A comparison of the direct medical costs for individuals with or without basal or squamous cell skin cancer: A study from Australia

Patterns and cost of care according to keratinocyte cancer risk stratification in a volunteer population screening clinic: Real-world data from the TRoPICS study

BACKGROUND

Risk prediction tools have been developed for keratinocyte cancers (KCs) to effectively categorize individuals with different levels of skin cancer burden. Few have been clinically validated nor routinely used in clinical settings.

OBJECTIVES

To assess whether risk prediction tool categories associate with interventions including chemoprophylaxis for skin cancer, and health-care costs in a dermatologist-run screening clinic.

METHODS

Adult participants who presented to a walk-in screening facility were invited to participate. A self-completed KC risk prediction tool was used to classify participants into one of the five risk categories. Participants subsequently underwent full skin examination by a dermatologist. Dermatological interventions and skin cancer-related medical prescriptions were documented. Total health-care costs, both to the health-care system and patients were evaluated.

RESULTS

Of the 507 participants recruited, 5-fluorouracil cream and nicotinamide were more frequently prescribed in the higher risk groups as chemoprophylaxis (p < 0.005). A significant association with high predicted risk was also observed in the use of cryotherapy and curettage and cautery (p < 0.05). The average health-care costs associated with a skin check visit increased from $90 ± 37 (standard deviation) in the lowest risk group to $149 ± 97 in the highest risk group (p < 0.0001).

CONCLUSIONS

We observed a positive association between higher predicted risk of skin cancer and the prescription of chemoprophylaxis and health-care costs involved with opportunistic community skin cancer screening. A clinical use of risk stratification may be to provide an opportunity for clinicians to discuss skin cancer prevention and chemoprophylaxis with individual patients.

Australian Experiences of Out-of-Pocket Costs and Financial Burden Following a Cancer Diagnosis: A Systematic Review

(1) Background: This systematic review was conducted to identify cancer patient experiences, and the impact of out-of-pocket costs and financial burden in Australia. (2) Methods: A systematic review, following the Preferring Reporting Items for Systematic Reviews and Meta-Analyses, was conducted. Cumulative Index of Nursing and Allied Health Literature and PubMed were searched. The primary outcome was financial burden among cancer patients and their families in Australia. The secondary outcome was out-of-pocket costs associated with cancer care and treatment within the population sample, and the impact of financial burden. (3) Results: Nineteen studies were included, covering more than 70,000 Australians affected by cancer. Out-of-pocket costs varied by cancer type and ranged from an average of AUD 977 for breast cancer and lymphoedema patients to AUD 11,077 for prostate cancer patients. Younger aged patients (≤65 years), Aboriginal and Torres Strait Islander people, people in rural and/or remote areas, households with low income, those who were unemployed and people with private health insurance were at increased risk of experiencing out-of-pocket costs, financial burden or a combination of both. (4) Conclusions: Australians diagnosed with cancer frequently experience financial burden, and the health and financial consequences are significant. Focusing efforts on the costs of care and options about where to have care within the context of informed decisions about cancer care is necessary.

Risk of Nonmelanoma Skin Cancers and Parkinson's Disease-Meta-Analysis and Systematic Review

Simple Summary

Non-melanoma skin cancers (NMSCs) are the most common cancers among fair-skinned people. It is estimated that 2–3 million new cases of NMSCs are diagnosed globally each year. The risk of development increases with age, just like in the case of Parkinson Disease. Due to the general aging of the population and substantially high medical costs of NMSC therapy, NMSCs and Parkinson’s disease (PD) are becoming an increasing health problem. In this paper, we conduct a meta-analysis and systematic review to evaluate the NMSC risk among patients with PD. This study is the first to focus on the effect of different epidemiologic aspects of NMSCs and PD in detail.

Abstract

Patients with Parkinson’s disease (PD) have an increased risk of melanoma compared with the general population. Considering that Nonmelanoma Skin Cancers (NMSCs) share similar risk factors with melanoma, there is a need to understand a possible connection between PD and NMSCs. The aim of the study was the evaluation of NMSC risk among PD patients via meta-analysis and systematic review. A comprehensive search of PubMed, Scopus, and Web of Science databases was conducted, including studies from January 2000 to April 2020. We identified 16 eligible studies including 140291 PD patients. Upon statistical analysis, a significantly higher risk of developing NMSCs in PD patients was found compared with the control group (odds ratio (OR) = 1.25, 95% CI: 1.17–1.33; p < 0.0001). Among all NMSCs, the risk of developing basal cell carcinoma in PD patients was significantly higher (OR = 1.30, 95% confidence interval (CI): 1.15–1.47; p < 0.0001), contrary to squamous cell carcinoma. Further analysis revealed a significantly higher risk of developing NMSCs in patients with previously diagnosed PD (OR = 1.26, 95% CI: 1.19–1.33; p < 0.0001). Our data suggest the necessity for regular skin examination of PD patients, though further studies are required to explore the mechanisms forming this relationship.

Outpatient surgical management of non-melanoma skin cancers of the head and neck in a regional centre: an analysis of costs and outcomes

BACKGROUND

Non-melanoma skin cancer is the most commonly diagnosed malignancy in Australia. Lesions of the head and neck are often outside the scope of primary care providers. The challenges of cancer care in regional Australia necessitate careful resource planning. This study presents an outpatient model that minimizes health service cost with local general practitioner follow-up.

METHODS

A retrospective review of 105 patients with 122 skin lesions in a dedicated Facial Lesion Assessment Management and Excision clinic was performed from July 2018 to 2019. Clinical outcomes, patient travel and cost analysis/comparison were recorded.

RESULTS

There were 85 malignant cases with 59 basal cell carcinomas and 25 squamous cell carcinomas. For basal cell carcinoma, clear margins (≥3 mm), close margins (<3 mm) and positive margins were achieved in 24 (48%), 23 (46%) and three (6%) cases, respectively. For squamous cell carcinoma, clear margins (≥5 mm), close margins (<5 mm) and positive margins were achieved in seven (38.8%), 11 (61.1%) and none (0%) of the cases, respectively. Complications included one haematoma and two wound infections. For 37% of patients living >100 km from the department, 72.3% had local general practitioner follow-up. Inpatient cost was $2870, $5697 and $9300 for primary closure, local flap and full-thickness skin graft, respectively, and outpatient cost was $746 for a single facial lesion.

CONCLUSION

This study presents a cost-effective model for the management of non-melanoma skin cancers with improved departmental efficiency and streamlined patient care in an outpatient skin cancer management model in a regional centre.

Basal cell carcinoma: Epidemiology; pathophysiology; clinical and histological subtypes; and disease associations

As the most common human cancer worldwide and continuing to increase in incidence, basal cell carcinoma is associated with significant morbidity and cost. Continued advances in research have refined both our insight and approach to this seemingly ubiquitous disease. This 2-part continuing medical education article will provide a comprehensive and contemporary review of basal cell carcinoma. The first article in this series describes our current understanding of this disease regarding epidemiology, cost, clinical and histopathologic presentations, carcinogenesis, natural history, and disease associations.