Expenditure and Financial Burden for Stomach Cancer Diagnosis and Treatment in China: A Multicenter Study

Analysis of Factors Influencing Hospitalization Expenses of Patients with Gastric Cancer in Shanghai, 2014-2021: Based on Grey Relational Analysis and Structural Equation Modeling

OBJECTIVES

This study analyzed the basic condition and the influencing factors of hospitalization costs of patients with gastric cancer in Shanghai from 2014 to 2021, so as to provide a scientific reference for promoting the reform of the medical and healthcare system.

METHODS

The study data were obtained from the electronic medical record system of Shanghai Hospital. The grey relational analysis was applied to analyze the correlation strength of various expenses with hospitalization costs. The structural equation modeling was constructed to analyze the influences of factors on the hospitalization expenses, as well as the relationship between each factor.

RESULTS

A total of 23 335 study subjects were included. The results of grey relational analysis showed that the total cost of drugs had the strongest correlation with hospitalization expenses, followed by material expenses and surgery cost, whereas those of others were lower. The results of the structural equation modeling showed that age had the greatest influence on hospitalization expenses with a path coefficient of 0.618. Other influencing factors included surgery history, length of stay, hospital level, gender, and medical insurance.

CONCLUSIONS

The total cost of drugs had the strongest correlation with hospitalization expenses. Factors such as gender, age, and hospital level all affect the hospitalization expenses. In the future, it is necessary to take further measures to control the cost of drugs and constantly optimize the structure of hospitalization costs. Meanwhile, the reform of the medical and healthcare system should be deepened to reasonably regulate the medical behaviors and reduce the financial burden of patients.

Real-world effectiveness of a new powered stapling system with gripping surface technology on the intraoperative clinical and economic outcomes of gastrectomy for gastric cancer

BACKGROUND

Surgical staplers have been widely used to facilitate surgeries, and this study aimed to examine the real-world effectiveness of a new powered stapling system with Gripping Surface Technology (GST) on intraoperative outcomes of gastrectomy for gastric cancer.

METHOD

The data were extracted from the Fourth Hospital of Hebei Medical University's (FHHMU) medical records system. Participants (N = 121 patients) were classified into the GST (n = 59) or non-GST group (n = 62), based on the use of the GST system. The intraoperative outcomes such as bleeding were assessed by reviewing video records. T-tests, Chi-square tests, and Mann-Whitney-U tests were used to compare the baseline characteristics between groups. Multivariate logistic regression was conducted for adjusting outcomes to study the effect of variables.

RESULTS

Compared with the non-GST group, the GST group had significantly lower risks for intraoperative bleeding, intraoperative anastomosis intervention rate, intraoperative suture, and intraoperative pression (aORs: 0.0853 (p < 0.0001), 0.076 (p = 0.0003), 0.167 (p = 0.0012), and 0.221 (p = 0.0107), respectively). The GST group also consumed one fewer cartridge than the non-GST group (GST:5 vs non-GST: 6, p = 0.0241).

CONCLUSION

The use of the GST system was associated with better intraoperative outcomes and lower cartridge consumption in Chinese real-world settings.

CRISPLD1 promotes gastric cancer progression by regulating the Ca2+/PI3K-AKT signaling pathway

Gastric cancer (GC) is a malignant tumor with poor prognosis. Studies have shown that cysteine-rich secretory protein LCCL domain containing 1 (CRISPLD1) is associated with tumor progression. However, its role in GC is unclear. The present study aimed to determine the pathogenic mechanism of CRISPLD1 in GC. Analysis of public databases revealed high mRNA expression of CRISPLD1 in GC, which was associated with poor prognosis. Additionally, CRISPLD1 expression levels showed significant correlations with T stage, overall survival events, and stage. Knockdown of CRISPLD1 reduced cell proliferation, invasion, and migration. Furthermore, CRISPLD1 knockdown decreased intracellular calcium levels in GC cells and inhibited the phosphatidylinositol-4,5-bisphosphate 3-kinase (PI3K)-protein kinase B (AKT) signaling pathway. Treatment with an AKT activator reversed the inhibitory effect of CRISPLD1 knockdown on GC cell migration and invasion. Our findings suggest that CRISPLD1 promotes tumor cell progression in GC by mediating intracellular calcium levels and activating the PI3K-AKT pathway, highlighting CRISPLD1 as a potential therapeutic target for GC.

Cost Drivers and Financial Burden for Cancer-Affected Families in China: A Systematic Review

This systematic review examined cancer care costs, the financial burden for patients, and their economic coping strategies in mainland China. We included 38 quantitative studies that reported out-of-pocket payment for cancer care and patients' coping strategies in English or Chinese (PROSPERO: CRD42021273989). We searched PubMed, Embase, Ovid, Web of Science, Cochrane, CNKI, and Wanfang Data from 1 January 2009 to 10 August 2022. We referred to the standards for reporting observational studies to assess the methodological quality and transparent reporting of the included studies and reported the costs narratively. Annual mean medical costs (including inpatient and outpatient costs and fees for self-purchasing drugs) ranged from USD 7421 to USD 10,297 per patient. One study investigated medical costs for 5 years and indicated that inpatient costs accounted for 51.6% of the total medical costs, followed by self-purchasing drugs (43.9%). Annual medical costs as a percentage of annual household income ranged from 36.0% to 63.1% with a metaproportion of 51.0%. The common coping strategies included borrowing money and reduction of household expenses and expenses from basic health services. Costs of inpatient care and self-purchasing drugs are major drivers of medical costs for cancer care, and many affected households shoulder a very heavy financial burden.

The impacts of the National Medication Price-Negotiated Policy on the financial burden of cancer patients in Shandong province, China: an interrupted time series analysis

BACKGROUND

In order to further regulate the price of anticancer medication and alleviate the financial burden of cancer patients, the Chinese government implemented the National Medication Price-Negotiated Policy (NMPNP) in 2017. This study aims to assess the impacts of implementation of the NMPNP on the access of anticancer medication and the financial burden for cancer patients in Shandong province, and to provide evidence to inform the design of similar policies in other developing countries.

METHODS

A quasi-experiment design of an interrupt time series analysis was conducted. The month of September 2017 was taken as the intervention point when the Shandong Provincial Reimbursement Drug Lists was updated based on the result of the NMPNP in 2017. The data used were the aggregated monthly claim data of cancer patients from 2016 to 2021, which were obtained from four cities in Shandong province. The outpatient and inpatient care visits per capita, proportion of OOP expenditure and medication costs in outpatient and inpatient medical costs were used as outcome variables. A segmented regression model was used to analyze the change of the access of anticancer medication and the financial burden for cancer patients.

RESULTS

The outpatient care visits per capita significantly decreased after the intervention. Compared to preintervention trend, the proportion of OOP expenditure in outpatient medical costs decreased by average 0.25 percentage point per month (p <  0.0001) after the intervention, however the proportion of OOP expenditure in inpatient medical costs increased by 0.02 percentage point per month (p = 0.76). Since the intervention, the proportion of medication costs in outpatient medical costs averagely rose by 0.28 percentage point (p <  0.0001), and its implementation caused the proportion of medication costs in inpatient medical costs averagely decreased 0.2 percentage point (p <  0.0001).

CONCLUSIONS

The NMPNP improved the access of anticancer medication, and relieved the financial burden of outpatient care. However, it did not effectively alleviate the financial burden of inpatient care. Additionally, the NMPNP impacted the behavior of the healthcare providers. The policymakers should closely monitor the change of providers behaviors, and dynamically adjust financial incentives policies of healthcare providers during the implementation of similar medication price negotiated policies.

Estimating the Cancer Treatment Cost for 5 Common Types of Cancer with Separating Out-of-Pocket and Governmental Costs in Afghanistan, 2020

The objective this study was to estimate the cost of cancer treatment services for 5 common types of cancer (Breast, Esophageal, Colorectal, Stomach and lung) by the public sector and patients. This study was a cross-sectional study that conducted using the medical records of patients who were registered in the Jamhuriyat Hospital from 1, 2020 to 12, 2020. The prevalence-based approach was used to estimate the costs of five major cancer types. The data of 769 patients were eligible to include for the analysis. The considered cost of services was obtained from the average cost in 3 private hospitals in Kabul. Also all costs converted in to US dollar using the exchange rate of each USD equaling to AFN 77 in 2020. The data was analyzed using Ms. Excel Program. The total number of patients with 5 types of cancer were 769. Of these, female, in the age group of 40-60 years and were illiterate. The most common cancers based on the cancer treatment services' costs of health services was breast cancer, followed by esophagus, colorectal, stomach and lung. Moreover, the most common cancers based on the cancer treatment services' costs of health services which cancer patients needed was breast cancer, followed by esophagus, colorectal, stomach and lung.  Moreover, total cost of cancer treatment is US$590,662.98, in which Patients paid USD 82,537 of it out-of-pocket. The costs of cancer treatment services for 5 common types of cancer are high which a considerable portion are paid by patients. There is a need for the government to pay more attention to the provision of these services and to increase the centers providing these services and the existing facilities. Also, support of the international community in this process can enable more people to access these services and reduce the economic burden on patients.

A systematic review of financial toxicity among cancer patients in China

Financial toxicity (FT) has been used to describe patients' whole economic experience that negatively impacts their well-being. FT's adverse effects on patients' health outcomes have been reported by reviews conducted in Western countries. However, these findings may not apply to patients in China. This review aimed to analyze existing data on the measures, prevalence, risk factors, and health-related consequences of FT in China. We searched 10 databases in May 2021 and again in January 2022 using Medical Subject Headings terms and free text. We also searched the reference lists of included articles. Two reviewers independently screened the studies, extracted the data, and assessed the quality of the included studies using the Joanna Briggs Institute Critical Appraisal Checklist. Thirty-one articles describing 30 studies were included in the analysis. Various FT measures were identified, but the number of validated measures was limited. The prevalence of material, psychological, and behavioral FT was 6%–78%, 61%–84%, and 10%–79%, respectively. We identified common risk factors and health-related consequences associated with FT similar to those reported in previous reviews. We also identified several potential risk factors (eg, increased length of hospital stay and larger household size) and consequences (patients' self-perceived burden) in a limited number of studies. Our findings show an urgent need for more data on the prevalence, risk factors, and health-related consequences associated with FT in Chinese cancer patients, and these data must be generated using validated measures.

The intergenerational relationship between conditional cash transfers and newborn health

Background

Lack of nutrition, inadequate housing, low education and limited access to quality care can negatively affect children’s health over their lifetime. Implemented in 2003, the Bolsa Familia (“Family Stipend”) Program (PBF) is a conditional cash transfer program targeting poor households in Brazil. This study investigates the long-term benefits of cash transfers through intergenerational transmission of health and poverty by assessing the early life exposure of the mother to the PBF.

Methods

We used data from the 100M SINASC-SIM cohort compiled and managed by the Center for Data and Knowledge Integration for Health (CIDACS), containing information about participation in the PBF and socioeconomic and health indicators. We analyzed five measures of newborn health: low (less than 2,500 g) and very low (less than 1,500 g) birth weight, premature (less than 37 weeks of gestation) and very premature (less than 28 weeks of gestation) birth, and the presence of some type of malformation (according to ICD-10 codes). Furthermore, we measured the early life exposure to the PBF of the mother as PBF coverage in the previous decade in the city where the mother was born. We applied multilevel logistic regression models to assess the associations between birth outcomes and PBF exposures.

Results

Results showed that children born in a household where the mother received BF were less likely to have low birth weight (OR 0.93, CI; 0.92-0.94), very low birth weight (0.87, CI; 0.84-0.89), as well as to be born after 37 weeks of gestation (OR 0.98, CI; 0.97-0.99) or 28 weeks of gestation (OR 0.93, CI; 0.88-0.97). There were no significant associations between households where the mother received BF and congenital malformation.

On average, the higher the early life exposure to the PBF of the mother, the lower was the prevalence of low birth weight, very low birth weight and congenital malformation of the newborn. No trend was noted for preterm birth.

Conclusion

The PBF might have indirect intergenerational effects on children’s health. These results provide important implications for policymakers who have to decide how to effectively allocate resources to improve child health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12565-7.

Ultrasound Image-Guided Nerve Block Combined with General Anesthesia under an Artificial Intelligence Algorithm on Patients Undergoing Radical Gastrectomy for Gastric Cancer during and after Operation

This study was aimed at investigating the location of gastric cancer by using a gastroscope image based on an artificial intelligence algorithm for gastric cancer and the effect of ultrasonic-guided nerve block combined with general anesthesia on patients undergoing gastric cancer surgery. A total of 160 patients who were undergoing gastric cancer surgery from March 2019 to March 2021 were collected as the research objects, and the convolutional neural network (CNN) algorithm was used to segment the gastroscope image of gastric cancer. The patients were randomly divided into a simple general anesthesia group of 80 cases and a transversus abdominis plane block combined with rectus abdominis sheath block combined with the general anesthesia group of 80 cases. Then, compare the systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) at the four time points T0, T1, T2, and T3. The times of analgesic drug use within 48 hours after operation and postoperative adverse reactions were recorded. The visual analog scale (VAS) scores were also recorded at 4 h, 12 h, 24 h, and 48 h. The results show that the image quality after segmentation is good: the accuracy of tumor location is 75.67%, which is similar to that of professional endoscopists. Compared with the general anesthesia group, the transversus abdominis plane block combined with the rectus sheath block combined with the general anesthesia group had fewer anesthetics, and the difference was statistically significant (P < 0.05). Compared with the general anesthesia group, SBP, DBP, and HR were significantly reduced at T1, T2, and T3 in the transverse abdominis plane block combined with rectus sheath block and general anesthesia group (P < 0.05). Compared with the simple general anesthesia group, the VAS scores of the transversus abdominis plane block combined with rectus sheath block combined with the general anesthesia group decreased at 4 h, 12 h, and 24 h after surgery, and the difference was statistically significant (P < 0.05). The number of analgesics used in transversus abdominis plane block combined with the rectus sheath block combined with the general anesthesia group within 48 hours after operation was significantly less than that in the general anesthesia group, and the difference was statistically significant (P < 0.05). The average incidence of adverse reactions in the nerve block combined with the general anesthesia group was 2.5%, which was lower than the average incidence of 3.75% in the general anesthesia group. In summary, the CNN algorithm can accurately segment the lesions in the ultrasonic images of gastric cancer, which was convenient for doctors to make a more accurate judgment on the lesions, and provided a basis for the preoperative examination of radical gastrectomy for gastric cancer. Ultrasonic-guided nerve block combined with general anesthesia can effectively improve the analgesic effect of radical gastrectomy for gastric cancer, reduced intraoperative and postoperative adverse reactions and analgesic drug dosage, and had a good effect on postoperative recovery of patients. The combined application of these two methods can further improve the precision treatment of gastric cancer patients and accelerate postoperative recovery.

Incidence and risk factors for suicidal ideation in a sample of Chinese patients with mixed cancer types

PURPOSE

Suicidal ideation (SI) is often overlooked as a risk factor for people with cancer. Because it is often a precursor for suicidal behavior, it is critical to identify and address SI in a timely manner. This study investigated SI incidence and risk factors in a cohort of Chinese patients with mixed cancer types.

METHODS

Data from this cross-sectional study were collected from 588 patients receiving medical therapy for tumors at Nanfang Hospital and the Integrated Hospital of Traditional Chinese Medicine at Southern Medical University. SI was measured using the Self-rating Idea of Suicide Scale (SIOSS). Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). The Chinese version of the Demoralization Scale II (DS-II-C) was used to assess demoralization. Univariate and correlation analyses were used to identify correlative factors of SI and multiple stepwise linear regression analysis was used to characterize potential risk factors.

RESULTS

SI was reported in 24.7% of participants and the SIOSS score was 14.00 (13.00, 15.00) in the SI group. Multiple linear regression results showed that demoralization, medical financial burden, cancer type, living condition, caretaker, working state, residence, gender, and marital status explained 32.1% of the SI in this cohort (F = 28.705, P < 0.001).

CONCLUSION

Approximately one-quarter of cancer patients in this study reported SI influenced by both external and internal factors. Characterizing these factors can be informative for prevention and treatment efforts.

Prognostic Value of Combination of Inflammatory and Tumor Markers in Resectable Gastric Cancer

BACKGROUND

Inflammatory response and tumor marker levels have been shown to correlate with the prognosis in several human tumors. However, only a few studies on these markers have been performed in gastric cancer (GC) patients; the clinical significance of the combined markers is unclear. We aimed to evaluate the role of the combination of preoperative neutrophil-to-lymphocyte ratio (NLR) and carbohydrate antigen 19-9 (CA19-9) for predicting the prognosis of patients with GC.

METHODS

This retrospective study included 458 patients who underwent gastrectomy with curative intent between January 2013 and July 2014 in the second hospital of Lanzhou University. Receiver operating characteristic curve (ROC) was performed to determine the cut-off values for biomarkers, and their prognostic values were assessed using the Kaplan-Meier curve. The combined score indicators were established based on the optimal cut-off values, which range from 0 to 2. Prognostic significances for overall survival (OS) were assessed by univariate and multivariate Cox regression analysis. Nomogram was used as a visual supplement for the prognostic score system, and the predictive accuracy and discriminative ability were determined by the concordance index (C-index) and calibration curve.

RESULTS

The Kaplan-Meier survival analysis showed that the 1-, 3-, and 5-year OS were 66.2% (n = 303), 42.8% (n = 196), and 40.2% (n = 184) in all 458 patients, respectively. The high NLR (≥1.96), PLR (≥126), CA19-9 (≥27 U/mL), and CEA (≥ 5 ng/mL) were associated with poor prognosis of GC patients. The NLR + CA19-9 score indicator proved to be related to tumor size, lymph node metastasis, vascular invasion, perineural invasion, T stage, N stage, TNM stage, PLR, and CEA in patients with GC and an independent prognostic factor for prediction of 5-year OS (score 1: HR = 1.423, 95%CI: 1.049-1.929, P = 0.023; score 2: HR = 2.740, 95%CI: 1.882-3.990, P < 0.001). NLR + CA19-9 has a better predictive ability than other combined or single score indicators based on inflammation and tumor markers (AUC = 0.662, 95%CI: 0.616-0.705, P < 0.001). Moreover, a nomogram was established by the significant characteristics in the multivariate analysis for OS, which represented high accuracy (C-index = 0.692, 95%CI: 0.675-0.708).

CONCLUSION

NLR + CA19-9 can independently predict the overall survival of patients with gastric cancer after surgery. The prognostic nomogram based on NLR + CA19-9 is a convenient, economical, and effective prognostic system for clinical practice.