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Zhang L, Zhuang X, Yang X, Xu F, Wang N, Guo Z, Chen J, Ding D. Analysis of hospitalization expenses and influencing factors for elderly cancer patients in a tertiary hospital in Dalian, China: a five‑year retrospective study. BMC Cancer 2024; 24:864. [PMID: 39026195 PMCID: PMC11264680 DOI: 10.1186/s12885-024-12635-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 07/12/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Because the proportion of elderly individuals and the incidence of cancer worldwide are continually increasing, medical costs for elderly inpatients with cancer are being significantly increasing, which puts tremendous financial pressure on their families and society. The current study described the actual direct medical costs of elderly inpatients with cancer and analyzed the influencing factors for the costs to provide advice on the prevention and control of the high medical costs of elderly patients with cancer. METHOD A retrospective descriptive analysis was performed on the hospitalization expense data of 11,399 elderly inpatients with cancer at a tier-3 hospital in Dalian between June 2016 and June 2020. The differences between different groups were analyzed using univariate analysis, and the influencing factors of hospitalization expenses were explored by multiple linear regression analysis. RESULTS The hospitalization cost of elderly cancer patients showed a decreasing trend from 2016 to 2020. Specifically, the top 3 hospitalization costs were material costs, drug costs and surgery costs, which accounted for greater than 10% of all cancers according to the classification: colorectal (23.96%), lung (21.74%), breast (12.34%) and stomach cancer (12.07%). Multiple linear regression analysis indicated that cancer type, surgery, year and length of stay (LOS) had a common impact on the four types of hospitalization costs (P < 0.05). CONCLUSION There were significant differences in the four types of hospitalization costs for elderly cancer patients according to the LOS, surgery, year and type of cancer. The study results suggest that the health administration department should enhance the supervision of hospital costs and elderly cancer patient treatment. Measures should be taken by relying on the hospital information system to strengthen the cost management of cancer diseases and departments, optimize the internal management system, shorten elderly cancer patients LOS, and reasonably control the costs of disease diagnosis, treatment and department operation to effectively reduce the economic burden of elderly cancer patients.
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Affiliation(s)
- Lilin Zhang
- Medical Department, Central Hospital of Dalian University of Technology, Dalian, 116033, China
| | - Xijing Zhuang
- Medical Department, Central Hospital of Dalian University of Technology, Dalian, 116033, China
| | - Xiumei Yang
- Group Work Department, Central Hospital of Dalian University of Technology, Dalian, 116033, China
| | - Feng Xu
- Medical Department, Central Hospital of Dalian University of Technology, Dalian, 116033, China
| | - Nan Wang
- Medical Department, Central Hospital of Dalian University of Technology, Dalian, 116033, China
| | - Zhanfang Guo
- Medical Department, Central Hospital of Dalian University of Technology, Dalian, 116033, China
| | - Junfeng Chen
- College of Public Health, Dalian Medical University, Dalian, 116044, China
| | - Ding Ding
- College of Public Health, Dalian Medical University, Dalian, 116044, China.
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Pilz MJ, Loth FLC, Nolte S, Thurner AMM, Gamper EM, Anota A, Liegl G, Giesinger JM. General population normative values for the EORTC QLQ-C30 by age, sex, and health condition for the French general population. J Patient Rep Outcomes 2024; 8:48. [PMID: 38695992 PMCID: PMC11065800 DOI: 10.1186/s41687-024-00719-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 03/07/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND General population normative values for the widely used health-related quality of life (HRQoL) measure EORTC QLQ-C30 support the interpretation of trial results and HRQoL of patients in clinical practice. Here, we provide sex-, age- and health condition-specific normative values for the EORTC QLQ-C30 in the French general population. METHODS French general population data was collected in an international EORTC project. Online panels with quota samples were used to recruit sex and age groups. Number and type of comorbidities were assessed. Descriptive statistics were used to calculate general population values for each QLQ-C30 scale, separately for sex, age, and presence of one- and more chronic health conditions. A multivariate linear regression model has been developed to allow estimating the effect of sex, age, and the presence for one- and more chronic health conditions on EORTC QLQ-C30 scores. Data was weighted according to United Nation statistics adjusting for the proportion of sex and age groups. RESULTS In total, 1001 French respondents were included in our analyses. The weighted mean age was 47.9 years, 514 (51.3%) participants were women, and 497 (52.2%) participants reported at least one health condition. Men reported statistically significant better scores for Emotional Functioning (+9.6 points, p = 0.006) and Fatigue (-7.8 point; p = 0.04); women reported better profiles for Role Functioning (+8.7 points; p = 0.008) and Financial Difficulty (-7.8 points, p = 0.011). According to the regression model, the sex effect was statistically significant in eight scales; the effect of increasing age had a statistically significant effect on seven of the 15 EORTC QLQ-C30 scales. The sex- and age effect varied in its direction across the various scales. The presence of health conditions showed a strong negative effect on all scales. CONCLUSION This is the first publication of detailed French normative values for the EORTC QLQ-C30. It aims to support the interpretation of HRQoL profiles in French cancer populations. The strong impact of health conditions on QLQ-C30 scores highlights the importance of considering the impact of comorbidities in cancer patients when interpreting HRQoL data.
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Affiliation(s)
- Micha J Pilz
- Health Outcomes Research Unit, University Hospital of Psychiatry II, Medical University of Innsbruck, Innrain 43, Innsbruck, 6020, Austria
| | - Fanny L C Loth
- Psychological Diagnostics and Intervention, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Sandra Nolte
- Department of Psychosomatic Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Melbourne Health Economics, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Anna M M Thurner
- Health Outcomes Research Unit, University Hospital of Psychiatry II, Medical University of Innsbruck, Innrain 43, Innsbruck, 6020, Austria
| | - Eva-Maria Gamper
- Department of Nuclear Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Amélie Anota
- Department of Clinical Research and Innovation and Human and Social Sciences Department, Centre Léon Bérard, Lyon, France
| | - Gregor Liegl
- Department of Psychosomatic Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Johannes M Giesinger
- Health Outcomes Research Unit, University Hospital of Psychiatry II, Medical University of Innsbruck, Innrain 43, Innsbruck, 6020, Austria.
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Winter A, Schulz SM, Schmitter M, Müller-Richter U, Kübler A, Kasper S, Hartmann S. Comprehensive Geriatric Assessment and Quality of Life Aspects in Patients with Recurrent/Metastatic Head and Neck Squamous Cell Carcinoma (HNSCC). J Clin Med 2023; 12:5738. [PMID: 37685806 PMCID: PMC10488489 DOI: 10.3390/jcm12175738] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
To define frailty in older cancer patients, the aim of this study was to assess the geriatric status and quality of life (QoL) aspects in patients suffering from recurrent/metastatic head and neck squamous cell carcinoma (r/m HNSCC) under palliative treatment. A comprehensive geriatric assessment (CGA) was performed on 21 r/m HNSCC patients at two defined assessments, and the QoL aspects and the impact of descriptive data were evaluated. The Kolmogorov-Smirnov test, Spearman's rho correlation, and two-way mixed ANOVA were used for statistical analysis. All patients were found to be "frail". Pain, fatigue, and the burden of illness were the highest-rated symptoms. Oral function and orofacial appearance were highly impaired. A significant impact of descriptive data on the CGA and QoL results was found (all p ≤ 0.05). Thus, the CGA results revealed high frailty, severe comorbidities, and high impairments in QoL aspects. The CGA and QoL results were negatively affected by the primary HNSCC treatment approach, the need for prosthetic treatment, and worse oral functional capacity. Therefore, frailty in r/m HNSCC patients seems to be multidimensional. The evaluation of the CGA and QoL aspects in r/m HNSCC patients can be recommended to detect special needs, organize aftercare, and improve the support for frail and vulnerable cancer patients to create a multidisciplinary treatment approach.
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Affiliation(s)
- Anna Winter
- Department of Prosthodontics, University Hospital Würzburg, Pleicherwall 2, 97070 Würzburg, Germany;
| | - Stefan M. Schulz
- Faculty I, Nursing Science, Department of Behavioural Medicine and Principles of Human Biology for the Health Sciences, Trier University, Universitätsring 15, 54296 Trier, Germany;
| | - Marc Schmitter
- Department of Prosthodontics, University Hospital Würzburg, Pleicherwall 2, 97070 Würzburg, Germany;
| | - Urs Müller-Richter
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070 Würzburg, Germany; (U.M.-R.); (A.K.); (S.K.); (S.H.)
| | - Alexander Kübler
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070 Würzburg, Germany; (U.M.-R.); (A.K.); (S.K.); (S.H.)
| | - Sylvia Kasper
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070 Würzburg, Germany; (U.M.-R.); (A.K.); (S.K.); (S.H.)
| | - Stefan Hartmann
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070 Würzburg, Germany; (U.M.-R.); (A.K.); (S.K.); (S.H.)
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Ribbands A, Boytsov N, Bailey A, Gorsh B, Luke E, Lambert A. Real-world patient-reported outcomes and concordance between patient and physician reporting of side effects across lines of therapy in multiple myeloma within the USA. Support Care Cancer 2023; 31:371. [PMID: 37268868 DOI: 10.1007/s00520-023-07836-x] [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: 01/04/2023] [Accepted: 05/24/2023] [Indexed: 06/04/2023]
Abstract
PURPOSE We aimed to explore patient-reported outcomes (PROs) and patient and physician concordance of side effects perception across lines of therapy (LOT) in multiple myeloma (MM) within the United States of America (USA). METHODS Data were drawn from the Adelphi Real World MM III Disease Specific Programme™, a point-in-time survey of hemato-oncologists/hematologists and their patients with MM conducted in the USA between August 2020 and July 2021. Physicians reported patient characteristics and side effects. Patients reported side-effect bother and health-related quality of life (HRQoL) using validated PRO tools (European Organisation for the Research and Treatment of Cancer Quality of Life Core Questionnaire/-MM Module [EORTC QLQ-C30/-MY20], EQ-5D-3L and Functional Assessment of Cancer Therapy-General Population physical item 5). Descriptive, linear regression and concordance analyses were performed. RESULTS Records from 63 physicians and 132 patients with MM were analyzed. EORTC QLQ-C30/-MY20 and EQ-5D-3L scores were consistent across LOTs. Scores tended to be worse with higher side-effect bother; patients "very much" bothered by side effects had lower median (interquartile range) global health status scores (33.3 [25.0-50.0]) than those "not at all" bothered (79.2 [66.7-83.3]). Patient and physician concordance on side-effect reporting was poor to fair. Patients frequently reported fatigue and nausea as bothersome side effects. CONCLUSION HRQoL of patients with MM was worse with greater side-effect bother. Discordant patient and physician reporting of side effects indicated a need for improved communication during management of MM.
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Affiliation(s)
| | | | | | | | - Emily Luke
- Oncology Franchise, Adelphi Real World, Bollington, UK
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Ram Z, Kim CY, Hottinger AF, Idbaih A, Nicholas G, Zhu JJ. Efficacy and Safety of Tumor Treating Fields (TTFields) in Elderly Patients with Newly Diagnosed Glioblastoma: Subgroup Analysis of the Phase 3 EF-14 Clinical Trial. Front Oncol 2021; 11:671972. [PMID: 34692470 PMCID: PMC8526342 DOI: 10.3389/fonc.2021.671972] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 08/31/2021] [Indexed: 01/05/2023] Open
Abstract
Background Understudied elderly patients comprise a large segment of high-risk patients with glioblastoma (GBM) that are challenging to treat. Tumor Treating Fields (TTFields) is a locoregional, noninvasive, antimitotic therapy delivering low-intensity, intermediate-frequency alternating electric fields to the tumor. In the phase 3 EF-14 clinical trial, TTFields (200 kHz) improved median progression-free survival (PFS) and median overall survival (OS) in patients with newly diagnosed GBM (ndGBM) when added concomitantly to maintenance temozolomide (TMZ). This EF-14 subgroup analysis evaluated the safety and efficacy of TTFields in elderly patients. Methods All 134 patients who are ≥65 years of age were included (TTFields/TMZ combination, n=89; TMZ monotherapy, n=45; 2:1 ratio of randomization). PFS and OS were analyzed using Kaplan-Meier methodology (α=0.05). Health-related quality-of-life (HRQoL) was assessed using the European Organisation for Research and Treatment of Cancer (EORTC) quality-of-life questionnaire QLQ-C30 supplemented with the brain tumor module (QLQ-BN20). Adverse events (AEs) were evaluated using Common Terminology Criteria for AEs (CTCAE) v4.0. Results The PFS was 6.5 months in patients randomized to the treatment group with TTFields/TMZ combination versus 3.9 months in patients treated with TMZ monotherapy (HR, 0.47; 95% CI, 0.30-0.74; P=0.0236). The OS was 17.4 months in patients treated with TTFields/TMZ combination versus 13.7 months in patients treated with TMZ monotherapy (HR, 0.51; 95% CI, 0.33-0.77; P=0.0204). Annual survival rates with TTFields/TMZ versus TMZ monotherapy were 39% (95% CI, 29-50%) versus 27% (95% CI, 15-41%; P=0.072) at 2 years, 19% (95% CI, 11-29%) versus 11% (95% CI, 4-23%; P=0.135) at 3 years, and 15% (95% CI, 7-25%) versus 0% at 5 years, respectively. There were no significant differences between groups in the preselected items of HRQoL assessment. Grade ≥3 systemic AEs were 46% in the TTFields/TMZ group versus 40% in the TMZ monotherapy group, without statistically significant difference between the two groups. The only TTFields-related AEs were reversible scalp skin reactions, with grades 1-2 and grade 3 skin reactions reported by 51% and 2% of patients, respectively. Conclusions Combining TTFields with maintenance TMZ significantly improved PFS and OS in elderly patients with ndGBM in the phase 3 EF-14 clinical trial, without significant increases in systemic toxicity or negatively affecting patient HRQoL. TTFields-related skin AEs were low-grade and manageable. Clinical Trial Registration https://clinicaltrials.gov/ct2/show/NCT00916409, identifier: NCT00916409.
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Affiliation(s)
- Zvi Ram
- Department of Neurosurgery, Tel Aviv Medical Center and Tel Aviv University School of Medicine, Tel Aviv, Israel
| | - Chae-Yong Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Andreas F Hottinger
- Department of Clinical Neuroscience, CHUV Lausanne University Hospital & University of Lausanne, Lausanne, Switzerland
| | - Ahmed Idbaih
- Service de Neurologie 2-Mazarin, Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, Paris, France
| | - Garth Nicholas
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jay-Jiguang Zhu
- Department of Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX, United States
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de Cassia Tornier S, Macedo FJ, Sassi LM, Schussel JL. Quality of life in cancer patients with or without medication-related osteonecrosis of the jaw. Support Care Cancer 2021; 29:6713-6719. [PMID: 33973080 DOI: 10.1007/s00520-021-06275-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 05/04/2021] [Indexed: 11/12/2022]
Abstract
PURPOSE Cancer and its therapies can have a significant impact on general and oral health and, therefore, cause a reduction in patients' quality of life (QoL). The study aimed to evaluate the QoL of cancer patients who use antiresorptive and anti-angiogenic medications with or without the development of medication-related osteonecrosis of the jaws (MRONJ). METHODS Sixty-two patients diagnosed with cancer under antiresorptive therapy answered three instruments from the European Organization for Cancer Research and Treatment (EORTC). The first questionnaire (QLQ-C30) aimed to measure the overall QoL, the second (QLQ-ELD14) is a complementary module for elderly patients, and the third (QLQ-OH15) aimed to assess oral health related to QoL. RESULTS The mean age of the patients was 62.19 years, and 12.9% developed MRONJ. There was no significant difference between sex and MRONJ. Among the QLQ-C30 scales, the item "role functioning (RF2)" presented a significant result (p = 0.019). Those patients without MRONJ had a better function performance both in their daily chores and in their free time. Age was not associated to MRONJ, although some concerns are common to the elderly and cancer patients. QoL related to oral health presented a significant result (p = 0.048) showing that MRONJ has a negative impact on patients' QoL. CONCLUSION Our results showed that MRONJ has a significant impact on the general and oral QoL of cancer patients, and therefore prevention and awareness must be a priority.
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Affiliation(s)
- Sara de Cassia Tornier
- Postgraduate Program in Dentistry, Universidade Federal Do Paraná, Curitiba, Paraná, Brazil
| | - Fernanda Joly Macedo
- Department of Oral and Maxillofacial Surgery, Erasto Gaertner Cancer Center, Curitiba, Paraná, Brazil
| | - Laurindo Moacir Sassi
- Department of Oral and Maxillofacial Surgery, Erasto Gaertner Cancer Center, Curitiba, Paraná, Brazil
| | - Juliana Lucena Schussel
- Postgraduate Program in Dentistry, Universidade Federal Do Paraná, Curitiba, Paraná, Brazil. .,Department of Oral and Maxillofacial Surgery, Erasto Gaertner Cancer Center, Curitiba, Paraná, Brazil.
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Correlations between long-term quality of life and patient needs and concerns following head and neck cancer treatment and the impact of psychological distress. A multicentric cross-sectional study. Eur Arch Otorhinolaryngol 2020; 278:2437-2445. [PMID: 32901366 DOI: 10.1007/s00405-020-06326-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/24/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To assess patient needs and concerns after head and neck squamous cell carcinoma (HNSCC) treatment and their possible correlations with long-term quality of life (QoL) and to examine the potential impact of psychological distress on these results. METHODS Alive and disease-free HNSCC patients at least 1 year after treatment were enrolled in this cross-sectional multicentric study and completed the EORTC QLQ-C30 and H&N35 QoL questionnaires, the head and neck cancer-specific patient concerns inventory (PCI-HN) questionnaire and the hospital anxiety and depression scale (HADS). Correlations between QoL outcomes and patient needs and concerns were investigated using Spearman's correlation tests. RESULTS Seventy-two patients were enrolled in the study. Fear of cancer recurrence was the main patient concern followed by dental, salivary, fatigue, speech, and eating problems. The leading patient needs in terms of consultation were to be referred to the surgeon, the speech, and swallow therapist and the oral rehabilitation team. The number of patient concerns correlated negatively (r < .40) with functioning scales score and positively (r > .40) with general and head and neck symptoms. Psychological distress was the main determinant of QoL outcomes (p < .0001). We found a significant impact of gender (p = .002) on the number of patient concerns, and of patient age (p = .003) on the number of staff members selected by patients. CONCLUSION Identification of patient needs and concerns along with multidisciplinary management of persistent symptoms and psychological distress seem essential steps towards improving QoL of HNSCC patients.
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Campos JADB, da Silva WR, Spexoto MCB, Serrano SV, Marôco J. Clinical, dietary and demographic characteristics interfering on quality of life of cancer patients. EINSTEIN-SAO PAULO 2018; 16:eAO4368. [PMID: 30517364 PMCID: PMC6276908 DOI: 10.31744/einstein_journal/2018ao4368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 05/21/2018] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To estimate the dietary intake of cancer patients and its relation with clinical and demographic characteristics, and to assess the contribution of dietary intake, appetite/symptoms and clinical and demographic characteristics to their quality of life. METHODS The consumption of energy and macronutrients of patients was estimated. The relation between dietary intake and clinical and demographic characteristics was evaluated by analysis of variance. The intake of energy and macronutrient of the patients was compared to the nutritional recommendations using 95% confidence interval. The Cancer Appetite and Symptom Questionnaire (CASQ) and the European Organization for Research and Treatment of Cancer (EORTC QLQ C-30) were used to assess appetite/symptoms and quality of life, respectively. The psychometric properties of the instruments were estimated. A structural equation model was prepared. RESULTS In this study, 772 cancer patients (63.1% women) participated. There was a significant relation between dietary intake and work activity, economic class, specialty field of cancer, type of treatment and nutritional status. Patients' energy and macronutrients intake was below recommended values. Both CASQ and EORTC QLQ C-30 were refined to fit the data. In the structural model, impaired appetite, more symptoms, presence of metastasis, being female and of higher economic classes were characteristics that significantly contributed to interfering in patients' quality of life. CONCLUSION The dietary intake of oncology patients did not reach the recommended values. Different characteristics impacted on quality of life of patients and should be considered in clinical and epidemiological protocols.
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Affiliation(s)
| | | | | | | | - João Marôco
- Instituto Universitário de Ciências Psicológicas, Sociais e da Vida, Lisboa, Portugal
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