RESUMO
PURPOSE: The present study is designed to evaluate and compare percutaneous radiologic arm port (R) and surgical subclavian port (S) devices in two homogeneous sets of breast cancer patients in terms of safety, efficacy, quality of life (QoL) and cost analysis. MATERIAL AND METHODS: This study involved a retrospective review of a prospective databank including 200 consecutive port device implantation attempted procedures performed over a 4-year period, in two similar groups of 100 breast cancer women who underwent either the surgical cephalic vein cutdown approach or the percutaneous basilic vein catheterization for intravenous adjuvant chemotherapy. Parameters analyzed included technical success, procedure duration, complications, QoL and cost evaluation for both techniques. RESULTS: The success rate for port implantation was higher for R than for S placement (96% versus 91%). Mean implant duration time was 5.6 and 7.6 months for R and S, respectively. The overall complication rate was 10 and 16% for R and S, respectively. Mean implant duration time, without any complication or death, was 6.4 and 7.8 months for R and S, respectively. Six and seven percent for R and S, respectively, had to be removed prematurely. Both techniques exhibited very good QoL. Direct costs were respectively euro 230.8 and 219.1 for R and S, respectively. CONCLUSION: The significant advantages of R over S include higher success rate, higher cosmetic results despite a 15% relative overcost for R placement. Both are indicated for breast cancer chemotherapy treatment, nevertheless R placement is mandatory in anxious patients who fear surgery, in case of previous cervico-thoracic irradiation or upper extremity venous thrombosis, or in patients at risk of respiratory insufficiency.
Assuntos
Neoplasias da Mama/tratamento farmacológico , Cateterismo Periférico/métodos , Tratamento Farmacológico/instrumentação , Qualidade de Vida , Análise e Desempenho de Tarefas , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Cateterismo Periférico/economia , Cateteres de Demora , Feminino , Custos de Cuidados de Saúde , Humanos , Pessoa de Meia-Idade , Radiografia Intervencionista/métodos , Estudos Retrospectivos , Resultado do Tratamento , Venostomia/métodosRESUMO
The aim of this retrospective study was to evaluate the cost and benefit of percutaneous fluoroscopic gastrostomy feeding (PFG) in 70 cancer patients with advanced stage disease of the upper-aero digestive tract; we retrospectively analyzed the consequences in terms of nutritional status (evaluated by weight and body mass index), the possibility to lead a treatment by high dose chemo-radiotherapy to the end of the therapeutic schedule, the feasibility, complications and cost ratios. Three weeks after the procedure, no major complication was observed, the initial nutritional threshold was conserved. PFG is a safe and effective technique; the additional cost is low (2%) compared with the total cost of hospitalization.
Assuntos
Carcinoma de Células Escamosas/complicações , Neoplasias Esofágicas/complicações , Gastroscopia/economia , Neoplasias Hipofaríngeas/complicações , Distúrbios Nutricionais/terapia , Nutrição Parenteral/economia , Adulto , Idoso , Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/radioterapia , Análise Custo-Benefício , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/radioterapia , Estudos de Viabilidade , Gastroscopia/efeitos adversos , Gastroscopia/métodos , Humanos , Neoplasias Hipofaríngeas/tratamento farmacológico , Neoplasias Hipofaríngeas/radioterapia , Pessoa de Meia-Idade , Estado Nutricional , Nutrição Parenteral/efeitos adversos , Nutrição Parenteral/métodos , Radiografia Intervencionista/efeitos adversos , Radiografia Intervencionista/economia , Estudos RetrospectivosRESUMO
The goal of this work was to evaluate the costs and benefits of percutaneous interventional radiological procedures (PIRP) in terminal cancer patients, from the perspective of the Radiodiagnostics Department. The subjects were 225 patients who underwent different kinds of treatments, such as placement of endovenous or urinary stents, percutaneous gastrostomy, alcoholization of metastatic disease, celiac plexus block, tumor embolization, and inferior vena caval filter. We retrospectively analyzed the consequences in terms of survival, quality of life and cost ratios and found that this study fully justifies the use of interventional radiology in palliative oncology: 60% and 40% of the patients, respectively, were still alive at 1 month and 3 months; the additional cost of PIRP procedures is low (< 12%) compared with the total cost of hospitalization.