ABSTRACT
Worldwide, the number of cancer survivors is rapidly increasing. The aim of this study was to quantify long-term health service costs of cancer survivorship on a population level. The study cohort comprised residents of Queensland, Australia, diagnosed with a first primary malignancy between 1997 and 2015. Administrative databases were linked with cancer registry records to capture all health service utilization. Health service costs between 2013-2016 were analyzed using a bottom-up costing approach. The cumulative mean annual healthcare expenditure (2013-2016) for the cohort of N = 230,380 individuals was AU$3.66 billion. The highest costs were incurred by patients with a history of prostate (AU$538 m), breast (AU$496 m) or colorectal (AU$476 m) cancers. Costs by time since diagnosis were typically highest in the first year after diagnosis and decreased over time. Overall mean annual healthcare costs per person (2013-2016) were AU$15,889 (SD: AU$25,065) and highest costs per individual were for myeloma (AU$45,951), brain (AU$30,264) or liver cancer (AU$29,619) patients. Our results inform policy makers in Australia of the long-term health service costs of cancer survivors, provide data for economic evaluations and reinforce the benefits of investing in cancer prevention.
Subject(s)
Cancer Survivors , Neoplasms , Australia/epidemiology , Health Care Costs , Health Services , Humans , Information Storage and Retrieval , Male , Neoplasms/epidemiology , Neoplasms/therapy , Queensland/epidemiologyABSTRACT
BACKGROUND: Sham feeding has been shown to hasten the return of GI function following colorectal surgery, before the advent of enhanced recovery after surgery protocols. Few data exist regarding the efficacy of sham feeding in the modern era, with rapid postoperative feeding. OBJECTIVE: We sought to perform a meta-analysis on the effect of sham feeding in colorectal surgery, with a separate analysis on trials that used rapid postoperative feeding. DATA SOURCES: Cochrane, MEDLINE, EMBASE, Scopus, and PubMed were searched by using the terms gum OR sham feeding OR chew AND (colorect OR resect). STUDY SELECTION: All studies were randomized controlled trials (in any language) performed on adults, comparing standard care with gum chewing following colorectal resection. From 439 citations, 10 articles were included. INTERVENTION: The intervention was sham feeding by means of gum chewing. MAIN OUTCOME MEASURES: The outcome measures were time to return of flatus, time to first bowel movement, complication rates, length of hospital stay, readmission rates, and reoperation rates. RESULTS: Ten randomized controlled trials (n = 612) were included. Sham feeding resulted in a reduction in time to flatus of 31 minutes (p = 0.003) and time to first bowel movement of 30 minutes (p = 0.05). Sham feeding also resulted in a reduction in length of stay by 0.5 days (p = 0.007), and a reduction in complication rates (relative risk = 0.687, p = 0.017), although this appeared to be associated with publication bias. Analysis of trials that used rapid postoperative feeding (n = 282) revealed no difference in postoperative GI function. LIMITATIONS: This review was limited by the heterogeneity of postoperative feeding regimes, in addition to limited reporting by trials of postoperative morbidity. CONCLUSIONS: Sham feeding following colorectal surgery is safe, results in small improvements in GI recovery, and is associated with a reduction in the length of hospital stay. It confers no advantage if patients are placed on a rapid postoperative feeding regime.
Subject(s)
Chewing Gum , Colectomy , Mastication , Postoperative Care/methods , Recovery of Function , Humans , Models, Statistical , Outcome Assessment, Health Care , Placebos , Randomized Controlled Trials as TopicABSTRACT
INTRODUCTION: Malignancies of the nasal septum are rare diseases and fewer than 400 cases were reported. The understanding of the disease is limited due to its rarity. METHODS: We present a series of patients with nasal septum malignancies, who were referred to the Princess Alexandra Hospital, Ear, Nose and Throat Department from 2007 to 2010. RESULTS: Seventeen patients were found to have nasal septum malignancies. The average age was 59.5 years old (range: 36 to 83 years old). The commonest initial symptom on presentation was nasal obstruction (nine out of 17, 53%), seconded by epistaxis (eight out of 17, 47%). The average time from the initial onset of symptoms to presentation averaged 18.8 months (range: 1 to 48 months). The commonest physical finding on presentation was nasal masses (11 out of 17, 65%), followed by nasal septum ulcers (four out of 17, 24%). The histology of the lesions was predominantly squamous cell carcinoma. The mean duration of follow-up was 24.7 months. The overall 3-year survival was 81.9% with the relapse free survival 66.7%. DISCUSSION: Nasal septum malignancies are highly treatable with good prognoses when in early stages. They required high degree of suspicion to be detected early. Treatment options include surgical resection and radiotherapy and they offered similar 3-year survival rate. Combined therapy is adopted in larger tumours; however, it is not verified with randomized trials. Vigilant follow-up is vital to detect early recurrence, which is common in advanced stage lesions.
