scholarly journals Hospital Costs of Colorectal Cancer Care

2009 ◽  
Vol 3 ◽  
pp. CMO.S2362
Author(s):  
D.A.L. Macafee ◽  
J. West ◽  
J.H. Scholefield ◽  
D.K. Whynes
Keyword(s):  
Colorectal Cancer ◽  
Nursing Care ◽  
Cancer Care ◽  
Recurrent Disease ◽  
Hospital Costs ◽  
Cost Of Care ◽  
Primary Data ◽  
Retrospective Case ◽  
Significant Difference ◽  
Costing Study

Objective In a hospital based setting, identify factors which influence the cost of colorectal cancer care? Design Retrospective case note review Setting Nottingham, United Kingdom Participants 227 patients treated for colorectal cancer Methods Retrospective review of the hospital records provided the primary data for the costing study and included all CRC related resource consumption over the study period. Results Of 700 people identified, 227 (32%) sets of hospital notes were reviewed. The median age of the study group was 70.3 (IQR 11.3) years and there were 128 (56%) males. At two years, there was a significant difference in costs between Dukes D cancers (£3641) and the other stages (£3776 Dukes A; £4921 Dukes B). Using univariate and multivariate regression, the year of diagnosis, Dukes stage of disease, intensive nursing care, stoma requirements and recurrent disease all significantly affected the total cost of care. Conclusions CRC remains costly with no significant difference in costs if diagnosed before compared to after 1992. Very early and very late stage cancers remain the least costly stage of cancers to treat. Other significant effectors of hospital costs were the site of cancer (rectal), intensive nursing care, recurrent disease and the need for a stoma.

Understanding the comorbidome and its effect on survival in colorectal cancer.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 210-210
Author(s):  
Erin Elizabeth Hahn ◽  
Ernest Shen ◽  
Janet S. Lee ◽  
Corrine E. Munoz-Plaza ◽  
Carly Parry ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Care ◽  
Latent Class ◽  
Stage Iv ◽  
Charlson Comorbidity Index Score ◽  
Multiple Chronic Conditions ◽  
Comorbid Conditions ◽  
Personalized Care ◽  
Kaplan Meier ◽  
Significant Difference

210 Background: Effectively managing comorbidities is an essential component of high-quality cancer care. Evidence suggests colorectal cancer (CRC) patients with multiple comorbid conditions are less likely to complete standard treatments and can have lower rates of survival. In order to provide personalized care, it is critical to understand how comorbid conditions cluster within CRC patients. Methods: We identified Kaiser Permanente Southern California CRC patients diagnosed with first malignancy between 01/01/2008 - 12/31/2013. We used latent class analysis to identify clinically useful phenotypes defined by combinations of comorbidities at diagnosis, and compared survival using the Kaplan-Meier method. Results: The cohort included 7803 patients: 52% male; average age at diagnosis 66 years (SD: 13); 22% Hispanic, 15% Black, 9% Asian, 52% White; 42% Stage I, 22% Stage II, 22% Stage III, and 14% Stage IV. One-fifth of patients had a Charlson comorbidity index score of ≥ 4. We found 4 distinct classes (Lo-Mendell-Rubin p<0.001). Class 1 was relatively healthy with few comorbidities (Table). Class 2 included individuals with cardiovascular diseases; those in Class 3 had complicated diabetes. Class 4 members had multiple chronic conditions, including diabetes with micro- and macrovascular complications. Kaplan-Meier estimates revealed a statistically significant difference in overall survival by class (log rank p<0.001). Conclusions: We identified 4 clinically distinct classes of comorbid conditions in CRC patients. These data can be used to inform personalized care for CRC patients throughout the cancer care continuum. [Table: see text]

Cost of colon cancer care: Results of nationwide inpatient sample (NIS) data.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 692-692 ◽  
Author(s):  
Pranshu Bansal ◽  
Ian Rabinowitz ◽  
Yanis Boumber ◽  
Dhruv Bansal
Keyword(s):  
Colon Cancer ◽  
Cancer Care ◽  
Hospital Admissions ◽  
Hospital Costs ◽  
Cost Of Care ◽  
Inpatient Setting ◽  
Hospital Data ◽  
For Profit ◽  
The Mean ◽  
Mean Cost

692 Background: Cost of cancer care including colon cancer continues to rise. Most of the recent advances in colon cancer inlcude biologics and targeted agents which are adminstered in an oupatient setting and more commonly thought to be responsible for increasing economic burden. Cost of care for cancer patients in an inpatient setting however continues to be a significant factor that needs to be identified better to help adopt cost effective quality improvement in future. Methods: We used NIS to extract data for patients hospitalized with primary diagnosis of colon cancer using clinical classification software code 14, and corresponding ICD9 codes for the years 2003-2013. ICD codes for colorectal and rectal cancer were eliminated. NIS is a nationally representative survey of hospitalizations conducted by the Healthcare Cost and Utilization Project. It represents 20% of all hospital data in US. Trend of rate of hospitalization, mean length of stay (LOS), mean cost of hospitalization and mean cost of hospitalization based on owner type- government, private not for profit (PNFP) and private for profit (PFP) was performed. Results: From the year 2003 to 2013 rate of hospitalizations for colon cancer decreased from 37.4 to 28.1 per 100,000 hospital admissions. Mean LOS declined from 9.06 to 7.76 between 2003-2013. In the same time period the mean cost of hospital stay increased from $39,430 to $73,219. The mean cost of hospitalization based on owner type in 2003 was government $33,507; PNFP $33,735 and PFP was $55,553 and in 2013 the mean costs were $63,194; $68,555 and $107,428 respectively. Conclusions: In the decade of 2003-2013 the rate of hospitalization decreased by approximately 25%, LOS decreased by 14% but the mean cost of hospitalization continued to increase throughout the decade with a mean increase of approximately 85% in hospital costs. The increase was observed across the spectrum of all owner types with the maximum increase of 104% in PNFP followed by PFP owner type at 93%, national inflation rate was 26% during this time. Progress made in decreasing LOS has not directly translated into reducing hospital costs and further studies focusing on factors in addition to cost of biologic agents that contribute to cancer care costs should be considered.

Does hospital academic status impact colon cancer care value?

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 6-6
Author(s):  
Christine Marie Veenstra ◽  
Andrew J Epstein ◽  
Craig Evan Pollack ◽  
Katrina Armstrong
Keyword(s):  
Colon Cancer ◽  
Overall Survival ◽  
Cancer Care ◽  
Cost Of Care ◽  
Stage Ii ◽  
Stage Iii ◽  
Academic Status ◽  
Risk Of Death ◽  
Academic Hospitals ◽  
Significant Difference

6 Background: Given the high cost of cancer care, delivery of high-value care is crucial. The effect of hospital academic status on value of care for patients with stage II and III colon cancer is unknown. Methods: SEER-Medicare cohort study of 20,118 patients age 66+ with stage II or III colon cancer diagnosed 2000-2005 and followed through December 31, 2007. Patients were assigned to a treating hospital based on hospital affiliation of the primary oncologist. We constructed Kaplan-Meier curves to assess unadjusted overall survival. We estimated a Cox proportional hazards model to assess adjusted overall survival. To examine associations between hospital academic status and mean cost of care we estimated a generalized linear model (GLM) with log link and gamma family. We estimated quantile regression models to examine associations between hospital teaching status and cost at various quantiles (25th, 50th, 75th, 90th, 95th, 99th, 99.5th, 99.9th). Standard errors were adjusted to account for clustering of patients within hospitals. Results: 4449/20,118 (22%) patients received care from providers affiliated with academic hospitals. There was no significant difference in unadjusted median survival based on hospital academic status for patients with stage II (academic 6.4 yrs vs. non-academic 6.3 yrs, p=0.711) or stage III disease (academic 4.2 yrs vs. non-academic 4.2 yrs, p=0.81). After adjustment, treatment at academic hospitals was not associated with significantly reduced risk of death from colon cancer (stage II HR 1.05, 95% CI: 0.97 - 1.13; p=0.23; stage III HR 0.99, 95% CI: 0.94-1.07; p=0.98). Excepting stage III patients at the 99.9th percentile of costs, there were no significant differences in adjusted costs between academic and non-academic hospitals. Conclusions: We find no difference in overall survival for patients with stage II or stage III colon cancer based on academic status of the treating hospital. Furthermore, costs of care are similar between academic and non-academic hospitals across virtually the full range of the cost distribution. Most colon cancer patients do not receive cancer care at academic hospitals. Our findings indicate that for patients with stage II or III disease, this inequity does not impact the value of care.

scholarly journals The Efficacy of the EUS for the Detection of Recurrent Disease in the Anastomosis of Colon

2001 ◽  
Vol 7 (3-4) ◽  
pp. 149-158 ◽  
Author(s):  
Shunichi Nakajima
Keyword(s):  
Colorectal Cancer ◽  
Surgical Resection ◽  
Advanced Colorectal Cancer ◽  
Recurrent Disease ◽  
Submucosal Tumor ◽  
Definitive Diagnosis ◽  
The Other ◽  
Anastomotic Recurrence ◽  
Postoperative Course ◽  
Significant Difference

Patients who underwent surgical resection of an advanced colorectal cancer during the period from June 1982 to July 2001 were examined for evidence of no anastomotic recurrence or recurrent lesions through combination of endoscopic ultrasonography (EUS) with endoscopy. Included in this study were 11 patients with recurrence and 36 patients without recurrence, 47 patients in all. Endoscopy revealed stenosis in 81.8% of patients with ana anastomotic recurrence, erosion including cancer exposure in 81.8% and submucosal tumor-like elevation in 45.5%. In the group of patients without recurrence it revealed stenosis in 13.9% of patients, erosion in 22.2%, and a scar-like change in 77.8%. There was a significant difference between the two groups in each change. EUS, on the other hand, revealed localized hypertrophy of the region extending from the submucosa to the mp due to edema early in the postoperative course. The rate of definitive diagnosis with EUS was 100%, compared to 90.1% for endoscopy. The results of this study indicate that EUS is helpful in detecting anastomotic recurrence of colorectal cancer.

Intensive radiographic and CEA screening and salvage resection in patients with stage II and III colorectal cancer.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 405-405 ◽  
Author(s):  
Ahmad Ali Fora ◽  
Annie M Patta ◽  
Kristopher Attwood ◽  
Gregory E. Wilding ◽  
Marwan Fakih
Keyword(s):  
Colorectal Cancer ◽  
Recurrent Disease ◽  
Salvage Surgery ◽  
Stage Ii ◽  
High Rate ◽  
Surveillance Strategy ◽  
Salvage Resection ◽  
Significant Difference ◽  
Intensive Surveillance

405 Background: The objective of this study was to determine the rate of salvage resection in patients with stage II and III colorectal cancer following intensive surveillance. Methods: Patients with stage II and III colorectal cancer with a minimum follow-up of 3 years were included. CEA was obtained every 3 months for 2 years and then every 6 months for years 3 to 5. CT of the chest, abdomen and pelvis was performed every 6 months for 2 years and then yearly for years 3 to 5. Colonoscopy was performed at year 1 and then every 3 years. Results: 177 patients were followed for a median of 59.5 months. 51% were male, and 65 % had colon cancer. Compliance with screening was excellent with 92 % of patients undergoing all scheduled studies within 2 months of the planned date. At the time of this report, the median follow-up of the overall population was 5 years. 44 patients were diagnosed with recurrent disease. 91% of the recurrences were in the first 3 years of follow-up. CT and CEA were the first signs of recurrence in 68% and 14% of patients, respectively. Among the 30 patients diagnosed radiographically, 20 had a normal CEA. 25 patients (57%) with recurrent disease underwent curative intent resection, 12 of whom are still cancer free, with a median follow-up of 6.7 years from salvage surgery. The DFS and OS in the operated recurrent population from the time of salvage resection was 18.8 months (95% CI: 15.5 – 29.4) and not-reached (95% CI: 37.4, NR), respectively. The corresponding OS (from the time of recurrence) of the recurrent population without resection was 20.7 months (95% CI: 21.9, 63.4). The difference in OS between the two groups was highly significant (p = 0.0003). Among the patients undergoing resection, a significant difference was detected in the DFS of resected lung or liver metastases vs. extra-hepatic/pulmonary disease (p = 0.03) and a trend towards improved survival was noted (p = 0.07). Conclusions: Our intensive surveillance strategy resulted in the highest reported salvage rate in stage II and III colorectal cancer and led to a high rate of sustained remissions following salvage surgery. Intensive, 6-monthly, radiographic surveillance and its duration should be investigated further in randomized studies.

Concordance between patient and family caregiver reports of quality of colorectal cancer care.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 187-187
Author(s):  
Rachel D. Havyer ◽  
Michelle van Ryn ◽  
Patrick Wilson ◽  
Joan M. Griffin
Keyword(s):  
Colorectal Cancer ◽  
Quality Of Care ◽  
Family Caregiver ◽  
Cancer Care ◽  
Patient Reports ◽  
Lower Stage ◽  
Care Assessment ◽  
Significant Difference ◽  
Patient Reported

187 Background: Patient-reported evaluations of interpersonal quality of care are essential elements of quality of cancer care assessment. At times, patients may be unable to report themselves on their care experience and systems may rely on proxy reports. The validity of this approach is dependent on the degree to which family caregiver assessments are concordant with patient assessments. Methods: A VA cohort of colorectal cancer (CRC) patients and their caregivers both completed a self-administered questionnaire on the quality of VA cancer care in 3 specific domains: surgery, chemotherapy overall and chemotherapy nursing care, all measured on a 5-point Likert scale. Because the kappa statistic penalizes skewed distributions which are commonly seen in patient satisfaction reports, agreement between patients and caregivers on perceptions of quality care were measured using Gwet’s AC2 statistic. Stratified analyses on caregiver burden, race, education, and age as well as patient’s stage of disease were used to assess variation in agreement. Results: 417 caregiver-patient dyads completed the survey (70% response rate), of whom 362 (86.8%) had surgery and 195 (46.8%) had chemotherapy. Overall agreement was high for the 3 quality of care domains: AC2 (95% CI): 0.870 (0.838, 0.903) for surgery, 0.835 (0.786, 0.884) for chemotherapy overall and 0.906 (0.868, 0.944) for chemotherapy nurses. Stratified analyses of agreement showed particular populations of higher or lower agreement; however the findings were inconsistent across the three domains and most were not statistically significant. Patients with lower stage (I-II) had higher agreement than higher stages (III-IV) (AC2: 0.967 and 0.879 respectively, P = 0.006) but only in the chemotherapy nurses domain. For the surgery domain, age was the only significant difference in agreement (0.816, 0.912, and 0.838 for < 50, 51-65, and > 65 respectively, P = 0.03). Conclusions: Family caregiver reports on the quality of CRC care were highly concordant with patient reports. Therefore, family caregivers may be able to provide reasonable proxy report on measures of quality of cancer care when patient reports are unavailable.

scholarly journals The Effect of Critical Pathway Care in Patients With Colorectal Cancer, Randomized Control Trials

2020 ◽  
Author(s):  
Bahareh Abavi-Torghabeh ◽  
Mehrsadat Mahdizadeh ◽  
Seyed-Mousa Mahdizadeh ◽  
Seyed-Reza Mazloom
Keyword(s):  
Colorectal Cancer ◽  
Side Effects ◽  
Nursing Care ◽  
Controlled Trial ◽  
Length Of Hospital Stay ◽  
Routine Care ◽  
Care Group ◽  
Critical Pathway ◽  
Significant Difference ◽  
Duration Of Hospitalization

Colorectal cancer and its treatment have short-term and long-term side effects for patients. One of the factors affecting these side effects is the nursing care method. This study was conducted to determine the effect of care based on the critical pathway on the duration of hospitalization, complications of the disease, and satisfaction with nursing care in patients with colorectal cancer. In a cluster-randomized controlled trial study, 70 patients with colorectal cancer were randomly selected from two hospitals of OMID (N=35) and GHAEM (N=35) in Mashhad, Iran. They were assigned to intervention and control groups. The data were collected using a characteristic of patients, and satisfaction questioner, a checklist of patient status and nursing performance, and analyzed by SPSS software version 18. There was a significant difference in the mean of satisfaction of patients from nursing care and length of hospital stay between pathway and routine care group (P<0.001). There were no significant differences between pathway and routine for the postoperative complications after 12 weeks of follow-up. Our study indicates that critical pathway care can increase the satisfaction of patients and decrease the duration of hospitalization. Future studies should investigate how to increase other clinical outcomes in the oncology wards.

scholarly journals Spinal Anesthesia is Safe and Cost-effective for Laparoscopic Appendectomy in Children: A Case-Control Study

2020 ◽  
Author(s):  
Md Jafrul Hannan ◽  
Mosammat Kohinoor Parveenl ◽  
Alak Nandy ◽  
Md Samiul Hasan
Keyword(s):  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Hospital Costs ◽  
Cost Effective ◽  
Patient Comfort ◽  
Controlled Study ◽  
Hospital Discharges ◽  
Retrospective Case ◽  
Post Surgery ◽  
Significant Difference

STRUCTURED ABSTRACTBackgroundOwing to the widespread use of general anesthesia, administration of spinal anesthesia in pediatrics is not widely practiced. Yet there is ample positive evidence demonstrating its safety, effectiveness and success.ObjectiveThe objective of this study is to demonstrate that laparoscopic appendectomies are successful under spinal anesthesia and elicit clear advantages over general anesthesia.MethodsThis was a retrospective analysis of 77 pediatric (5-8 year old) laparoscopic appendectomies that took place in a Hospital in Chittagong, Bangladesh in 2019. Approximately half of the patients underwent spinal anesthesia while the other half underwent general anesthesia. Variables such as surgery and operation theatre times, pain score, incidence of post-surgery vomiting, analgesic usage, discharge times and hospital costs were recorded. Statistical analysis was used to analyze the data as a function of form of anesthesia.ResultsThe probability of vomiting when using spinal compared to general anesthesia was much lower within the first 5 hours (P < .001) and after 6 hours (P = .008) of operation. Highly significant difference (P < .001) was observed in the total costs of the procedures. A significantly higher likelihood of patients being discharged the same day of the procedure was noted if spinal anesthesia was used (P = .008).ConclusionsSpinal anesthesia is superior to general anesthesia for pediatric laparoscopic appendectomies. Patient comfort is improved through a significant decrease in vomiting. This enables more rapid hospital discharges and a significant cost saving, without compromising the outcome of the procedure.MINI-ABSTRACTSpinal anesthesia is seldom used for laparoscopy in children. This retrospective case-controlled study compared spinal anesthesia with general anesthesia in children between 5 and 8 years of age. Spinal anesthesia proved to be safer and cost-effective for laparoscopy in children.

Efficacy and Toxicity of Addition of Bevacizumab to Chemotherapy in Patients with Metastatic Colorectal Cancer

2019 ◽  
Vol 21 (10) ◽  
pp. 718-724 ◽  
Author(s):  
Wen-Cong Ruan ◽  
Yue-Ping Che ◽  
Li Ding ◽  
Hai-Feng Li
Keyword(s):  
Colorectal Cancer ◽  
Adverse Event ◽  
Metastatic Colorectal Cancer ◽  
Line Treatment ◽  
Second Line ◽  
First Line ◽  
Second Line Therapy ◽  
Clinical Prognosis ◽  
Line Therapy ◽  
Significant Difference

Background: Pre-treated patients with first-line treatment can be offered a second treatment with the aim of improving their poor clinical prognosis. The therapy of metastatic colorectal cancer (CRC) patients who did not respond to first-line therapy has limited treatment options. Recently, many studies have paid much attention to the efficacy of bevacizumab as an adjuvant treatment for metastatic colorectal cancer. Objectives: We aimed to evaluate the efficacy and toxicity of bevacizumab plus chemotherapy compared with bevacizumab-naive based chemotherapy as second-line treatment in people with metastatic CRC. Methods: Electronic databases were searched for eligible studies updated to March 2018. Randomized-controlled trials comparing addition of bevacizumab to chemotherapy without bevacizumab in MCRC patients were included, of which, the main interesting results were the efficacy and safety profiles of the addition of bevacizumab in patients with MCRC as second-line therapy. Result: Five trials were eligible in the meta-analysis. Patients who received the combined bevacizumab and chemotherapy treatment in MCRC as second-line therapy showed a longer overall survival (OS) (OR=0.80,95%CI=0.72-0.89, P<0.0001) and progression-free survival (PFS) (OR=0.69,95%CI=0.61-0.77, P<0.00001). In addition, there was no significant difference in objective response rate (ORR) (RR=1.36,95%CI=0.82-2.24, P=0.23) or severe adverse event (SAE) (RR=1.02,95%CI=0.88-1.19, P=0.78) between bevacizumab-based chemotherapy and bevacizumabnaive based chemotherapy. Conclusion: Our results suggest that the addition of bevacizumab to the chemotherapy therapy could be an efficient and safe treatment option for patients with metastatic colorectal cancer as second-line therapy and without increasing the risk of an adverse event.

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