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Kim D. How to determine surgical management in octogenarian patients with lung cancer? J Thorac Dis 2023; 15:4130-4133. [PMID: 37691664 PMCID: PMC10482627 DOI: 10.21037/jtd-23-626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/07/2023] [Indexed: 09/12/2023]
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Han KT, Chang J, Choi DW, Kim S, Kim DJ, Chang YJ, Kim SJ. Association of institutional transition of cancer care with mortality in elderly patients with lung cancer: a retrospective cohort study using national claim data. BMC Cancer 2022; 22:452. [PMID: 35468762 PMCID: PMC9040246 DOI: 10.1186/s12885-022-09590-5] [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: 11/11/2021] [Accepted: 04/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background Although survival based outcomes of lung cancer patients have been well developed, institutional transition of cancer care, that is, when patients transfer from primary visiting hospitals to other hospitals, and mortality have not yet been explored using a large-scale representative population-based sample. Methods Data from the Korean National Elderly Sampled Cohort survey were used to identify patients with lung cancer who were diagnosed during 2005–2013 and followed up with for at least 1 year after diagnosis (3738 patients with lung cancer aged over 60 years). First, the authors examined the distribution of the study population by mortality, and Kaplan-Meier survival curves/log-rank test were used to compare mortality based on institutional transition of cancer care. Survival analysis using the Cox proportional hazard model was conducted after controlling for all other variables. Results Results showed that 1-year mortality was higher in patients who underwent institutional transition of cancer care during 30 days after diagnosis (44.2% vs. 39.7%, p = .027); however, this was not associated with 5-year mortality. The Cox proportional hazard model showed that patients who underwent institutional transition of cancer care during 30 days after diagnosis exhibited statistically significant associations with high mortality for 1 year and 5 years (1-year mortality, Hazard ratio [HR]: 1.279, p = .001; 5-year mortality, HR: 1.158, p = .002). Conclusion This study found that institutional transition of cancer care was associated with higher mortality among elderly patients with lung cancer. Future consideration should also be given to the limitation of patients’ choice when opting for institutional transition of care since there are currently no control mechanisms in this regard. Results of this study merit health policymakers’ attention.
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Affiliation(s)
- Kyu-Tae Han
- Division of Cancer Control & Policy, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Jongwha Chang
- Department of Healthcare Administration, College of Business, Texas Woman's University, Denton, TX, USA
| | - Dong-Woo Choi
- Cancer Big Data Center, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Seungju Kim
- Department of Nursing, College of Nursing, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong Jun Kim
- Division of Cancer Control & Policy, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Yoon-Jung Chang
- Division of Cancer Control & Policy, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Sun Jung Kim
- Department of Health Administration and Management, College of Medical Science, Soonchunhyang University, 22 Soonchunhyang-ro, Asan, 31538, Republic of Korea. .,Center for Healthcare Management Science, Soonchunhyang University, Asan, Republic of Korea. .,Department of Software Convergence, Soonchunhyang University, Asan, Republic of Korea.
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Kim D, Lee JW. Current Status of Lung Cancer and Surgery Based on Studies Using a Nationwide Database. J Chest Surg 2021; 55:1-9. [PMID: 34907096 PMCID: PMC8824654 DOI: 10.5090/jcs.21.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 11/16/2022] Open
Abstract
Lung cancer is a fatal disease, highlighting the importance of research on related topics, including surgery for lung cancer. However, systematic research analyzing surgery on a national scale is limited. This study aimed to investigate the research on lung cancer using nationwide data in South Korea and to analyze trends in lung cancer surgery, including its clinical implications. Published articles and data from the Korean National Health Insurance database were used. Although the incidence and mortality of lung cancer have been improving, it is predicted to be the most common and fatal type of cancer in South Korea in 2021. The number of surgical procedures for lung cancer is increasing, especially among women, those ≥76 years of age, residents of non-metropolitan cities, and middle-income patients. Lobectomy and sublobectomy, including segmentectomy, are increasingly common. However, the proportion of pneumonectomy relative to other procedures is not increasing. Surgery has shown a reasonable survival rate, especially after lobectomy, but survival remains poor in patients ≥76 years of age who undergo pneumonectomy. The frequency of lung cancer surgery is increasing concomitantly with various socioeconomic changes. Lobectomy has become increasingly common, and the clinical results of surgery are satisfactory. Further research on the changing composition of surgical candidates is required.
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Affiliation(s)
- Dohun Kim
- Department of Thoracic and Cardiovascular Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Jung-Won Lee
- Department of Biochemistry, School of Medicine, Institute for Tumor Research, Chungbuk National University, Cheongju, Korea
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Kim D, Kang GW, Jang H, Cho JY, Yang B, Yang HC, Hwang J. Trend of lung cancer surgery, hospital selection, and survival between 2005 and 2016 in South Korea. Thorac Cancer 2021; 13:210-218. [PMID: 34800078 PMCID: PMC8758424 DOI: 10.1111/1759-7714.14247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/07/2021] [Accepted: 11/08/2021] [Indexed: 11/29/2022] Open
Abstract
Background Studies on the clinical implication of hospital selection for patients with lung cancer are few. Therefore, this study aimed to analyze 2005–2016 data from the Korean national database to assess annual trends of lung cancer surgery and clinical outcomes according to hospital selection. Methods Data of 212 554 patients with lung cancer who underwent upfront surgery were screened. Trends according to sex, age, residence, and income were examined. Descriptive statistics were performed, and ptrend values were estimated. The association between survival and hospital selection was assessed using the log‐rank test. A multivariate Cox regression analysis was also performed. Results A total of 49 021 patients were included in this study. Surgery was prevalent among men, patients aged 61–75 years, capital area residents, and high‐income patients. However, with the increasing rate of surgery among women, patients aged ≥76 years, city residents, and middle‐income patients, the current distribution of lung cancer surgery could change. The rate of lobectomy among these groups increased. All patients, except those in capital areas, preferred a hospital outside their area of residence (HOR); the number of patients with this tendency also increased. However, this trend was not observed among low‐income patients and those aged ≥76 years. There were significant differences in survival according to hospital selection. Conclusions The trend of lung cancer surgery is changing. The current medical system is effective in providing lobectomy for patients including women, aged ≥76 years, city residents, and middle‐income. Increasing tendency to choose an HOR requires further study.
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Affiliation(s)
- Dohun Kim
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Chungbuk National University, Chungbuk National University Hospital, Cheong-ju, South Korea
| | - Gil-Won Kang
- Department of Health Informatics and Management, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Hoyeon Jang
- Department of Health Informatics and Management, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Jun Yeun Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Cheong-ju, South Korea
| | - Bumhee Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Cheong-ju, South Korea
| | - Hee Chul Yang
- Center for lung cancer, National Cancer Center, Goyang, South Korea
| | - Jinwook Hwang
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Korea University, Seoul, South Korea
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Han KT, Kim W, Song A, Ju YJ, Choi DW, Kim S. Is time-to-treatment associated with higher mortality in Korean elderly lung cancer patients? Health Policy 2021; 125:1047-1053. [PMID: 34176673 DOI: 10.1016/j.healthpol.2021.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 05/13/2021] [Accepted: 06/14/2021] [Indexed: 11/28/2022]
Abstract
Lung cancer is a leading cause of cancer-related deaths in many countries, including South Korea. As treatment delays after diagnosis may correlate with survival, this study aimed to investigate the association between time-to-treatment and one-and five-year overall mortality in patients aged 60 years or above. Survival analysis using the Cox proportional hazard model were conducted after controlling for all independent variables. Of a total of 1,535 individuals who received surgical treatment due to lung cancer, 837 patients received treatment within 30 days and 698 after 30 days of initial diagnosis. Individuals who received surgical treatment after 30 days of diagnosis were more likely to die within 1-year (Hazard Ratio, HR: 1.15, 95% Confidence Interval, CI: 1.01-1.32) and 5-year (HR: 1.16, 95% CI: 1.02-1.33) compared to those who received treatment within 30 days. The increase in mortality risk with time delay persisted when applying other cut-off times, including standards at 2, 3, and 6 months. We also found that the mortality rate of lung cancer patients differs depending on age (74 years or younger), household income (<80 percentile), patient severity, and the residing region. Our findings show that time delay is an important factor that can influence the outcome of lung cancer patients, highlighting the importance of monitoring and providing appropriate and timely treatment.
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Affiliation(s)
- Kyu-Tae Han
- Division of Cancer Control & Policy, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Woorim Kim
- Division of Cancer Control & Policy, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Areum Song
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yeong Jun Ju
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Dong-Woo Choi
- Department of Biostatistics, Yonsei University Graduate School of Public Health, Seoul, Korea
| | - Seungju Kim
- Department of Nursing, College of Nursing, The Catholic University of Korea, Seoul, Republic of Korea.
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Noh J, Jang H, Cho J, Kang DR, Kim TH, Shin DC, Kim C. Estimating the disease burden of lung cancer attributable to residential radon exposure in Korea during 2006-2015: A socio-economic approach. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 749:141573. [PMID: 32841859 DOI: 10.1016/j.scitotenv.2020.141573] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/05/2020] [Accepted: 08/07/2020] [Indexed: 06/11/2023]
Abstract
Estimating the lung cancer disease burden can provide evidence for public health practitioners, researchers, and policymakers. This study uses claim data from lung cancer patients for 2006-2015 from the Korean National Health Insurance Service to estimate the lung cancer burdens attributable to residential radon in Korea using disability-adjusted life years (DALY) and patients' annual economic burden with societal perspectives using the cost-of-illness (COI) method. The number of patients increased during our study period (from 35,866 to 59,168). The disease burden and that attributable to residential radon, respectively, increased from 517.57 to 695.74 and 64.62 (95%; CIs 61.33-67.69) to 86.99 (95%; CIs 82.7-91.1) DALYs per 100,000 patients. The percentage of years lost due to disability among the DALY doubled from 8% to 17%. The cost for all the patients was US$2.33 billion, with US$292 (95%; CIs 278-306) million attributable to residential radon. During the last decade, the lung cancer disease burden increased by 1.34 times, with a doubled percentage of non-fatal burden and average annual growth rate of 9.5% of the total cost. Hence, the burden and cost of lung cancer in Korean provinces have been steadily increasing. The findings could be used as input data for future cost-effectiveness analysis of policies regarding radon reduction.
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Affiliation(s)
- Juhwan Noh
- Department of Preventive Medicine, Yonsei University, College of Medicine, Seoul, Republic of Korea; Institute of Human Complexity and Systems Science, Yonsei University, Seoul, Republic of Korea.
| | - Heeseon Jang
- Department of Preventive Medicine, Yonsei University, College of Medicine, Seoul, Republic of Korea; Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.
| | - Jaelim Cho
- Institute of Human Complexity and Systems Science, Yonsei University, Seoul, Republic of Korea; School of Medicine, University of Auckland, Auckland, New Zealand; Institute for Environmental Research, Yonsei University, College of Medicine, Seoul, Republic of Korea.
| | - Dae Ryong Kang
- Center of Biomedical Data Science, Yonsei University, Wonju College of Medicine, Wonju, Republic of Korea.
| | - Tae Hyun Kim
- Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea.
| | - Dong Chun Shin
- Department of Preventive Medicine, Yonsei University, College of Medicine, Seoul, Republic of Korea; Institute for Environmental Research, Yonsei University, College of Medicine, Seoul, Republic of Korea.
| | - Changsoo Kim
- Department of Preventive Medicine, Yonsei University, College of Medicine, Seoul, Republic of Korea; Institute of Human Complexity and Systems Science, Yonsei University, Seoul, Republic of Korea; Institute for Environmental Research, Yonsei University, College of Medicine, Seoul, Republic of Korea.
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Zang S, Zhan H, Zhou L, Wang X. Research on Current Curative Expenditure among Lung Cancer Patients Based on the "System of Health Accounts 2011": Insights into Influencing Factors. J Cancer 2019; 10:6491-6501. [PMID: 31777579 PMCID: PMC6856899 DOI: 10.7150/jca.34891] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 09/22/2019] [Indexed: 01/02/2023] Open
Abstract
PURPOSE To investigate the total current curative expenditure (CCE) of lung cancer in Hunan Province, China under the framework of the System of Health Accounts 2011 (SHA 2011) and explore the effect of insurance status, surgery and length of stay on the hospitalization expenses of patients with lung cancer. METHODS Through multistage stratified cluster random sampling, a total of 46,214 patients with lung cancer were enrolled from 1,072 medical institutions in Hunan Province in 2016. Under the SHA 2011 framework, the lung cancer CCE was analyzed. The relationships between hospitalization expenditure and the following factors (surgery, type of hospital, insurance status, length of stay, institution level, age and sex) were analyzed using Spearman's correlation analyses, and how these factors influenced hospital expenditure was explored through multiple stepwise regression analysis and structural equation modelling. RESULTS The CCE for lung cancer patients was 8063.75 million CNY. In total, 96.03% of the CCE for lung cancer occurred in hospitals and 58.88% of the expenditure flowed to general hospitals. The highest expenditures were incurred in the group aged 55-74 y, which accounted for 61.58% of the CCE. Drugs accounted for the greatest share expenditure to lung cancer patients at 34.31% of the CCE. Surgery, insurance status, institution level, sex and hospital type explained 57.5% of the variance in hospital expenses. The hospitalization expenses were related to surgery, insurance status, institution level and sex (rs = 0.033-0.688, p < 0.001). Surgery, insurance status and length of stay had direct effects on hospitalization expenses. Length of stay mediated the relationship between surgery and hospitalization expenses for lung cancer patients. Surgery mediated the relationship between insurance status and hospitalization expenses. All of these variables can explain 45% of the variance in hospitalization expenses. CONCLUSIONS The CCE of lung cancer is extremely high. The problems related to treatment efficiency and equity are serious for lung cancer patients in China. It is essential to expand health insurance coverage and reduce the curative expenditure of lung cancer.
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Affiliation(s)
- Shuang Zang
- School of Nursing, China Medical University, Shenyang, Liaoning
| | - Huan Zhan
- School of Humanities and Management, Hunan University of Chinese Medicine, Changsha, Hunan
| | - Liangrong Zhou
- School of Humanities and Management, Hunan University of Chinese Medicine, Changsha, Hunan
| | - Xin Wang
- College of the Humanities and Social Sciences, China Medical University, Shenyang, Liaoning
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