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Buja A, De Luca G, Gatti M, Bonaldi F, Gardi M, Bortolami A, Sepulcri M, Bimbatti D, Baldo V, Scioni M, Maruzzo M, Basso U, Zagonel V. Estimated Direct Costs of Renal Cancer by Stage of Disease at Diagnosis and Phase of Its Management: A Whole-Disease Model. Clin Genitourin Cancer 2023:S1558-7673(23)00034-4. [PMID: 36906433 DOI: 10.1016/j.clgc.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/31/2023] [Accepted: 02/04/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Renal cell carcinoma (RCC) is the seventh most common neoplasm in high-income countries. New clinical pathways have been developed to deal with this tumor, which includes costly drugs that pose an economic threat to the sustainability of healthcare services. This study provides an estimate of the direct costs of care for patients with RCC by stage of disease (early vs. advanced) at diagnosis, and disease management phase along the pathway recommended by local and international guidelines. MATERIALS AND METHODS Considering the clinical pathway for RCC adopted in the Veneto region (north-east Italy) and the latest guidelines, we developed a very detailed "whole-disease" model that covers the probabilities of all potentially necessary diagnostic and therapeutic actions involved in the management of RCC. Based on the cost of each procedure according to the Veneto Regional Authority's official reimbursement tariffs, we estimated the total and average per-patient costs by stage of disease (early or advanced) and phase of its management. RESULTS In the first year after diagnosis, the mean expected cost of a patient with RCC is €12,991 if it is localized or locally-advanced and reaches €40,586 if it is advanced. For early disease, the main cost is incurred by surgery, whereas medical therapy (first and second line) and supportive care become increasingly important for metastatic disease. CONCLUSION It is crucially important to examine the direct costs of care for RCC, and to predict the burden on healthcare services of new oncological therapies and treatments, as the findings could be useful for policy-makers planning the allocation of resources.
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Affiliation(s)
- Alessandra Buja
- Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, University of Padua, Padova, Italy.
| | - Giuseppe De Luca
- Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, University of Padua, Padova, Italy
| | - Maura Gatti
- Statistics Department, University of Padua, Padova, Italy; Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Filippo Bonaldi
- Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, University of Padua, Padova, Italy
| | - Mario Gardi
- Urology Clinic, Azienda Ospedale Universita Padova, Padova, Italy
| | - Alberto Bortolami
- Coordinamento Rete Oncologica Veneta ROV, Istituto Oncologico Veneto IOV IRCCS, Padova
| | - Matteo Sepulcri
- Radiotherapy Unit, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Davide Bimbatti
- Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Vincenzo Baldo
- Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, University of Padua, Padova, Italy
| | - Manuela Scioni
- Statistics Department, University of Padua, Padova, Italy
| | - Marco Maruzzo
- Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Umberto Basso
- Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Vittorina Zagonel
- Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
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Affiliation(s)
- Samar B Hasan
- Division of Infection & Immunity, Cardiff University, University Hospital of Wales, Cardiff, UK
| | | | - F Collier
- NHS Forth Valley Dermatology Department, Stirling Community Hospital Stirling, Scotland
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Buja A, Rugge M, De Luca G, Zorzi M, Cozzolino C, Vecchiato A, Del Fiore P, Tropea S, Bortolami A, Benini P, Rossi CR, Mocellin S. Clinical performance indicators for monitoring the management of cutaneous melanoma: a population-based perspective. Melanoma Res 2022; 32:353-9. [PMID: 35855661 DOI: 10.1097/CMR.0000000000000841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
The prognosis of cutaneous malignant melanoma (CMM) is based on disease progression. The highly heterogeneous clinical-pathological characteristics of CMM necessitate standardized diagnostic and therapeutic interventions tailored to cancer's stage. This study utilizes clinical performance indicators to assess the quality of CMM care in Veneto (Northeast Italy). This population-based study focuses on all incidences of CMMs registered by the Veneto Cancer Registry in 2015 (1279 patients) and 2017 (1368 patients). An interdisciplinary panel of experts formulated a set of quality-monitoring indicators for diagnostic, therapeutic, and end-of-life clinical interventions for CMM. The quality of clinical care for patients was assessed by comparing the reference thresholds established by experts to the actual values obtained in clinical practice. The prevalence of stage I-CMM decreased significantly from 2015 to 2017 (from 71.8 to 62.4%; P < 0.001), and almost all the pathology reports mentioned the number of nodes dissected during a lymphadenectomy. More than 90% of advanced CMMs were promptly tested for molecular BRAF status, but the proportion of patients given targeted therapies fell short of the desired threshold (61.1%). The proportion of stage I-IIA CMM patients who inappropriately underwent computerized tomography/MRI/PET dropped from 17.4 to 3.3% ( P < 0.001). Less than 2% of patients received medical or surgical anticancer therapies in the month preceding their death. In the investigated regional context, CMM care exhibited both strengths and weaknesses. The evaluated clinical indicators shed essential insight on the clinical procedures requiring corrective action. It is crucial to monitor clinical care indicators to improve care for cancer patients and promote the sustainability of the healthcare system.
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Gulliver W, Alavi A, Wiseman MC, Gooderham MJ, Rao J, Shayesteh Alam M, Papp KA, Desjardins O, Jean C. Real-World Moderate-to-Severe Hidradenitis Suppurativa: Decrease in Disease Burden With Adalimumab. J Cutan Med Surg 2022; 26:361-370. [PMID: 35322692 DOI: 10.1177/12034754221088584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Real-world knowledge of the burden of hidradenitis suppurativa (HS) on patients remains limited. OBJECTIVES To measure the impact of adalimumab on moderate-to-severe HS patients' health-related quality of life (HRQoL) and work productivity. METHODS In 23 Canadian centres, 138 adults with moderate-to-severe HS requiring a change in ongoing therapy were treated with adalimumab for up to 52 weeks as per the physician's practice. Patient-reported outcome measures (PROMs) were obtained at baseline, weeks 24 and 52 to measure overall HRQoL, HS severity, levels of anxiety and depression, impact and symptoms of HS, work productivity and activity impairment. A post-hoc analysis further explored the PROMs by abscess and inflammatory nodule (AN) count at baseline (≤5, low; 6-10, medium; ≥11, high). RESULTS From baseline to weeks 24 and 52, all PRO overall scores improved significantly (P ≤ .0023). The number of patients reporting "good disease control" and "complete disease control" increased from 9.7% to 66.4% over 52 weeks. The score in Health Utility Index Mark 3 (HUI3) pain attribute meaningfully decreased over 52 weeks (mean difference ≥.05). The HS symptoms skin "tenderness" and "itchiness" improved the most. Work productivity loss and activity impairment improved by approximately 20% over 52 weeks. Disease burden improved more in 24 week responders with low and medium AN counts at baseline than in those with high AN count or in 24 week nonresponders. CONCLUSION At week 24 and maintained at week 52 in a real-world setting, adalimumab meaningfully improved HRQoL, work productivity, and activity impairment in moderate-to-severe HS patients.
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Affiliation(s)
- Wayne Gulliver
- NewLab Clinical Research Inc, St. John's, NL, Canada.,Faculty of Medicine, Memorial University of Newfoundland, NL, Canada
| | - Afsaneh Alavi
- 6915 Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,468790 Probity Medical Research Inc, Waterloo, ON, Canada
| | - Marni C Wiseman
- 468790 Probity Medical Research Inc, Waterloo, ON, Canada.,Department of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Wiseman Dermatology Research, Winnipeg, Canada
| | - Melinda J Gooderham
- 468790 Probity Medical Research Inc, Waterloo, ON, Canada.,SKiN Centre for Dermatology, Peterborough, ON, Canada.,Queen's University, Kingston, ON, Canada
| | - Jaggi Rao
- 468790 Probity Medical Research Inc, Waterloo, ON, Canada.,Division of Dermatology, University of Alberta, Edmonton, AB, Canada
| | - Maryam Shayesteh Alam
- 468790 Probity Medical Research Inc, Waterloo, ON, Canada.,SimcoMed Health Ltd, Barrie, ON, Canada
| | - Kim A Papp
- 468790 Probity Medical Research Inc, Waterloo, ON, Canada.,Kim Papp Clinical Research, Waterloo, ON, Canada
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Filoni A, Del Fiore P, Cappellesso R, Dall'Olmo L, Salimian N, Spina R, Tropea S, Rastrelli M, Russano F, D'Amico M, Collodetto A, Rossi CR, Buja A, Vecchiato A, Alaibac M, Mocellin S. Management of melanoma patients during COVID-19 pandemic in an Italian skin unit. Dermatol Ther 2021; 34:e14908. [PMID: 33619813 PMCID: PMC7995113 DOI: 10.1111/dth.14908] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/18/2021] [Accepted: 02/04/2021] [Indexed: 12/19/2022]
Abstract
Due to the COVID‐19 crisis, many scheduled medical and surgical activities have been suspended. This interruption to the healthcare system can negatively affect the diagnosis and management of melanoma. Neglecting melanoma throughout the outbreak may be associated with increased rates of mortality, morbidity, and healthcare expenses. We performed a retrospective review of all dermatological and surgical activity performed in our Melanoma Skin Unit between 23 February 2020 and 21 May 2020 and compared these data with those from the same period in 2019. During the lockdown period, we observed a decrease in dermatologic follow‐up (DFU) (−30.2%) and in surgical follow‐up (SFU) (−37%), and no modification of melanoma diagnosis (−3%). Finally, surgical excisions (SE) (+ 31.7%) increased, but sentinel lymph node biopsy (SLNB) (−29%) and lymph node dissections(LND) (−64%) decreased compared to the same period in 2019. Our experience supports the continuation of surgical and diagnostic procedures in patients with melanoma during the COVID‐19 pandemic. Surgical and follow‐up procedures for the diagnosis and treatment of melanoma should not be postponed considering that the pandemic is lasting for an extended period.
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Affiliation(s)
- Angela Filoni
- Melanoma and Sarcoma Surgical Oncology Unit, Veneto Institute of Oncology (IRCCS), Padova, Italy
| | - Paolo Del Fiore
- Melanoma and Sarcoma Surgical Oncology Unit, Veneto Institute of Oncology (IRCCS), Padova, Italy
| | - Rocco Cappellesso
- Division of Surgical Pathology and Cytopathology, Department of Medicine, School of Medicine and Surgery, University of Padua, Padua, Italy
| | - Luigi Dall'Olmo
- Melanoma and Sarcoma Surgical Oncology Unit, Veneto Institute of Oncology (IRCCS), Padova, Italy
| | - Nick Salimian
- Faculty of Medicine and Surgery, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Romina Spina
- Melanoma and Sarcoma Surgical Oncology Unit, Veneto Institute of Oncology (IRCCS), Padova, Italy
| | - Saveria Tropea
- Melanoma and Sarcoma Surgical Oncology Unit, Veneto Institute of Oncology (IRCCS), Padova, Italy
| | - Marco Rastrelli
- Melanoma and Sarcoma Surgical Oncology Unit, Veneto Institute of Oncology (IRCCS), Padova, Italy.,Faculty of Medicine and Surgery, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Francesco Russano
- Melanoma and Sarcoma Surgical Oncology Unit, Veneto Institute of Oncology (IRCCS), Padova, Italy
| | - Mattia D'Amico
- Melanoma and Sarcoma Surgical Oncology Unit, Veneto Institute of Oncology (IRCCS), Padova, Italy
| | - Alessandra Collodetto
- Melanoma and Sarcoma Surgical Oncology Unit, Veneto Institute of Oncology (IRCCS), Padova, Italy
| | - Carlo Riccardo Rossi
- Melanoma and Sarcoma Surgical Oncology Unit, Veneto Institute of Oncology (IRCCS), Padova, Italy.,Faculty of Medicine and Surgery, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Alessandra Buja
- Department of Cardiac, Thoracic, and Vascular Sciences, School of Medicine and Surgery, University of Padua, Padua, Italy
| | - Antonella Vecchiato
- Melanoma and Sarcoma Surgical Oncology Unit, Veneto Institute of Oncology (IRCCS), Padova, Italy
| | - Mauro Alaibac
- Division of Dermatology, Department of Medicine, University of Padua, Padua, Italy
| | - Simone Mocellin
- Melanoma and Sarcoma Surgical Oncology Unit, Veneto Institute of Oncology (IRCCS), Padova, Italy.,Faculty of Medicine and Surgery, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
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Reyes-Marcelino G, Tabbakh T, Espinoza D, Sinclair C, Kang YJ, McLoughlin K, Caruana M, Fernández-Peñas P, Guitera P, Aitken JF, Canfell K, Dobbinson S, Cust AE. Prevalence of skin examination behaviours among Australians over time. Cancer Epidemiol 2020; 70:101874. [PMID: 33341599 DOI: 10.1016/j.canep.2020.101874] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 11/26/2020] [Accepted: 11/29/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND We aimed to examine the prevalence and correlates of opportunistic skin check behaviours among Australians and whether changes over time might explain increasing underlying rates of melanoma in situ. METHODS The National Sun Protection Survey involved periodic telephone-based cross-sectional surveys during summer since 2003. Skin checks by a doctor in the past 12 months was asked in four summers over 2006-2017, and responses from 23,374 Australians aged 12-69 years were analysed. Prevalence estimates were weighted to be representative of the Australian population. Chi-square tests compared the prevalence over time and by characteristics. RESULTS The overall proportion reporting whole-body skin checks in the past 12 months was 20 % in 2006-07 and 2010-11, 21 % in 2013-14, and 22 % in 2016-17; but increased from 29 % in 2006-07 to 37 % in 2016-17 for those aged 45-69 years (p < 0.0001). In 2016-17, 5% reported a skin check of part-body and 9% for a specific mole or spot. The proportion reporting no skin checks increased from 61 % to 64 % over time (p < 0.0001). Whole-body skin checks were more common among older respondents, females, and also varied by residence location, skin sensitivity, skin colour, risk perception, and socio-economic index (all p < 0.001). CONCLUSION Approximately one third of Australians had their skin checked by a doctor within a 12-month period, but this varied across population sub-groups. Skin check behaviours were relatively stable over time, with modest increases in the prevalence of skin checks for those aged 45-69 years. These findings do not explain underlying large increases in rates of melanoma in situ.
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Affiliation(s)
- Gillian Reyes-Marcelino
- Sydney School of Public Health, Building A27, The University of Sydney, NSW 2006, Australia.
| | - Tamara Tabbakh
- Cancer Council Victoria, 615St Kilda Rd, Melbourne, VIC 3004, Australia.
| | - David Espinoza
- NHMRC Clinical Trials Centre, The University of Sydney, NSW 2006, Australia.
| | - Craig Sinclair
- Cancer Council Victoria, 615St Kilda Rd, Melbourne, VIC 3004, Australia.
| | - Yoon-Jung Kang
- Cancer Council New South Wales, 153 Dowling Street, Woolloomooloo, NSW 2011, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia.
| | - Kirstie McLoughlin
- Cancer Council New South Wales, 153 Dowling Street, Woolloomooloo, NSW 2011, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia.
| | - Michael Caruana
- Cancer Council New South Wales, 153 Dowling Street, Woolloomooloo, NSW 2011, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia.
| | - Pablo Fernández-Peñas
- Department of Dermatology, Westmead Clinical School, The University of Sydney, NSW 2006, Australia.
| | - Pascale Guitera
- Melanoma Institute Australia, The University of Sydney, 40 Rocklands Rd, Wollstonecraft, NSW 2065, Australia; Department of Dermatology, Central Clinical School, The University of Sydney, NSW 2006, Australia; Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, NSW 2050, Australia.
| | - Joanne F Aitken
- Cancer Council Queensland, 553 Gregory Terrace, Fortitude Valley, QLD 4006, Australia.
| | - Karen Canfell
- Cancer Council New South Wales, 153 Dowling Street, Woolloomooloo, NSW 2011, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Suzanne Dobbinson
- Cancer Council Victoria, 615St Kilda Rd, Melbourne, VIC 3004, Australia.
| | - Anne E Cust
- Sydney School of Public Health, Building A27, The University of Sydney, NSW 2006, Australia; Melanoma Institute Australia, The University of Sydney, 40 Rocklands Rd, Wollstonecraft, NSW 2065, Australia.
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