1
|
Zhang S, He J, Liu J. Characteristics and survival of patients with gynecological cancers who refuse radiotherapy: a retrospective cohort study. BMC Womens Health 2023; 23:562. [PMID: 37915037 PMCID: PMC10621229 DOI: 10.1186/s12905-023-02720-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/18/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Radiotherapy improves survival for many cancer patients. However, some patients still refuse radiotherapy despite the recommendations of their physicians. We aimed to investigate the impact of refusing recommended radiotherapy on overall survival in patients with gynecological cancers (GC) and attempted to describe what characteristics are associated with the refusal of radiotherapy. METHODS Data were extracted from the Surveillance, Epidemiology and End Result (SEER) database for patients who were diagnosed with GC and recommended for radiotherapy between 1988 and 2016. Kaplan-Meier and multivariate Cox regression analyses were utilized to analyze the impact of refusal of radiotherapy on overall survival. Univariate and multivariate logistic regression analyses were used to identify characteristics associated with refusal of radiotherapy. RESULTS In total, 1,226 of 208,093 patients (0.6%) refused radiotherapy. Multivariate Cox regression analysis showed that refusal of radiotherapy was associated with poorer overall survival in GC patients with stage I/II [hazard ratio (HR) = 1.64; 95% confidence interval (CI), 1.50-1.79], but may not affect overall survival in patients with stage III/IV (HR = 1.03; 95%CI, 0.84-1.25). Multivariate logistic regression analysis demonstrated that factors such as older age (40-65 years, > 65 years), unmarried status (divorced, single, widowed), higher foreign-born rate (1.87-2.82%, 1.51-2.19), refusal of surgery (recommended but not performed), and higher grade (poorly differentiated, undifferentiated/anaplastic) may increase the likelihood of refusing radiotherapy (all P < 0.05). Factors that may reduce the likelihood of refusing radiotherapy include higher income (> 42,810$), lower grade (well-differentiated), primary site of ovarian cancer, and no/unknown chemotherapy (all P < 0.05). CONCLUSION Refusal of radiotherapy is related to worse overall survival in GC patients with stage I/II, and many characteristics may affect a patient's choice of refusal of radiotherapy.
Collapse
Affiliation(s)
- Shuangli Zhang
- Department of Gynecology, Beijing Ditan Hospital, Capital Medical University, No.8 Jingshun East Street, Chaoyang District, Beijing, 100200, China
| | - Jie He
- Department of Gynecology, Beijing Liangxiang Hospital, Capital Medical University, Beijing, 102401, China
| | - Jun Liu
- Department of Gynecology, Beijing Ditan Hospital, Capital Medical University, No.8 Jingshun East Street, Chaoyang District, Beijing, 100200, China.
| |
Collapse
|
2
|
Dau H, Gottschlich A, Metz L, Pineda N, Pineda A, Alvarez CS, Bevliacqua K, Mendoza-Montano C, Ogilvie G, Rivera-Andrade A, Gharzouzi E, Meza R. The role of daughters in relation to their mother's cervical cancer diagnosis and treatment in Guatemala: a descriptive study. BMC Womens Health 2023; 23:142. [PMID: 36991461 PMCID: PMC10053719 DOI: 10.1186/s12905-023-02305-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/23/2023] [Indexed: 03/31/2023] Open
Abstract
PURPOSE There is currently no information on how caregivers for women diagnosed with cervical cancer in Guatemala, particularly daughters, are affected by their supportive role. This study's objective was to describe the support role of caregivers in the country, with a focus on daughters with a mother diagnosed with cervical cancer. METHODS This analysis utilizes data from a cross-sectional study which aimed to understand pathways to cervical cancer care. Women seeking cervical cancer treatment at the Instituto de Cancerologia (INCAN) in Guatemala City, Guatemala and their companions were surveyed. Descriptive statistics were calculated. RESULTS One hundred forty-five women seeking treatment and 71 companions participated in the study. Patient's daughters were most frequently reported as the person who provided the most support (51%) and as the most reported to have encouraged the patient to seek care. Furthermore, daughters were noted as the person most reported to fulfill the major household and livelihood roles of the patient while they were seeking or receiving treatment (38.0%). Most daughters reported that they were missing housework (77%), childcare (63%), and income-earning activities (60%) to attend the appointment with their mothers. CONCLUSION Our study suggests that in Guatemala cervical cancer patient's daughters have a significant support role in their mother's cancer diagnosis. Furthermore, we found that while caring for their mothers, daughters in Guatemala are often unable to participate in their primary labor activities. This highlights the additional burden that cervical cancer has on women in Latin America.
Collapse
Affiliation(s)
- Hallie Dau
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
- Women's Health Research Institute, BC Women's Hospital and Health Centre, Room H203J - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Anna Gottschlich
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada.
- Women's Health Research Institute, BC Women's Hospital and Health Centre, Room H203J - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada.
| | - Lynn Metz
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Natalia Pineda
- Institute of Nutrition of Central America and Panama, Research Center for the Prevention of Chronic Diseases, Guatemala City, Guatemala
| | - Andres Pineda
- Institute of Nutrition of Central America and Panama, Research Center for the Prevention of Chronic Diseases, Guatemala City, Guatemala
| | | | - Kristin Bevliacqua
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carlos Mendoza-Montano
- Institute of Nutrition of Central America and Panama, Research Center for the Prevention of Chronic Diseases, Guatemala City, Guatemala
| | - Gina Ogilvie
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
- Women's Health Research Institute, BC Women's Hospital and Health Centre, Room H203J - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Alvaro Rivera-Andrade
- Institute of Nutrition of Central America and Panama, Research Center for the Prevention of Chronic Diseases, Guatemala City, Guatemala
| | | | - Rafael Meza
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
3
|
Dau H, Trawin J, Nakisige C, Payne BA, Vidler M, Singer J, Orem J, Smith L, Ogilvie G. The social and economic impacts of cervical cancer on women and children in low- and middle-income countries: A systematic review. Int J Gynaecol Obstet 2023; 160:751-761. [PMID: 35962711 DOI: 10.1002/ijgo.14395] [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: 01/20/2022] [Revised: 08/01/2022] [Accepted: 08/09/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND There is limited knowledge on the social and economic impacts of a diagnosis of cervical cancer on women and children in low- and middle-income countries (LMICs). OBJECTIVES To determine the social and economic impacts associated with cervical cancer among women and children living in LMICs. SEARCH STRATEGY The MEDLINE, PsychInfo, CINAHL, Pais International, and CAB Global Health databases were systematically searched to retrieve studies up to June 2021. SELECTION CRITERIA Studies were included if they reported on either the social or economic impacts of women or children in a LMIC. DATA COLLECTION AND ANALYSIS Data was independently extracted by two co-authors. The authors performed a quality assessment on all included articles. MAIN RESULTS In all, 53 studies were included in the final review. Social impacts identified included social support, education, and independence. Economic impacts included employment and financial security. No study reported the economic impact on children. Studies that utilized quantitative methods typically reported more positive results than those that utilized qualitative methods. CONCLUSIONS Additional mixed-methods research is needed to further understand the social support needs of women with cervical cancer. Furthermore, research is needed on the impact of a mother's diagnosis of cervical cancer on her children.
Collapse
Affiliation(s)
- Hallie Dau
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Jessica Trawin
- Women's Health Research Institute, Vancouver, British Columbia, Canada
| | | | - Beth A Payne
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joel Singer
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | - Laurie Smith
- Women's Health Research Institute, Vancouver, British Columbia, Canada.,BC Cancer, Vancouver, British Columbia, Canada
| | - Gina Ogilvie
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Women's Health Research Institute, Vancouver, British Columbia, Canada.,BC Centre for Disease Control, Vancouver, British Columbia, Canada
| |
Collapse
|
4
|
Kraus RD, Weil CR, Abdel-Wahab M. Benefits of Adopting Hypofractionated Radiotherapy as a Standard of Care in Low-and Middle-Income Countries. JCO Glob Oncol 2022; 8:e2200215. [PMID: 36525619 PMCID: PMC10166538 DOI: 10.1200/go.22.00215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Ryan D Kraus
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Christopher R Weil
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - May Abdel-Wahab
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| |
Collapse
|
5
|
Trends in Hospitalization and Mortality from Cervical Cancer in Brazil Are Linked to Socioeconomic and Care Indicators. WOMEN 2022. [DOI: 10.3390/women2030026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We aimed, through an ecological survey of cervical cancer outcomes in Brazil, to analyze the influence of socioeconomic and care indicators of social vulnerability. The study sample (2010–2015) is composed of women diagnosed with cervical cancer, in different regions of the country. Data were collected from the Department of Health, in addition to searching the social vulnerability database of the Institute of Applied Economic Research. The incidence of age-standardized hospital admission declined over the years of the study in almost all regions but only one region showed a significant decline in indices of social vulnerability. In two other regions, one important indicator (human capital) significantly decreased. There was a positive correlation between vulnerability indices and age-standardized hospital admissions in most of the country. Decreasing vulnerability by easy access to cancer screening and early treatment improves cervical cancer outcomes.
Collapse
|
6
|
Xiang E, Guzman P, Mims M, Badr H. Balancing Work and Cancer Care: Challenges Faced by Employed Informal Caregivers. Cancers (Basel) 2022; 14:cancers14174146. [PMID: 36077682 PMCID: PMC9454561 DOI: 10.3390/cancers14174146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/19/2022] [Accepted: 08/25/2022] [Indexed: 11/25/2022] Open
Abstract
Simple Summary Caregiving for a family member or close friend with cancer can be particularly demanding for employed individuals who are juggling work responsibilities while providing care. With an eye toward stimulating research to develop programs and resources to support this vulnerable subgroup of caregivers, this narrative review first describes the financial, work, and mental health impacts of cancer on employed caregivers. Next, critical knowledge gaps are identified and directions for future research are described. The article concludes by formulating an agenda for practice that includes a multipronged effort on behalf of employers, healthcare, and community-based organizations to support and empower employed cancer caregivers. Abstract Individuals with cancer commonly rely on their informal caregivers (e.g., spouse/partner, family member, close friend) to help them manage the demands of the disease and its treatment. Caregiving, including helping with patient care, performing household chores, and providing emotional and practical support, can be particularly demanding for employed caregivers, who must juggle their work responsibilities while providing care. Although a burgeoning literature describes the toll that balancing these oft-competing demands can exact, few resources exist to support employed cancer caregivers. To address this gap, we conducted a narrative review of the impacts of cancer on employed caregivers. We found that employed caregivers experience significant financial impacts in terms of lost time and income. They also experience a variety of work-related (e.g., reduced productivity, absenteeism) and mental health (e.g., stress, burden) impacts. Going forward, prospective studies are needed to characterize changes in caregiver support needs and preferences at different time points along the cancer care continuum (e.g., at diagnosis, during treatment, end-of-life) so that appropriate workplace accommodations can be provided. More population-based studies are also needed to develop models for identifying caregivers who are at increased risk for poor employment or mental health outcomes so that more targeted support programs can be developed. Ultimately, a multipronged effort on behalf of employers, healthcare, and community-based organizations may be needed to support and empower this vulnerable subgroup.
Collapse
Affiliation(s)
- Ellen Xiang
- Department of Medicine, Section of Epidemiology and Population Science, Baylor College of Medicine, Houston, TX 77030, USA
| | - Patricia Guzman
- McGovern Medical School, Health Science Center, The University of Texas, Houston, TX 77225, USA
| | - Martha Mims
- Department of Medicine, Section of Hematology & Oncology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Hoda Badr
- Department of Medicine, Section of Epidemiology and Population Science, Baylor College of Medicine, Houston, TX 77030, USA
- Correspondence: ; Tel.: +1-713-798-1588
| |
Collapse
|
7
|
Al-Sukhun S, Tbaishat F, Hammad N. Breast Cancer Priorities in Limited-Resource Environments: The Price-Efficacy Dilemma in Cancer Care. Am Soc Clin Oncol Educ Book 2022; 42:1-7. [PMID: 35731988 DOI: 10.1200/edbk_349861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Breast cancer has become one of the leading causes of morbidity and mortality in low- and middle-income countries, where 62% of the world's total new cases are diagnosed. Therefore, the productivity loss because of premature death resulting from female breast cancer is also on the rise. The major challenge in low- and middle-income countries is to reduce the proportion of women presenting with advanced-stage disease, a challenge unlikely to be overcome by adoption of expensive national mammography screening programs. Awareness and education campaigns should focus not only on patients and societies but also on policy makers to address and optimize breast cancer care. Adaptation of existing guidelines and prioritization according to local resources are essential to address the unique needs and overcome the unique barriers of each society to facilitate practical implementation and improve outcomes. Emphasis on the principle of a cancer groundshot in addressing value in cancer care is vital to improving access to therapies that are proven to work rather than chasing after new drugs or innovations of doubtful or marginal clinical benefit. Until we have drug-pricing interventions that take into account the local income of each society, we must acknowledge the fact that the delivery of cancer care will never be the same all around the world.
Collapse
Affiliation(s)
| | - Fayez Tbaishat
- Department of Oncology, Al Bashir Hospital, Amman, Jordan
| | | |
Collapse
|
8
|
Khanna NR, Kumar A, Kataki K, Sehra N, Laskar SG, Mummudi N, Gupta T, Tibdewal A, Pathak R, Wadasadawala T, Krishnatry R, Chopra S, Goda JS, Chatterjee A, Budrukkar A, Gurram L, Engineer R, Murthy V, Swain M, Laskar S, Sarin R, Agarwal JP. Compliance of Radiotherapy Treatment at a Tertiary Cancer Center in India—A Clinical Audit. Indian J Med Paediatr Oncol 2022. [DOI: 10.1055/s-0042-1742666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Introduction Noncompliance to planned radiotherapy (RT) treatment is associated with inferior outcomes and also serves as an indicator of quality of care offered to the patients. Identification of the rate of noncompliance and its causative factors can help us develop an insight toward implementing mitigation measures thereby improving the quality of treatment.
Objective To ascertain the incidence of noncompliance and the factors affecting the same in patients offered RT appointments.
Materials and Methods We retrospectively reviewed the records of patients from January 1, 2019, to December 31, 2019, who were noncompliant (defaulted RT simulation or defaulted initiation of RT or defaulted planned RT during the course of RT but excluding planned/unplanned treatment breaks or early conclusions prescribed by the treating radiation oncologist) for the planned RT treatment.
Results Of the 8,607 appointments (7,699 external beam RT and 908 brachytherapy) given to the patients attending the radiation oncology outpatient department in the year 2019, a total of 197 (2.28%) patients were found to be noncomplaint. Ninety-seven patients defaulted RT simulation (49.2%), 53 defaulted RT starting (26.9%), and 47 defaulted while on RT (23.9%). Half of these had either head–neck (29.9%) or gynecological (20.8%) malignancies. Patients with breast cancers had the least noncompliance rates (0.02%). The cause for noncompliance was ascertained in 135 patients (68.5%). The common causes of noncompliance were the desire to continue treatment closer to home (21.5%) followed by logistic (17%), lack of confidence in the curative potential of the planned therapy (17%), and financial reasons (11.8%). Patients with head–neck and gynecological malignancies were more often with advanced staged disease and were planned multimodal treatment protocols. The majority of the 23 patients who defaulted palliative RT were planned for fractionated treatments (73.9%).
Conclusion The incidence of noncompliance in patients planned for RT in our institute can be considered optimum. Appropriate counseling of patients at the time of scheduling appointment, upfront identification of patients at high risk of noncompliance, and assisting patients with financial and logistic challenges are imperative to ensure adherence to planned treatment schedule.
Collapse
Affiliation(s)
- Nehal R. Khanna
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Anuj Kumar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Kaushik Kataki
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Nishtha Sehra
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sarbani Ghosh Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Naveen Mummudi
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Tejpal Gupta
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Anil Tibdewal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Rima Pathak
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Tabassum Wadasadawala
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Rahul Krishnatry
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Supriya Chopra
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Jayant Sastri Goda
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Abhishek Chatterjee
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Ashwini Budrukkar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Lavanya Gurram
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Reena Engineer
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Monali Swain
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Siddhartha Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Rajiv Sarin
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| |
Collapse
|
9
|
Burrowes S, Holcombe SJ, Leshargie CT, Hernandez A, Ho A, Galivan M, Youb F, Mahmoud E. Perceptions of cervical cancer care among Ethiopian women and their providers: a qualitative study. Reprod Health 2022; 19:2. [PMID: 34983586 PMCID: PMC8725313 DOI: 10.1186/s12978-021-01316-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/04/2021] [Indexed: 01/26/2023] Open
Abstract
Background Cervical cancer is the second most commonly diagnosed cancer among Ethiopian women, killing an estimated 4700 women each year. As the government rolls out the country’s first national cancer control strategy, information on patient and provider experiences in receiving and providing cervical cancer screening, diagnosis, and treatment is critical. Methods This qualitative study aimed to assess the availability of cervical cancer care; explore care barriers and sources of delay; and describe women’s and providers’ perceptions and experiences of care. We analyzed data from 45 informants collected at 16 health centers, district hospitals and referral hospitals in East Gojjam Zone and a support center in Addis Ababa. Thirty providers and ten women receiving care were interviewed, and five women in treatment or post-treatment participated in a focus group discussion. Deductive and inductive codes were used to thematically analyze data. Results Providers lacked equipment and space to screen and treat patients and only 16% had received in-service cervical cancer training. Consequently, few facilities provided screening or preventative treatment. Patients reported low perceptions of risk, high stigma, a lack of knowledge about cervical cancer, and delayed care initiation. All but one patient sought care only when she became symptomatic, and, pre-diagnosis, only half of the patients knew about cervical cancer. Even among those aware of cervical cancer, many assumed they were not at risk because they were not sexually active. Misdiagnosis was another common source of delay experienced by half of the patients. Once diagnosed, women faced multiple-month waits for referrals, and, once in treatment, broken equipment and shortages of hospital beds resulted in additional delays. Barriers to therapeutic treatment included a lack of housing and travel funds. Patient-provider communication of cancer diagnosis was often lacking. Conclusions In-service provider training should be intensified and should include discussions of cervical cancer symptoms. Better distribution of screening and diagnostic supplies to lower-level facilities and better maintenance of treatment equipment at tertiary facilities are also a priority. Expanded cervical cancer health education should focus on stigma reduction and emphasize a broad, wide-spread risk of cervical cancer. Cervical cancer is the second most commonly diagnosed cancer among Ethiopian women, killing an estimated 4700 women each year. This study aimed to assess patient and provider experiences in receiving and providing cervical cancer screening, diagnosis, and treatment. We interviewed 30 midlevel providers and ten women receiving care and held a focus group discussion with five women who were receiving treatment or who had recently completed treatment. Patients reported bottlenecks and delays at each stage of care. Low perception of risk, high stigma, and a lack of knowledge about cervical cancer among both providers and patients, were significant sources of delay in initiating care. Few patients had been aware of cervical cancer before they were diagnosed and of those who were aware, many assumed that they were not at risk because they were not sexually active. Misdiagnosis was another common source of delay. Once diagnosed correctly, women faced multiple-month delays after referrals, and, once in treatment, broken equipment and a shortage of hospital beds resulted in additional delays. The most frequently mentioned barriers to care were a lack of housing and travel funds while receiving treatment in the capital. Patient-provider communication of cancer diagnosis was often poor. Our findings suggest the need to intensify in-service training for providers, focusing initially on alerting them to cervical cancer symptoms. Better distribution of screening and diagnostic supplies to lower-level facilities and better maintenance of treatment equipment at tertiary facilities should also be a priority.
Collapse
Affiliation(s)
| | - Sarah Jane Holcombe
- Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | | | - Anthony Ho
- Touro University California, Vallejo, CA, USA
| | | | - Fatuma Youb
- Touro University California, Vallejo, CA, USA
| | | |
Collapse
|
10
|
Dey T, Ghoshal S, Arora M, Chakrabarti A, Datta A. The socio-economic burden of cancer: An observation from the palliative care OPD. J Family Med Prim Care 2022; 11:821-824. [PMID: 35495789 PMCID: PMC9051693 DOI: 10.4103/jfmpc.jfmpc_1247_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/11/2021] [Accepted: 10/13/2021] [Indexed: 11/30/2022] Open
Abstract
A cross-sectional study was planned to assess the socio-economic burden of cancer among patients referred for palliative care. Patients referred within 6 months of diagnosis were grouped as early while others were late referrals. The socio-economic status, out-of-pocket expenditure (OOPE), and budget adjustments were noted and compared between the two groups using SPSS v 23.0. A total of 96 patients were included among which 57 were referred late. Most patients belonged to middle- and lower-income groups but only 22/96 had some kind of social security. The demographic profiles of the two groups were comparable. Although the patients referred late had more OOPE compared to the early ones, the difference was not statistically significant. Patients receiving chemotherapy had a significantly higher OOPE (P = 0.001). Job interruptions and loss of family income leading to budget adjustments were reported by 50 patients. The study indicates that there is a significant economic impact and OOPE that needs to be addressed in our patient population.
Collapse
|
11
|
Nuche-Berenguer B, Sakellariou D. Socioeconomic Determinants of Participation in Cancer Screening in Argentina: A Cross-Sectional Study. Front Public Health 2021; 9:699108. [PMID: 34504827 PMCID: PMC8423085 DOI: 10.3389/fpubh.2021.699108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/22/2021] [Indexed: 12/24/2022] Open
Abstract
Low socioeconomic status is associated with late cancer diagnosis and mortality in Argentina. It is important that cancer screening services are accessible to the whole population so that cancer can be detected early. Our aim in this study was to investigate socioeconomic determinants for the disparities in the use of breast, cervical, and colorectal cancer screening services in Argentina, and to measure the country progress in reducing differences in cancer screening participation across socioeconomic levels. We performed a secondary analysis of cross-sectional data from the 2018 National Survey of Risk Factors of Argentina. The sample included data from 49,170 households. We also compared the results with data from the 2013 wave of the same survey in order to assess progress on cancer screening participation across income and education categories. Income, education, health insurance, disability, and marital status were associated with cancer screening underuse in Argentina. Comparison between 2013 and 2018 demonstrated that there has been some progress toward increasing cancer screening uptake, but this increase is not equitably distributed across the population. To further reduce disparities in cancer participation across socioeconomic levels, cancer screening programs in Argentina should reinforce strategies to become more accessible. It is important to proactively reach those populations that are underusers of cancer screening and ensure that barriers that stop people from accessing cancer screening are explored and adequately addressed.
Collapse
|
12
|
Chilinda G, Massamba L, Meja S, Ngo C, Dupre PF. Implementing a comprehensive cervical cancer program in Southern Malawi: a 'Médecins Sans Frontières', Ministry of Health, and College of Medicine of Blantyre Collaborative Project. Int J Gynecol Cancer 2021; 31:1606-1607. [PMID: 34083379 DOI: 10.1136/ijgc-2021-002743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 12/24/2022] Open
Affiliation(s)
- George Chilinda
- Department of Obstetrics, Gynecology & Gynecological Oncology, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Leo Massamba
- Department of Oncology, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Samuel Meja
- Department of Obstetrics and Gynecology, Queen Elizabeth Central Hospital, Blantyre, Malawi.,University of Malawi College of Medicine, Blantyre, Malawi
| | - Charlotte Ngo
- Oncology Department, Médecins Sans Frontières Oncology Département MSF OCP Paris, Paris, France
| | - Pierre-Francois Dupre
- Breast & Gynaecological Oncology, CHU Brest, Brest, France .,Team GTCA, INSERM U1078, Brest, France
| |
Collapse
|
13
|
Nymark L, Vassall A. A comprehensive framework for considering additional unintended consequences in economic evaluation. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2020; 18:27. [PMID: 32774177 PMCID: PMC7405373 DOI: 10.1186/s12962-020-00218-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 06/27/2020] [Indexed: 11/30/2022] Open
Abstract
Background In recent years there has been a growth in economic evaluations that consider indirect health benefits to populations due to advances in mathematical modeling. In addition, economic evaluations guidelines have suggested the inclusion of impact inventories to include non-health direct and indirect consequences. We aim to bring together this literature, together with the broader literature on internalities and externalities to propose a comprehensive approach for analysts to identify and characterize all unintended consequences in economic evaluations. Methods We present a framework to assist analysts identify and characterize additional costs and effects beyond that of direct health impact primarily intended to be influenced by the intervention/technology. We build on previous checklists to provide analysts with a comprehensive framework to justify the inclusion or exclusion of effects, supporting the use of current guidelines, to ensure any unintended effects are considered. We illustrate this framework with examples from immunization. These were identified from a previous systematic review, PhD thesis work, and general search scoping in PubMed databases. Results We present a comprehensive framework to consider additional consequences, exemplified by types and categories. We bring this and other guidance together to assist analysts identify possible unintended consequences whether taking a provider or societal perspective. Conclusions Although there are many challenges ahead to standardize the inclusion of additional consequences in economic evaluation, we hope by moving beyond generic statements to reporting against a comprehensive framework of additional effects we can support further consistency in this aspect of cost-effectiveness analysis going forward.
Collapse
Affiliation(s)
- Liv Nymark
- Department of Global Health, The University of Amsterdam and the Academic Medical Center (AMC), Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Anna Vassall
- Department of Global Health, The University of Amsterdam and the Academic Medical Center (AMC), Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, WC1E 7HT UK
| |
Collapse
|
14
|
Parsons M, Lloyd S, Johnson S, Scaife C, Varghese T, Glasgow R, Garrido-Laguna I, Tao R. Refusal of Local Therapy in Esophageal Cancer and Impact on Overall Survival. Ann Surg Oncol 2020; 28:663-675. [PMID: 32648178 DOI: 10.1245/s10434-020-08761-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/08/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The aim of this study was to understand factors associated with refusal of local therapy in esophageal cancer and compare the overall survival (OS) of patients who refuse therapies with those who undergo recommended treatment. METHODS National Cancer Database data for patients with non-metastatic esophageal cancer from 2006 to 2013 were pooled. T1N0M0 tumors were excluded. Pearson's Chi-square test and multivariate logistic regression analyses were used to assess demographic, clinical, and treatment factors. After propensity-score matching with inverse probability of treatment weighting, OS was compared between patients who refused therapies and those who underwent recommended therapy, using Kaplan-Meier analyses and doubly robust estimation with multivariate Cox proportional hazards modeling. RESULTS In total, 37,618 patients were recommended radiation therapy (RT) and/or esophagectomy; we found 1403 (3.7%) refused local therapies. Specifically, 890 of 18,942 (4.6%) patients refused surgery and 667 of 31,937 (2.1%) refused RT. Older patients, females, those with unknown lymphovascular space invasion, and those uninsured or on Medicare were more likely to refuse. Those with squamous cell carcinoma, N1 disease, higher incomes, living farther from care, and those who received chemotherapy were less likely to refuse. Five-year OS was decreased in patients who refused (18.1% vs. 27.6%). The survival decrement was present in adenocarcinoma but not squamous cell carcinoma. In patients who received surgery or ≥ 50.4 Gy RT, there was no OS decrement to refusing the other therapy. CONCLUSIONS We identified characteristics that correlate with refusal of local therapy. Refusal of therapy was associated with decreased OS. Patients who received either surgery or ≥ 50.4 Gy RT had no survival decrement from refusing the opposite modality.
Collapse
Affiliation(s)
- Matthew Parsons
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Shane Lloyd
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Skyler Johnson
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Courtney Scaife
- Department of Surgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Thomas Varghese
- Department of Thoracic Surgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Robert Glasgow
- Department of Surgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Ignacio Garrido-Laguna
- Department of Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Randa Tao
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
| |
Collapse
|
15
|
|
16
|
Nuche-Berenguer B, Sakellariou D. Socioeconomic determinants of cancer screening utilisation in Latin America: A systematic review. PLoS One 2019; 14:e0225667. [PMID: 31765426 PMCID: PMC6876872 DOI: 10.1371/journal.pone.0225667] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 11/08/2019] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Cancer incidence and mortality in Latin America are rising. While effective cancer screening services, accessible to the whole population and enabling early cancer detection are needed, existing research shows the existence of disparities in screening uptake in the region. OBJECTIVE We conducted a systematic review to investigate the socioeconomic determinants for the disparities in the use of breast, cervical and colorectal cancer screening services in Latin America. METHODS We searched for studies reporting on socioeconomic determinants impacting on access to breast, cervical and colorectal cancer screening, published from 2009 through 2018. The studies that qualified for inclusion contained original analyses on utilisation of breast, cervical and colorectal cancer screening across socioeconomic levels in Latin America. For each study, paired reviewers performed a quality analysis followed by detailed review and data extraction. RESULTS Twenty-four articles that met the eligibility criteria and were of sufficient quality were included in this review. Thirteen of the included articles were written in English, eight in Portuguese and three in Spanish, and they reported on the use of breast or cervical cancer screening. No studies were found on the socioeconomic determinants regarding the utilisation of colorectal cancer screening in Latin America. Low income, low education level, lack of health insurance and single marital status were all found to be determinants of underuse of breast and cervical cancer screening services. CONCLUSIONS Cancer screening programs in the region must prioritize reaching those populations that underuse cancer screening services to ensure equitable access to preventive services. It is important to develop national screening programmes that are accessible to all (including uninsured people) through, for example, the use of mobile units for mammography and self-screening methods.
Collapse
Affiliation(s)
| | - Dikaios Sakellariou
- School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom
- * E-mail:
| |
Collapse
|
17
|
Health-related quality of life in locally advanced cervical cancer patients treated with neoadjuvant therapy followed by radical surgery: A single-institutional retrospective study from a prospective database. Gynecol Oncol 2019; 154:583-589. [PMID: 31307665 DOI: 10.1016/j.ygyno.2019.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/24/2019] [Accepted: 07/01/2019] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To evaluate the health-related quality of life (HRQOL) in locally advanced cervical cancer (LACC) patients treated with neoadjuvant concurrent chemoradiation (CCRT) or radiation (RT) alone followed by radical surgery (RS). METHODS In a single-center retrospective study from a prospective database, 275 FIGO Stage IB2-IIIB patients who underwent CCRT/RT + RS were included. HRQOL was prospectively assessed by EORTC QLQ-C30 and EORTC QLQ-CX24 prior to any treatment (baseline) and 6 months after surgery, respectively. RESULTS A statistically significant and clinically relevant improvement in physical functioning (P < 0.001) and role functioning (P = 0.002, P = 0.031) was observed in patients receiving either CCRT+RS or RT + RS at follow-up. In addition, quality of life (QoL), physical functioning, and social functioning were better in the RT + RS group than the CCRT+RS group after treatment (P = 0.028, P = 0.010, P = 0.014). Symptom scores of fatigue decreased in both groups over time (P < 0.001, P = 0.004) while insomnia decreased only in the RT + RS group (P = 0.042). Worsened menopausal symptoms were documented in both groups at follow-up (P = 0.001, P = 0.047), while lymphedema was deteriorated only in patients receiving CCRT + RS (P < 0.001). Sexuality scores did not differ between groups or over time with the exception of sexual worry, which was deteriorated in patients receiving RT + RS (P = 0.042). CONCLUSIONS QLQ-C30 functioning and tumor-related symptoms scores improved while lymphedema and menopausal symptoms worsened 6 months after neoadjuvant CCRT or RT alone followed by RS in LACC patients. Patients treated with RT + RS had a generally better HRQOL compared with those receiving CCRT+RS, though further validation with prospective randomized clinical trials is warranted.
Collapse
|
18
|
Jain R, Nigam RK, Malik R, Jain P. Clinicopathological Presentation of Cervical Cancer in Bhopal. Indian J Med Paediatr Oncol 2019. [DOI: 10.4103/ijmpo.ijmpo_185_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Aim: To study the clinicopathological spectrum of cervical cancers in tertiary care center to assess scenario in Central India. Materials and Methods: Retrospective study in the Department of Pathology in our institution to evaluate cases of cervical cancers from January 2014 to August 2015. Histopathological diagnosis was correlated with age, symptoms, gravida, Federation of Gynecology and Obstetrics staging, and other relevant clinical details wherever deemed necessary. The biostatical analysis was performed for quantitative data student’s t-test was applied. P value was considered statistically significant if P < 0.05. Results: A total of 180 cases were of neoplasia cervix. Majority of cases were squamous cell carcinoma type, i.e., 96.6% (174 cases) followed by adenocarcinoma constituting only 2.8% (5 cases) with a mean age of 50.7 years and average gravida of 3.78. Majority of cases (50.01%) complained of postmenopausal bleeding followed by abnormal spotting (26.67%) and lower abdominal pain (7.78%). The most common presentation was in Stage IIB with 45.56% (82) cases. Conclusion: Histomorphology remains the mainstay of diagnosis of cervical cancers. In low compliance settings such as ours, colposcopy-guided biopsy is the preferred course of management, especially in elderly females to be definite to rule out or diagnose neoplasia. National level cervical cancer program is immediate need of the hour and should include human papilloma virus vaccine, awareness, and screening programs as well as treatment assistance for low socioeconomic strata.
Collapse
Affiliation(s)
- Rubal Jain
- Department of Pathology, Gandhi Medical College, Bhopal, Madhya Pradesh, India
| | | | - Reeni Malik
- Department of Pathology, Gandhi Medical College, Bhopal, Madhya Pradesh, India
| | - Pramila Jain
- Department of Pathology, Gandhi Medical College, Bhopal, Madhya Pradesh, India
| |
Collapse
|
19
|
Hailemichael Y, Hailemariam D, Tirfessa K, Docrat S, Alem A, Medhin G, Lund C, Chisholm D, Fekadu A, Hanlon C. Catastrophic out-of-pocket payments for households of people with severe mental disorder: a comparative study in rural Ethiopia. Int J Ment Health Syst 2019; 13:39. [PMID: 31164919 PMCID: PMC6544918 DOI: 10.1186/s13033-019-0294-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 05/23/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There are limited data on healthcare spending by households containing a person with severe mental disorder (SMD) in low- and middle-income countries (LMIC). This study aimed to estimate the incidence and intensity of catastrophic out-of-pocket (OOP) payments and coping strategies implemented by households with and without a person with SMD in a rural district of Ethiopia. METHODS A comparative cross-sectional community household survey was carried out from January to November 2015 as part of the Emerald programme (emerging mental health systems in low- and middle-income countries). A sample of 290 households including a person with SMD and 289 comparison households without a person with SMD participated in the study. An adapted and abbreviated version of the World Health Organization SAGE (Study on global Ageing and adult health) survey instrument was used. Households were considered to have incurred catastrophic health expenditure if their annual OOP health expenditures exceeded 40% of their annual non-food expenditure. Multiple logistic regression was used to explore factors associated with catastrophic expenditure and types of coping strategies employed. RESULTS The incidence of catastrophic OOP payments in the preceding 12 months was 32.2% for households of a person with SMD and 18.2% for comparison households (p = 0.006). In households containing a person with SMD, there was a significant increase in the odds of hardship financial coping strategies (p < 0.001): reducing medical visits, cutting down food consumption, and withdrawing children from school. Households of a person with SMD were also less satisfied with their financial status and perceived their household income to be insufficient to meet their livelihood needs (p < 0.001). CONCLUSIONS Catastrophic OOP health expenditures in households of a person with SMD are high and associated with hardship financial coping strategies which may lead to poorer health outcomes, entrenchment of poverty and intergenerational disadvantage. Policy interventions aimed at financial risk pooling mechanisms are crucial to reduce the intensity and impact of OOP payments among vulnerable households living with SMD and support the goal of universal health coverage.
Collapse
Affiliation(s)
- Yohannes Hailemichael
- Department of Reproductive Health and Health Services Management, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Damen Hailemariam
- Department of Reproductive Health and Health Services Management, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kebede Tirfessa
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sumaiyah Docrat
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Atalay Alem
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Girmay Medhin
- Aklilu-Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Crick Lund
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Dan Chisholm
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Abebaw Fekadu
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | - Charlotte Hanlon
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| |
Collapse
|
20
|
Mabelele MM, Materu J, Ng’ida FD, Mahande MJ. Knowledge towards cervical cancer prevention and screening practices among women who attended reproductive and child health clinic at Magu district hospital, Lake Zone Tanzania: a cross-sectional study. BMC Cancer 2018; 18:565. [PMID: 29769124 PMCID: PMC5956852 DOI: 10.1186/s12885-018-4490-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 05/08/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cervical cancer is a global leading cause of morbidity and mortality, attributable to the death of approximately 266,000 women every year. Majority (87%) of cervical cancer deaths occur in developing countries including Tanzania. Though knowledge of cervical cancer is an important determinant of women's participation in prevention and screening for cervical cancer, little is known about this topic in Tanzania. This study aimed to determine the knowledge of cervical cancer prevention services and screening practices among women who attended Reproductive Child Health clinic at a district hospital in Lake Zone, Tanzania. This information is important to help designing appropriate interventions and scaling up cervical cancer control programs, hence accelerate the achievement towards Sustainable Development Goals. METHODS A cross-sectional study was conducted from March to June 2017, involving 307 women attending reproductive and child health clinic at Magu district hospital. A questionnaire adopted from the validated Cervical Cancer Awareness Measure was used to collect data from the study participants. Data was analysed using SPSS version 20. Descriptive statistics were summarized using frequencies and percentages for categorical variables while mean and standard deviation was used for continuous variables. Multivariable logistic regressions model was used to estimate Adjusted Odds ratio with 95% CI for factors associated with knowledge. RESULTS Knowledge of cervical cancer was low, where 82.7% of the women scored less than 50%. Majority (82.4%) were aware about cervical cancer. Secondary education or higher (OR = 7.77, 95% CI: 1.70-35.48) and "knowing someone who has ever had cervical cancer" (OR = 2.19, 95% CI: 1.16-4.13) were significantly associated with higher knowledge. Only 14.3% of participants practiced cervical cancer screening. CONCLUSIONS Majority of women lack comprehensive knowledge of cervical cancer and only few utilize screening services. Strategies for awareness creation about cervical cancer may help to improve knowledge and utilization of cancer screening practices.
Collapse
Affiliation(s)
- Mabula M. Mabelele
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - John Materu
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Faraja D. Ng’ida
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Michael J. Mahande
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| |
Collapse
|
21
|
Morton RL, Schlackow I, Gray A, Emberson J, Herrington W, Staplin N, Reith C, Howard K, Landray MJ, Cass A, Baigent C, Mihaylova B. Impact of CKD on Household Income. Kidney Int Rep 2017; 3:610-618. [PMID: 29854968 PMCID: PMC5976816 DOI: 10.1016/j.ekir.2017.12.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 12/11/2017] [Accepted: 12/18/2017] [Indexed: 11/30/2022] Open
Abstract
Introduction The impact of chronic kidney disease (CKD) on income is unclear. We sought to determine whether CKD severity, serious adverse events, and CKD progression affected household income. Methods Analyses were undertaken in a prospective cohort of adults with moderate-to-severe CKD in the Study of Heart and Renal Protection (SHARP), with household income information available at baseline screening and study end. Logistic regressions, adjusted for sociodemographic characteristics, smoking, and prior diseases at baseline, estimated associations during the 5-year follow-up, among (i) baseline CKD severity, (ii) incident nonfatal serious adverse events (vascular or cancer), and (iii) CKD treatment modality (predialysis, dialysis, or transplanted) at study end and the outcome “fall into relative poverty.” This was defined as household income <50% of country median income. Results A total of 2914 SHARP participants from 14 countries were included in the main analysis. Of these, 933 (32%) were in relative poverty at screening; of the remaining 1981, 436 (22%) fell into relative poverty by study end. Compared with participants with stage 3 CKD at baseline, the odds of falling into poverty were 51% higher for those with stage 4 (odds ratio [OR]: 1.51; 95% confidence interval [CI]: 1.09–2.10), 66% higher for those with stage 5 (OR: 1.66; 95% CI: 1.11–2.47), and 78% higher for those on dialysis at baseline (OR: 1.78, 95% CI: 1.22–2.60). Participants with kidney transplant at study end had approximately half the risk of those on dialysis or those with CKD stages 3 to 5. Conclusion More advanced CKD is associated with increased odds of falling into poverty. Kidney transplantation may have a role in reducing this risk.
Collapse
Affiliation(s)
- Rachael L Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia.,Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, UK
| | - Iryna Schlackow
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, UK
| | - Alastair Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, UK
| | - Jonathan Emberson
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - William Herrington
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Natalie Staplin
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Christina Reith
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Kirsten Howard
- School of Public Health, The University of Sydney, Sydney, Australia
| | - Martin J Landray
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Colin Baigent
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK.,Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Borislava Mihaylova
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, UK
| | | |
Collapse
|
22
|
Apás Pérez De Nucci A, Minig L, Perrotta M. Patterns of cervical cancer care in Argentina: Applying ASCO recommendations adjusted by local resources. Gynecol Oncol Rep 2017; 21:61-66. [PMID: 28702501 PMCID: PMC5496480 DOI: 10.1016/j.gore.2017.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 06/04/2017] [Accepted: 06/22/2017] [Indexed: 12/29/2022] Open
Abstract
There are significant differences in cervical cancer incidence and mortality between low-middle and high-income countries. The American Society of Clinical Oncology (ASCO) resource-stratified clinical practice guideline was designed to provide an appropriate cervical cancer treatment based on the best available evidence in scenarios with different diagnostic and therapeutic resources. Argentina, a Latin American high middle income country, shows however, that cervical cancer rates are similar to those of low-income countries. In addition, significant disparities in incidence and mortality are described throughout the country. The present article describes the current pattern of care of cervical cancer in Argentina and establishes recommendations adjusted to local resources in different regions of the country according to the ASCO guideline.
Collapse
Affiliation(s)
| | - Lucas Minig
- Department of Gynecology, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - Myriam Perrotta
- Gynecologic Oncology Unit, Department of Gynecology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| |
Collapse
|
23
|
Brage E, Vindrola-Padros C. An ethnographic exploration of the delivery of psychosocial care to children with cancer in Argentina. Eur J Oncol Nurs 2017; 29:91-97. [PMID: 28720272 DOI: 10.1016/j.ejon.2017.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 02/21/2017] [Accepted: 05/08/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE The integration of psychosocial care in the routine care of cancer patients has been set as an international standard, but there are healthcare contexts where these services are lacking as psychosocial care providers are not incorporated in multidisciplinary teams and screening for psychological distress is not carried out routinely or systematically. METHOD In this article, we discuss the findings from an ethnographic study that focused on exploring the working experiences of psychosocial care providers from one children's hospital in Buenos Aires, Argentina. The study is based on 10 in-depth interviews with hospital staff members and participant observation in selected hospital areas. The transcripts from the interviews and fieldnotes from the observations were analyzed using thematic analysis. RESULTS We found that psychosocial care providers encounter difficulties while attempting to deliver services to children and their families, produced mainly by their lack of collaboration with other professional groups, insufficient human resources, and a growing patient population. As a result of this situation, psychosocial care providers often prioritize some patients over others, leaving a considerable number of patients and family members without psychosocial support. CONCLUSIONS The study highlighted the barriers psychosocial care providers encounter while attempting to deliver services to children and their families. Further work needs to be carried out to fully integrate psychosocial care in national health policies and ensure this type of support is available for all patients and their families.
Collapse
Affiliation(s)
- Eugenia Brage
- Facultad de Filosofia y Letras, Universidad de Buenos Aires, CONICET, Buenos Aires, Argentina
| | | |
Collapse
|
24
|
Matsuo K, Machida H, Ragab OM, Garcia-Sayre J, Yessaian AA, Roman LD. Patient compliance for postoperative radiotherapy and survival outcome of women with stage I endometrioid endometrial cancer. J Surg Oncol 2017; 116:482-491. [PMID: 28543055 DOI: 10.1002/jso.24690] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 04/26/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES To examine characteristics and survival outcome of women with endometrial cancer who declined postoperative radiotherapy. METHODS A retrospective study was conducted to examine surgically-treated grade 1-2 stage IB and grade 3 stage IA-IB endometrioid endometrial cancer in the Surveillance, Epidemiology, and End Results Program between 1983 and 2013 (n = 10 613). Associations of patient declination for guideline-based postoperative radiotherapy and clinico-pathological demographics or survival outcome were examined on multivariable analysis. RESULTS There were 323 (3.0%) women who declined adjuvant radiotherapy. Women who declined postoperative radiotherapy were more likely to be older, White, Western U.S. residents, and register in recent years (all, adjusted-P < 0.05). On multivariable analysis, patient declination for guideline-based postoperative radiotherapy remained an independent prognostic factor for decreased endometrial cancer-specific survival in unstaged grade 1-2 stage IB or staged/unstated grade 3 stage IA-IB diseases (adjusted-hazard ratio 1.84, 95% confidence interval 1.34-2.51, P = 0.001). Association of patient declination for guideline-based postoperative radiotherapy and decreased overall survival remained independent in the entire cohort on multivariable analysis (adjuvant-hazard ratio 1.71, 95% confidence interval 1.44-2.02, P < 0.001). CONCLUSIONS Our study suggested that patient compliance to guideline-based postoperative radiotherapy is a prognostic factor for women with stage I endometrioid endometrial cancer.
Collapse
Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California.,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Hiroko Machida
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California
| | - Omar M Ragab
- Department of Radiation Oncology, University of Southern California, Los Angeles, California
| | - Jocelyn Garcia-Sayre
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California
| | - Annie A Yessaian
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California.,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California.,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| |
Collapse
|
25
|
Ginsburg O, Bray F, Coleman MP, Vanderpuye V, Eniu A, Kotha SR, Sarker M, Huong TT, Allemani C, Dvaladze A, Gralow J, Yeates K, Taylor C, Oomman N, Krishnan S, Sullivan R, Kombe D, Blas MM, Parham G, Kassami N, Conteh L. The global burden of women's cancers: a grand challenge in global health. Lancet 2017; 389:847-860. [PMID: 27814965 PMCID: PMC6191029 DOI: 10.1016/s0140-6736(16)31392-7] [Citation(s) in RCA: 574] [Impact Index Per Article: 82.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 07/19/2016] [Accepted: 08/05/2016] [Indexed: 12/15/2022]
Abstract
Every year, more than 2 million women worldwide are diagnosed with breast or cervical cancer, yet where a woman lives, her socioeconomic status, and agency largely determines whether she will develop one of these cancers and will ultimately survive. In regions with scarce resources, fragile or fragmented health systems, cancer contributes to the cycle of poverty. Proven and cost-effective interventions are available for both these common cancers, yet for so many women access to these is beyond reach. These inequities highlight the urgent need in low-income and middle-income countries for sustainable investments in the entire continuum of cancer control, from prevention to palliative care, and in the development of high-quality population-based cancer registries. In this first paper of the Series on health, equity, and women's cancers, we describe the burden of breast and cervical cancer, with an emphasis on global and regional trends in incidence, mortality, and survival, and the consequences, especially in socioeconomically disadvantaged women in different settings.
Collapse
Affiliation(s)
- Ophira Ginsburg
- Women's College Research Institute, Faculty of Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; World Health Organization, Geneva, Switzerland.
| | - Freddie Bray
- Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France
| | - Michel P Coleman
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Verna Vanderpuye
- National Center for Radiotherapy, Korlebu Teaching Hospital, Accra, Ghana
| | | | - S Rani Kotha
- Institute for Global Health Equity and Innovation, University of Toronto, Toronto, ON, Canada
| | - Malabika Sarker
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Tran Thanh Huong
- Hanoi Medical University and National Institute for Cancer Control, Hanoi, Vietnam
| | - Claudia Allemani
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Allison Dvaladze
- Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Centre, University of Washington, Seattle, WA, USA
| | - Julie Gralow
- Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Centre, University of Washington, Seattle, WA, USA
| | - Karen Yeates
- Queen's University Faculty of Health Sciences, Office of Global Health, Queen's University, Kingston, ON, Canada
| | | | - Nandini Oomman
- Independent Global Health Specialist, Washington, DC, USA
| | - Suneeta Krishnan
- Research Triangle Institute Global India Pvt Ltd, New Delhi, India; St John's Research Institute, Bengarulu, India
| | - Richard Sullivan
- Institute of Cancer Policy, King's Health Partners Comprehensive Cancer Centre, London, UK; King's Centre for Global Health, King's Health Partners and King's College London, UK
| | | | - Magaly M Blas
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Groesbeck Parham
- Department of Obstetrics and Gynecology University of North Carolina, Chapel Hill, NC, USA; University of Zambia, Lusaka, Zambia
| | - Natasha Kassami
- Health Economics Group, School of Public Health, Imperial College London, London, UK
| | - Lesong Conteh
- Health Economics Group, School of Public Health, Imperial College London, London, UK
| |
Collapse
|
26
|
Rudat V, Nour A, Hammoud M, Abou Ghaida S. Better compliance with hypofractionation vs. conventional fractionation in adjuvant breast cancer radiotherapy : Results of a single, institutional, retrospective study. Strahlenther Onkol 2017; 193:375-384. [PMID: 28233048 PMCID: PMC5405099 DOI: 10.1007/s00066-017-1115-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 02/07/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of the study was to identify factors significantly associated with the occurrence of unintended treatment interruptions in adjuvant breast cancer radiotherapy. PATIENTS AND METHODS Patients treated with postoperative radiotherapy of the breast or chest wall between March 2014 and August 2016 were evaluated. The radiotherapy regimens and techniques applied were either conventional fractionation (CF; 28 daily fractions of 1.8 Gy or 25 fractions of 2.0 Gy) or hypofractionation (HF; 15 daily fractions of 2.67 Gy) with inverse planned intensity-modulated radiotherapy (IMRT) or three-dimensional planned conformal radiotherapy (3DCRT). Logistic regression analysis was used to identify factors associated with noncompliance. Noncompliance was defined as the missing of at least one scheduled radiotherapy fraction. RESULTS In all, 19 of 140 (13.6%) patients treated with HF and 39 of 146 (26.7%) treated with CF experienced treatment interruptions. Of 23 factors tested, the fractionation regimen emerged as the only independent significant prognostic factor for noncompliance on multivariate analysis (CF; p = 0.007; odds ratio, 2.3; 95% confidence interval, 1.3-4.2). No statistically significant differences concerning the reasons for treatment interruptions could be detected between patients treated with CF or HF. CONCLUSION HF is significantly associated with a better patient compliance with the prescribed radiotherapy schedule compared with CF. The data suggest that this finding is basically related to the shorter overall treatment time of HF.
Collapse
Affiliation(s)
- Volker Rudat
- Department of Radiation Oncology, Saad Specialist Hospital, 31952 Al Khobar, Saudi Arabia
| | - Alaa Nour
- Department of Radiation Oncology, Saad Specialist Hospital, 31952 Al Khobar, Saudi Arabia
| | - Mohamed Hammoud
- Department of Radiation Oncology, Saad Specialist Hospital, 31952 Al Khobar, Saudi Arabia
| | - Salam Abou Ghaida
- Department of Radiation Oncology, Saad Specialist Hospital, 31952 Al Khobar, Saudi Arabia
| |
Collapse
|
27
|
Arrossi S, Paolino M, Thouyaret L, Laudi R, Campanera A. Evaluation of scaling-up of HPV self-collection offered by community health workers at home visits to increase screening among socially vulnerable under-screened women in Jujuy Province, Argentina. Implement Sci 2017; 12:17. [PMID: 28193227 PMCID: PMC5307871 DOI: 10.1186/s13012-017-0548-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 02/03/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Self-collection has been proposed as a strategy to increase cervical screening coverage among hard-to-reach women. However, evaluations of the implementation of this strategy on a large scale are scarce. This paper describes the process and measurement of the scaling-up of self-collection offered by community health workers during home visits as a strategy to reach under-screened women aged 30+ with public health coverage, defined as the target women. METHODS We used an adaptation of the Health System Framework to analyze key drivers of scaling-up. A content analysis approach was used to collect and analyze information from different sources. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) model was used to evaluate the impact of the strategy. RESULTS HPV self-collection was scaled-up in the province of Jujuy in 2014 after a RCT (Self-collection Modality Trial, initials EMA in Spanish) was carried out locally in 2012 and demonstrated effectiveness of the strategy to increase screening uptake. Facilitators of scaling-up were the organizational capacity of the provincial health system, sustainable funding for HPV testing, and local consensus about the value of the technology. Reach: In 2014, 9% (2983/33,245) of target women were screened through self-collection in the Jujuy public health sector. Effectiveness: In 2014, 17% (n = 5657/33,245) of target women were screened with any HPV test (self-collected and clinician-collected tests) vs. 11.7% (4579/38,981) in 2013, the pre-scaling-up period (p < 0.0001). IMPLEMENTATION Training about the strategy was provided to 84.2% (n = 609/723) of total community health workers (CHWs). Of 414 HPV+ women, 77.5% (n = 320) had follow-up procedures. Of 113 women with positive triage, 66.4% (n = 75) had colposcopic diagnosis. Treatment was provided to 80.7% of CIN2+ women (n = 21/26). Adoption: Of trained CHWs, 69.3% (n = 422/609) had at least one woman with self-collection; 85.2% (n = 315/368) of CHWs who responded to an evaluation survey were satisfied with self-collection strategy. Maintenance: During 2015, 100.0% (723/723) CHWs were operational and 63.8% (461/723) had at least one woman with self-collection. CONCLUSIONS The strategy was successfully scaled-up, with a high level of adoption among CHWs, which resulted in increased screening among socially vulnerable under-screened women.
Collapse
Affiliation(s)
- Silvina Arrossi
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Sánchez de Bustamante 27, Buenos Aires, 1193 Argentina
| | - Melisa Paolino
- Programa Nacional de Prevención de Cáncer Cervicouterino/Instituto Nacional del Cáncer, Julio A. Roca 781, Buenos Aires, 1067 Argentina
| | - Laura Thouyaret
- Programa Nacional de Prevención de Cáncer Cervicouterino/Instituto Nacional del Cáncer, Julio A. Roca 781, Buenos Aires, 1067 Argentina
| | - Rosa Laudi
- Programa Nacional de Prevención de Cáncer Cervicouterino/Instituto Nacional del Cáncer, Julio A. Roca 781, Buenos Aires, 1067 Argentina
| | - Alicia Campanera
- Ministerio de Salud de la Provincia de Jujuy, Av. Italia esq. Independencia, San Salvador de Jujuy, 4600 Argentina
| |
Collapse
|
28
|
de Moor JS, Dowling EC, Ekwueme DU, Guy GP, Rodriguez J, Virgo KS, Han X, Kent EE, Li C, Litzelman K, McNeel TS, Liu B, Yabroff KR. Employment implications of informal cancer caregiving. J Cancer Surviv 2017; 11:48-57. [PMID: 27423439 PMCID: PMC5239760 DOI: 10.1007/s11764-016-0560-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 06/25/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Previous research describing how informal cancer caregiving impacts employment has been conducted in small samples or a single disease site. This paper provides population-based estimates of the effect of informal cancer caregiving on employment and characterizes employment changes made by caregivers. METHODS The samples included cancer survivors with a friend or family caregiver, participating in either the Medical Expenditure Panel Survey Experiences with Cancer Survivorship Survey (ECSS) (n = 458) or the LIVESTRONG 2012 Survey for People Affected by Cancer (SPAC) (n = 4706). Descriptive statistics characterized the sample of survivors and their caregivers' employment changes. Multivariable logistic regression identified predictors of caregivers' extended employment changes, comprising time off and changes to hours, duties, or employment status. RESULTS Among survivors with an informal caregiver, 25 % from the ECSS and 29 % from the SPAC reported that their caregivers made extended employment changes. Approximately 8 % of survivors had caregivers who took time off from work lasting ≥2 months. Caregivers who made extended employment changes were more likely to care for survivors: treated with chemotherapy or transplant; closer to diagnosis or end of treatment; who experienced functional limitations; and made work changes due to cancer themselves compared to caregivers who did not make extended employment changes. CONCLUSIONS Many informal cancer caregivers make employment changes to provide care during survivors' treatment and recovery. IMPLICATIONS FOR CANCER SURVIVORS This study describes cancer caregiving in a prevalent sample of cancer survivors, thereby reflecting the experiences of individuals with many different cancer types and places in the cancer treatment trajectory.
Collapse
Affiliation(s)
- Janet S de Moor
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA.
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, 3E438, MSC 9764, Bethesda, MD, 20892-9764, USA.
| | - Emily C Dowling
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA, USA
| | - Donatus U Ekwueme
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gery P Guy
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Juan Rodriguez
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Katherine S Virgo
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Xuesong Han
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA, USA
| | - Erin E Kent
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Chunyu Li
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kristen Litzelman
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | | | - Benmei Liu
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - K Robin Yabroff
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| |
Collapse
|
29
|
Ohri N, Rapkin BD, Guha C, Kalnicki S, Garg M. Radiation Therapy Noncompliance and Clinical Outcomes in an Urban Academic Cancer Center. Int J Radiat Oncol Biol Phys 2016; 95:563-70. [DOI: 10.1016/j.ijrobp.2016.01.043] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 12/28/2015] [Accepted: 01/22/2016] [Indexed: 12/31/2022]
|
30
|
Tadesse SK. Socio-economic and cultural vulnerabilities to cervical cancer and challenges faced by patients attending care at Tikur Anbessa Hospital: a cross sectional and qualitative study. BMC Womens Health 2015; 15:75. [PMID: 26376638 PMCID: PMC4571133 DOI: 10.1186/s12905-015-0231-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 09/02/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Cervical cancer is a leading cause of death among women in Ethiopia, affecting them at a time of their life when they are critical to social and economic stability. This study was mainly focused on assessing different socioeconomic and cultural related factors that make women vulnerable to cervical cancer and challenges women face in the process of diagnosis and treatment. METHODS To achieve the objective of the study both qualitative and quantitative methods were utilized.198 participants were enrolled in a cross- sectional survey and 10 in-depth interviews were conducted with patients in Tikur Anbessa Hospital. A consecutive sampling method was used to select participants in the survey while purposive sampling was employed to select participants in the qualitative design. RESULTS For the population covered in the study, poverty along with other socio-cultural practices such as early marriage, high parity and to certain extent polygamy were identified as factors that increased the vulnerability of women to cervical cancer. In addition, the study has uncovered several challenges faced by cervical cancer patients in the diagnosis and treatment process. Three types of challenges that include, health care based, psychological and economic were identified. System and practitioner delay were found as the main hurdles within the variable of health care related challenges. What's more, the psychological challenges identified included, fear of recurrence, negative social attitude and distress associated with the side effects from treatments such as fecal & urinary leakage. Furthermore, inability of bearing costs related to treatment and accommodation were cited as the main economic challenges. CONCLUSION The study showed various socio-economic and cultural vulnerabilities that expose women to cervical cancer and the challenges encountered by cervical cancer patients after their diagnosis. Addressing this issue largely lies in strengthening primary and secondary preventive mechanisms, providing public education about safer sex practices, family planning and eliminating cultural practices such as early marriage and polygamy in connection to cervical cancer. Furthermore, improving the diagnostic and treatment procedures and facilities is also a crucial component that needs due emphasis in the fight against cervical cancer.
Collapse
|
31
|
Kimman M, Jan S, Yip CH, Thabrany H, Peters SA, Bhoo-Pathy N, Woodward M. Catastrophic health expenditure and 12-month mortality associated with cancer in Southeast Asia: results from a longitudinal study in eight countries. BMC Med 2015; 13:190. [PMID: 26282128 PMCID: PMC4539728 DOI: 10.1186/s12916-015-0433-1] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 07/24/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND One of the biggest obstacles to developing policies in cancer care in Southeast Asia is lack of reliable data on disease burden and economic consequences. In 2012, we instigated a study of new cancer patients in the Association of Southeast Asian Nations (ASEAN) region - the Asean CosTs In ONcology (ACTION) study - to assess the economic impact of cancer. METHODS The ACTION study is a prospective longitudinal study of 9,513 consecutively recruited adult patients with an initial diagnosis of cancer. Twelve months after diagnosis, we recorded death and household financial catastrophe (out-of-pocket medical costs exceeding 30% of annual household income). We assessed the effect on these two outcomes of a range of socio-demographic, clinical, and economic predictors using a multinomial regression model. RESULTS The mean age of participants was 52 years; 64% were women. A year after diagnosis, 29% had died, 48% experienced financial catastrophe, and just 23% were alive with no financial catastrophe. The risk of dying from cancer and facing catastrophic payments was associated with clinical variables, such as a more advanced disease stage at diagnosis, and socioeconomic status pre-diagnosis. Participants in the low income category within each country had significantly higher odds of financial catastrophe (odds ratio, 5.86; 95% confidence interval, 4.76-7.23) and death (5.52; 4.34-7.02) than participants with high income. Those without insurance were also more likely to experience financial catastrophe (1.27; 1.05-1.52) and die (1.51; 1.21-1.88) than participants with insurance. CONCLUSIONS A cancer diagnosis in Southeast Asia is potentially disastrous, with over 75% of patients experiencing death or financial catastrophe within one year. This study adds compelling evidence to the argument for policies that improve access to care and provide adequate financial protection from the costs of illness.
Collapse
|
32
|
Financial catastrophe, treatment discontinuation and death associated with surgically operable cancer in South-East Asia: Results from the ACTION Study. Surgery 2015; 157:971-82. [DOI: 10.1016/j.surg.2015.02.012] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/28/2015] [Accepted: 02/28/2015] [Indexed: 11/26/2022]
|
33
|
Chaker L, Falla A, van der Lee SJ, Muka T, Imo D, Jaspers L, Colpani V, Mendis S, Chowdhury R, Bramer WM, Pazoki R, Franco OH. The global impact of non-communicable diseases on macro-economic productivity: a systematic review. Eur J Epidemiol 2015; 30:357-95. [PMID: 25837965 PMCID: PMC4457808 DOI: 10.1007/s10654-015-0026-5] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 03/24/2015] [Indexed: 12/23/2022]
Abstract
Non-communicable diseases (NCDs) have large economic impact at multiple levels. To systematically review the literature investigating the economic impact of NCDs [including coronary heart disease (CHD), stroke, type 2 diabetes mellitus (DM), cancer (lung, colon, cervical and breast), chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD)] on macro-economic productivity. Systematic search, up to November 6th 2014, of medical databases (Medline, Embase and Google Scholar) without language restrictions. To identify additional publications, we searched the reference lists of retrieved studies and contacted authors in the field. Randomized controlled trials, cohort, case-control, cross-sectional, ecological studies and modelling studies carried out in adults (>18 years old) were included. Two independent reviewers performed all abstract and full text selection. Disagreements were resolved through consensus or consulting a third reviewer. Two independent reviewers extracted data using a predesigned data collection form. Main outcome measure was the impact of the selected NCDs on productivity, measured in DALYs, productivity costs, and labor market participation, including unemployment, return to work and sick leave. From 4542 references, 126 studies met the inclusion criteria, many of which focused on the impact of more than one NCD on productivity. Breast cancer was the most common (n = 45), followed by stroke (n = 31), COPD (n = 24), colon cancer (n = 24), DM (n = 22), lung cancer (n = 16), CVD (n = 15), cervical cancer (n = 7) and CKD (n = 2). Four studies were from the WHO African Region, 52 from the European Region, 53 from the Region of the Americas and 16 from the Western Pacific Region, one from the Eastern Mediterranean Region and none from South East Asia. We found large regional differences in DALYs attributable to NCDs but especially for cervical and lung cancer. Productivity losses in the USA ranged from 88 million US dollars (USD) for COPD to 20.9 billion USD for colon cancer. CHD costs the Australian economy 13.2 billion USD per year. People with DM, COPD and survivors of breast and especially lung cancer are at a higher risk of reduced labor market participation. Overall NCDs generate a large impact on macro-economic productivity in most WHO regions irrespective of continent and income. The absolute global impact in terms of dollars and DALYs remains an elusive challenge due to the wide heterogeneity in the included studies as well as limited information from low- and middle-income countries.
Collapse
Affiliation(s)
- Layal Chaker
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Office NA29-16, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Novaes HMD, Itria A, Silva GAE, Sartori AMC, Rama CH, de Soárez PC. Annual national direct and indirect cost estimates of the prevention and treatment of cervical cancer in Brazil. Clinics (Sao Paulo) 2015; 70:289-95. [PMID: 26017797 PMCID: PMC4418354 DOI: 10.6061/clinics/2015(04)12] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 01/27/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To estimate the annual direct and indirect costs of the prevention and treatment of cervical cancer in Brazil. METHODS This cost description study used a "gross-costing" methodology and adopted the health system and societal perspectives. The estimates were grouped into sets of procedures performed in phases of cervical cancer care: the screening, diagnosis and treatment of precancerous lesions and the treatment of cervical cancer. The costs were estimated for the public and private health systems, using data from national health information systems, population surveys, and literature reviews. The cost estimates are presented in 2006 USD. RESULTS From the societal perspective, the estimated total costs of the prevention and treatment of cervical cancer amounted to USD $1,321,683,034, which was categorized as follows: procedures (USD $213,199,490), visits (USD $325,509,842), transportation (USD $106,521,537) and productivity losses (USD $676,452,166). Indirect costs represented 51% of the total costs, followed by direct medical costs (visits and procedures) at 41% and direct non-medical costs (transportation) at 8%. The public system represented 46% of the total costs, and the private system represented 54%. CONCLUSION Our national cost estimates of cervical cancer prevention and treatment, indicating the economic importance of cervical cancer screening and care, will be useful in monitoring the effect of the HPV vaccine introduction and are of interest in research and health care management.
Collapse
Affiliation(s)
| | - Alexander Itria
- Universidade Federal de Goiás, Instituto de Patologia Tropical e Saúde Pública, Department of Public Health, Goiânia/GO, Brazil
| | - Gulnar Azevedo e Silva
- Universidade do Estado do Rio de Janeiro, Instituto de Medicina Social, Rio de Janeiro, RJ/Brazil
| | - Ana Marli Christovam Sartori
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Department of Infectious and Parasitic Diseases, São Paulo/SP, Brazil
| | - Cristina Helena Rama
- Secretaria do Estado da Saúde, Hospital e Maternidade Leonor Mendes de Barros, São Paulo/SP, Brazil
| | - Patrícia Coelho de Soárez
- Faculdade de Medicina da Universidade de São Paulo, Department of Preventive Medicine, São Paulo/SP, Brazil
- E-mail:
| |
Collapse
|
35
|
Ohri N, Rapkin BD, Guha D, Haynes-Lewis H, Guha C, Kalnicki S, Garg M. Predictors of Radiation Therapy Noncompliance in an Urban Academic Cancer Center. Int J Radiat Oncol Biol Phys 2015; 91:232-8. [DOI: 10.1016/j.ijrobp.2014.09.030] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 09/18/2014] [Accepted: 09/22/2014] [Indexed: 11/26/2022]
|
36
|
The global impact of non-communicable diseases on households and impoverishment: a systematic review. Eur J Epidemiol 2014; 30:163-88. [PMID: 25527371 DOI: 10.1007/s10654-014-9983-3] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 12/12/2014] [Indexed: 10/24/2022]
Abstract
The global economic impact of non-communicable diseases (NCDs) on household expenditures and poverty indicators remains less well understood. To conduct a systematic review and meta-analysis of the literature evaluating the global economic impact of six NCDs [including coronary heart disease, stroke, type 2 diabetes mellitus (DM), cancer (lung, colon, cervical and breast), chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD)] on households and impoverishment. Medline, Embase and Google Scholar databases were searched from inception to November 6th 2014. To identify additional publications, reference lists of retrieved studies were searched. Randomized controlled trials, systematic reviews, cohorts, case-control, cross-sectional, modeling and ecological studies carried out in adults and assessing the economic consequences of NCDs on households and impoverishment. No language restrictions. All abstract and full text selection was done by two independent reviewers. Data were extracted by two independent reviewers and checked by a third independent reviewer. Studies were included evaluating the impact of at least one of the selected NCDs and on at least one of the following measures: expenditure on medication, transport, co-morbidities, out-of-pocket (OOP) payments or other indirect costs; impoverishment, poverty line and catastrophic spending; household or individual financial cost. From 3,241 references, 64 studies met the inclusion criteria, 75% of which originated from the Americas and Western Pacific WHO region. Breast cancer and DM were the most studied NCDs (42 in total); CKD and COPD were the least represented (five and three studies respectively). OOP payments and financial catastrophe, mostly defined as OOP exceeding a certain proportion of household income, were the most studied outcomes. OOP expenditure as a proportion of family income, ranged between 2 and 158% across the different NCDs and countries. Financial catastrophe due to the selected NCDs was seen in all countries and at all income levels, and occurred in 6-84% of the households depending on the chosen catastrophe threshold. In 16 low- and middle-income countries (LMIC), 6-11% of the total population would be impoverished at a 1.25 US dollar/day poverty line if they would have to purchase lowest price generic diabetes medication. NCDs impose a large and growing global impact on households and impoverishment, in all continents and levels of income. The true extent, however, remains difficult to determine due to the heterogeneity across existing studies in terms of populations studied, outcomes reported and measures employed. The impact that NCDs exert on households and impoverishment is likely to be underestimated since important economic domains, such as coping strategies and the inclusion of marginalized and vulnerable people who do not seek health care due to financial reasons, are overlooked in literature. Given the scarcity of information on specific regions, further research to estimate impact of NCDs on households and impoverishment in LMIC, especially the Middle Eastern, African and Latin American regions is required.
Collapse
|
37
|
Abstract
Vaccination has led to remarkable health gains over the last century. However, large coverage gaps remain, which will require significant financial resources and political will to address. In recent years, a compelling line of inquiry has established the economic benefits of health, at both the individual and aggregate levels. Most existing economic evaluations of particular health interventions fail to account for this new research, leading to potentially sizable undervaluation of those interventions. In line with this new research, we set forth a framework for conceptualizing the full benefits of vaccination, including avoided medical care costs, outcome-related productivity gains, behavior-related productivity gains, community health externalities, community economic externalities, and the value of risk reduction and pure health gains. We also review literature highlighting the magnitude of these sources of benefit for different vaccinations. Finally, we outline the steps that need to be taken to implement a broad-approach economic evaluation and discuss the implications of this work for research, policy, and resource allocation for vaccine development and delivery.
Collapse
Affiliation(s)
- Till Bärnighausen
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA 02115; and Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba 3935, South Africa
| | - David E Bloom
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA 02115; and
| | | | - Jennifer Carroll O'Brien
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA 02115; and
| |
Collapse
|
38
|
PrediQt-Cx: post treatment health related quality of life prediction model for cervical cancer patients. PLoS One 2014; 9:e89851. [PMID: 24587074 PMCID: PMC3935936 DOI: 10.1371/journal.pone.0089851] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 01/26/2014] [Indexed: 12/22/2022] Open
Abstract
Background Cervical cancer is the third largest cause of cancer mortality in India. The objectives of the study were to compare the pre and the post treatment quality of life in cervical cancer patients and to develop a prediction model to provide an insight into the possibilities in the treatment modules. Methodology/Principal Findings A total of 198 patients were assessed with two structured questionnaires of Health Related Quality of Life (The European Organisation for Research and Treatment of Cancer, EORTC QLQ C-30 and CX-24). The baseline observations were recorded when the patients first reported (T1) and second evaluation was done at 6 months post treatment (T2). The mean age of detection was 50.9 years with the literacy level being non-educated or less than high school. Majority of them were married/cohabiting 179 (90.4%). On histopathological examination (HPE) squamous cell carcinoma was found to be the most common cell type carcinoma 147 (74.2%) followed by Adenocarcinoma 31 (15.7%). Radical hysterectomy was the most common treatment modality 76 (38.4%), followed by Wertheims Hysterectomy 46 (23.2%) and Radiochemotherapy 59 (29.8%). The mean score of global health of cervical cancer patients post treatment was 77.90, which was significantly higher than the pre - treatment score (54.32). Mean “symptoms score” post treatment was 21.69 with an aggravation of 7.32 compared to pre treatment scores. Patients experienced substantial decrease in sexual activity post treatment. Conclusions/Significance The prediction model(PrediQt-Cx), based on Support Vector Machine(SVM) for predicting post treatment HRQoL in cervical cancer patients was developed and internally cross validated. After external validation PrediQt-Cx can be easily employed to support decision making by clinicians and patients from north India region, through openly made available for access at http://prediqt.org.
Collapse
|
39
|
Kankeu HT, Saksena P, Xu K, Evans DB. The financial burden from non-communicable diseases in low- and middle-income countries: a literature review. Health Res Policy Syst 2013; 11:31. [PMID: 23947294 PMCID: PMC3751656 DOI: 10.1186/1478-4505-11-31] [Citation(s) in RCA: 229] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 07/18/2013] [Indexed: 11/17/2022] Open
Abstract
Non-communicable diseases (NCDs) were previously considered to only affect high-income countries. However, they now account for a very large burden in terms of both mortality and morbidity in low- and middle-income countries (LMICs), although little is known about the impact these diseases have on households in these countries. In this paper, we present a literature review on the costs imposed by NCDs on households in LMICs. We examine both the costs of obtaining medical care and the costs associated with being unable to work, while discussing the methodological issues of particular studies. The results suggest that NCDs pose a heavy financial burden on many affected households; poor households are the most financially affected when they seek care. Medicines are usually the largest component of costs and the use of originator brand medicines leads to higher than necessary expenses. In particular, in the treatment of diabetes, insulin--when required--represents an important source of spending for patients and their families. These financial costs deter many people suffering from NCDs from seeking the care they need. The limited health insurance coverage for NCDs is reflected in the low proportions of patients claiming reimbursement and the low reimbursement rates in existing insurance schemes. The costs associated with lost income-earning opportunities are also significant for many households. Therefore, NCDs impose a substantial financial burden on many households, including the poor in low-income countries. The financial costs of obtaining care also impose insurmountable barriers to access for some people, which illustrates the urgency of improving financial risk protection in health in LMIC settings and ensuring that NCDs are taken into account in these systems. In this paper, we identify areas where further research is needed to have a better view of the costs incurred by households because of NCDs; namely, the extension of the geographical scope, the inclusion of certain diseases hitherto little studied, the introduction of a time dimension, and more comparisons with acute illnesses.
Collapse
Affiliation(s)
- Hyacinthe Tchewonpi Kankeu
- Aix-Marseille University (Aix-Marseille School of Economics), CNRS & EHESS, Centre de la Vieille Charité, 2 Rue de la Charité, 13236 Marseille, Cedex 2, France
| | - Priyanka Saksena
- Department of Health Systems Financing, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Ke Xu
- WHO Regional Office for the Western Pacific Region, P.O. Box 2932, 1000 Manila, Philippines
| | - David B Evans
- Department of Health Systems Financing, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| |
Collapse
|
40
|
Iyoke CA, Ugwu GO. Burden of gynaecological cancers in developing countries. World J Obstet Gynecol 2013; 2:1-7. [DOI: 10.5317/wjog.v2.i1.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 11/07/2012] [Accepted: 12/17/2012] [Indexed: 02/05/2023] Open
Abstract
Approximately 1:4 of all cancers in women in developing countries (excluding non-melanoma skin cancer) is a gynaecological cancer. The gynaecological cancer burden in developing countries is huge primarily due to the high incidence and mortality of cervical cancer. Cervical cancer accounts for over 60% of the gynaecological cancer burden in developing countries despite being preventable by current technologies. This is due to the absence of effective nationally organized screening programmes in most developing countries. Institution of such programmes, therefore, has the potential to dramatically reduce gynaecological cancer burden in these countries. Subsidized human papilloma virus (HPV) vaccine and HPV typing as well as cheap screening techniques such as visual inspection aided with acetic acid hold the key to effective prevention of cervical cancer in these countries. This is because a significant proportion of patients in developing countries are unable to access and avail themselves of the few available preventive, diagnostic and treatment services because of poverty. Although, advocacy and the political will to invest in the development of human resources and healthcare infrastructure appear critical to gynaecological cancer control and reducing the burden of disease in many developing countries, the proposition assumes that resources are truly available for this investment. This may not be true. Many developing countries rely on foreign aids for developmental programmes and these aids have dwindled significantly with the current global economic meltdown.
Collapse
|
41
|
Hailu A, Mariam DH. Patient side cost and its predictors for cervical cancer in Ethiopia: a cross sectional hospital based study. BMC Cancer 2013; 13:69. [PMID: 23391288 PMCID: PMC3576296 DOI: 10.1186/1471-2407-13-69] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 02/05/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Cervical cancer is a leading cause of death from cancer among women in low-resource settings, affecting women at a time of life when they are critical to social and economic stability. In addition, the economic burden is important for policy formulation. The aim of this study is to estimate patient side cost and to determine predictors of its variation for the treatment of cervical cancer. METHODS Analytic cross sectional study involving 227 cervical cancer cases at Tikur Anbessa Hospital, Ethiopia was conducted. Cost estimation was based on patients' perspective and using the prevalence-based model as a time frame. Productivity losses were estimated from lost working days. RESULTS The mean outpatient cost per patient for cervical cancer was $407.2 (Median = $206.9). Direct outpatient cost (Mean = $334.2) takes the largest share compared with the indirect counterpart ($150). The outpatient cost for half of the respondent falls in a range between $93.7 and $478. The mean inpatient cost for hospitalized patients was $404.4. The average direct inpatient cost was $329 (74% medical costs and 26% non medical costs). The mean value for total inpatient cost for half of the respondents was in the range of $133.5 and $493.9. For every additional day of inpatient hospital stay, there is a daily incremental inpatient cost of $4.2. CONCLUSION As has been found in other studies, our findings revealed that cervical cancer creates an immense financial burden on patients. Primary prevention measures, vaccination against HPV and screening, should be initiated and expanded to reduce morbidity from cervical cancer and subsequent costs in both human lives and money resources. Control of co-morbidity and complication should be emphasized during management of cervical cancer patients. Capacitating regional hospitals and provision of low cost or fee exemption schemes should be arranged and strengthened.
Collapse
Affiliation(s)
- Alemayehu Hailu
- School of Public Health, Addis Ababa University, P,O,Box 9086, Addis Ababa, Ethiopia.
| | | |
Collapse
|
42
|
Bärnighausen T, Bloom DE, Cafiero ET, O'Brien JC. Economic evaluation of vaccination: capturing the full benefits, with an application to human papillomavirus. Clin Microbiol Infect 2012; 18 Suppl 5:70-6. [PMID: 22882176 DOI: 10.1111/j.1469-0691.2012.03977.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Vaccination has been among the greatest contributors to the past century's dramatic improvements in health and life expectancy. Recent advances in vaccinology have resulted in new vaccines that will likely lead to substantial future health gains. However, the high cost of these new vaccines, such as the human papillomavirus (HPV) vaccine, poses an obstacle to their widespread adoption in many countries. Economic evaluation can help to determine if investment in vaccine introduction is worthwhile. However, existing economic evaluations usually focus on a narrow set of vaccination-mediated benefits-most notably avoided medical-care costs-and fail to account for several categories of potentially important gains. We consider three sources of such benefit and discuss them with respect to HPV vaccination: (i) outcome-related productivity gains, (ii) behaviour-related productivity gains, and (iii) externalities. We also highlight that HPV vaccination protects against more than just cervical cancer and that these other health gains should be taken into account. Failing to account for these broader benefits of HPV vaccination could result in substantial underestimation of the value of HPV vaccination, thereby leading to ill-founded decisions regarding its introduction into national immunization programmes.
Collapse
Affiliation(s)
- T Bärnighausen
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA
| | | | | | | |
Collapse
|
43
|
Effect of socio-economic factors on delayed access to health care among Chinese cervical cancer patients with late rectal complications after radiotherapy. Gynecol Oncol 2011; 124:395-8. [PMID: 22138228 DOI: 10.1016/j.ygyno.2011.11.040] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Revised: 11/18/2011] [Accepted: 11/21/2011] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To determine the effect of socio-economic status (SES) on delayed access to medical treatment by Chinese cervical cancer patients who suffered from late rectal sequelae (LRS) after external beam radiation therapy (EBRT) and intracavitary brachytherapy. METHODS Patients diagnosed with LRS were interviewed for their SES, factors including age, residing district, religion, marital status, income, education, insurance and patient delay (the time interval from the onset of symptoms to the first medical consultation) and other factors such as weight, symptom duration and disease stage at diagnosis. RESULTS One hundred and twenty nine patients were interviewed. Seventy-one patients (55%) sought medical treatment within three months after the first symptom being recognized and fifty-eight patients (45%) delayed their medical treatment over 3 months. The study shows that age ≥ 55 (OR=12.1; 95% CI: 3.3-43.9), lower education (OR=4.6; 95% CI: 2.0-10.4 for women with primary school education or illiterate), low annual household income (OR=2.3; 95% CI: 1.2-5.1) and widow/divorce (OR=0.1; 95% CI: 0.01-0.07) were the high risk factors for delayed reporting. Patients with bleeding or bleeding plus other symptoms (61.2%) were more likely to seek treatment within three months, compared to patients with other symptoms only (38.8%) (p=0.002). Additionally, delayed reporting was found to be significantly associated with the late stage of late rectal sequelae (LRS) (p=0.000) and the patients with 55 years or older (p=0.000). CONCLUSIONS Delayed reporting and late-stage presentation of late rectal sequelae are more prevalent among Chinese cervical cancer patients with 55 years or older, low education, poor marital status, or poor financial status. Effective social support and educational programs should be implemented to encourage these patients to seek medical treatment as soon as possible.
Collapse
|