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Takes RP, Halmos GB, Ridge JA, Bossi P, Merkx MAW, Rinaldo A, Sanabria A, Smeele LE, Mäkitie AA, Ferlito A. Value and Quality of Care in Head and Neck Oncology. Curr Oncol Rep 2020; 22:92. [PMID: 32651680 PMCID: PMC7351804 DOI: 10.1007/s11912-020-00952-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW The concept of value-based health care (VBHC) was articulated more than a decade ago. However, its clinical implementation remains an on-going process and a particularly demanding one for the domain of head and neck cancer (HNC). These cancers often present with fast growing tumors in functionally and cosmetically sensitive sites and afflict patients with differing circumstances and comorbidity. Moreover, the various treatment modalities and protocols have different effects on functional outcomes. Hence, the interpretation of what constitutes VBHC in head and neck oncology remains challenging. RECENT FINDINGS This monograph reviews developments in specific aspects of VBHC for HNC patients, including establishment of registries and quality indices (such as infrastructure, process, and outcome indicators). It emphasizes the importance of the multidisciplinary team, "time to treatment intervals," and adherence to guidelines. The discussion addresses major indicators including survival, quality of life and functional outcomes, and adverse events. Also, strengths and weaknesses of nomograms, prognostic and decision models, and variation of care warrant attention. Health care professionals, together with patients, must properly define quality and relevant outcomes, both for the individual patient as well as the HNC population. It is essential to capture and organize the relevant data so that they can be analyzed and the results used to improve both outcomes and value.
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Affiliation(s)
- Robert P Takes
- Department of Otolaryngology/Head and Neck Surgery, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Gyorgy B Halmos
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - John A Ridge
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Paolo Bossi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Matthias A W Merkx
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Hospital Universitario San Vicente Fundacion. CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Universidad de Antioquia, Medellín, Colombia
| | - Ludi E Smeele
- Department of Head and Neck Oncology and Surgery, Antoni Van Leeuwenhoek Hospital, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Antti A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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Xu J, Nicholas S, Wang J, Yang Y. A retrospective analysis of hospital treatment expenditures among young and middle age patients with cancer, 2013-2017 under health reform. Int J Health Plann Manage 2020; 35:878-887. [PMID: 31903663 DOI: 10.1002/hpm.2957] [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: 10/25/2019] [Accepted: 10/28/2019] [Indexed: 11/08/2022] Open
Abstract
Under 60 year olds represent a rapidly growing segment of the cancer population. They often face longer hospital stays, higher treatment intensity, and hospitalization costs. In this background, we aim to assess the impact of the 2009 reforms on the hospital expenses of younger cancer inpatients. Our study sample included 11 791 young and middle age stomach, lung, colorectal, esophageal, and breast cancer inpatients hospitalized during 2013 to 2017. Hospitalization treatment costs of under 60 cancer inpatients increased, but it fell in 2017 under the impact of the health reforms. However, out-of-pocket expenditures rose, which partly reflected the failure of the health insurance scheme to adequately cover cancer inpatient cost, potentially imposing financial hardships on cancer inpatients and their families. To continue to reduce the economic burden of cancer patients, early screening and diagnosis among younger populations and enhanced hospice care integrated with the ongoing primary health care reform are important.
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Affiliation(s)
- Junfang Xu
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Stephen Nicholas
- School of Economics and School of Management, Tianjin Normal University, Tianjin, China.,Guangdong Research Institute for International Strategies, Guangdong University of Foreign Studies, Guangdong, China.,TOP Education Institute 1 Central Avenue Australian Technology Park, Sydney, New South Wales, Australia.,Newcastle Business School, University of Newcastle, Newcastle, New South Wales, Australia
| | - Jian Wang
- Dong Furen Institute of Economic and Social Development, Wuhan University, Beijing, China
| | - Yuxia Yang
- Center for Health Economic Experiments and Public Policy, Department of Social Medicine and Administration, School of Public Health, Shandong University, Jinan, China.,The Second Hospital of Shandong University, Jinan, China
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Paleri V, Patterson J, Rousseau N, Moloney E, Craig D, Tzelis D, Wilkinson N, Franks J, Hynes AM, Heaven B, Hamilton D, Guerrero-Urbano T, Donnelly R, Barclay S, Rapley T, Stocken D. Gastrostomy versus nasogastric tube feeding for chemoradiation patients with head and neck cancer: the TUBE pilot RCT. Health Technol Assess 2019; 22:1-144. [PMID: 29650060 DOI: 10.3310/hta22160] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Approximately 9000 new cases of head and neck squamous cell cancers (HNSCCs) are treated by the NHS each year. Chemoradiation therapy (CRT) is a commonly used treatment for advanced HNSCC. Approximately 90% of patients undergoing CRT require nutritional support via gastrostomy or nasogastric tube feeding. Long-term dysphagia following CRT is a primary concern for patients. The effect of enteral feeding routes on swallowing function is not well understood, and the two feeding methods have, to date (at the time of writing), not been compared. The aim of this pilot randomised controlled trial (RCT) was to compare these two options. METHODS This was a mixed-methods multicentre study to establish the feasibility of a RCT comparing oral feeding plus pre-treatment gastrostomy with oral feeding plus as-required nasogastric tube feeding in patients with HNSCC. Patients were recruited from four tertiary centres treating cancer and randomised to the two arms of the study (using a 1 : 1 ratio). The eligibility criteria were patients with advanced-staged HNSCC who were suitable for primary CRT with curative intent and who presented with no swallowing problems. MAIN OUTCOME MEASURES The primary outcome was the willingness to be randomised. A qualitative process evaluation was conducted alongside an economic modelling exercise. The criteria for progression to a Phase III trial were based on a hypothesised recruitment rate of at least 50%, collection of outcome measures in at least 80% of those recruited and an economic value-of-information analysis for cost-effectiveness. RESULTS Of the 75 patients approached about the trial, only 17 consented to be randomised [0.23, 95% confidence interval (CI) 0.13 to 0.32]. Among those who were randomised, the compliance rate was high (0.94, 95% CI 0.83 to 1.05). Retention rates were high at completion of treatment (0.94, 95% CI 0.83 to 1.05), at the 3-month follow-up (0.88, 95% CI 0.73 to 1.04) and at the 6-month follow-up (0.88, 95% CI 0.73 to 1.04). No serious adverse events were recorded in relation to the trial. The qualitative substudy identified several factors that had an impact on recruitment, many of which are amenable to change. These included organisational factors, changing cancer treatments and patient and clinician preferences. A key reason for the differential recruitment between sites was the degree to which the multidisciplinary team gave a consistent demonstration of equipoise at all patient interactions at which supplementary feeding was discussed. An exploratory economic model generated from published evidence and expert opinion suggests that, over the 6-month model time horizon, pre-treatment gastrostomy tube feeding is not a cost-effective option, although this should be interpreted with caution and we recommend that this should not form the basis for policy. The economic value-of-information analysis indicates that additional research to eliminate uncertainty around model parameters is highly likely to be cost-effective. STUDY LIMITATIONS The recruitment issues identified for this cohort may not be applicable to other populations undergoing CRT. There remains substantial uncertainty in the economic evaluation. CONCLUSIONS The trial did not meet one of the three criteria for progression, as the recruitment rate was lower than hypothesised. Once patients were recruited to the trial, compliance and retention in the trial were both high. The implementation of organisational and operational measures can increase the numbers recruited. The economic analysis suggests that further research in this area is likely to be cost-effective. FUTURE WORK The implementation of organisational and operational measures can increase recruitment. The appropriate research question and design of a future study needs to be identified. More work is needed to understand the experiences of nasogastric tube feeding in patients undergoing CRT. TRIAL REGISTRATION Current Controlled Trials ISRCTN48569216. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 16. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Vinidh Paleri
- Head and Neck Unit, The Royal Marsden Hospital, London, UK.,Division of Clinical Studies, Institute of Cancer Research, London, UK.,Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Joanne Patterson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Nikki Rousseau
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Eoin Moloney
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Dawn Craig
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Dimitrios Tzelis
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Nina Wilkinson
- Biostatistics Research group, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Jeremy Franks
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Ann Marie Hynes
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Ben Heaven
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - David Hamilton
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Rachael Donnelly
- Department of Radiation Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Stewart Barclay
- Department of Restorative Dentistry, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Tim Rapley
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Deborah Stocken
- Biostatistics Research group, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.,Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
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Patterson JM, McColl E, Carding PN, Wilson JA. Swallowing beyond six years post (chemo)radiotherapy for head and neck cancer; a cohort study. Oral Oncol 2018; 83:53-58. [PMID: 30098779 DOI: 10.1016/j.oraloncology.2018.06.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 05/10/2018] [Accepted: 06/01/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE The objective of this prospective study is to report on long-term swallowing outcomes in a group of head and neck cancer patients following (chemo) radiotherapy treatment, assess for changes over time and identify any predictor variables of outcome. MATERIALS AND METHODS 42 survivors were assessed on four swallowing measures and followed up from pre-treatment to six years post 3D (chemo) radiotherapy. Measures included a swallowing specific QOL questionnaire, penetration-aspiration scale, dietary restrictions and a timed water swallow test. RESULTS At six years, 71% reported swallowing difficulties on the questionnaire. One fifth of patients had aspiration, with a raised risk of chest infection. Seven percent required a laryngectomy for a dysfunctional larynx. Despite this, half the group reported having a normal diet. There was variation in the pattern of change between one and six years. A significant deterioration was only observed in the timed water swallow test (p < 0.0001). Larger radiotherapy volume predicted this outcome. None of the variables tested predicted outcome for the other three swallow measures. CONCLUSION Patients continue to report swallowing difficulties at six years, with a proportion having persistent aspiration. Further work on identifying the risk factors associated with aspiration tolerance, aspiration pneumonia, prevention and management is warranted. Long-term dysphagia remains a significant and serious concern following (chemo) radiotherapy for HNC and swallowing outcomes should continue to be monitored over time.
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Affiliation(s)
- J M Patterson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK; Speech & Language Therapy Dept., Sunderland Royal Hospital, Sunderland, UK.
| | - E McColl
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - P N Carding
- School of Allied and Public Health, Australian Catholic University, Brisbane, Australia
| | - J A Wilson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Paleri V, Wood J, Patterson J, Stocken DD, Cole M, Vale L, Franks J, Guerrero-Urbano T, Donnelly R, Barclay S, Rapley T, Rousseau N. A feasibility study incorporating a pilot randomised controlled trial of oral feeding plus pre-treatment gastrostomy tube versus oral feeding plus as-needed nasogastric tube feeding in patients undergoing chemoradiation for head and neck cancer (TUBE trial): study protocol. Pilot Feasibility Stud 2016; 2:29. [PMID: 27965848 PMCID: PMC5154009 DOI: 10.1186/s40814-016-0069-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 05/17/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND There are 7000 new cases of head and neck squamous cell cancers (HNSCC) treated by the NHS each year. Stage III and IV HNSCC can be treated non-surgically by radio therapy (RT) or chemoradiation therapy (CRT). CRT can affect eating and drinking through a range of side effects with 90 % of patients undergoing this treatment requiring nutritional support via gastrostomy (G) or nasogastric (NG) tube feeding. Long-term dysphagia following CRT is a primary concern for patients. The effect of enteral feeding routes on swallowing function is not well understood, and the two feeding methods have, to date, not been compared to assess which leads to a better patient outcome. The purpose of this study is to explore the feasibility of conducting a randomised controlled trial (RCT) comparing these two options with particular emphasis on patient willingness to be randomised and clinician willingness to approach eligible patients. METHODS/DESIGN This is a mixed methods multicentre study to establish the feasibility of a randomised controlled trial comparing oral feeding plus pre-treatment gastrostomy versus oral feeding plus as required nasogastric tube feeding in patients with HNSCC. A total of 60 participants will be randomised to the two arms of the study (1:1 ratio). The primary outcome of feasibility is a composite of recruitment (willingness to randomise and be randomised) and retention. A qualitative process evaluation investigating patient, family and friends and staff experiences of trial participation will also be conducted alongside an economic modelling exercise to synthesise available evidence and provide estimates of cost-effectiveness and value of information. Participants will be assessed at baseline (pre-randomisation), during CRT weekly, 3 months and 6 months. DISCUSSION Clinicians are in equipoise over the enteral feeding options for patients being treated with CRT. Swallowing outcomes have been identified as a top priority for patients following treatment and this trial would inform a future larger scale RCT in this area to inform best practice. TRIAL REGISTRATION ISRCTN48569216.
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Affiliation(s)
- Vinidh Paleri
- Department of Otolaryngology–Head and Neck Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- University of Manchester, Manchester, UK
| | | | - Joanne Patterson
- City Hospitals Sunderland NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Deborah D. Stocken
- Clinical Trials and Biostatistics, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Mike Cole
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Luke Vale
- Health Economics, Newcastle University, Newcastle upon Tyne, UK
| | | | | | | | - Stewart Barclay
- Restorative Dentistry, Newcastle Dental Hospital, Newcastle upon Tyne, UK
| | - Tim Rapley
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Nikki Rousseau
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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6
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Nouraei S, Mace A, Middleton S, Hudovsky A, Vaz F, Moss C, Ghufoor K, Mendes R, O'Flynn P, Jallali N, Clarke P, Darzi A, Aylin P. A stratified analysis of the perioperative outcome of 17623 patients undergoing major head and neck cancer surgery in England over 10 years: Towards an Informatics-based Outcomes Surveillance Framework. Clin Otolaryngol 2016; 42:11-28. [DOI: 10.1111/coa.12649] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2016] [Indexed: 11/28/2022]
Affiliation(s)
- S.A.R. Nouraei
- Department of Otolaryngology - Head & Neck Surgery Surgery; University College Hospital NHS Foundation Trust; London UK
- National Institute of Health and Care Excellence (NICE) 2013 Scholar; London UK
- The Ear Institute; University College London; London UK
| | - A.D. Mace
- Department of Otolaryngology - Head & Neck Surgery; Imperial College Healthcare NHS Trust; London UK
| | | | - A. Hudovsky
- Department of Clinical Coding; Imperial College Healthcare NHS Trust; London UK
| | - F. Vaz
- Department of Otolaryngology - Head & Neck Surgery Surgery; University College Hospital NHS Foundation Trust; London UK
| | - C. Moss
- Department of Oral & Maxillofacial Surgery; University College Hospital NHS Foundation Trust; London UK
| | - K. Ghufoor
- Department of Otolaryngology - Head & Neck Surgery; Barts Health, Royal London Hospital; London UK
| | - R. Mendes
- Department of Clinical Oncology; University College Hospital NHS Foundation Trust; London UK
| | - P. O'Flynn
- Department of Otolaryngology - Head & Neck Surgery Surgery; University College Hospital NHS Foundation Trust; London UK
| | - N. Jallali
- Department of Plastic & Reconstructive Surgery; Imperial College Healthcare NHS Trust; London UK
| | - P.M. Clarke
- Department of Otolaryngology - Head & Neck Surgery; Imperial College Healthcare NHS Trust; London UK
| | - A. Darzi
- Academic Surgical Unit; Department of Surgery & Cancer; St Mary's Hospital; London UK
| | - P. Aylin
- Dr Foster Unit at Imperial College; Department of Primary Care and Public Health; Imperial College London; London UK
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Abstract
In the USA, increasing attention is being paid to adopting a value-based framework for measuring and ultimately improving health care delivery. Value is defined as the benefit achieved relative to costs. The numerator of the value equation includes quality of care and outcomes achieved. The denominator includes costs, both financial costs and harms of treatment. Herein, we describe these elements of value as they pertain to head and neck cancer. A particular focus is to identify areas of the value equation where physicians have some control. We examine quality in each of three dimensions: structure, process, and outcomes. We also adopt Porter's three-tiered hierarchy of outcomes model, with specific outcomes relevant to patients with head and neck and thyroid cancer. Finally, we review issues related to costs and harms. We believe these findings can serve as a framework for further efforts to drive value-based delivery of head and neck cancer care.
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Affiliation(s)
- Benjamin R Roman
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA,
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Tadiparthi S, Enache A, Kalidindi K, O'Hara J, Paleri V. Hospital stay following complex major head and neck resection: what factors play a role? Clin Otolaryngol 2014; 39:156-63. [DOI: 10.1111/coa.12250] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2014] [Indexed: 11/28/2022]
Affiliation(s)
- S. Tadiparthi
- Department of Plastic Surgery; Newcastle upon Tyne Hospitals; Newcastle-Upon-Tyne UK
| | - A. Enache
- Department of Otolaryngology; Newcastle-Upon-Tyne Hospitals; Newcastle-Upon-Tyne UK
| | | | - J. O'Hara
- Department of Otolaryngology; City Hospitals Sunderland; Sunderland UK
| | - V. Paleri
- Department of Otolaryngology; Newcastle-Upon-Tyne Hospitals; Newcastle-Upon-Tyne UK
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Nouraei SAR, Xie C, Hudosvky A, Middleton SE, Mace AD, Clarke PM. Development and validation of a health informatics algorithm for identifying major head and neck cancer surgery amidst Hospital Episode Statistics data. Clin Otolaryngol 2013; 38:186-8. [PMID: 23577889 DOI: 10.1111/coa.12092] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2012] [Indexed: 11/26/2022]
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Kim K, Amonkar MM, Högberg D, Kasteng F. Economic burden of resected squamous cell carcinoma of the head and neck in an incident cohort of patients in the UK. HEAD & NECK ONCOLOGY 2011; 3:47. [PMID: 22035422 PMCID: PMC3219567 DOI: 10.1186/1758-3284-3-47] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 10/28/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND SCCHN is the sixth most common cancer worldwide. Locally advanced SCCHN continues to be a therapeutic challenge with high rates of morbidity and mortality and a low cure rate. Despite the apparent impact of SCCHN on patients and presumably society, the economic burden of the treatment of resected SCCHN patients in the UK has not been investigated. METHODS This retrospective data analysis was based on in- and outpatient care records extracted from Hospital Episode Statistic database and linked to mortality data in the UK. SCCHN patients with resection of lip, tongue, oral cavity, pharynx or larynx were followed for at least one year (max. of 5 years) from the date of first resection. RESULTS A total of 11,403 patients (mean age 63.2 years, 69.8% males) who met study criteria were followed for an average of 31 months. 32.3% of patients died in the follow-up period and the mean time to death was 16.9 months. In the first year, mean number of days of hospitalization and number of outpatient visits was 21.6 and 4.2, respectively; mean number of reconstructive and secondary surgeries was 0.32 and 0.14 per patient, respectively; 4.7% of the patients received radiotherapy and 12.2% received chemotherapy. From the second to fifth year healthcare utilizations rates were lower. Mean cost of post-operative healthcare utilization was £23,212 over 5 years (£19,778 for the first year and £1477, £847, £653 and £455 for years 2-5). Total cost of post-operative healthcare utilisation was estimated to be £255.5 million over the 5-year follow-up. CONCLUSIONS In the UK, SCCHN patients after surgical resection needed considerable healthcare resources and incurred substantial costs. Study findings might provide a useful source for clinicians and decision makers in understanding the economic burden of managing SCCHN in the UK and also suggests a need for new therapies that could improve outcomes and reduce the disease burden.
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Affiliation(s)
- Kun Kim
- OptumInsight, Stockholm, Sweden.
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11
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Abstract
Improving the quality of health care has become a national priority, as indicated by the establishment of multiple federal initiatives and by the actions of national medical societies and the American Board of Medical Specialties. Health care can be assessed in each of three dimensions: structure, process, and outcomes. Here we review recent efforts to evaluate the quality of care delivered to head and neck cancer patients and to develop methods for improvement and continual assessment, with a particular emphasis on the evaluation of process of care.
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Affiliation(s)
- Carol M Lewis
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1445, Houston, TX 77030, USA.
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12
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Kerawala CJ, Bisase B, Lee J. The use of examination under anaesthesia and panendoscopy in patients presenting with oral cavity and oropharyngeal squamous cell carcinoma. Ann R Coll Surg Engl 2009; 91:609-12. [PMID: 19686610 DOI: 10.1308/003588409x432446] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Although examination under anaesthesia and panendoscopy (EUAP) has traditionally been used in the assessment of patients presenting with oral cavity and oropharyngeal squamous cell carcinoma (SCC), the era of modern medicine with its advanced imaging techniques has meant that the indications for this technique have potentially reduced. SUBJECTS AND METHODS In an attempt to quantify the current use of EUAP in the UK, a structured telephone questionnaire was undertaken of 50 maxillofacial units. Information was gathered regarding whether the technique was adopted on a routine or selective basis. Likewise perceived disadvantages were sought. RESULTS Twenty-two units (44%) carried out EUAP on all patients presenting with oral cavity and oropharyngeal SCC. Of the remaining 28 units, all employed EUAP on a selective basis, the most commonly for the assessment of the primary tumour. The most common perceived disadvantage of carrying out EUAP routinely was its potential to increase the waiting time to definitive treatment. CONCLUSIONS These results suggest a gradual move towards the selective use of EUAP in patients presenting with oral cavity and oropharyngeal SCC.
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Nouraei SAR, O'Hanlon S, Butler CR, Hadovsky A, Donald E, Benjamin E, Sandhu GS. A multidisciplinary audit of clinical coding accuracy in otolaryngology: financial, managerial and clinical governance considerations under payment-by-results. Clin Otolaryngol 2009; 34:43-51. [PMID: 19260884 DOI: 10.1111/j.1749-4486.2008.01863.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To audit the accuracy of otolaryngology clinical coding and identify ways of improving it. DESIGN Prospective multidisciplinary audit, using the 'national standard clinical coding audit' methodology supplemented by 'double-reading and arbitration'. SETTINGS Teaching-hospital otolaryngology and clinical coding departments. PARTICIPANTS Otolaryngology inpatient and day-surgery cases. MAIN OUTCOME MEASURES Concordance between initial coding performed by a coder (first cycle) and final coding by a clinician-coder multidisciplinary team (MDT; second cycle) for primary and secondary diagnoses and procedures, and Health Resource Groupings (HRG) assignment. RESULTS 1250 randomly-selected cases were studied. Coding errors occurred in 24.1% of cases (301/1250). The clinician-coder MDT reassigned 48 primary diagnoses and 186 primary procedures and identified a further 209 initially-missed secondary diagnoses and procedures. In 203 cases, patient's initial HRG changed. Incorrect coding caused an average revenue loss of 174.90 pounds per patient (14.7%) of which 60% of the total income variance was due to miscoding of a eight highly-complex head and neck cancer cases. The 'HRG drift' created the appearance of disproportionate resource utilisation when treating 'simple' cases. At our institution the total cost of maintaining a clinician-coder MDT was 4.8 times lower than the income regained through the double-reading process. CONCLUSIONS This large audit of otolaryngology practice identifies a large degree of error in coding on discharge. This leads to significant loss of departmental revenue, and given that the same data is used for benchmarking and for making decisions about resource allocation, it distorts the picture of clinical practice. These can be rectified through implementing a cost-effective clinician-coder double-reading multidisciplinary team as part of a data-assurance clinical governance framework which we recommend should be established in hospitals.
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Affiliation(s)
- S A R Nouraei
- Department of ENT Surgery, Charing Cross Hospital, London, UK.
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14
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Olofsson J. Multidisciplinary team a prerequisite in the management of head and neck cancer? Eur Arch Otorhinolaryngol 2009; 266:159-60. [PMID: 19057922 DOI: 10.1007/s00405-008-0883-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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