[Medical and non-medical direct costs of cancers in patients hospitalized in Imam Khomeini cancer institution - 2010]

With more than 12 million new cases of cancers and nearly 7.6 million deaths all around the world in 2007, cancer currently is the third leading cause of death in the world. This study was conducted to determine medical and non-medical direct costs of cancer patients' hospitalized in the cancer institute affiliated with Imam Khomeini hospital. This was a cross-sectional study. All patients over 18 years old with kind of head, neck, and stomach cancers that undertaken of oncology treatments in the cancer institute which affiliated " Imam Khomeini Hospital". Initially eligible patients invited to participate in this study. The data was collected through structured interviews with patients and or their carers. The data, then, was analyzed by SPSS software. The average medical and non-medical direct out-of-pocket costs during primary treatment were 2,609,000 and 245,000 Tomans per patient, respectively. Furthermore, the direct average of medical costs for patients who lived in Tehran and other cities were 3,313,000 and 1,870,000 Tomans; while the direct average of non-medical costs for patients who lived in Tehran and other cities were 136,000 and 360,000 Tomans, respectively. The new policies for costs coverage related to cancer patients', particularly the medical insurance organizations, financial supports from finance intuits like as banks or charity organizations, appropriate distribution of cancer's centers or providing accommodation to cancer patients who are referred from the remote sites in other cities, and also achieving the equities in health sectors could be reduced the financial costs of cancer patients and might be helped them to manage of cancers efficiently and effectively

Omission of postoperative nasogastric tube in esophagectomy: a randomized clinical trial

Nasogastric tube [NG tube] usage was first described in 1921 by Levin. Surgeons routinely use NG tube in most esophageal resections. Considering the numerous complications caused by this tube, the uncertainty about its usefulness and the scarcity of studies conducted on the subject, particularly in esophageal cancer patients, we investigated the necessity of the NG tube in these cases. This clinical trial was performed at the Cancer Institute of Imam Khomeini Hospital. Esophageal cancer patients were randomized into groups either with or without postoperative NG tube; the latter group was also prescribed metoclopramide. Postoperative obstruction was the exclusion criteria. The operation was done by a team of surgeons using the surgical techniques of McKeown or Orringer. All patients received ranitidine, heparin and antibiotics postoperatively. All patients received postoperative chest X-ray and chest physiotherapy. The NG tube was inserted or reinserted for those with abdominal distention and/or repeated vomiting. The NG tube was pulled out after return of bowel movements. The variables recorded for each patient included the first day of flatus, the first day of defecation, the first day of bowel sound [BS] upon auscultation, duration of post-operative hospitalization, nausea and vomiting, abdominal distension, pulmonary complications, wound complications, anastomotic leakage and the need for placing/replacing the NG tube. Statistical analysis was performed using SPSS, v. 11.5. After randomization, the NG tube was inserted for 22 patients, and 18 patients had no NG tube. The incidence of anastomotic leakage was significantly higher in the NG-tube group. No significant differences between the two groups were found for other complications. The mean times until first passage of flatus, defecation and BS upon auscultation and the duration of post-operative hospitalization were not significantly different. The need for placing/replacing the NG tube was the same for both groups. There was no difference in the perioperative death rates between the two groups. We conclude that the routine use of NG tubes after surgery is not recommended for all patients. NG tube should be used according to the specific needs of each patient. This protocol will protect patients from undesired complications

Nutritional assessment of GI cancer patients at admission and seven days after major intraabdominal surgery

Pre-existing malnutrition has been reported to affect a high percentage of cancer patients. Various methods are being used to assess nutritional status in hospitalized patients. The aim of this study was to apply two different nutritional assessment techniques to determine the prevalence of malnutrition in GI cancer patients and to assess their nutritional status, at admission and seven days after surgery. For this purpose, the nutritional status of fifty one patients who underwent major intraabdominal surgery was assessed. The Subjective Global Assessment [SGA], Nutritional Risk Index [NRI], anthropometric measurements, serum albumin, prealbumin, lymphocyte count and hematocrit were used to assess nutritional status of the patients. At the time of admission, based on the SGA and NRI, 70.6% and 74.5% of the patients were malnourished respectively. Both anthropometric and laboratory data, including weight, body mass index, mid arm circumference, triceps skin fold, mid arm muscle circumference, albumin, prealbumin, hematocrit and lymphocyte decreased significantly seven days after surgery [p<0.01]. The malnutrition rates increased significantly to 98% with both the SGA and NRI, seven days after surgery [p<0.01]. From the findings of this study it is concluded that there was a high prevalence of malnutrition in GI cancer patients and in almost all patients, nutritional status deteriorated seven days after surgery. Both methods proved useful for detection of the prevalence and development of malnutrition. Based on these results it is suggested that nutritional care after surgery should be improved by providing enough calories via enteral and/or parenteral route