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Ozluk AA, Outlaw D, Akce M, Fowler ME, Hess DL, Giri S, Williams GR. Management of Older Adults With Colorectal Cancer: The Role of Geriatric Assessment. Clin Colorectal Cancer 2023; 22:390-401. [PMID: 37949790 PMCID: PMC11065137 DOI: 10.1016/j.clcc.2023.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/17/2023] [Accepted: 10/05/2023] [Indexed: 11/12/2023]
Abstract
Older adults share a growing burden of cancer morbidity and mortality. This is present across the spectrum of oncologic diagnoses and is particularly true with colorectal cancer (CRC), where older adults continue to share the burden of diagnoses. However, optimal cancer treatment decision making in older adults remains a significant challenge, as the majority of previous clinical trials shaping the current treatment landscape have focused on younger patients, often with more robust performance status and fewer medical comorbid conditions. The heterogeneous aging process of older adults with CRC necessitates a personalized treatment approach, as approximately three-quarters of older adults with CRC also have a concominant geriatric syndrome and more than half of older adults with CRC are pre-frail or frail. Treatment decisions shoud be multifaceted, including consultation with the patient and their familes regarding their wishes, with consideration of the patient's quality of life, functional status, medical comorbid conditions, social support, and treatment toxicity risk. Geriatric assessment is a systematic and validated approach to assess an older adults's potential strengths and vulnerabilities, which can in turn be used to assist with comprehensive cancer care planning and support. In this review, we will summarize current treatment approaches for older adults with CRC, with a particular focus on the incorporation of the geriatric assessment.
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Affiliation(s)
- Ahmet Anil Ozluk
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Darryl Outlaw
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Mehmet Akce
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Mackenzie E Fowler
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Daniel L Hess
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Smith Giri
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Grant R Williams
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.
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Francisci S, Capodaglio G, Gigli A, Mollica C, Guzzinati S. Cancer cost profiles: The Epicost estimation approach. Front Public Health 2022; 10:974505. [PMID: 36211660 PMCID: PMC9533128 DOI: 10.3389/fpubh.2022.974505] [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: 06/21/2022] [Accepted: 08/02/2022] [Indexed: 01/21/2023] Open
Abstract
Sustainability of cancer burden is becoming increasingly central in the policy makers' debate, and poses a challenge for the welfare systems, due to trends towards greater intensity of healthcare service use, which imply increasing costs of cancer care. Measuring and projecting the economic burden associated with cancer and identifying effective policies for minimising its impact are important issues for healthcare systems. Scope of this paper is to illustrate a novel comprehensive approach (called Epicost) to the estimation of the economic burden of cancer, based on micro-data collected from multiple data sources. It consists of a model of cost analysis to estimate the amount of reimbursement payed by the National Health Service to health service providers (hospitals, ambulatories, pharmacies) for the expenses incurred in the diagnoses and treatments of a cohort of cancer patients; these cancer costs are estimated in various phases of the disease reflecting patients' patterns of care: initial, monitoring and final phase. The main methodological features are illustrated using a cohort of colon cancer cases from a Cancer Registry in Italy. This approach has been successfully implemented in Italy and it has been adapted to other European countries, such as Belgium, Norway and Poland in the framework of the Innovative Partnership for Action Against Cancer (iPAAC) Joint Action, sponsored by the European Commission. It is replicable in countries/regions where population-based cancer registry data is available and linkable at individual level with administrative data on costs of care.
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Affiliation(s)
- Silvia Francisci
- National Centre for Disease Prevention and Health Promotion, National Health Institute, Rome, Italy
| | - Guilia Capodaglio
- Screening and Health Impact Assessment Unit, Azienda Zero, Padova, Italy
| | - Anna Gigli
- Institute for Research on Population and Social Policies, National Research Council, Rome, Italy
| | - Cristina Mollica
- Department of Statistical Sciences, Sapienza University of Rome, Rome, Italy
| | - Stefano Guzzinati
- Regional Epidemiological Service, Veneto Cancer Registry (RTV), Azienda Zero, Padova, Italy,*Correspondence: Stefano Guzzinati
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Busco S, Tavilla A, Gigli A, Lopez T, Pierannunzio D, Mallone S, Guzzinati S, Capodaglio G, Giusti F, Angiolini C, Francisci S. A direct method for the identification of patterns of care using administrative databases: the case of breast cancer. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:1477-1485. [PMID: 34312745 PMCID: PMC8558165 DOI: 10.1007/s10198-021-01327-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/27/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To identify and provide lists of procedures and drugs related to diagnosis and treatment of breast cancer. These lists can be used for the estimation of the cost of illness. METHODS The method consists of identifying lists of procedures/interventions/drugs related to the tumour of interest, drawn by a panel of expert clinicians and oncologists on the basis of clinical guidelines and current practice. The lists are applied to data referring to breast cancer female patients, collected by population-based Cancer Registries and linked at individual level with information on health care treatments. A comparison with lists obtained via the matched control method is implemented. RESULTS The distribution of administered procedures and drug prescriptions is coherent with the patient clinical pathway: surgery is the main cause of hospitalization in the first year since diagnosis, diagnostic and monitoring interventions are more frequent in the following years (recurrences detection), and at end-of-life (palliative care). Most outpatient services are due to diagnosis and monitoring, one third of services in the first year since diagnosis is radiotherapy and chemotherapy. Drugs prescribed to patients and sold in pharmacy include hormonal drugs as first course treatment and analgesics as palliative care. CONCLUSIONS This direct method represents a valid alternative to the matched control method in describing patterns of care and costs related to the entire disease pathway. It is particularly suitable in case of cancer sites with complex patterns of care, such as breast cancer. The lists of codes developed here are based on international classification systems and can be easily applicable to other countries.
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Affiliation(s)
- Susanna Busco
- UOC Programmazione Controllo E Governo Clinico-ASL Latina, Latina, Italy
| | - Andrea Tavilla
- National Centre for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Anna Gigli
- Institute for Research on Population and Social Policies, National Research Council, via Palestro 32, 00185, Rome, Italy.
| | - Tania Lopez
- National Centre for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Daniela Pierannunzio
- National Centre for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Sandra Mallone
- National Centre for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | | | | | | | - Catia Angiolini
- Breast Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Silvia Francisci
- National Centre for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
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The Economic Impact of Rectal Cancer: A Population-Based Study in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020474. [PMID: 33430156 PMCID: PMC7827442 DOI: 10.3390/ijerph18020474] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/02/2021] [Accepted: 01/04/2021] [Indexed: 12/24/2022]
Abstract
Costs of cancer care are increasing worldwide, and sustainability of cancer burden is critical. In this study, the economic impact of rectal cancer on the Italian healthcare system, measured as public healthcare expenditure related to investigation and treatment of rectal cancer patients is estimated. A cross-sectional cohort of 9358 rectal cancer patients is linked, on an individual basis, to claims associated to rectal cancer diagnosis and treatments. Costs refer mainly to years 2010–2011 and are estimated by phase of care, as healthcare needs vary along the care pathway: diagnostic procedures are mainly provided in the first year, surveillance procedures are addressed to chronically ill patients, and end-of-life procedures are given in the terminal status. Clinical approaches and corresponding costs are specific by cancer type and vary by phase of care, stage at diagnosis, and age. Surgery is undertaken by the great majority of patients. Thus, hospitalization is the main cost driver. The evidence produced can be used to improve planning and allocation of healthcare resources. In particular, early diagnosis of rectal cancer is a gain in healthcare budget. Policies raising spreading of and adherence to screening plans, above all when addressed to people living in Southern Italy, should be strongly encouraged.
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Groome PA, McBride ML, Jiang L, Kendell C, Decker KM, Grunfeld E, Krzyzanowska MK, Winget M. Lessons Learned: It Takes a Village to Understand Inter-Sectoral Care Using Administrative Data across Jurisdictions. Int J Popul Data Sci 2018; 3:440. [PMID: 32935017 PMCID: PMC7299469 DOI: 10.23889/ijpds.v3i3.440] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Cancer care is complex and exists within the broader healthcare system. The CanIMPACT team sought to enhance primary cancer care capacity and improve integration between primary and cancer specialist care, focusing on breast cancer. In Canada, all medically-necessary healthcare is publicly funded but overseen at the provincial/territorial level. The CanIMPACT Administrative Health Data Group's (AHDG) role was to describe inter-sectoral care across five Canadian provinces: British Columbia, Alberta, Manitoba, Ontario and Nova Scotia. This paper describes the process used and challenges faced in creating four parallel administrative health datasets. We present the content of those datasets and population characteristics. We provide guidance for future research based on 'lessons learned'. The AHDG conducted population-based comparisons of care for breast cancer patients diagnosed from 2007-2011. We created parallel provincial datasets using knowledge from data inventories, our previous work, and ongoing bi-weekly conference calls. Common dataset creation plans (DCPs) ensured data comparability and documentation of data differences. In general, the process had to be flexible and iterative as our understanding of the data and needs of the broader team evolved. Inter-sectoral data inconsistencies that we had to address occurred due to differences in: 1) healthcare systems, 2) data sources, 3) data elements and 4) variable definitions. Our parallel provincial datasets describe the breast cancer diagnostic, treatment and survivorship phases and address ten research objectives. Breast cancer patient demographics reflect inter-provincial general population differences. Across provinces, disease characteristics are similar but underlying health status and use of healthcare services differ. Describing healthcare across Canadian jurisdictions assesses whether our provincial healthcare systems are delivering similar high quality, timely, accessible care to all of our citizens. We have provided a description of our experience in trying to achieve this goal and, for future use, we include a list of 'lessons learned' and a list of recommended steps for conducting this kind of work. KEY FINDINGS The conduct of inter-sectoral research using linked administrative health data requires a committed team that is adequately resourced and has a set of clear, feasible objectives at the start.Guiding principles include: maximization of sectoral participation by including single-jurisdiction expertise and making the most inclusive data decisions; use of living documents that track all data decisions and careful consideration about data quality and availability differences.Inter-sectoral research requires a good understanding of the local healthcare system and other contextual issues for appropriate interpretation of observed differences.
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Affiliation(s)
- Patti Ann Groome
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, Kingston, Ontario Canada
| | - Mary L McBride
- Cancer Control Research, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Li Jiang
- Critical Care Services Ontario, Toronto, Ontario, Canada
| | - Cynthia Kendell
- Cancer Outcomes Research Program, Dalhousie University and Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Kathleen M Decker
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Eva Grunfeld
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Monika K Krzyzanowska
- University Health Network, Toronto, Ontario, Canada
- Cancer Care Ontario, Toronto, Ontario, Canada
| | - Marcy Winget
- Stanford University School of Medicine, Stanford, California, U.S.A.
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Guzzinati S, Virdone S, De Angelis R, Panato C, Buzzoni C, Capocaccia R, Francisci S, Gigli A, Zorzi M, Tagliabue G, Serraino D, Falcini F, Casella C, Russo AG, Stracci F, Caruso B, Michiara M, Caiazzo AL, Castaing M, Ferretti S, Mangone L, Rudisi G, Sensi F, Mazzoleni G, Pannozzo F, Tumino R, Fusco M, Ricci P, Gola G, Giacomin A, Tisano F, Candela G, Fanetti AC, Pala F, Sardo AS, Rugge M, Botta L, Dal Maso L. Characteristics of people living in Italy after a cancer diagnosis in 2010 and projections to 2020. BMC Cancer 2018; 18:169. [PMID: 29426306 PMCID: PMC5807846 DOI: 10.1186/s12885-018-4053-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 01/25/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Estimates of cancer prevalence are widely based on limited duration, often including patients living after a cancer diagnosis made in the previous 5 years and less frequently on complete prevalence (i.e., including all patients regardless of the time elapsed since diagnosis). This study aims to provide estimates of complete cancer prevalence in Italy by sex, age, and time since diagnosis for all cancers combined, and for selected cancer types. Projections were made up to 2020, overall and by time since diagnosis. METHODS Data were from 27 Italian population-based cancer registries, covering 32% of the Italian population, able to provide at least 7 years of registration as of December 2009 and follow-up of vital status as of December 2013. The data were used to compute the limited-duration prevalence, in order to estimate the complete prevalence by means of the COMPREV software. RESULTS In 2010, 2,637,975 persons were estimated to live in Italy after a cancer diagnosis, 1.2 million men and 1.4 million women, or 4.6% of the Italian population. A quarter of male prevalent cases had prostate cancer (n = 305,044), while 42% of prevalent women had breast cancer (n = 604,841). More than 1.5 million people (2.7% of Italians) were alive since 5 or more years after diagnosis and 20% since ≥15 years. It is projected that, in 2020 in Italy, there will be 3.6 million prevalent cancer cases (+ 37% vs 2010). The largest 10-year increases are foreseen for prostate (+ 85%) and for thyroid cancers (+ 79%), and for long-term survivors diagnosed since 20 or more years (+ 45%). Among the population aged ≥75 years, 22% will have had a previous cancer diagnosis. CONCLUSIONS The number of persons living after a cancer diagnosis is estimated to rise of approximately 3% per year in Italy. The availability of detailed estimates and projections of the complete prevalence are intended to help the implementation of guidelines aimed to enhance the long-term follow-up of cancer survivors and to contribute their rehabilitation needs.
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Affiliation(s)
- Stefano Guzzinati
- Veneto Tumor Registry, Veneto Region, Padova, Passaggio Gaudenzio 1, 35131 Padova, Italy
| | - Saverio Virdone
- Cancer Epidemiology Unit, CRO Aviano National Cancer Institute IRCCS, Via Franco Gallini 2, 33081 Aviano, PN Italy
| | | | - Chiara Panato
- Cancer Epidemiology Unit, CRO Aviano National Cancer Institute IRCCS, Via Franco Gallini 2, 33081 Aviano, PN Italy
| | - Carlotta Buzzoni
- Tuscany Cancer Registry, Clinical and Descriptive Epidemiology Unit, Cancer Prevention and Research Institute (ISPO), Florence, Italy
- AIRTUM Database, Florence, Italy
| | - Riccardo Capocaccia
- Dipartimento di Ricerca Epidemiologica e Medicina Molecolare (DREaMM), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Anna Gigli
- Institute for Research on Population and Social Policies, National Research Council, Rome, Italy
| | - Manuel Zorzi
- Veneto Tumor Registry, Veneto Region, Padova, Passaggio Gaudenzio 1, 35131 Padova, Italy
| | - Giovanna Tagliabue
- Lombardy Cancer Registry, Varese Province, Cancer Registry Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Diego Serraino
- Cancer Epidemiology Unit, CRO Aviano National Cancer Institute IRCCS, Via Franco Gallini 2, 33081 Aviano, PN Italy
| | - Fabio Falcini
- Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (Forlì), Italy-Azienda Usl della Romagna, Forlì, Italy
| | - Claudia Casella
- Registro Tumori Ligure, Epidemiologia Clinica, Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Antonio Giampiero Russo
- Cancer Registry of Milan, Epidemiology Unit, Agency for Health Protection of Milan, Milan, Italy
| | - Fabrizio Stracci
- Public Health Section, Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Bianca Caruso
- Modena Cancer Registry, Public Health Department, AUSL Modena, Modena, Italy
| | - Maria Michiara
- Parma Cancer Registry, Oncology Unit, Azienda Ospedaliera Universitaria di Parma, Parma, Italy
| | | | - Marine Castaing
- Registro Tumori Integrato Catania-Messina-Siracusa-Enna, Università degli Studi di Catania, Catania, Italy
| | - Stefano Ferretti
- Ferrara Cancer Registry, Ferrara Local Health Board, University of Ferrara, USL Ferrara, Ferrara, Italy
| | - Lucia Mangone
- Reggio Emilia Cancer Registry, Epidemiology unit, AUSL ASMN-IRCCS, Azienda USL di Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppa Rudisi
- Palermo and Province Cancer Registry, Clinical Epidemiology Unit, Azienda Ospedaliera Universitaria Policlinico “Paolo Giaccone”, Palermo, Italy
| | - Flavio Sensi
- North Sardinia Cancer Registry, Azienda Regionale per la Tutela della Salute, Sassari, Italy
| | | | - Fabio Pannozzo
- Cancer Registry of Latina Province, AUSL Latina, Latina, Italy
| | | | - Mario Fusco
- Cancer Registry of ASL Napoli 3 Sud, Napoli, Italy
| | - Paolo Ricci
- Mantova Cancer Registry, Epidemilogy Unit, Agenzia di Tutela della Salute (ATS) della Val Padana, Mantova, Italy
| | - Gemma Gola
- Como Cancer Registry, ATS Insubria, Varese, Italy
| | - Adriano Giacomin
- Registro Tumori Piemonte, Provincia di Biella CPO, Biella, Italy
| | - Francesco Tisano
- Cancer Registry of of the Province of Siracusa, Local Health Unit of Siracusa, Siracusa, Italy
| | - Giuseppa Candela
- Trapani Cancer Registry, Dipartimento di Prevenzione della Salute, Trapani, Italy
| | | | - Filomena Pala
- Nuoro Cancer Registry, RT Nuoro, ASSL Nuoro/ATS Sardegna, Nuoro, Italy
| | | | - Massimo Rugge
- Veneto Tumor Registry, Veneto Region, Padova, Passaggio Gaudenzio 1, 35131 Padova, Italy
- Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Laura Botta
- Dipartimento di Ricerca Epidemiologica e Medicina Molecolare (DREaMM), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luigino Dal Maso
- Cancer Epidemiology Unit, CRO Aviano National Cancer Institute IRCCS, Via Franco Gallini 2, 33081 Aviano, PN Italy
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Fleming ST, Mackley HB, Camacho F, Yao N, Gusani NJ, Seiber EE, Matthews SA, Yang TC, Hwang W. Patterns of Care for Metastatic Colorectal Cancer in Appalachia, and the Clinical, Sociodemographic, and Service Provider Determinants. J Rural Health 2015; 32:113-24. [PMID: 26241785 DOI: 10.1111/jrh.12132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Appalachia has high colorectal cancer (CRC) incidence and mortality, at least in part due to screening disparities. This paper examines patterns and determinants of metastatic colorectal cancer care. METHODS CRC patients diagnosed in 2006-2008 from 4 cancer registries (Kentucky, Ohio, Pennsylvania, and North Carolina) were linked to Medicare claims (2005-2009.) The final sample after exclusions included 855 stage IV and 590 stages I-III patients with metachronous or synchronous metastases. We estimate bivariate and multivariate analyses for several surgical and chemotherapeutic strategies of care using clinical, sociodemographic, and contextual determinants. RESULTS Among 1,445 CRC patients, 84% had primary tumor resection and 44% received chemotherapy. Of the chemotherapy patients, 44% received newer systemic agents for at least 75% of the cycles. One year survivors with liver or lung metastases were more likely to have their primary tumor resected immediately (86.1% vs 69.5% for liver, and 78.2% vs 64.9% for lung) and have their metastases resected/ablated (15.7% vs 2.6% for liver and 15.0% vs 0.5% for lung). Patients with stages I-III primary tumors (versus IV) were much more likely to be resected, but they were less likely to receive chemotherapy. Patients with comorbidities (congestive heart failure, dementia, or respiratory disease) had lower odds of chemotherapy. Smaller hospital size and surgical volume had higher odds of immediate versus delayed surgery. The newer chemotherapeutic agents were more common with higher surgical volume. CONCLUSIONS Metastatic colorectal cancer has clinical, sociodemographic, and service provider determinants.
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Affiliation(s)
- Steven T Fleming
- College of Public Health, University of Kentucky, Lexington, Kentucky
| | - Heath B Mackley
- College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Fabian Camacho
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Nengliang Yao
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Niraj J Gusani
- College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Eric E Seiber
- College of Public Health, Ohio State University, Columbus, Ohio
| | - Stephen A Matthews
- Department of Sociology, The Pennsylvania State University, University Park, Pennsylvania
| | - Tse-Chuan Yang
- Department of Sociology, University at Albany, SUNY, Albany, New York
| | - Wenke Hwang
- College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
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De Roo ML, Francke AL, Van den Block L, Donker GA, Alonso JEL, Miccinesi G, Moreels S, Onwuteaka-Philipsen BD, Salvetti A, Deliens L. Hospitalizations of cancer patients in the last month of life: quality indicator scores reveal large variation between four European countries in a mortality follow-back study. BMC Palliat Care 2014; 13:54. [PMID: 25859157 PMCID: PMC4391682 DOI: 10.1186/1472-684x-13-54] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 11/13/2014] [Indexed: 11/17/2022] Open
Abstract
Background Repeated and long hospitalizations of cancer patients at the end of life have been suggested as indicators of low quality of palliative care. Comparing the care delivered between different countries with the help of these quality indicators may identify opportunities to improve practice. Our objective is twofold: firstly, to describe the scores for the existing quality indicators “the percentage of time spent in hospital” and “the proportion of adult patients with more than one hospitalization in the last 30 days of life” in populations of cancer patients in four European countries and to see whether these countries met previously defined performance standards; secondly, to assess whether these scores are related to receiving palliative care from their GP. Methods A mortality follow-back study was conducted, based on data recorded by representative GP networks for samples of cancer patients living at home who died non-suddenly in Belgium (n = 500), the Netherlands (n = 310), Italy (n = 764), and Spain (n = 224). Results The quality indicator score for “the percentage of time spent in hospital” in the last month of life was 14.1% in the Netherlands, 17.7% in Spain, 22.2% in Italy, and 24.6% in Belgium, which means that none of the countries met the performance standard of <10%. For the “proportion of patients with more than one hospitalization in the last 30 days of life”, two countries met the performance standard of <4%: the Netherlands (0.6%) and Italy (3.1%). Spain had a score of 4.0% and Belgium scored 5.4%. When patients received palliative care from their GP, significantly less time was spent in hospital in the last month and fewer hospitalizations took place. Conclusions European countries differ regarding the frequency and duration of hospitalizations of cancer patients in the last month of life. This reflects country-specific differences in the organization of palliative care and highlights the important role of the GP in palliative care provision.
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Affiliation(s)
- Maaike L De Roo
- Department of Public and Occupational Health, Expertise Center of Palliative Care, VU University Medical Center, EMGO Institute for Health and Care Research, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
| | - Anneke L Francke
- Department of Public and Occupational Health, Expertise Center of Palliative Care, VU University Medical Center, EMGO Institute for Health and Care Research, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands ; NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, the Netherlands
| | - Lieve Van den Block
- Vrije Universiteit Brussel (VUB), End-of-life Care Research Group Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Gé A Donker
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, the Netherlands
| | - Jose E Lozano Alonso
- Public Health Directorate General, Regional Ministry of Health, Government of Castilla y León, Paseo de Zorrilla 1, 47071 Valladolid, Spain
| | - Guido Miccinesi
- Clinical and Descriptive Epidemiology Unit, Cancer Prevention and Research Institute, ISPO, via Oblate 2, Pal 28/A, 50141 Florence, Italy
| | - Sarah Moreels
- Scientific Institute of Public Health, Public Health and Surveillance, Health Services Research, Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Expertise Center of Palliative Care, VU University Medical Center, EMGO Institute for Health and Care Research, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
| | - Andrea Salvetti
- Italian Society of General Practioners (SIMG), Via del Pignoncino 9-11, 50142 Florence, Italy
| | - Luc Deliens
- Department of Public and Occupational Health, Expertise Center of Palliative Care, VU University Medical Center, EMGO Institute for Health and Care Research, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands ; Vrije Universiteit Brussel (VUB), End-of-life Care Research Group Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium
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9
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Yabroff KR, Francisci S, Mariotto A, Mezzetti M, Gigli A, Lipscomb J. Advancing comparative studies of patterns of care and economic outcomes in cancer: challenges and opportunities. J Natl Cancer Inst Monogr 2014; 2013:1-6. [PMID: 23962506 DOI: 10.1093/jncimonographs/lgt005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- K Robin Yabroff
- Health Services and Economics Branch/Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Dr, 3E436, Rockville, MD 20850, USA.
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10
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Yabroff KR, Borowski L, Lipscomb J. Economic studies in colorectal cancer: challenges in measuring and comparing costs. J Natl Cancer Inst Monogr 2014; 2013:62-78. [PMID: 23962510 DOI: 10.1093/jncimonographs/lgt001] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Estimates of the costs associated with cancer care are essential both for assessing burden of disease at the population level and for conducting economic evaluations of interventions to prevent, detect, or treat cancer. Comparisons of cancer costs between health systems and across countries can improve understanding of the economic consequences of different health-care policies and programs. We conducted a structured review of the published literature on colorectal cancer (CRC) costs, including direct medical, direct nonmedical (ie, patient and caregiver time, travel), and productivity losses. We used MEDLINE to identify English language articles published between 2000 and 2010 and found 55 studies. The majority were conducted in the United States (52.7%), followed by France (12.7%), Canada (10.9%), the United Kingdom (9.1%), and other countries (9.1%). Almost 90% of studies estimated direct medical costs, but few studies estimated patient or caregiver time costs or productivity losses associated with CRC. Within a country, we found significant heterogeneity across the studies in populations examined, health-care delivery settings, methods for identifying incident and prevalent patients, types of medical services included, and analyses. Consequently, findings from studies with seemingly the same objective (eg, costs of chemotherapy in year following CRC diagnosis) are difficult to compare. Across countries, aggregate and patient-level estimates vary in so many respects that they are almost impossible to compare. Our findings suggest that valid cost comparisons should be based on studies with explicit standardization of populations, services, measures of costs, and methods with the goal of comparability within or between health systems or countries. Expected increases in CRC prevalence and costs in the future highlight the importance of such studies for informing health-care policy and program planning.
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Affiliation(s)
- K Robin Yabroff
- Health Services and Economics Branch/Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Dr, 3E436, Rockville, MD 20850, USA.
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Lipscomb J, Yabroff KR, Hornbrook MC, Gigli A, Francisci S, Krahn M, Gatta G, Trama A, Ritzwoller DP, Durand-Zaleski I, Salloum R, Chawla N, Angiolini C, Crocetti E, Giusti F, Guzzinati S, Mezzetti M, Miccinesi G, Mariotto A. Comparing cancer care, outcomes, and costs across health systems: charting the course. J Natl Cancer Inst Monogr 2014; 2013:124-30. [PMID: 23962516 DOI: 10.1093/jncimonographs/lgt011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Joseph Lipscomb
- Department of Health Policy and Management, Rollins School of Public Health, Rm 720, 1518 Clifton Road, NE, Atlanta, GA 30322, USA.
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