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1.
Medicine (Baltimore) ; 98(40): e17395, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31577748

RESUMEN

To date, few studies have examined the end-of-life (EOL) care for patients with hematological malignancies (HMs). We evaluated the effects of palliative care on the quality of EOL care and health care costs for adult patients with HMs in the final month of life.We conducted a population-based study and analyzed data from Taiwan's Longitudinal Health Insurance Database, which contains claims information for patient medical records, health care costs, and insurance system exit dates (our proxy for death) between 2000 and 2011.A total of 724 adult patients who died of HMs were investigated. Of these patients, 43 (5.9%) had received only inpatient palliative care (i-Pal group), and 19 (2.6%) received home palliative care (h-Pal group). The mean health care costs during the final month of life were not significantly different between the non-Pal and Pal groups (p=0.315) and between the non-Pal, i-Pal, and h-Pal groups (p=0.293) either. By the multivariate regression model, the i-Pal group had lower risks of chemotherapy, ICU admission, and receipt of CPR, but higher risks of at least two hospitalizations and dying in hospital after adjustments. The h-Pal group had the similar trends as the i-Pal group but lower risk of dying in hospital after adjustments.Patients with HMs who had received palliative care could benefit from less aggressive EOL cancer care in the final month of life. However, 8.6% patients with HMs received palliative care. The related factors of more hospitalizations and dying in hospital warrant further investigation.


Asunto(s)
Neoplasias Hematológicas/epidemiología , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Cuidados Paliativos/organización & administración , Cuidado Terminal/organización & administración , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Antineoplásicos/uso terapéutico , Comorbilidad , Femenino , Gastos en Salud/estadística & datos numéricos , Neoplasias Hematológicas/tratamiento farmacológico , Neoplasias Hematológicas/economía , Servicios de Atención de Salud a Domicilio/economía , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Humanos , Unidades de Cuidados Intensivos/economía , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Cuidados Paliativos/economía , Cuidados Paliativos/estadística & datos numéricos , Características de la Residencia , Índice de Severidad de la Enfermedad , Factores Sexuales , Factores Socioeconómicos , Taiwán , Cuidado Terminal/economía , Cuidado Terminal/estadística & datos numéricos
2.
Schmerz ; 33(5): 384-391, 2019 Oct.
Artículo en Alemán | MEDLINE | ID: mdl-31473816

RESUMEN

BACKGROUND: Geriatric patients often suffer from a long history of pain and have a limited life expectancy. Cannabinoid receptor agonists like dronabinol may be an effective, low-risk treatment option for geriatric patients with chronic pain. OBJECTIVES: The effectiveness and side effects of dronabinol therapy in geriatric patients are analyzed. The effects of the approval requirement are presented. METHODS: In our retrospective monocentric cohort study, the study population comprised all geriatric patients over the age of 80 years who were treated in our office since the cannabis law came into effect on 10 March 2017 until 17 July 2018 (evaluation date). Geriatric, nonpalliative pain patients (group A) and geriatric palliative patients (group B) were investigated. The basis of the evaluation was a questionnaire sheet that we use in our office with details of dosages, pain intensity, treatment effects and side effects from dronabinol therapy. RESULTS: By using dronabinol, 21 of the 40 geriatric patients (52.5%) achieved pain relief of more than 30%, 10% of the patients of more than 50%. On average, about four symptoms or side effects related to previous treatment were positively influenced. 26% of patients reported side effects. The rejection rates on the part of the health insurances were 38.7% (group A) and 10.3% (group B). CONCLUSIONS: This study is one of the few analyses of the use of Dronabinol in geriatric patients. We show that cannabis-based drugs (in this case dronabinol) are an effective, low-risk treatment option that should be considered early in therapy. Regarding the indication spectrum, further clinical studies and an approval-free test phase are necessary.


Asunto(s)
Atención Ambulatoria , Dronabinol , Dolor , Cuidados Paliativos , Anciano , Atención Ambulatoria/economía , Atención Ambulatoria/normas , Estudios de Cohortes , Dronabinol/uso terapéutico , Humanos , Dolor/tratamiento farmacológico , Cuidados Paliativos/economía , Cuidados Paliativos/normas , Estudios Retrospectivos
3.
Expert Rev Pharmacoecon Outcomes Res ; 19(5): 509-515, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31370715

RESUMEN

Introduction: Sick persons need doctors who understand their pathology, know how to treat their problem, and accompany them through their illness. This study aimed to synthesize the state of knowledge regarding the concept of value-based medicine (VBM) through an integrative literature review, and establish how VBM can be applied in palliative care. Areas covered: An integrative review was conducted with the keywords 'value-based medicine,' 'patient-centered care,' and 'medicina baseada em valor' (Portuguese for VBM) in PubMed and Virtual Health Library, identifying 17,189 articles in total. Of these, 10 articles met the eligibility criteria. VBM combines the highest level of technical-scientific data with patients' values. It is defined as the combination of evidence-based medicine, patient-centered care, and cost-effectiveness. Patients' values are a set of preferences, concerns, and expectations that contribute toward accommodating their needs in the treatment clinic. Expert opinion: Like VBM, palliative care focuses on patients' values and quality of life, respecting natural limits. The early development of a care plan with active participation of the patient in the face of life-threatening diseases should be encouraged and can bring peace and comfort in a person's final moments.


Asunto(s)
Medicina Basada en la Evidencia/métodos , Cuidados Paliativos/métodos , Calidad de Vida , Análisis Costo-Beneficio , Toma de Decisiones , Medicina Basada en la Evidencia/economía , Humanos , Cuidados Paliativos/economía , Atención Dirigida al Paciente/economía , Atención Dirigida al Paciente/métodos
4.
BMC Palliat Care ; 18(1): 48, 2019 Jun 05.
Artículo en Inglés | MEDLINE | ID: mdl-31167656

RESUMEN

BACKGROUND: Sustainable funding is key for ensuring the quality and coverage of palliative care services. This study examined the sources of funding for stand-alone palliative care services in Uganda as well as their services financial sustainability plans. METHODS: Researchers conducted a cross sectional survey of all stand-alone palliative care organizations that have operated for five or more years. Researchers administered a questionnaire survey and interviews on the audited financial statements, services provided and sustainability plans. RESULTS: Nine of the stand-alone palliative care organizations surveyed had operated for five to 25 years. 93% of the funding for palliative care services comes from donations; while 7% is from income generating activities. 94% of the donations are from external sources. The Government of Uganda's major contribution is in the form of medicines, training and payment of taxes. All the organizations had good financial records. Six of the fifteen Hospices/palliative care providers had sustainability plans included in their operational manuals. The older organizations (those that had been operational for more than 10 years) had better resource mobilization capacity and strategies. CONCLUSION: The majority of stand-alone palliative care organizations in Uganda are largely donor funded. They have considerable financial sustainability and fund-raising capacity. Government support is in the form of medicines and training. Based on this study findings, the capacity of the stand-alone palliative care services to raise funds should be increased. The Government of Uganda should include palliative care in the national health system and increase funding for these services.


Asunto(s)
Financiación de la Atención de la Salud , Cuidados Paliativos/economía , Evaluación de Programas y Proyectos de Salud/tendencias , Estudios Transversales , Humanos , Cuidados Paliativos/organización & administración , Cuidados Paliativos/estadística & datos numéricos , Estudios Retrospectivos , Uganda
5.
Bull Cancer ; 106(9): 796-804, 2019 Sep.
Artículo en Francés | MEDLINE | ID: mdl-31174856

RESUMEN

Early palliative care is now recommended in international guidelines. A meta-analyze combining seven randomized studies has been published in 2007. It confirms that early palliative care improves patient's quality of life and reduces symptom burden. There is also a trend for the reduction of depressive disorder and the increase of overall survival. Other studies show that early palliative care improves quality of life of patient's relatives and reduces end of life care aggressiveness. Most of the time, early palliative care is introduced as soon as the diagnosis of advanced cancer is made, and the precise referral criteria need to be addressed. Other studies have assessed the palliative care consultation; patient-centered care, focusing on symptom management, filling information and education needs about illness and prognosis, helping psychologic adaptation and coping.


Asunto(s)
Neoplasias/terapia , Cuidados Paliativos/métodos , Calidad de Vida , Cuidado Terminal/métodos , Supervivientes de Cáncer/estadística & datos numéricos , Depresión/terapia , Humanos , Oncología Médica , Metaanálisis como Asunto , Neoplasias/mortalidad , Neoplasias/psicología , Cuidados Paliativos/economía , Educación del Paciente como Asunto , Ensayos Clínicos Controlados Aleatorios como Asunto
6.
World J Gastroenterol ; 25(19): 2373-2382, 2019 May 21.
Artículo en Inglés | MEDLINE | ID: mdl-31148908

RESUMEN

BACKGROUND: Endoscopic biliary stenting is a well-established palliative treatment for patients with unresectable distal malignant biliary obstruction (MBO). However, the main problem with stent placement is the relatively short duration of stent patency. Although self-expanding metal stents (SEMSs) have a longer patency period than plastic stents (PSs), the higher costs limit the wide use of SEMSs. A PS with an antireflux valve is an attractive idea to prolong stent patency, but no ideal design for an antireflux PS (ARPS) has been proposed. We developed a new ARPS with a "duckbilled" valve attached to the duodenal end of the stent. AIM: To compare the patency of ARPSs with that of traditional PSs (TPSs) in patients with unresectable distal MBO. METHODS: We conducted a single-center, prospective, randomized, controlled, double-blind study. This study was conducted at the West China Hospital of Sichuan University. Consecutive patients with extrahepatic MBO were enrolled prospectively. Eligible patients were randomly assigned to receive either an ARPS or a TPS. Patients were followed by clinic visits or telephone interviews every 1-2 mo until stent exchange, death, or the final study follow-up in October 2018. The primary outcome was the duration of stent patency. Secondary outcomes included the rate of technical success, the rate of clinical success, adverse events, and patient survival. RESULTS: Between February 2016 and December 2017, 38 patients were randomly assigned to two groups, with 19 patients in each group, to receive ARPSs or TPSs. Stent insertion was technically successful in all patients. There were no significant differences between the two groups in the rates of clinical success or the rates of early or late adverse events (P = 0.660, 1.000, and 1.000, respectively). The median duration of stent patency in the ARPS group was 285 d [interquartile range (IQR), 170], which was significantly longer than that in the TPS group (median, 130 d; IQR, 90, P = 0.005). No significant difference in patient survival was noted between the two groups (P = 0.900). CONCLUSION: The new ARPS is safe and effective for the palliation of unresectable distal MBO, and has a significantly longer stent patency than a TPS.


Asunto(s)
Reflujo Biliar/prevención & control , Colestasis Extrahepática/terapia , Neoplasias/complicaciones , Diseño de Prótesis , Stents/efectos adversos , Anciano , Anciano de 80 o más Años , Reflujo Biliar/etiología , Colangiopancreatografia Retrógrada Endoscópica/instrumentación , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colestasis Extrahepática/etiología , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/terapia , Cuidados Paliativos/economía , Cuidados Paliativos/métodos , Plásticos/economía , Estudios Prospectivos , Falla de Prótesis , Stents/economía , Resultado del Tratamiento
7.
Anticancer Res ; 39(6): 3137-3140, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31177159

RESUMEN

BACKGROUND/AIM: Because aggressive oncological management just prior to death constitutes a substantial proportion of end-of-life (EOL) costs, we investigated patterns of EOL oncologic care for stage IV non-small cell lung cancer (NSCLC) in USA to better determine at which point in the patient's management new treatments were being initiated. MATERIALS AND METHODS: The National Cancer Database was queried for stage IV NSCLC patients who received any cancer-directed therapy with known timing thereof. RESULTS: A total of 281,990 stage IV NSCLC patients were analyzed. Of all patients, 10.8% commenced any first-course cancer therapy within four weeks of death, and 24.5% within eight weeks of death. CONCLUSION: 10-15% of stage IV NSCLC patients start cancer therapy within four weeks of death, and 25-30% within eight weeks. This represents a population for whom cancer therapy may not be required, which has implications on reducing EOL healthcare costs.


Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/terapia , Neoplasias Pulmonares/terapia , Oncología Médica/tendencias , Oncólogos/tendencias , Cuidados Paliativos/tendencias , Pautas de la Práctica en Medicina/tendencias , Cuidado Terminal/tendencias , Anciano , Anciano de 80 o más Años , Carcinoma de Pulmón de Células no Pequeñas/economía , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Pulmón de Células no Pequeñas/patología , Bases de Datos Factuales , Femenino , Costos de la Atención en Salud/tendencias , Humanos , Neoplasias Pulmonares/economía , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Masculino , Oncología Médica/economía , Persona de Mediana Edad , Estadificación de Neoplasias , Oncólogos/economía , Cuidados Paliativos/economía , Pautas de la Práctica en Medicina/economía , Cuidado Terminal/economía , Factores de Tiempo , Resultado del Tratamiento , Estados Unidos
8.
BMC Cancer ; 19(1): 420, 2019 May 06.
Artículo en Inglés | MEDLINE | ID: mdl-31060544

RESUMEN

BACKGROUND: At present, palliative systemic chemotherapy is the standard treatment in the Netherlands for gastric cancer patients with peritoneal dissemination. In contrast to lymphatic and haematogenous dissemination, peritoneal dissemination may be regarded as locoregional spread of disease. Administering cytotoxic drugs directly into the peritoneal cavity has an advantage over systemic chemotherapy since high concentrations can be delivered directly into the peritoneal cavity with limited systemic toxicity. The combination of a radical gastrectomy with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has shown promising results in patients with gastric cancer in Asia. However, the results obtained in Asian patients cannot be extrapolated to Western patients. The aim of this study is to compare the overall survival between patients with gastric cancer with limited peritoneal dissemination and/or tumour positive peritoneal cytology treated with palliative systemic chemotherapy, and those treated with gastrectomy, CRS and HIPEC after neoadjuvant systemic chemotherapy. METHODS: In this multicentre randomised controlled two-armed phase III trial, 106 patients will be randomised (1:1) between palliative systemic chemotherapy only (standard treatment) and gastrectomy, CRS and HIPEC (experimental treatment) after 3-4 cycles of systemic chemotherapy.Patients with gastric cancer are eligible for inclusion if (1) the primary cT3-cT4 gastric tumour including regional lymph nodes is considered to be resectable, (2) limited peritoneal dissemination (Peritoneal Cancer Index < 7) and/or tumour positive peritoneal cytology are confirmed by laparoscopy or laparotomy, and (3) systemic chemotherapy was given (prior to inclusion) without disease progression. DISCUSSION: The PERISCOPE II study will determine whether gastric cancer patients with limited peritoneal dissemination and/or tumour positive peritoneal cytology treated with systemic chemotherapy, gastrectomy, CRS and HIPEC have a survival benefit over patients treated with palliative systemic chemotherapy only. TRIAL REGISTRATION: clinicaltrials.gov NCT03348150 ; registration date November 2017; first enrolment November 2017; expected end date December 2022; trial status: Ongoing.


Asunto(s)
Procedimientos Quirúrgicos de Citorreducción/métodos , Hipertermia Inducida/métodos , Cuidados Paliativos/métodos , Neoplasias Peritoneales/terapia , Neoplasias Gástricas/terapia , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Quimioterapia Adyuvante/economía , Quimioterapia Adyuvante/métodos , Ensayos Clínicos Fase III como Asunto , Análisis Costo-Beneficio , Procedimientos Quirúrgicos de Citorreducción/economía , Supervivencia sin Enfermedad , Femenino , Gastrectomía/economía , Gastrectomía/métodos , Humanos , Hipertermia Inducida/economía , Estimación de Kaplan-Meier , Masculino , Estudios Multicéntricos como Asunto , Países Bajos/epidemiología , Cuidados Paliativos/economía , Neoplasias Peritoneales/economía , Neoplasias Peritoneales/secundario , Peritoneo/patología , Ensayos Clínicos Controlados Aleatorios como Asunto , Neoplasias Gástricas/economía , Neoplasias Gástricas/patología
9.
Int J Health Geogr ; 18(1): 8, 2019 05 06.
Artículo en Inglés | MEDLINE | ID: mdl-31060555

RESUMEN

BACKGROUND: Little is known about the role of geographic access to inpatient palliative and end of life care (PEoLC) facilities in place of death and how geographic access varies by settlement (urban and rural). This study aims to fill this evidence gap. METHODS: Individual-level death data in 2014 (N = 430,467, aged 25 +) were extracted from the Office for National Statistics (ONS) death registry and linked to the ONS postcode directory file to derive settlement of the deceased. Drive times from patients' place of residence to nearest inpatient PEoLC facilities were used as a proxy estimate of geographic access. A modified Poisson regression was used to examine the association between geographic access to PEoLC facilities and place of death, adjusting for patients' socio-demographic and clinical characteristics. Two models were developed to evaluate the association between geographic access to inpatient PEoLC facilities and place of death. Model 1 compared access to hospice, for hospice deaths versus home deaths, and Model 2 compared access to hospitals, for hospital deaths versus home deaths. The magnitude of association was measured using adjusted prevalence ratios (APRs). RESULTS: We found an inverse association between drive time to hospice and hospice deaths (Model 1), with a dose-response relationship. Patients who lived more than 10 min away from inpatient PEoLC facilities in rural areas (Model 1: APR range 0.49-0.80; Model 2: APR range 0.79-0.98) and urban areas (Model 1: APR range 0.50-0.83; Model 2: APR range 0.98-0.99) were less likely to die there, compared to those who lived closer (i.e. ≤ 10 min drive time). The effects were larger in rural areas compared to urban areas. CONCLUSION: Geographic access to inpatient PEoLC facilities is associated with where people die, with a stronger association seen for patients who lived in rural areas. The findings highlight the need for the formulation of end of life care policies/strategies that consider differences in settlements types. Findings should feed into local end of life policies and strategies of both developed and developing countries to improve equity in health care delivery for those approaching the end of life.


Asunto(s)
Accesibilidad a los Servicios de Salud/economía , Cuidados Paliativos/economía , Vigilancia de la Población , Población Rural , Cuidado Terminal/economía , Población Urbana , Adulto , Anciano , Anciano de 80 o más Años , Inglaterra/epidemiología , Femenino , Accesibilidad a los Servicios de Salud/tendencias , Humanos , Pacientes Internos , Masculino , Persona de Mediana Edad , Cuidados Paliativos/tendencias , Características de la Residencia , Población Rural/tendencias , Cuidado Terminal/tendencias , Población Urbana/tendencias
10.
Support Care Cancer ; 27(12): 4733-4744, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30972644

RESUMEN

Disparities in access to palliative care services for populations with social disparities have been reported in Western countries. Studies indicate that these populations tend to report higher symptom distress than other population groups. We need to further investigate how social disparities influence symptom burden to improve symptom relief in these populations. PURPOSE: To examine the perspectives of specialist palliative care providers concerning the relationship between social disparities and symptom burden in populations with advanced cancer. METHODS: Two sequential qualitative studies that followed a combination of interpretive and critical methodologies. The interpretive approach was outlined by van Manen's hermeneutic phenomenology while the critical component was informed by the works of Paulo Freire. Participants involved two specialist palliative care teams from a large acute care hospital and a large cancer center in Western Canada. Participants included 11 palliative care providers including registered nurses, nurse practitioners, physicians, and pharmacists. RESULTS: Participants perceived that social conditions that might aggravate symptom burden included low income, low education, lack of social support, language barriers, and rurality. The relationship between income and symptom burden reflected diverse views. Participants identified populations prone to complex symptom burden including homeless individuals, Indigenous people, people with a history of addictions, and people with mental health or psychosocial issues. CONCLUSION: Participants perceived that social disparities may increase symptom complexity in populations with advanced cancer. Participants did not identify ethnicity and gender as influencing symptom burden. Further research is needed to examine the interactions of social disparities, patient individuality, and symptom burden.


Asunto(s)
Accesibilidad a los Servicios de Salud , Disparidades en Atención de Salud , Neoplasias/economía , Neoplasias/terapia , Cuidados Paliativos/economía , Canadá , Femenino , Personal de Salud , Humanos , Masculino , Neoplasias/patología , Cuidados Paliativos/métodos , Investigación Cualitativa , Clase Social , Apoyo Social
11.
J Manag Care Spec Pharm ; 25(3-b Suppl): S1-S11, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30827188

RESUMEN

BACKGROUND: There are a lack of guideline recommendations for patients with metastatic castration-resistant prostate cancer (mCRPC) undergoing treatment progression and sequencing. Understanding treatment patterns and associated utilization and costs may help inform stakeholders and guide decision making. OBJECTIVE: To describe treatment patterns and health care costs in prostate cancer (PC) patients with bone metastases treated with agents approved by the FDA for mCRPC. METHODS: 2 large integrated claims databases (MarketScan and PharMetrics) were used to identify males aged ≥ 18 years who were diagnosed and treated for PC (ICD-9-CM code 185.xx or 233.4) with bone metastases (ICD-9-CM code 198.5) from June 2013 to September 2014. Patients were required to be continuously enrolled for ≥ 6 months before and after initiation of treatment with abiraterone, cabazitaxel, docetaxel, enzalutamide, mitoxantrone, radium-223, sipuleucel-T, or other chemotherapy. Study endpoints included lines of therapy, health care resource utilization per patient per month (PPPM), PPPM costs, and mortality rate. Descriptive analysis was completed for the study sample, and survival function was calculated via Kaplan-Meier estimates. RESULTS: There were 953 patients meeting all inclusion criteria in the MarketScan database and 565 patients in the PharMetrics database. The median follow-up time was 18 months (interquartile range [IQR] = 14-23) for MarketScan and 14 months (IQR = 11-18) for PharMetrics. Mean age (SD) was 71 (± 10.7) and 66 (± 9.3) years, respectively. Before mCRPC treatment initiation, patients received palliative radiation therapy and bone antiresorptive therapy. For MarketScan and PharMetrics, respectively, 14.0% and 18.2% of patients received radiation therapy, 36.1% and 40.0% received denosumab; 16.5% and 16.8% received zoledronic acid; and 0.2% and 0.8% received pamidronate. Across both databases, abiraterone was the most commonly received bone metastasis treatment agent across all lines of therapy, except fourth line. Radium-223, cabazitaxel, and mitoxantrone were the least utilized therapies. The median cost PPPM during the post-index period was $10,916 (IQR=$5,334-$13,457) in MarketScan and $10,292 (IQR = $7,245-$14,699) in PharMetrics. The cost PPPM during the 6-month pre-index period was $2,643 (IQR = $850-$4,357) in MarketScan and $2,742 (IQR = $1,484-$4,730) in PharMetrics. CONCLUSIONS: Patients were treated mainly with abiraterone across most lines of care, with radium-223, cabazitaxel, and mitoxantrone as the least utilized therapies. Median costs PPPM increased by approximately $8,900 after initiation of FDA-approved agents for mCRPC, with the largest increase in cost stemming from oral medications. DISCLOSURES: Funding for this study was provided by Bayer HealthCare Pharmaceuticals. All authors were employees at Bayer HealthCare Pharmaceuticals at the time this study was conducted. This study was presented as a poster at the 2017 American Society of Clinical Oncology (ASCO) Genitourinary Cancers Symposium; February 16-18, 2017; Orlando, FL.


Asunto(s)
Antineoplásicos/administración & dosificación , Neoplasias Óseas/terapia , Costos de la Atención en Salud , Neoplasias de la Próstata Resistentes a la Castración/terapia , Adulto , Anciano , Anciano de 80 o más Años , Antineoplásicos/economía , Conservadores de la Densidad Ósea/economía , Conservadores de la Densidad Ósea/uso terapéutico , Neoplasias Óseas/economía , Neoplasias Óseas/secundario , Estudios de Cohortes , Terapia Combinada , Bases de Datos Factuales , Costos de los Medicamentos , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Cuidados Paliativos/economía , Cuidados Paliativos/métodos , Neoplasias de la Próstata Resistentes a la Castración/economía , Neoplasias de la Próstata Resistentes a la Castración/patología , Estudios Retrospectivos
12.
Ann Palliat Med ; 8(3): 274-284, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30823841

RESUMEN

Radiotherapy is an essential component of cancer therapy. Lack of access to radiotherapy in less-developed countries prevents its use for both cure and symptom relief, resulting in a significant disparity in patient suffering. Several recent initiatives have highlighted the need for expanded access to both palliative medicine and radiotherapy globally. Yet, these efforts have remained largely independent, without attention to overlap and integration. This review provides an update on the progress toward global palliative radiotherapy access and proposes a strategic framework to address further scale-up. Synergies between radiotherapy, palliative medicine, and other global health initiatives will be essential in bringing palliative radiotherapy to patients around the globe.


Asunto(s)
Países en Desarrollo , Accesibilidad a los Servicios de Salud/economía , Agencias Internacionales/organización & administración , Cuidados Paliativos/métodos , Oncología por Radiación/organización & administración , Equipos y Suministros , Salud Global , Asignación de Recursos para la Atención de Salud/economía , Fuerza Laboral en Salud/organización & administración , Humanos , Agencias Internacionales/economía , Cuidados Paliativos/economía , Oncología por Radiación/economía , Integración de Sistemas
13.
Int J Technol Assess Health Care ; 35(2): 141-149, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30871648

RESUMEN

OBJECTIVES: Uncontrolled pain in advanced cancer is a common problem and has significant impact on individuals' quality of life and use of healthcare resources. Interventions to help manage pain at the end of life are available, but there is limited economic evidence to support their wider implementation. We conducted a case study economic evaluation of two pain self-management interventions (PainCheck and Tackling Cancer Pain Toolkit [TCPT]) compared with usual care. METHODS: We generated a decision-analytic model to facilitate the evaluation. This modelled the survival of individuals at the end of life as they moved through pain severity categories. Intervention effectiveness was based on published meta-analyses results. The evaluation was conducted from the perspective of the U.K. health service provider and reported cost per quality-adjusted life-year (QALY). RESULTS: PainCheck and TCPT were cheaper (respective incremental costs -GBP148 [-EUR168.53] and -GBP474 [-EUR539.74]) and more effective (respective incremental QALYs of 0.010 and 0.013) than usual care. There was a 65 percent and 99.5 percent chance of cost-effectiveness for PainCheck and TCPT, respectively. Results were relatively robust to sensitivity analyses. The most important driver of cost-effectiveness was level of pain reduction (intervention effectiveness). Although cost savings were modest per patient, these were considerable when accounting for the number of potential intervention beneficiaries. CONCLUSIONS: Educational and monitoring/feedback interventions have the potential to be cost-effective. Economic evaluations based on estimates of effectiveness from published meta-analyses and using a decision modeling approach can support commissioning decisions and implementation of pain management strategies.


Asunto(s)
Dolor en Cáncer/terapia , Protocolos Clínicos/normas , Manejo del Dolor/economía , Manejo del Dolor/métodos , Cuidados Paliativos/organización & administración , Análisis Costo-Beneficio , Técnicas de Apoyo para la Decisión , Humanos , Modelos Económicos , Monitoreo Ambulatorio/economía , Monitoreo Ambulatorio/métodos , Cuidados Paliativos/economía , Educación del Paciente como Asunto/organización & administración , Años de Vida Ajustados por Calidad de Vida , Índice de Severidad de la Enfermedad , Cuidado Terminal , Reino Unido
14.
Nurs Forum ; 54(2): 280-290, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30737798

RESUMEN

The inclusion of caregivers in a holistic care approach represents a basic principle in palliative care. However, many palliative care professionals have a lack of understanding of difficulties or unmet needs among caregivers. To enhance the quality of life of caregivers and the quality of care for patients, healthcare professionals should be better informed about the constructs of caregiver burden. The aim of this study is to synthesize the concept of caregiver burden in palliative care, providing implications for the caregivers and their support systems. This concept analysis study adopts the integrative review approach and the basic text analysis method (ie, word frequency). The PubMed, CINAHL, Embase, and PsycINFO databases are explored for eligible studies. From this literature search, 66 articles from 1998 to 2018 are located. After data collection is completed, the two authors independently evaluate the quality of studies published before 1 September 2018. The caregiver burden is then redefined with its attributes, antecedents, consequences, empirical referents, and facilitators. It is recommended that the multidimensional concept of caregiver burden in palliative care be measured by considering caregiver characteristics and the caregiving context.


Asunto(s)
Cuidadores/psicología , Cuidados Paliativos/métodos , Calidad de Vida , Adaptación Psicológica , Anciano , Anciano de 80 o más Años , Cuidadores/economía , Formación de Concepto , Minería de Datos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidados Paliativos/economía , Cuidados Paliativos/psicología
15.
Aten. prim. (Barc., Ed. impr.) ; 51(2): 80-90, feb. 2019. tab, graf
Artículo en Español | IBECS | ID: ibc-181072

RESUMEN

Objetivo: Evaluar el proceso y el impacto económico de un programa integrado de cuidados paliativos. Diseño: Estudio transversal comparativo. Emplazamiento: Organizaciones Sanitarias Integradas Alto Deba y Goierri Alto-Urola, País Vasco. Participantes: Pacientes fallecidos (oncológicos y no oncológicos) en 2012 (grupo control) y 2015 (grupo intervención) susceptibles de necesitar cuidados paliativos según la estimación mínima de McNamara. Intervenciones: Identificación de pacientes con el código de cuidados paliativos en atención primaria, uso de rutas asistenciales conjuntas en atención primaria y hospitalaria e impartición de cursos formativos. Mediciones principales: Cambio en el perfil de uso de recursos del paciente durante sus últimos 3 meses de vida. Se utilizó el genetic matching para evitar sesgos. Mediante análisis univariante se compararon los grupos y mediante regresiones logísticas y modelos lineales generalizados se analizaron las relaciones entre variables. Resultados: Se identificaron 1.023 pacientes en 2012 y 1.142 en 2015. En 2015 aumentó al doble la probabilidad de ser identificado como paliativo en pacientes oncológicos (19-33%) y no oncológicos (7-16%). La prescripción de opiáceos subió (25-68%) y el fallecimiento en hospital se mantuvo estable. Los contactos por paciente con atención primaria y hospitalización a domicilio aumentaron, mientras que las hospitalizaciones tradicionales disminuyeron. El coste por paciente aumentó un 26%. Conclusiones: El modelo integrado incrementó la identificación de la población diana. La relación entre variables mostró que la identificación repercutió positivamente en la prescripción de opiáceos, fallecimiento fuera del hospital y extensión a enfermedades no oncológicas. Aunque también disminuyeron los ingresos, el coste aumentó debido al uso de hospitalización a domicilio


Objective: Evaluate the process and the economic impact of an integrated palliative care program. Design: Comparative cross-sectional study. Location: Integrated Healthcare Organizations of Alto Deba and Goierri Alto-Urola, Basque Country. Participants: Patients dead due to oncologic and non-oncologic causes in 2012 (control group) and 2015 (intervention group) liable to need palliative care according to McNamara criteria. Interventions: Identification as palliative patients in primary care, use of common clinical pathways in primary and secondary care and arrange training courses for health professionals. Main measures: Change in the resource use profile of patients in their last 3 months. Propensity score by genetic matching method was used to avoid non-randomization bias. The groups were compared by univariate analysis and the relationships between variables were analysed by logistic regressions and generalized linear models. Results: One thousand and twenty-three patients were identified in 2012 and 1,142 patients in 2015. In 2015 doubled the probability of being identify as palliative patient in deaths due to oncologic (19-33%) and non-oncologic causes (7-16%). Prescriptions of opiates rise (25-68%) and deaths in hospital remained stable. Contacts per patient with primary care and home hospitalization increased, while contacts with hospital admissions decreased. Cost per patient rise 26%. Conclusions: The integrated palliative care model increased the identification of the target population. Relationships between variables showed that the identification had a positive impact on prescription of opiates, death outside the hospital and extension to non-oncologic diseases. Although the identification decreased admissions in hospital, costs per patient had a slight increase due to home hospitalizations


Asunto(s)
Humanos , Masculino , Femenino , Anciano de 80 o más Años , Cuidados Paliativos/economía , Cuidados Paliativos/organización & administración , Evaluación del Impacto en la Salud/economía , Atención Primaria de Salud , Estudios Transversales , Modelos Logísticos , Calidad de la Atención de Salud/economía , Calidad de la Atención de Salud/organización & administración
16.
Obstet Gynecol Clin North Am ; 46(1): 179-197, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30683263

RESUMEN

The integration of palliative care and hospice into standard gynecologic oncology care is associated with cost-savings, longer survival, lower symptom burden, and better quality of life for patients and caregivers. Consequently, this comprehensive approach is formally recognized and endorsed by the Society of Gynecologic Oncology, the National Comprehensive Cancer Network, and the American Society of Clinical Oncology. This article reviews the background, benefits, barriers, and most practical delivery models of palliative care. It also discusses management of common symptoms experienced by gynecologic oncology patients.


Asunto(s)
Continuidad de la Atención al Paciente/normas , Neoplasias de los Genitales Femeninos/terapia , Cuidados Paliativos/normas , Transferencia de Pacientes/normas , Enfermo Terminal , Continuidad de la Atención al Paciente/economía , Femenino , Neoplasias de los Genitales Femeninos/mortalidad , Humanos , Cuidados Paliativos/economía , Transferencia de Pacientes/economía , Guías de Práctica Clínica como Asunto , Calidad de la Atención de Salud , Calidad de Vida
17.
BMC Cancer ; 19(1): 39, 2019 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-30621633

RESUMEN

BACKGROUND: Cancer imposes substantial burdens on cancer suffers, their families and the health system, especially in the end of life (EOL) of care patients. There are few developing country studies of EOL health care costs and no specialist studies of the disparities in cancer treatment and care costs by geographical location in China. We sought to examine geographical disparities in the types of cancer treatments and care costs during the last 3 months of life for Chinese cancer patients. METHODS: Using snowball sampling and face-to-face interviews, field research was conducted with a specialist questionnaire. Data were collected on 792 cancer patients who died between July 2013 and June 2016 in China. Total EOL health care costs were modeled using generalized linear models (GLMs) with log link and gamma distribution. RESULTS: Total health care costs were highest for urban (US$12,501) and western region (US$9808) patients and lowest for rural (US$5996) and central region (US$5814) patients. Our study revealed about 40% of the health care expenses occur in the last three months of life, and was mainly driven by hospital costs that accounted for about 70% of EOL expenditures. Patients faced out-of-pocket expenses for health care, with the ability to borrow from family and friends also impacting the type of treatment and health facility. Life-extending treatments per cancer patient was about two times that of patients receiving conservative treatments.Urban patients were more likely to receive life-extending treatments, financed by higher incomes and a greater capacity to borrow from family and friends to bridge the gap between health insurance reimbursements and out-of-pocket expenditures. Cancer patients in western region and urban area were significantly more likely to access hospice care. CONCLUSIONS: We found significant urban-rural and regional disparities in EOL types of cancer treatment, utilization of medical care and the health care expenditures. The EOL cancer care costs imposed heavy economic burdens in China.We recommend better clinical guidelines, improved EOL conversations and fuller information on treatment regimes among patients, family caregivers and doctors. Policies and information should pay more attention to palliative care options and the socio-cultural context of cancer care decision-making by family.


Asunto(s)
Costos de la Atención en Salud , Gastos en Salud , Neoplasias/economía , Neoplasias/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , China/epidemiología , Femenino , Cuidados Paliativos al Final de la Vida/economía , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/patología , Neoplasias/terapia , Cuidados Paliativos/economía , Estudios Retrospectivos , Encuestas y Cuestionarios , Cuidado Terminal/economía
18.
J Med Econ ; 22(2): 163-168, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30479174

RESUMEN

BACKGROUND: In light of constrained budgets and the need to fund efficient treatment options, this study set out to assess the cost-effectiveness of sorafenib as a first-line treatment of hepatocellular carcinoma (HCC) compared to best supportive care (BSC) from the military hospital perspective in Egypt. METHODS: A decision analytic Markov model simulated disease progression with clinical parameters and utility values derived from published data. Data on direct medical costs were collected from the local healthcare system or payer. Costs and effects were discounted at 3.5% annually and reported in USD using purchasing power parity adjustments. Deterministic and probabilistic sensitivity analyses were conducted. RESULTS: Mortality occurred less frequently in the sorafenib group (sorafenib group: 99.96%, BSC group: 99.99%). The total quality-adjusted life years (QALYs) of the sorafenib cohort were estimated to be 46.24 compared with 42.27 for the BSC cohort, which resulted in an incremental gain of 3.96 QALYs. The total costs for the sorafenib and BSC cohorts were USD 4,229,940 and USD 3,092,886, respectively (incremental cost = $1,137,054), resulting in an incremental cost-effectiveness ratio (ICER) of USD 286,776 per QALY gained for the sorafenib cohort. One-way sensitivity analyses that addressed the uncertainty of the BSC estimates indicated that the progression-free survival for BSC and utility value of progression had the greatest effects on the results. CONCLUSION: This study concluded that sorafenib does offer increased survival and quality-of-life at an increased cost but at an ICER that exceeds the nationally accepted cost-effectiveness threshold. The findings support healthcare decision-making of the efficient allocation of healthcare system resources to improve the health of the Egyptian population. Whether sorafenib is cost-effective in specific sub-groups with additional risk factors needs to be addressed in future studies.


Asunto(s)
Antineoplásicos/uso terapéutico , Carcinoma Hepatocelular/tratamiento farmacológico , Neoplasias Hepáticas/tratamiento farmacológico , Sorafenib/uso terapéutico , Antineoplásicos/efectos adversos , Antineoplásicos/economía , Carcinoma Hepatocelular/mortalidad , Análisis Costo-Beneficio , Progresión de la Enfermedad , Supervivencia sin Enfermedad , Egipto , Femenino , Gastos en Salud , Humanos , Estimación de Kaplan-Meier , Neoplasias Hepáticas/mortalidad , Masculino , Cadenas de Markov , Persona de Mediana Edad , Modelos Econométricos , Cuidados Paliativos/economía , Años de Vida Ajustados por Calidad de Vida , Sorafenib/efectos adversos , Sorafenib/economía
20.
BMJ Support Palliat Care ; 9(2): 120-129, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30274970

RESUMEN

INTRODUCTION: Of the 40 million people globally in need of palliative care (PC), just 14% receive it, predominantly in high-income countries. Within fragile health systems that lack PC, incurable illness is often marked by pain and suffering, as well as burdensome costs. In high-income settings, PC decreases healthcare utilisation, thus enhancing value. Similar cost-effectiveness models are lacking in low-income and middle-income countries and with them, the impetus and funding to expand PC delivery. METHODS: We conducted a systematic search of seven databases to gather evidence of the cost-effectiveness of PC in low-income and middle-income countries. We extracted and synthesised palliative outcomes and economic data from original research studies occurring in low-income and middle-income countries. This review adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and includes a quality appraisal. RESULTS: Our search identified 10 eligible papers that included palliative and economic outcomes in low-income and middle-income countries. Four provided true cost-effectiveness analyses in comparing the costs of PC versus alternative care, with PC offering cost savings, favourable palliative outcomes and positive patient-reported and family-reported outcomes. CONCLUSIONS: Despite the small number of included studies, wide variety of study types and lack of high-quality studies, several patterns emerged: (1) low-cost PC delivery in low-income and middle-income countries is possible, (2) patient-reported outcomes are favourable and (3) PC is less costly than the alternative. This review highlights the extraordinary need for robust cost-effectiveness analysis of PC in low-income and middle-income countries in order to develop health economic models for the delivery of PC, direct resource allocation and guide healthcare policy for PC delivery in low-income and middle-income countries.


Asunto(s)
Análisis Costo-Beneficio , Prestación de Atención de Salud/economía , Enfermería de Cuidados Paliativos al Final de la Vida/economía , Cuidados Paliativos/economía , Aceptación de la Atención de Salud/estadística & datos numéricos , Pobreza/economía , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino
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