Health related quality of life in patients with actinic keratosis--an observational study of patients treated in dermatology specialist care in Denmark.

BACKGROUND: Actinic keratosis (AK) is a common skin condition that may progress to non-melanoma skin cancer (NMSC). The disease may influence Health Related Quality of Life (HRQoL), but studies of HRQoL in patients with AK are limited. The purpose of the study was to analyze HRQoL in patients with different severity levels of AK treated in dermatology specialist care using generic and disease-specific HRQoL instruments and to analyze their relationship. METHODS: AK patients who visited dermatological clinics in Denmark were included in an observational, cross-sectional, study in a multi-center setting. Dermatologists assessed AK severity and patients completed: Actinic Keratosis Quality of Life Questionnaire (AKQoL), Dermatology Life Quality Index (DLQI), and EQ-5D-5 L including EQ-VAS. Differences between categorical subgroups were tested with Wilcoxon rank-sum test. The relationship between instruments was analyzed with the Spearman correlation test. RESULTS: A total of 312 patients were included in the analyses. Patients reported impairment in the disease specific HRQoL instrument AKQoL (mean AKQoL 6.7, DLQI 2, EQ-5D-5 L 0.88, and EQ-VAS 79). HRQoL was least affected in patients with mild actinic disease, whereas patients with severe actinic damage suffered from further impaired HRQoL (mean AKQoL 10.1 and DLQI 4.6). Correlations between DLQI and AKQoL were moderate, whereas the correlations between DLQI and EQ-5D-5 L and between AKQoL and EQ-5D-5 L were weak. CONCLUSIONS: Patients with severe actinic damage showed more impairment in HRQoL than those with mild disease. Correlations between instruments suggest that they are complementary as they measure different aspects of HRQoL and are used for different purposes.

Painful bone metastases in hormone-refractory prostate cancer: economic costs of strontium-89 and/or external radiotherapy.

OBJECTIVES: In a prospective randomized Canadian trial, addition of radionuclide strontium (89Sr) to external radiotherapy (ER) was found to prolong the time to further ER by 15 weeks (35 versus 20, P = 0.006) compared to ER alone in patients with hormone-refractory metastatic prostate cancer (HRMPC). The total direct lifetime costs within the Swedish health care system for the following two treatment strategies was estimated as follows: (a) ER initially and in the event of relapse and (b) ER + 89Sr initially and ER in the event of relapse. METHODS: Calculation of lifetime costs was based on the initial total treatment cost and the probability of future treatment costs. In a retrospective analysis, the average cost of a relapse treated with ER alone was calculated from the actual care consumption of 79 consecutive patients from the south of Sweden who received ER because of skeletal pain due to HRMPC. The costs related to ER included skeletal scintigraphy, ER, outpatient visits, inpatients days, and travel to the treatment center. When 89Sr was added, the cost also included the radionuclide and its administration. Costs in Swedish currency (SEK) were based on the regional tariff for 1993 (U.S. $1 = SEK 8.30). RESULTS: The initial cost for one relapse treated with ER alone was estimated to be SEK 31,011 (U.S. $3736) per patient resident within county (close to hospital) and SEK 48,585 (U.S. $5854) per patient resident out of county (far from hospital). The corresponding figure for initial addition of 89Sr to ER was SEK 43,426 (U.S. $5232) and 61,000 (U.S. $7349), respectively. However, comparison between estimated lifetime cost for the two treatment strategies indicated potential cost savings with initial addition of 89Sr to 3% SEK 2720 (U.S. $328) and 7% SEK 11,290 (U.S. $1360), respectively. CONCLUSIONS: Strontium-89 as initial supplement to ER for palliation of pain in HRMPC is beneficial both from the patient and lifetime health service costs perspectives.

[Prenatal diagnosis. Ethics - counselling.].

During the last years great progress has been made in the field of prenatal diagnosis. The possibility of monitoring the growth, development and well being of a child in the womb is priceless and can offer the mother a sense of security regarding the pregnancy. But the growing technology leads at the same time to various questions and discussions and it is good for all those who are a part of the maternal care to think about them. Is it unquestionable to eliminate all those fetuses that are diagnosed with an abnormality of any kind? Where would such a development lead us? Are we, with the means of a continuing better technology, bit by bit "eliminating" certain groups within the society? Is it to be an unquestioned "routine" or even duty, that every woman should be subjected to those diagnoses that are possible? We have within the field of ethics many different views on those questions. One view stresses the complete freedom of abortion. Another demands that all life should be protected, and a fetus should never be terminated, even if it is sick or disabled. The author of this article wants to demonstrate the rule of the sanctity of all life, that all human life should be respected, that this rule should always be applied within the field of medicine. At the same time it should be stressed that this respect for life is not always best given by sustaining and saving all life. Death is not always the worst choise. We must evaluate each and every case, that each and every parents to be should make their own decision based on their own ethical views, after having received appropriate information, professional support and counselling. It is important that professionals deal with these matters with respect for life and respect for the parents who already have disabled children and the disabled themselves. All the prenatal diagnosis which is available may lead to that parents to be have to take difficult decisions regarding the pregnancy. It is therefore of the utmost importance that a pregnant woman and her partner should know the meaning and purpose of the prenatal care which is offered and that they are fully aware of the decisions they may have to face. If the results are not in the favor of the fetus, the couple should receive the support and care whatever their decision may be.