterKeelung Chang Gung Memorial HospitalKeelungTaiwan
- College of MedicineChang Gung UniversityTaiwan
| | - Wan‐Ming Chen
- Graduate Institute of Business Administration, College of ManagementFu Jen Catholic UniversityTaipeiTaiwan
- Artificial Intelligence Development CenterFu Jen Catholic UniversityTaipeiTaiwan
| | - Ben‐Chang Shia
- Graduate Institute of Business Administration, College of ManagementFu Jen Catholic UniversityTaipeiTaiwan
- Artificial Intelligence Development CenterFu Jen Catholic UniversityTaipeiTaiwan
| | - Szu‐Yuan Wu
- Graduate Institute of Business Administration, College of ManagementFu Jen Catholic UniversityTaipeiTaiwan
- Artificial Intelligence Development CenterFu Jen Catholic UniversityTaipeiTaiwan
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health ScienceAsia UniversityTaichungTaiwan
- Division of Radiation Oncology, Lo‐Hsu Medical FoundationLotung Poh‐Ai HospitalYilanTaiwan
- Big Data Center, Lo‐Hsu Medical FoundationLotung Poh‐Ai HospitalYilanTaiwan
- Department of Healthcare Administration, College of Medical and Health ScienceAsia UniversityTaichungTaiwan
- Cancer Center, Lo‐Hsu Medical FoundationLotung Poh‐Ai HospitalYilanTaiwan
- Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang HospitalTaipei Medical UniversityTaipeiTaiwan
- Department of Management, College of ManagementFo Guang UniversityYilanTaiwan
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Raman S, Shafie AA, Tan BY, Abraham MT, Chen Kiong S, Cheong SC. Economic Evaluation of Oral Cancer Screening Programs: Review of Outcomes and Study Designs. Healthcare (Basel) 2023; 11:healthcare11081198. [PMID: 37108032 PMCID: PMC10138408 DOI: 10.3390/healthcare11081198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/09/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
A lack of guidance on economic evaluations for oral cancer screening programs forms a challenge for policymakers and researchers to fill the knowledge gap on their cost-effectiveness. This systematic review thus aims to compare the outcomes and design of such evaluations. A search for economic evaluations of oral cancer screening was performed on Medline, CINAHL, Cochrane, PubMed, health technology assessment databases, and EBSCO Open Dissertations. The quality of studies was appraised using QHES and the Philips Checklist. Data abstraction was based on reported outcomes and study design characteristics. Of the 362 studies identified, 28 were evaluated for eligibility. The final six studies reviewed consisted of modeling approaches (n = 4), a randomized controlled trial (n = 1), and a retrospective observational study (n = 1). Screening initiatives were mostly shown to be cost-effective compared to non-screening. However, inter-study comparisons remained ambiguous due to large variations. The observational and randomized controlled trials provided considerably accurate evidence of implementation costs and outcomes. Modeling approaches, conversely, appeared more feasible for the estimation of long-term consequences and the exploration of strategy options. The current evidence of the cost-effectiveness of oral cancer screening remains heterogeneous and inadequate to support its institutionalization. Nevertheless, evaluations incorporating modeling methods may provide a practical and robust solution.
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Affiliation(s)
- Sivaraj Raman
- Centre for Health Economics Research, Institute for Health Systems Research, National Institutes of Health, Shah Alam 40170, Malaysia
| | - Asrul Akmal Shafie
- Institutional Planning and Strategic Center, Universiti Sains Malaysia, Penang 11800, Malaysia
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang 11800, Malaysia
| | - Bee Ying Tan
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang 11800, Malaysia
| | - Mannil Thomas Abraham
- Oral and Maxillofacial Surgery Department, Hospital Tengku Ampuan Rahimah, Ministry of Health, Klang 41200, Malaysia
| | - Shim Chen Kiong
- Oral and Maxillofacial Surgery Department, Hospital Umum Sarawak, Ministry of Health, Kuching 93586, Malaysia
| | - Sok Ching Cheong
- Digital Health Research Unit, Cancer Research Malaysia, Subang Jaya 47500, Malaysia
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, University of Malaya, Kuala Lumpur 50603, Malaysia
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Juan YC, Su YF, Bai CH, Fan YC, Kuo TT, Ko HH, Peng HH, Chiang CP, Fwu CW, Cheng SJ. ZNF582 hypermethylation as a prognostic biomarker for malignant transformation of oral lesions. Oral Dis 2023; 29:505-514. [PMID: 34145953 DOI: 10.1111/odi.13946] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/12/2021] [Accepted: 06/05/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This hospital-based cohort study evaluated whether ZNF582 and PAX1 methylation levels at baseline can be used as biomarkers to identify lesions with a high potential for malignant transformation in patients with normal mucosa and oral potentially malignant disorders. PATIENTS AND METHODS We recruited 171 adult patients with normal mucosa and oral potentially malignant disorders in 2012-2014. They were followed until 2017. Outcomes, including advanced histopathological findings and oral cancer occurrence, were obtained from medical charts, the Taiwan Cancer Registry, and cause-of-death data. Kaplan-Meier analysis and Cox proportional hazards regression models were used to examine the association of ZNF582 and PAX1 methylation levels at baseline with subsequent outcome occurrences. RESULTS After 260,192 days of follow-up, 11 cases of oral cancer and 4 cases of advanced histopathological progression occurred. Patients with higher ZNF582 and PAX1 methylation levels at baseline had a higher incidence of disease progression. After adjustment for all studied factors using Cox proportional hazards regression models, ZNF582m level (adjusted hazard ratio, 11.41; 95% CI, 2.05-63.36; p = 0.005) was the only significant and independent predictor of disease progression. CONCLUSIONS ZNF582 hypermethylation can be an effective and noninvasive biomarker for identifying oral lesions with a high potential for malignant transformation.
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Affiliation(s)
- Yi-Chen Juan
- iStat Biomedical Co., Ltd., New Taipei City, Taiwan
| | - Yee-Fun Su
- iStat Biomedical Co., Ltd., New Taipei City, Taiwan
| | - Chyi-Huey Bai
- Department of Public Health, College of Medicine, Taipei Medical University, Taipei, Taiwan.,School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Yen-Chun Fan
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Tzu-Tung Kuo
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Hui-Hsin Ko
- School of Dentistry, Graduate Institute of Clinical Dentistry, National Taiwan University, Taipei, Taiwan.,Department of Dentistry, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Dentistry, College of Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Hsin-Hui Peng
- School of Dentistry, Graduate Institute of Clinical Dentistry, National Taiwan University, Taipei, Taiwan.,Department of Dentistry, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Dentistry, College of Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Chun-Pin Chiang
- School of Dentistry, Graduate Institute of Clinical Dentistry, National Taiwan University, Taipei, Taiwan.,Department of Dentistry, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Dentistry, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Department of Dentistry, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | | | - Shih-Jung Cheng
- School of Dentistry, Graduate Institute of Clinical Dentistry, National Taiwan University, Taipei, Taiwan.,Department of Dentistry, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan.,School of Dentistry, National Taiwan University, Taipei, Taiwan
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9
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Lo WC, Hu TH, Hwang JS. Lifetime exposure to PM 2.5 air pollution and disability-adjusted life years due to cardiopulmonary disease: A modeling study based on nationwide longitudinal data. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 855:158901. [PMID: 36176245 DOI: 10.1016/j.scitotenv.2022.158901] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 09/07/2022] [Accepted: 09/17/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND As knowledge of the health risks of PM2.5 has grown, the focus of PM2.5-related health impact assessments has evolved from simple risk models to burden-of-disease estimates. We proposed an ecological approach to directly estimate the impacts of lifetime exposure to PM2.5 on expected health losses due to cardiopulmonary diseases for older adult populations in Taiwan. METHODS We created study cohorts of 3.5 million older people living in 350 townships in Taiwan. We used a weighted regression model, with adjustments of area characteristic variables, to directly estimate the impacts of lifetime mean PM2.5 exposure on health losses among the 350 cohorts. Potential avoidable disability-adjusted life years (DALYs) by assuming that ambient PM2.5 met the air quality standard was estimated. RESULTS Each 10 μg/m3 increase in lifetime mean exposure to PM2.5 for an individual corresponded to an increment of 0.25 (95 % confidence interval (CI): 0.18-0.32) DALYs due to cardiopulmonary diseases, after adjusting for a wide range of ecological covariates. We estimated that 611.8 (95 % CI: 440.4-783.2) DALYs per 1000 older adult population could potentially be avoided by achieving air quality standards of WHO in Taiwan. CONCLUSIONS Reducing PM2.5 pollution in Taiwan associated with significant health co-benefits, providing important implications for public health and environmental management.
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Affiliation(s)
- Wei-Cheng Lo
- Master Program in Applied Epidemiology, College of Public Health, Taipei Medical University, Taipei 10675, Taiwan
| | - Tsuey-Hwa Hu
- Institute of Statistical Science, Academia Sinica, Taipei 11529, Taiwan
| | - Jing-Shiang Hwang
- Institute of Statistical Science, Academia Sinica, Taipei 11529, Taiwan.
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10
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do Rêgo TJR, Lemos JVM, Matos APL, Caetano CFF, Dantas TS, Sousa FB, de Barros EM, Silva PGDB. Development and professional validation of an App to support Oral Cancer Screening. Braz Dent J 2022; 33:44-55. [PMID: 36477964 PMCID: PMC9733366 DOI: 10.1590/0103-6440202204895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/12/2022] [Indexed: 12/12/2022] Open
Abstract
The objective of this study was to develop and validate an App for identifying risk factors for oral cancer. To this end, we developed an App (OCS: Oral Cancer Screening) with predictors of Oral Cancer (OC) and algorithm assembly to estimate the risk of its development. METHODOLOGY Simulated clinical cases were designed so that 40 professionals with expertise in oral diagnostics could validate the algorithm and test its usability (SUS: System Usability Score) and acceptability (TAM: Technology Acceptance Model). Cronbach's alpha coefficient, Friedman/Dunn tests, and Spearman correlation evaluated the SUS and TAM scales. ROC curve was plotted to estimate the cutoff point of the algorithm in suggesting a high risk for OCS of the simulated cases. Chi-square and Fisher's exact tests were additionally used (p<0.05, SPSS v20.0). RESULTS Professionals with expertise in oral diagnosis had usability of 84.63±10.66 and acceptability of 84.75±10.62, which correlated positively (p<0.001, r=0.647). Acting in clinical areas of dentistry (p=0.034) and history of performing OC risk factor orientation (p=0.048) increased acceptability while acting in higher education increased usability (p=0.011). The cutoff point suggested by the App after validation of the simulated clinical cases showed high sensitivity of 84.8% and lower specificity of 58.4%. CONCLUSION The OCS was effective and with adequate sensitivity, usability, and acceptability and may contribute to the detection of early oral lesions.
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Affiliation(s)
- Talita Jordânia Rocha do Rêgo
- Centro Universitário Christus, Departamento de Odontologia, Fortaleza, Ceará, Brazil.,Universidade Federal do Ceará. Fortaleza, Ceará, Brazil
| | - José Vitor Mota Lemos
- Centro Universitário Christus, Departamento de Odontologia, Fortaleza, Ceará, Brazil.,Universidade Federal do Ceará. Fortaleza, Ceará, Brazil
| | - Amanda Pinheiro Leitão Matos
- Centro Universitário Christus, Departamento de Odontologia, Fortaleza, Ceará, Brazil.,Universidade Federal do Ceará. Fortaleza, Ceará, Brazil
| | | | - Thinali Sousa Dantas
- Centro Universitário Christus, Departamento de Odontologia, Fortaleza, Ceará, Brazil
| | - Fabrício Bitu Sousa
- Centro Universitário Christus, Departamento de Odontologia, Fortaleza, Ceará, Brazil
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11
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Yang CC, Su YF, Cheng HC, Juan YC, Chiu YW, Wu CH, Chen PY, Lee YH, Chen YL, Chen YT, Peng CY, Lu MY, Yu CH, Huang YF, Kao SY, Fwu CW, Liu CJ. Improving the Diagnostic Performance by Adding Methylation Marker to Conventional Visual Examination in Identifying Oral Cancer. Diagnostics (Basel) 2022; 12:diagnostics12071544. [PMID: 35885450 PMCID: PMC9320763 DOI: 10.3390/diagnostics12071544] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 11/26/2022] Open
Abstract
Background: Visual oral examination (VOE) is a conventional oral cancer screening method. This study aimed to evaluate the value of methylation marker to assist VOE in identifying oral epithelial dysplasia and oral squamous cell carcinoma (OED/OSCC) from non-cancerous lesions in a real-world situation. Methods: 201 patients with high-risk personal habits who self-perceived oral anomaly were VOE examined, ZNF582 methylation (ZNF582m) tested, and histologically diagnosed. Results: Among them, 132 patients (65.7%) were histologically diagnosed OED/OSCC. Using VOE, 56.1% OED/OSCC patients had possible oral cancer, whereas 37.7% non-OED/OSCC patients had leukoplakia. ZNF582m-positive was detected in 90.2% OED/OSCC patients and 44.9% non-OED/OSCC patients. Various logistic regression models were postulated to evaluate the diagnostic performance of conventional VOE and new strategies using ZNF582m. ROC analysis and its corresponding C-index demonstrated that either triage or co-testing models of VOE and ZNF582m could improve diagnostic performance and discriminative abilities compared with the VOE only approach. Conclusions: In conclusion, methylation marker test shows equivalent performance to an experienced judgment by oral maxillofacial surgeons and plays a significantly supplementary role in increasing the efficacy in identifying oral malignant lesions. ZNF582m may be an especially important tool for family physicians or general dentists to properly diagnose suspicious oral lesions.
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Affiliation(s)
- Cheng-Chieh Yang
- Department of Stomatology, Oral and Maxillofacial Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (C.-C.Y.); (H.-C.C.); (C.-H.W.); (S.-Y.K.)
- Department of Dentistry, School of Dentistry, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan;
| | - Yee-Fun Su
- iStat Biomedical Co., Ltd., New Taipei City 22102, Taiwan; (Y.-F.S.); (Y.-C.J.)
| | - Han-Chieh Cheng
- Department of Stomatology, Oral and Maxillofacial Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (C.-C.Y.); (H.-C.C.); (C.-H.W.); (S.-Y.K.)
- Department of Dentistry, School of Dentistry, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan;
| | - Yi-Chen Juan
- iStat Biomedical Co., Ltd., New Taipei City 22102, Taiwan; (Y.-F.S.); (Y.-C.J.)
| | - Yu-Wei Chiu
- Department of Dentistry, School of Dentistry, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan;
- Department of Stomatology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan; (P.-Y.C.); (Y.-H.L.); (Y.-L.C.); (Y.-T.C.); (C.-Y.P.); (M.-Y.L.); (C.-H.Y.); (Y.-F.H.)
- College of Oral Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Cheng-Hsien Wu
- Department of Stomatology, Oral and Maxillofacial Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (C.-C.Y.); (H.-C.C.); (C.-H.W.); (S.-Y.K.)
- Department of Dentistry, School of Dentistry, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan;
| | - Pei-Yin Chen
- Department of Stomatology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan; (P.-Y.C.); (Y.-H.L.); (Y.-L.C.); (Y.-T.C.); (C.-Y.P.); (M.-Y.L.); (C.-H.Y.); (Y.-F.H.)
- College of Oral Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Yu-Hsien Lee
- Department of Stomatology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan; (P.-Y.C.); (Y.-H.L.); (Y.-L.C.); (Y.-T.C.); (C.-Y.P.); (M.-Y.L.); (C.-H.Y.); (Y.-F.H.)
- College of Oral Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Yen-Lin Chen
- Department of Stomatology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan; (P.-Y.C.); (Y.-H.L.); (Y.-L.C.); (Y.-T.C.); (C.-Y.P.); (M.-Y.L.); (C.-H.Y.); (Y.-F.H.)
- College of Oral Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Yi-Tzu Chen
- Department of Stomatology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan; (P.-Y.C.); (Y.-H.L.); (Y.-L.C.); (Y.-T.C.); (C.-Y.P.); (M.-Y.L.); (C.-H.Y.); (Y.-F.H.)
- College of Oral Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Chih-Yu Peng
- Department of Stomatology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan; (P.-Y.C.); (Y.-H.L.); (Y.-L.C.); (Y.-T.C.); (C.-Y.P.); (M.-Y.L.); (C.-H.Y.); (Y.-F.H.)
- College of Oral Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Ming-Yi Lu
- Department of Stomatology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan; (P.-Y.C.); (Y.-H.L.); (Y.-L.C.); (Y.-T.C.); (C.-Y.P.); (M.-Y.L.); (C.-H.Y.); (Y.-F.H.)
- College of Oral Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Chuan-Hang Yu
- Department of Stomatology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan; (P.-Y.C.); (Y.-H.L.); (Y.-L.C.); (Y.-T.C.); (C.-Y.P.); (M.-Y.L.); (C.-H.Y.); (Y.-F.H.)
- College of Oral Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Yu-Feng Huang
- Department of Stomatology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan; (P.-Y.C.); (Y.-H.L.); (Y.-L.C.); (Y.-T.C.); (C.-Y.P.); (M.-Y.L.); (C.-H.Y.); (Y.-F.H.)
- College of Oral Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Shou-Yen Kao
- Department of Stomatology, Oral and Maxillofacial Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (C.-C.Y.); (H.-C.C.); (C.-H.W.); (S.-Y.K.)
- Department of Dentistry, School of Dentistry, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan;
| | - Chyng-Wen Fwu
- iStat Biomedical Co., Ltd., New Taipei City 22102, Taiwan; (Y.-F.S.); (Y.-C.J.)
- Correspondence: (C.-W.F.); (C.-J.L.); Tel.: +886-(2)2696-3518 (C.-W.F.); +886-(2)5433535 (C.-J.L.)
| | - Chung-Ji Liu
- Department of Oral and Maxillofacial Surgery, MacKay Memorial Hospital, Taipei 10449, Taiwan
- Correspondence: (C.-W.F.); (C.-J.L.); Tel.: +886-(2)2696-3518 (C.-W.F.); +886-(2)5433535 (C.-J.L.)
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12
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Yang CW, Chu YH, Chen HC, Huang WC, Chen PJ, Chang WK. Gastrointestinal Endoscopy Performed by Gastroenterologists: Opportunistic Screening Strategy for Newly Diagnosed Head and Neck Cancers. Front Oncol 2022; 12:793318. [PMID: 35692778 PMCID: PMC9185840 DOI: 10.3389/fonc.2022.793318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
Aim Approximately 66% of head and neck cancers are diagnosed at an advanced stage. This prospective study aimed to detect newly diagnosed head and neck cancers using regular upper gastrointestinal (UGI) endoscopy with oral-pharynx-larynx examination. Methods A total of 2,849 patients underwent UGI endoscopy with an additional oral-pharynx-larynx examination. Patients aged < 20 years, those who were pregnant, had a history of head and neck cancers, were undergoing emergency endoscopy, and had a poor laryngopharyngeal view were excluded. The symptoms, incidence, location, pathology, and stage of malignant neoplasms were investigated. Results A total of 2,720 patients were enrolled. Endoscopically observable 23 abnormal findings (0.85%) included 18 (0.66%) benign lesions and 5 (0.18%) newly diagnosed malignant neoplasms. Notably, 4 (80%) of 5 patients with malignant neoplasms were diagnosed at an early stage (Stage 0, I, and II). Conclusions UGI endoscopy with oral-pharynx-larynx examination can achieve opportunistic head neck cancer screening and is recommended for every patient in endoscopy units.
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Affiliation(s)
- Chih-Wei Yang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yueng-Hsiang Chu
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsin-Chien Chen
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Chen Huang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Peng-Jen Chen
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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13
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Vijayashree Priyadharsini J, Anitha P. Quantitative malignant index diagnosis system (qMIDS) for effective diagnosis of oral premalignant lesions. Oral Oncol 2022; 129:105902. [DOI: 10.1016/j.oraloncology.2022.105902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 04/30/2022] [Indexed: 11/25/2022]
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14
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Jhuang JR, Su SY, Chiang CJ, Yang YW, Lin LJ, Hsu TH, Lee WC. Forecast of peak attainment and imminent decline after 2017 of oral cancer incidence in men in Taiwan. Sci Rep 2022; 12:5726. [PMID: 35388051 PMCID: PMC8987068 DOI: 10.1038/s41598-022-09736-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 03/21/2022] [Indexed: 12/24/2022] Open
Abstract
Oral cancer is the fourth most common cancer among men in Taiwan. The age-standardized incidence rate of oral cancer among men in Taiwan has increased since 1980 and became six times greater in 2014. To enable effective public health planning for oral cancer, research on the projection of oral cancer burden is essential. We conducted an age-period-cohort analysis on the incidence of oral cancer among men in Taiwan from 1997 to 2017 and extrapolated the trend to 2025. We found that the period trends for young adults aged between 25 and 44 have already peaked before 2017; the younger, the earlier, and then the trends declined. The cohort trends have peaked roughly at the 1972 birth cohort and then declined for all ages. Despite the increasing trend in the age-standardized incidence rate for oral cancer among men in Taiwan from 1997 to 2017, we forecast a peak attained, an imminent decline after 2017, and a decrease of 8.4% in age-standardized incidence rate from 2017 to 2025. The findings of this study contribute to developing efficient and comprehensive strategies for oral cancer prevention and control.
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Affiliation(s)
- Jing-Rong Jhuang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Rm. 536, No. 17, Xuzhou Rd., Taipei, 100, Taiwan.,Taiwan Cancer Registry, Taipei, Taiwan
| | - Shih-Yung Su
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Rm. 536, No. 17, Xuzhou Rd., Taipei, 100, Taiwan.,Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chun-Ju Chiang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Rm. 536, No. 17, Xuzhou Rd., Taipei, 100, Taiwan.,Taiwan Cancer Registry, Taipei, Taiwan
| | - Ya-Wen Yang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Rm. 536, No. 17, Xuzhou Rd., Taipei, 100, Taiwan.,Taiwan Cancer Registry, Taipei, Taiwan
| | - Li-Ju Lin
- Health Promotion Administration, Taipei, Taiwan
| | | | - Wen-Chung Lee
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Rm. 536, No. 17, Xuzhou Rd., Taipei, 100, Taiwan. .,Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan. .,Taiwan Cancer Registry, Taipei, Taiwan.
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15
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Molecular Signatures of Tumour and Its Microenvironment for Precise Quantitative Diagnosis of Oral Squamous Cell Carcinoma: An International Multi-Cohort Diagnostic Validation Study. Cancers (Basel) 2022; 14:cancers14061389. [PMID: 35326543 PMCID: PMC8945999 DOI: 10.3390/cancers14061389] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/04/2022] [Accepted: 03/04/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Heterogeneity in oral potentially malignant disorder (OPMD) poses a problem for accurate prognosis that impacts on treatment strategy and patient outcome. A holistic assessment based on gene expression signatures from both the tumour cells and their microenvironment is necessary to provide a more precise prognostic assessment than just tumour cell signatures alone. METHODS We reformulated our previously established multigene qPCR test, quantitative Malignancy Index Diagnostic System (qMIDS) with new genes involved in matrix/stroma and immune modulation of the tumour microenvironment. An algorithm calculates and converts a panel of 16 gene mRNA expression levels into a qMIDS index to quantify risk of malignancy for each sample. RESULTS The new qMIDSV2 assay was validated in a UK oral squamous cell carcinoma (OSCC) cohort (n = 282) of margin and tumour core samples demonstrating significantly better diagnostic performance (AUC = 0.945) compared to previous qMIDSV1 (AUC = 0.759). Performance of qMIDSV2 were independently validated in Chinese (n = 35; AUC = 0.928) and Indian (n = 95; AUC = 0.932) OSCC cohorts. Further, 5-year retrospective analysis on an Indian dysplastic lesion cohort (n = 30) showed that qMIDSV2 was able to significantly differentiate between lesions without transformation and those with malignant transformation. CONCLUSIONS This study validated a novel multi-gene qPCR test on a total of 535 tissue specimens from UK, China and India, demonstrating a rapid minimally invasive method that has a potential application for dysplasia risk stratification. Further study is required to establish if qMIDSV2 could be used to improve OPMD patient management, guide treatment strategy and reduce oral cancer burden.
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16
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Different Impacts of Cancer Types on Cancer Screening During COVID-19 Pandemic in Taiwan. J Formos Med Assoc 2022; 121:1993-2000. [PMID: 35227585 PMCID: PMC8843332 DOI: 10.1016/j.jfma.2022.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 09/06/2021] [Accepted: 02/08/2022] [Indexed: 11/22/2022] Open
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17
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Cramer JD, Grauer J. Modeling oral cancer screening in the United States population. Oral Oncol 2021; 124:105656. [PMID: 34864525 DOI: 10.1016/j.oraloncology.2021.105656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/23/2021] [Accepted: 11/26/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To evaluate the impact of oral cancer screening if applied to the United States (US) population or various high-risk populations in the US. METHODS We modeled the effects of applying an oral cancer screening program to the US population assuming a similar mortality reduction as seen in the randomized Kerala trial. We combined data on the incidence of oral cancer in the Surveillance, End Results, and Epidemiology database, data on the relative risk in various high-risk groups from the Prostate, Lung, Cervical, and Ovarian screening trial, and the National Lung Screening Trial and data on the prevalence of cigarette use from the National Health Interview Survey. RESULTS When extrapolating to the US population we predict the number needed to screen to prevent one oral cancer death (NNS) = 9,845 in all individuals aged 35 + . Screening efficiency would increase if applied to higher-risk populations. If oral cancer screening were applied to male ≥ 60 pack-year current smokers or former smokers who have quit within 15 years aged 50-79 we predict a 4.6% reduction in oral cancer mortality with an NNS = 1,485. CONCLUSIONS Targeted screening of individuals at high risk for oral cancer has the potential to maximize the efficiency of screening and meaningfully impact oral cancer mortality. We suggest a future screening trial in high-risk individuals be considered to clarify the role of oral cancer screening in the US.
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Affiliation(s)
- John D Cramer
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA.
| | - Jordan Grauer
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA
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18
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Thankappan K, Subramanian S, Balasubramanian D, Kuriakose MA, Sankaranarayanan R, Iyer S. Cost-effectiveness of oral cancer screening approaches by visual examination: Systematic review. Head Neck 2021; 43:3646-3661. [PMID: 34260118 DOI: 10.1002/hed.26816] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/22/2021] [Accepted: 07/08/2021] [Indexed: 01/20/2023] Open
Abstract
The present study is the first systematic review of papers that have performed a full economic evaluation on oral cancer screening strategies using visual oral examination. The review questions were (1) Is screening a cost-effective strategy in oral cancer? (2) What is the most cost-effective strategy among the different screening approaches in oral cancer? The main outcome measure was the incremental cost-effectiveness ratio. The study identifies and reviews seven full economic evaluations. The included studies scored 75%-100% on the methodological appraisal. Majority of the studies reports that oral cancer screening is a cost-effective strategy, especially in an opportunistic setting and high-risk subset of patients. The results were sensitive to cost and effectiveness parameters. Oral cancer screening, though found cost-effective, the uncertainty around these parameters necessitates additional studies that include better estimates in the modeling assessments. The heterogeneity in studies limited comparison and generalization.
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Affiliation(s)
- Krishnakumar Thankappan
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences and Research Center, Amrita Vishwa Vidyapeetham, Kochi, India
| | | | - Deepak Balasubramanian
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences and Research Center, Amrita Vishwa Vidyapeetham, Kochi, India
| | | | | | - Subramania Iyer
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences and Research Center, Amrita Vishwa Vidyapeetham, Kochi, India
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19
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Lin CN, Lee KT, Chang SM, Wang JD. Cost-effectiveness evaluation of mammography screening program in Taiwan: Adjusting different distributions of age and calendar year for real world data. J Formos Med Assoc 2021; 121:633-642. [PMID: 34246512 DOI: 10.1016/j.jfma.2021.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/18/2021] [Accepted: 06/16/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND/PURPOSE We estimated loss-of-life expectancy (LE) and lifetime medical expenditures (LME) stratified by stages to evaluate the cost-effectiveness of breast cancer (BC) screening in Taiwan. METHODS We interlinked four national databases- Cancer Registry, Mortality Registry, National Health Insurance Claim, and Mammography Screening. A cohort of 123,221 BC was identified during 2002-2015 and followed until December 31, 2017. We estimated LE and loss-of-LE by rolling extrapolation algorithm using age-, sex-, and calendar-year-matched referents simulated from vital statistics. LME was estimated by multiplying monthly cost with survival probability and adjusted for annual discount rate. We calculated incremental cost-effectiveness ratio (ICER) by comparing the loss-of-LE of those detected by screening versus non-screening after accounting for administration fees and radiation-related excess BC. RESULTS The LEs of stages I, II, III, and IV were 31.4, 27.2, 20.0, and 5.2 years, respectively, while the loss-of-LEs were 1.2, 4.9, 11.7, and 25.0 years with corresponding LMEs of US$ 73,791, 79,496, 89,962, and 66,981, respectively. The difference in LE between stages I and IV was 26.2 years while that of loss-of-LE was 23.8 years, which implies that a potential lead time bias may exist if diagnosis at younger ages for earlier stages were not adjusted for. The ICER of mammography seemed cost-saving after the coverage exceeded half a million. CONCLUSION Mammography could detect BC early and be cost-saving after adjustment for different distributions of age and calendar year of diagnosis. Future studies exploring healthcare expenditure and impaired quality of life for false-positive cases are warranted.
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Affiliation(s)
- Chia-Ni Lin
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kuo-Ting Lee
- Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Sheng-Mao Chang
- Department of Statistics, National Cheng Kung University, Tainan, Taiwan
| | - Jung-Der Wang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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20
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Lai WW, Chung CH, Lin CN, Yang SC, Hwang JS, Wang JD. QALYs and medical costs saved from prevention of a cancer: Analysis of nation-wide real-world data of Taiwan with lifetime horizon. J Formos Med Assoc 2021; 120:2089-2099. [PMID: 34020855 DOI: 10.1016/j.jfma.2021.04.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/11/2021] [Accepted: 04/26/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND/PURPOSE To quantify savings of loss-of-QALE (quality-adjusted life expectancy) and lifetime medical costs from prevention of different cancers. METHODS We collected nation-wide data on 808,700 new cancer cases of 14 different organ systems and followed them from 1998 to 2014 in Taiwan. We also collected 13,005 cancer patients from a medical center and 47,320 repeated measurements of quality of life (QoL) of EQ-5D to obtain utility values and multiplied them with the corresponding survival rates to calculate QALE. With Kaplan-Meier estimation to survival function to the end of follow-up, we extrapolated to lifetime through a rolling over algorithm on the logit transform of the survival ratio between the index cohort and age-, sex, and calendar year matched referents simulated from vital statistics. Lifetime costs for each cancer were estimated by multiplying survival with average monthly costs after adjustment with annual discount rate. The loss-of-QALE was estimated by the difference in QALE between the index cancer cohort and corresponding referents. RESULTS The dynamic changes and weighted averages of the QoL utility values of 14 different cancers ranged from 0.82 to 0.95. Successful prevention of liver, lung, esophagus, or nasopharynx cancer would save more than 10 quality-adjusted life years and more than 21,000 USD per case for both genders. Since the saving of loss-of-QALE was adjusted for different age, sex, and calendar-year distributions, it could be used in cost effectiveness evaluation. CONCLUSION Savings of loss-of-QALE and lifetime costs could be used for comparison of prevention, diagnosis, treatment and rehabilitation from a lifetime horizon.
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Affiliation(s)
- Wu-Wei Lai
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Hua Chung
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Chia-Ni Lin
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Szu-Chun Yang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | | | - Jung-Der Wang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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21
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Kang SK, Mali RD, Braithwaite RS, Kerr AR, McDevitt J. Point-of-care characterization and risk-based management of oral lesions in primary dental clinics: A simulation model. PLoS One 2020; 15:e0244446. [PMID: 33382762 PMCID: PMC7774939 DOI: 10.1371/journal.pone.0244446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/09/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Oral potentially malignant disorders (OPMDs) encompass histologically benign, dysplastic, and cancerous lesions that are often indistinguishable by appearance and inconsistently managed. We assessed the potential impact of test-and-treat pathways enabled by a point-of-care test for OPMD characterization. MATERIALS AND METHODS We constructed a decision-analytic model to compare life expectancy of test-treat strategies for 60-year-old patients with OPMDs in the primary dental setting, based on a trial for a point-of-care cytopathology tool (POCOCT). Eight strategies of OPMD detection and evaluation were compared, involving deferred evaluation (no further characterization), prompt OPMD characterization using POCOCT measurements, or the commonly recommended usual care strategy of routine referral for scalpel biopsy. POCOCT pathways differed in threshold for additional intervention, including surgery for any dysplasia or malignancy, or for only moderate or severe dysplasia or cancer. Strategies with initial referral for biopsy also reflected varied treatment thresholds in current practice between surgery and surveillance of mild dysplasia. Sensitivity analysis was performed to assess the impact of variation in parameter values on model results. RESULTS Requisite referral for scalpel biopsy offered the highest life expectancy of 20.92 life-years compared with deferred evaluation (+0.30 life-years), though this outcome was driven by baseline assumptions of limited patient adherence to surveillance using POCOCT. POCOCT characterization and surveillance offered only 0.02 life-years less than the most biopsy-intensive strategy, while resulting in 27% fewer biopsies. When the probability of adherence to surveillance and confirmatory biopsy was ≥ 0.88, or when metastasis rates were lower than reported, POCOCT characterization extended life-years (+0.04 life-years) than prompt specialist referral. CONCLUSION Risk-based OPMD management through point-of-care cytology may offer a reasonable alternative to routine referral for specialist evaluation and scalpel biopsy, with far fewer biopsies. In patients who adhere to surveillance protocols, POCOCT surveillance may extend life expectancy beyond biopsy and follow up visual-tactile inspection.
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Affiliation(s)
- Stella K. Kang
- Department of Radiology, New York University Grossman School of Medicine, New York, New York, United States of America
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Rahul D. Mali
- Department of Radiology, New York University Grossman School of Medicine, New York, New York, United States of America
| | - R. Scott Braithwaite
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Alexander R. Kerr
- Department of Oral and Maxillofacial Pathology, Radiology, and Medicine, New York University College of Dentistry, New York, New York, United States of America
| | - John McDevitt
- Department of Biomaterials, New York University College of Dentistry, New York, New York, United States of America
- Chemical and Biomolecular Engineering, Tandon School of Engineering, New York University, Brooklyn, New York, United States of America
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22
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Modulating effect of Coronarin D in 5-fluorouracil resistance human oral cancer cell lines induced apoptosis and cell cycle arrest through JNK1/2 signaling pathway. Biomed Pharmacother 2020; 128:110318. [PMID: 32502840 DOI: 10.1016/j.biopha.2020.110318] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/21/2020] [Accepted: 05/23/2020] [Indexed: 12/24/2022] Open
Abstract
Coronarin D (CD) is one of the main components of Hedychium coronarium rhizome, which has therapeutic potential by reducing cell proliferation in cancer cells. However, the mechanism of CD to 5-fluorouracil (5FU) oral cancer cell remain unclearly. This study discusses the CD to 5FU chemoresistance oral squamous cell carcinoma (OSCC) biochemical mechanisms and possibly pathways to inhibit multiplication in oral cancer. The effect of CD-treated 5FU-chemoresistance human oral cancer cell lines were subjected to MTT assay, cell cycle assay, DAPI assay, annexin-V/PI double staining assay and mitochondrial membrane potential measurement. Furthermore, western blotting was performed to assess the effect of CD on the expression levels of apoptosis related protein and MAPK signaling pathway. The results of the study evidenced that CD reduced viability of 5FU cancer cells in a dose- and time-dependent manner compared with control. The cytotoxic effect of CD lead to cell cycle arrest in the G2/M phase and induced apoptosis in both internal and external pathways. CD induces apoptosis by enhancing phosphorylation of JNK, further exploring the combination of CD and SP600125 reduced the overexpression of phosphate JNK levels. The mechanism of action of CD in 5FU on human oral cancer cells is reported for the first time and can hopeful to be a potential therapeutic agent for 5FU against human oral cancer cells.
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23
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Hwang JS, Hu TH. Later-Life Exposure to Moderate PM 2.5 Air Pollution and Life Loss of Older Adults in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17061873. [PMID: 32183123 PMCID: PMC7143176 DOI: 10.3390/ijerph17061873] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 11/16/2022]
Abstract
Background: Few studies have directly estimated expected life loss attributable to lifetime exposure to fine particulate matter (PM2.5). Methods: We used claims data from Taiwan’s National Health Insurance to create 63 study cohorts of 1.91 million residents aged 60–79 years old residing in small areas where air quality monitoring stations are situated. The survival status of each person was followed from 2001 to 2016. We applied an extrapolation algorithm to estimate the lifetime survival function so that we could directly estimate life expectancy (LE) and the lifetime exposure to PM2.5 of each cohort. We estimated the association between LE and lifetime exposure to PM2.5 among the 63 cohorts. We also fit a Cox proportional hazards model to all the data combined to estimate the relative risk of mortality. Results: Older adults who lived in an area with a higher lifetime weighted average PM2.5 of 10 μg/m3 had a shortened LE by 0.34 (95% CI: 0.22–0.46) years. The hazard ratio of mortality was 1.0245 (1.0242–1.0248) per one μg/m3 increase in lifetime average PM2.5. Conclusion: This study provides strong evidence that later-life exposure to moderate PM2.5 air pollution had a substantial impact on the life loss of older adults.
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24
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Chung CH, Hu TH, Wang JD, Hwang JS. Estimation of Quality-Adjusted Life Expectancy of Patients With Oral Cancer: Integration of Lifetime Survival With Repeated Quality-of-Life Measurements. Value Health Reg Issues 2019; 21:59-65. [PMID: 31655464 DOI: 10.1016/j.vhri.2019.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 06/05/2019] [Accepted: 07/23/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Quality-adjusted life year is widely applied nowadays, which consider both survival and quality of life (QoL). When most diseases are becoming chronic, it is imperative to quantify the overall health impact of a disease in lifetime perspective. OBJECTIVE The purpose of this study is to introduce methods for estimating quality-adjusted life expectancy (QALE) and loss of QALE in patients with a disease or specific conditions. METHODS The QALE of an index cohort can be represented as the integration of the product of lifetime survival function and mean QoL function. We introduce a robust extrapolation approach for estimating lifetime survival function and propose an approach for estimating lifetime mean QoL function for studies with limited follow-up. The best part of the proposed method is that the survival data and QoL data can be collected separately. A cohort of patients with a specific condition can be identified by databases that regularly collect data for the control of diseases, and their survival status is verified by linking to a mortality registry. Although nationwide QoL data are not available, researchers can implement a relative short-term follow-up interview on a random sample of patients to collect QoL data. For demonstration, we applied the proposed methods to estimate QALE and loss of QALE of oral cancer patients. RESULTS The estimates (95% confidence interval) of QALE for oral cancer patients were 11.0 (10.5-11.6) and 14.2 (12.7-15.5) quality-adjusted life years (QALYs) for men and women, respectively. The estimates of loss of QALE for the male and female patients with oral cancer were 14.4 (13.8-14.9) and 7.5 (6.2-9.0) QALYs, respectively. CONCLUSIONS The methods for estimating QALE and loss of QALE can be applied to economic evaluation of cancer control, including screening.
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Affiliation(s)
- Chia-Hua Chung
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Tsuey-Hwa Hu
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Jung-Der Wang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
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