Estimation of potential gain in quality of life from early detection of cervical cancer

Effective prevention in clinical practice may save human capital loss: Real-world evidence from Taiwan's National Health Insurance

BACKGROUND/PURPOSE

Effective prevention could protect the health of the workforce, save human capital loss, and maintain employee productivity as well as economic growth.

METHODS

Using real-world data of patients with end-stage kidney disease (ESKD) and lung cancer, we multiplied their lifetime survival functions with employment ratios and working salaries to estimate the lifetime employment durations and earnings. They were compared with corresponding age-, sex-, and calendar year-matched referents to assess the differences in loss of lifetime employment duration and earnings. From 2000 to 2017, 83,358 patients with end-stage kidney disease (ESKD) were associated with 32-66% lifetime productivity losses. Similarly, we collected 24,904 incident cases of lung adenocarcinoma during 2011-2018 and estimated the potential savings in human capital due to early detection. Based on the evolving trends of ESKD incidence rates in Taiwan, we calculated the lifetime human capital losses of ESKD patients in GDP (gross domestic product) percentages during 2000-2020.

RESULTS

The aggregate lifetime productivity losses of ESKD in terms of GDP% varied between 0.000398% and 0.01% for male patients and between 0.0001% and 0.009% for female patients. The younger the patients, the bigger the losses in GDP%. Similarly, early detection of lung adenocarcinoma saved lives and productivity to some extent.

CONCLUSIONS

Successful prevention of catastrophic illnesses at early stages would save the lifetime employment duration and productivity of the workforce. Future reform on the NHI could consider closer coordination between public health and healthcare organizations, focusing on effective prevention of diseases and complications to save productivity loss.

Study on Appropriate Rectal Volume for External Irradiation in Patients With Cervical Cancer

Objective

To investigate the appropriate rectal volume for external irradiation of cervical cancer.

Methods

A retrospective study of 143 patients with cervical cancer who underwent external radiotherapy from January 2017 to September 2020 was conducted. Average rectum volumes and the cumulative dose (V30, V40, V50, D2cc) to organs at risk (bladder, rectum, and small bowel) during radiotherapy were evaluated using the treatment planning system. Rates of radiation cystitis and radiation proctitis were assessed.

Results

The median follow-up was 48 months, and the included patients had a median age of 53 years. Patients were divided into 3 groups based on their average rectum volume: Group A: <40 ml; Group B: 40–70 ml; and Group C: ≥70 ml. V30 and V40 in the rectum bladder and small bowel were highest in Group A (mean ± SD standard deviation), but V50 and D2cc in the rectum and bladder were highest in Group C (mean ± SD). Patients in Group B had the lower incidence of both radiation cystitis and radiation proctitis. (p<0.05).

Conclusions

For external irradiation in patients with cervical cancer, a rectum volume of 40–70 ml seems most appropriate, whereas >70 ml increases the risk of severe radiation cystitis and radiation proctitis, and <40 ml increases the risk of mild radiation cystitis and mild radiation proctitis.

QALYs and medical costs saved from prevention of a cancer: Analysis of nation-wide real-world data of Taiwan with lifetime horizon

BACKGROUND/PURPOSE

To quantify savings of loss-of-QALE (quality-adjusted life expectancy) and lifetime medical costs from prevention of different cancers.

METHODS

We collected nation-wide data on 808,700 new cancer cases of 14 different organ systems and followed them from 1998 to 2014 in Taiwan. We also collected 13,005 cancer patients from a medical center and 47,320 repeated measurements of quality of life (QoL) of EQ-5D to obtain utility values and multiplied them with the corresponding survival rates to calculate QALE. With Kaplan-Meier estimation to survival function to the end of follow-up, we extrapolated to lifetime through a rolling over algorithm on the logit transform of the survival ratio between the index cohort and age-, sex, and calendar year matched referents simulated from vital statistics. Lifetime costs for each cancer were estimated by multiplying survival with average monthly costs after adjustment with annual discount rate. The loss-of-QALE was estimated by the difference in QALE between the index cancer cohort and corresponding referents.

RESULTS

The dynamic changes and weighted averages of the QoL utility values of 14 different cancers ranged from 0.82 to 0.95. Successful prevention of liver, lung, esophagus, or nasopharynx cancer would save more than 10 quality-adjusted life years and more than 21,000 USD per case for both genders. Since the saving of loss-of-QALE was adjusted for different age, sex, and calendar-year distributions, it could be used in cost effectiveness evaluation.

CONCLUSION

Savings of loss-of-QALE and lifetime costs could be used for comparison of prevention, diagnosis, treatment and rehabilitation from a lifetime horizon.

Health expenditures spent for prevention, economic performance, and social welfare

BACKGROUND

Countries with limited resources in economic downturns often reduce government expenditures, of which spending on preventive healthcare with no apparent immediate health impact might be cut down first. This research aims to find the optimum share of preventive health expenditure to gross domestic product (GDP) and investigate the implications of preventive health services on economic performance and the population's wellbeing.

METHODS

We develop the economic growth model to undertake health-economic analyses and parameterize for Taiwan setting. Based on the US experiences over the period from 1975 to 2013, this research further examines the model's predictions on the relationship between preventive health expenditure and economic performance.

RESULTS

Theoretical analysis and numerical simulations show that an inverse U-shaped relationship exists between the proportion of GDP spent on prevention and social welfare, as well as between the proportion spent on prevention and economic growth. Empirical analysis shows an under-investment in prevention in Taiwan. The spending of preventive healthcare in Taiwan government was 0.0027 GDP in 2014, while the optimization levels for economic development and social welfare would be 0 · 0119 and 0 · 0203, respectively. There is a statistically significant nonlinear relationship between health expenditure on prevention and the estimated real impact of economic performance from US experiences. The welfare-maximizing proportion of preventive expenditure is usually greater than the proportion maximizing economic growth, indicating a conflict between economic growth and welfare after a marginal share.

CONCLUSION

Our findings indicate that it is worthwhile increasing investment on prevention up until an optimization level for economic development and social welfare. Such levels could also be estimated in other economies.

Health-Related Quality of Life and Sexual Functioning of HIV-Positive Men Who Have Sex With Men Who Are Treated for Anal Intraepithelial Neoplasia

BACKGROUND

The impact of the treatment of precursor lesions of anal cancer (anal intraepithelial neoplasia) on health-related quality of life has not been investigated.

OBJECTIVE

This study aimed to evaluate the impact of 3 treatment options for anal intraepithelial neoplasia on health-related quality of life and sexual functioning in HIV-positive men who have sex with men.

DESIGN

The prospective cohort was embedded in a randomized clinical trial evaluating the optimal treatment of anal intraepithelial neoplasia.

SETTING

This study was performed at the HIV outpatient clinic of the Academic Medical Center, Amsterdam, the Netherlands.

PATIENTS

Included in the study were HIV-positive men who have sex with men with anal intraepithelial neoplasia.

INTERVENTION

Treatment with imiquimod (n = 54), topical fluorouracil (n = 48), or electrocautery (n = 46) was given for 16 weeks.

MAIN OUTCOME MEASURES

Health-related quality of life and sexual functioning were assessed before, during, and 4 weeks after treatment. Health-related quality of life was assessed using the EQ5D, sexual functioning was assessed using items derived from the International Index of Erectile Function, and the female sexual function index adapted for anal intercourse.

RESULTS

One hundred forty-five patients (98%) completed at least 1 questionnaire. There was a significant different pattern of change over time in health-related quality of life among the 3 treatment groups. Patients in the imiquimod group were more likely to report pain/discomfort at week 8 than patients in the electrocautery group. Patients in the electrocautery group were more likely to report anxiety/depression and were less satisfied with their overall sex life at week 16 than patients in the imiquimod and fluorouracil groups, and patients in the electrocautery group were also more likely to report pain/discomfort and problems with usual activities at week 20 than patients in the fluorouracil group.

LIMITATIONS

The follow-up method differed slightly among treatment groups. There is no standardized, validated sexual functioning questionnaire for HIV-positive men who have sex with men.

CONCLUSIONS

All treatment options have a negative impact on aspects of health-related quality of life. Electrocautery has significantly more negative effects on health-related quality of life than imiquimod and fluorouracil and also has a negative effect on sexual functioning.

Sexual function and quality of life in women with cervical cancer before radiotherapy: a pilot study

PURPOSE

To achieve a better understanding of issues related to sexual function and quality of life (QOL) of women with cervical cancer before radiotherapy treatment.

METHODS

A pilot study with 80 women with cervical cancer from Jan/2013 to Mar/2014. The outcome variables were sexual function assessed using the Female Sexual Function Index (FSFI) and QOL, assessed using the World Health Organization questionnaire. Independent variables were clinical and sociodemographic data. Statistical analysis was carried out using Student's t test, Mann-Whitney test, ANOVA and multiple linear regression.

RESULTS

The mean age was 48.1 years, 57.5 % were premenopausal and 55 % had clinical stage IIIB. Thirty percent had been sexually active in the 3 months prior to their interviews. The main adverse events during sexual intercourse were bleeding (41.7 %), lack of pleasure (33.3 %), dyspareunia (25 %), and vaginal dryness (16.7 %). The 18 women who had been sexually active in the previous month showed significant sexual dysfunction (total mean FSFI score = 25.6). Advanced clinical stage, using any chronic medication and not having undergone surgery for cancer were negatively correlated with QOL. Higher family income, a longer duration of schooling and no smoking were positive correlated with QOL.

CONCLUSIONS

One-third of women with cervical cancer were sexually active 3 months prior to their interviews, but have concomitant significant sexual dysfunction. Factors related to the disease are primarily responsible for the deterioration of sexual function. QOL is influenced not only by factors related to the cancer itself, but also by lifestyle habits, comorbidities, and sociodemographic characteristics.

Cervical cancer survivorship: long-term quality of life and social support

PURPOSE

Surgery, radiotherapy, and chemotherapy are the mainstays of cervical cancer treatment. Many patients receive multiple treatment modalities, each with its own long-term effects. Given the high 5-year survival rate for cervical cancer patients, evaluation and improvement of long-term quality of life are essential.

METHODS

Pertinent articles were identified through searches of PubMed for literature published from 1993 to 2014. We summarize quality of life data from long-term follow-up studies of cervical cancer patients. We additionally summarize small group interviews of Hispanic and non-Hispanic cervical cancer survivors regarding social support and coping.

FINDINGS

Data are varied in terms of the long-term impact of treatment on quality of life, but consistent in suggesting that patients who receive radiotherapy as part of their treatment have the highest risk of increased long-term dysfunction of bladder and bowel, as well as sexual dysfunction and psychosocial consequences. Rigorous investigations regarding long-term consequences of treatment modalities are lacking.

IMPLICATIONS

Continued work to improve treatment outcomes and survival should also include a focus on reducing adverse long-term side effects. Providing supportive care during treatment and evaluating the effects of supportive care can reduce the prevalence and magnitude of long-term sequelae of cervical cancer, which will in turn improve quality of life and quality of care.