Total burden of esophageal cancer disability adjusted life years in Golestan Province during 1387

Maintenance of health and its fair and just promotion in any society is the responsibility and duty of its respective government. Appropriate financial allocations and prudent decisions in the health sector requires the definition of an index that would reveal the loss resulting from early deaths of any cause and originate from disabilities due to nonfatal outcomes. The disability adjusted life years [DALY] index has such a characteristic. Esophageal cancer is the third prevalent cancer of the gastrointestinal tract. In Golestan Province, among the variety of cancers, it is the third leading cause of death and its incidence rate in the province is the highest in the country. In this study we try to compute the burden of this cancer. In this manner, while estimating the importance of this disease in Golestan Province, we aim to pave the way for scientific and effective assessments of this disease and determine an action plan for its containment. In this cross-sectional study, we used Dismod II software that has been designed for cancer modeling in populations. With this software, we computed the burden of cancer for the year 1387 in Golestan Province. The data needed as input for Dismod II included the population of the province, mortality and incidence rates that originated from esophageal cancer, all which were obtained from the 1385 census, Mortality Registry System, Cancer Registry' System and expert panel views. Total burden of esophageal cancer according to DALY in Golestan Province during 1387 was 2992/48 years in the total population. Amongst males, it was 1533/65 years and 1408/46 years in females due to years of lost life [YLL]. As a result of years lived with disability [YLD], it was 25/54 years in males and 24/84 years in females. The burden of esophageal cancer per 1000 population of Golestan Province equaled 1 /76 years for females and 1/88 years for males. The peak age of esophageal cancer burden was in the age groups of 60 to 80 years and above 80 years. The relative high burden of esophageal cancer in Golestan Province compared to other parts of the country is justifiable due to the existence of the highest incidence rate in this province. Therefore, we believe that esophageal cancer should be one of the highest priorities of the health system of the province. However, the final and definitive judgment is contingent upon computations of the burden of other cancers and diseases at the provincial level and its respective rankings

[Inoperable esophageal cancer and outcome of palliative care in Golestan province, Iran]

Dysphagia is the most distressing problem in patients with advanced inoperable esophageal cancer. Palliative interventions like balloon dilation and stenting are used to improve quality of life and make patients enable to eat more comfortably. This study was designed to determine the outcome of palliative care in esophageal cancer patients referred to Gorgan and Gonbad gastrointestinal clinics, northeast Iran. This cross-sectional study was performed on inoperable esophageal cancer cases during 2005-2006. Demographic data were collected during the procedure and cases were followed every month for six months. Improvement proportion was calculated with 95% confidence interval, to determine the rate of improvement. Survival analysis and Kaplan-Meier methods were used to estimate the duration of palliative care effectiveness. We recruited 39 cases into the study. Male to female ratio was 1.6 to 1 and mean age was 67.5 +/- 13.7 years. Twenty two patients had grade 3 dysphagia and other 17 had grade 4 at the begining of the study. Dilation was the most preferred method [89.7%] and stenting was performed in 4 [10/3%] cases. Decreasing dysphagia score was not related to palliation method used or pathologic type of carcinoma but it was showed to be related to the age of the patients significantly. Mean survival was significantly different between 2 groups [with and without dysphagia improvement in first month of follow-up]. Results of this study showed a lower survival rate after palliative care in advanced esophageal cancer cases, although dysphagia scores showed some improvement