Advanced

Register studies of cancer in the Southern Health Care Region in Sweden

Attner, Bo LU (2012) In Lund University, Faculty of Medicine Doctoral Dissertation Series 2012:71.
Abstract (Swedish)
Popular Abstract in Swedish

Södra Regionvårdsnämnden har önskat att få belyst om vi har en rättvis och jämlik cancervård i Södra sjukvårdsregionen. Därför har en populationsbaserad registerstudie med många olika etapper genomförts. Basinformationen har hämtats från Tumörregistret i Södra sjukvårdsregionen. Första diagnosdatum noterades och hemort (kommun, distrikt, län) samt sjukhus definierades efter registreringarna vid detta första diagnosdatum. I inledande etapper användes data för åren 2000-2005 för patienter som diagnostiserats med de fem vanligaste cancerformerna: kolon-, rektal-, bröst- prostata- och lungcancer (ca 50 % av all cancer). I senare etapper breddades studien genom att ta med alla cancerformer och data... (More)
Popular Abstract in Swedish

Södra Regionvårdsnämnden har önskat att få belyst om vi har en rättvis och jämlik cancervård i Södra sjukvårdsregionen. Därför har en populationsbaserad registerstudie med många olika etapper genomförts. Basinformationen har hämtats från Tumörregistret i Södra sjukvårdsregionen. Första diagnosdatum noterades och hemort (kommun, distrikt, län) samt sjukhus definierades efter registreringarna vid detta första diagnosdatum. I inledande etapper användes data för åren 2000-2005 för patienter som diagnostiserats med de fem vanligaste cancerformerna: kolon-, rektal-, bröst- prostata- och lungcancer (ca 50 % av all cancer). I senare etapper breddades studien genom att ta med alla cancerformer och data avsåg då även åren 2006-2007.

Delstudierna har på olika sätt kompletterats med data från befolkningsregistret, olika patientregister, läkemedelsregistret (förmån, öppen vård), kvalitetsregister avseende prostata- respektive lungcancer, vård- och kostnadsdata i Region Skåne (sjukhusvård/offentlig primärvård/privat vård) och även försäkringskassans register över sjukdagar/-episoder (i tilläggsartiklar).

Studien har belyst insjuknande, omfattning och lokalisering av vård, överlevnad och kostnader för cancerpatienter/anhöriga i Södra sjukvårdsregionen. Analyser har gjorts avseende händelser som kan indikera bättre möjligheter till snabbare diagnos och lika behandling oavsett var man bor i regionen (har endast presenterats i en rapport). Särskilda kostnadsjämförelser har gjorts för de som har överlevt jämfört med de som avlidit. Analyser gjordes över samband mellan personers andra sjukdomar och den cancer man insjuknat i för att ta reda på om personer som var multisjuka (hade komorbiditet) hade större risk att insjukna i cancer. Vidare har kostnadsanalyser gjorts av olika behandlingar av prostata- och lungcancer. Överlevnad beräknades från diagnosdatum i dagar. Patientens hemort analyserades som bostadsort vid diagnos. Fördjupad analys över dödligheten har gjorts för patienter som insjuknat i lung cancer.

Säkerställda skillnader mellan olika befolkningsområden har påvisats för de fem stora cancerformerna avseende insjuknande, främst lungcancer och i överlevnad/dödlighet, främst avseende prostata- och lungcancer. Män hade klart lägre överlevnad än kvinnor vid kolon-, rektal- och lungcancer. I den utvidgade studien fanns på motsvarande sätt säkerställda skillnader mellan befolkningsområden i dödlighet även för bl a malignt lymfom och levercancer. Resultaten har redovisats i fyra olika rapporter.

Samband mellan 18 olika cancerformer och demens, diabetes, fetma och onormala blodfetter har analyserats. Diagnosen demens var klart lägre hos cancerpatienterna än hos kontrollgruppen. Säkerställda resultat var för sig uppnåddes för: koloncancer, prostatacancer, lungcancer, melanom och cancer i urinblåsan eller i urinvägarna. Sammantaget förekom demens i 40 procent lägre omfattning bland personerna med cancer. Ju längre in i kroppen tumörerna har suttit, desto lägre var förekomsten bland dementa. Detta tyder på att man inte tittar efter ordentligt hos patienterna med demens och för den gruppen bara diagnostiserar de tumörer som är lätta att upptäcka.

Samtidigt har de som har diabetes, fetma eller onormala blodfetter betydligt större risk att få olika former av cancer. För de senare sjukdomsgrupperna gjordes även både enkla och kombinerade analyser dvs de som hade diabetes jämfördes med kontroller samtidigt som de som hade t ex både diabetes och fetma också jämfördes med kontroller. De som insjuknar i diabetes visade sig ha en ökad risk att senare drabbas av bröstcancer samt cancer i lever, tjocktarm, bukspottkörtel och urinblåsa. Hos de som lider av fetma är det vanligare med cancer i livmodern, tjocktarm och njure samt för dem över 60 även bröstcancer.

För patienter med prostata fanns en stor skillnad mellan kostnader för överlevande och avlidna patienter. Sjukvårdskostnaderna steg med högre Gleason-score (sjukdomsgrad) året efter diagnostillfället. Högst sjukvårdkostnader konstaterades för patienter som fick strålbehandling. Lägst kostnader hade patienterna som inte fick någon behandling. Patienter med kurativ behandling hade högre kostnader än de som fick palliativ behandling. Anhöriga ökade sin sjukvårdskonsumtion både det första och det andra året efter att patienten fått sin prostata-cancerdiagnos innebärande ökade sjukvårdskostnader.

Större delen av kostnaderna för patienter med lung cancer uppstår första året efter diagnos. Det fanns även här stor skillnad i kostnader för de som överlever och de som senare avlider. Patienter som opererats hade högre kostnader jämfört med de som endast fick cellgifter eller som strål-behandlades. Totalt sjönk kostnaden ju svårare sjuk patienten var.

En problematik vid kostnadsanalyser är att kostnader för läkemedel vid utprovning/test i särskilda studier och som då bekostas av läkemedelsföretag oftast inte finns med i redovisningen. När kostnaderna för olika behandlingar jämförs med överlevnadstiden för behandlingarna fanns en del svårförklarliga resultat som kräver ytterligare studier för man ska kunna dra några slutsatser.

Eftersom det hade påvisats stora skillnader i överlevnad/dödlighet för patienter med lungcancer i den inledande studien gjordes en analys för att undersöka hur olika faktorer påverkar utfallet. Hög dödlighet förklaras främst av att patienten inte fått någon behandling, har dåligt allmäntillstånd eller har insjuknat i ett avancerat sjukdomsstadium. De mest ‖skyddande‖ faktorerna är om patienten blivit opererad eller haft kort remisstid från besök till behandling. Här visades också att befolkningen i de geografiska områden som i grundstudien hade högre dödlighet fortfarande hade detta även när hänsyn togs olika bakgrundsfaktorer.

För anhöriga visar resultatet en ökad vårdkonsumtion och ökade vårdkostnader tiden efter patientens cancerdiagnos hos framförallt anhöriga till patienter med koloncancer och lungcancer. Antalet sjukdomsdiagnoser ökade signifikant för hela anhöriggruppen med 24 % året efter den cancersjukes diagnos. Psykiatriska diagnoser ökade signifikant hos anhöriga till kolon-, lung- och prostatacancer.

Lungcancerpatienterna hade högst och patienterna med prostatacancer lägst antal sjukskrivnings-dagar. Patienter med anhöriga hade 48 % fler sjukskrivningsdagar än de som var utan anhörig. Anhöriga till lungcancersjuka hade störst antal sjukskrivningsepisoder och antal sjukdagar, och en jämförelse med normalbefolkningen visade att en signifikant ökning av sjukskrivning för denna grupp med 76 %. (Detta har redovisats i artiklar som inte ingår i avhandlingen). (Less)
Abstract
The overall aim was to study different aspect of health care use and health care costs on a population based level for persons with cancer and their partners, and from an individual level to explore the impact of comorbidities in incidence and survival. In the beginning of the study all persons in the Southern Health Care Region in Sweden diagnosed with colon, rectal, breast, prostate and lung cancer during the period 2000 to 2005 were identified via the Swedish Cancer Register. Lately, including the period 2006 to 2007, all persons diagnosed with cancer were analysed with specification of 18 types of cancer. The obtained information was linked to other population based registries. Comorbidity diagnoses for patients and all data for up to... (More)
The overall aim was to study different aspect of health care use and health care costs on a population based level for persons with cancer and their partners, and from an individual level to explore the impact of comorbidities in incidence and survival. In the beginning of the study all persons in the Southern Health Care Region in Sweden diagnosed with colon, rectal, breast, prostate and lung cancer during the period 2000 to 2005 were identified via the Swedish Cancer Register. Lately, including the period 2006 to 2007, all persons diagnosed with cancer were analysed with specification of 18 types of cancer. The obtained information was linked to other population based registries. Comorbidity diagnoses for patients and all data for up to 8 eight control persons were also extracted from health care registries in Skåne.



Results showed that the major part of health care costs for prostate and lung cancer patients occurred during the first year following the diagnosis. A clear difference was seen between costs for survivors and patients who later died. For patients with prostate cancer health care costs increased with higher Gleason score (rate of aggressiveness) in the year following the diagnosis. Higher health care costs were seen for patients treated with primary radiotherapy and costs were higher for patients with curative treatments compared to those with palliative treatments. For patients with lung cancer the costs totally were declining with higher stage. Highest health care costs were seen for patients treated with endoscopic therapy of the bronchus. Health care costs were higher for operated patients compared to those with treatments only by chemotherapy or radiotherapy.



Higher survival in patients with non-small cell lung cancer (NSCLC) was explained by surgery, short waiting time, treatments by chemotherapy or radiotherapy and patients living in a specific geographic area. Lower survival was connected to no treatment, tumour stage, performance status and alcoholic related diseases. Overall a diagnosis of dementia was significantly less common among the cancer cases. Because the effect was seen for all tumour types and especially for patients older than 70 years and since the deficit was more pronounced for patients with tumours situated within the body, the data suggest that malignancies are underdiagnosed for persons with dementia. Diabetes was significantly more common prior to diagnosis in patients with liver, pancreatic, colon and urinary tract/bladder cancer and in patients with breast cancer diagnosed with diabetes 0–4 years prior to the cancer diagnosis. A lower risk of diabetes was seen in patients with prostate carcinoma among individuals with diabetes diagnosed 5–10 years prior to the cancer diagnosis. Obesity was significantly more common in patients with endometrial, colon and kidney cancer and with breast cancer above the age of 60 years in those where obesity was diagnosed close to the diagnosis of cancer. High blood lipids were significantly more common in patients with ovarian cancer and less common in patients with breast cancer. From a public health view avoiding overweight and obesity, as well as preventing type II diabetes mellitus, are important in preventing cancer and other diseases. Measures should be taken early on and should be based on healthy eating and physical activity patterns throughout life. Health care consumption and health care costs for partners increased in the years following the cancer diagnosis of the person with cancer especially for partners to colon, prostate and lung cancer patients. The number of diagnoses increased significantly among partners in the whole sample with the largest increase in psychiatric diagnoses.



In the future, new treatments, especially new pharmacy, are to change the relationship between treatments, costs and survival. It is of importance further examine in what way results are affected by how the patient contacts the health care system, the patient´s lifestyle and socioeconomic background or the health care system itself (organisation, competence etc). Furthermore, the new knowledge concerning cancer and comorbidities may provide an insight into the mechanisms of tumour development. Postponing the onset of comorbidity may also prevent/postpone the diagnosis of cancer. Further research is needed to learn more about the situation of the partner and to identify persons at risk of psychiatric morbidity. Knowledge is also needed on how to support the partner in the most efficient way. When planning for care and allocation of resources for care the impact on the partner should also be considered. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • Professor Lambe, Mats, Institutionen för medicinsk epidemiologi och biostatistik vid Karolinska institutet
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Cancer risk, epidemiology, incidence, comorbidity, survival, partner, health care costs, population-based register study
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
volume
2012:71
pages
68 pages
publisher
Department of Cancer Epidemiology, Clinical Sciences, Lund University
defense location
Rune Grubb-salen, BMC, Sölvegatan 19, Skånes universitetssjukhus i Lund
defense date
2012-09-12 09:00
ISSN
1652-8220
ISBN
978-91-87189-34-0
language
English
LU publication?
yes
id
c303bab2-ae63-45f6-bc92-547e584a78a6 (old id 3045207)
date added to LUP
2012-08-28 11:20:20
date last changed
2016-09-19 08:44:45
@phdthesis{c303bab2-ae63-45f6-bc92-547e584a78a6,
  abstract     = {The overall aim was to study different aspect of health care use and health care costs on a population based level for persons with cancer and their partners, and from an individual level to explore the impact of comorbidities in incidence and survival. In the beginning of the study all persons in the Southern Health Care Region in Sweden diagnosed with colon, rectal, breast, prostate and lung cancer during the period 2000 to 2005 were identified via the Swedish Cancer Register. Lately, including the period 2006 to 2007, all persons diagnosed with cancer were analysed with specification of 18 types of cancer. The obtained information was linked to other population based registries. Comorbidity diagnoses for patients and all data for up to 8 eight control persons were also extracted from health care registries in Skåne. <br/><br>
<br/><br>
Results showed that the major part of health care costs for prostate and lung cancer patients occurred during the first year following the diagnosis. A clear difference was seen between costs for survivors and patients who later died. For patients with prostate cancer health care costs increased with higher Gleason score (rate of aggressiveness) in the year following the diagnosis. Higher health care costs were seen for patients treated with primary radiotherapy and costs were higher for patients with curative treatments compared to those with palliative treatments. For patients with lung cancer the costs totally were declining with higher stage. Highest health care costs were seen for patients treated with endoscopic therapy of the bronchus. Health care costs were higher for operated patients compared to those with treatments only by chemotherapy or radiotherapy.<br/><br>
<br/><br>
Higher survival in patients with non-small cell lung cancer (NSCLC) was explained by surgery, short waiting time, treatments by chemotherapy or radiotherapy and patients living in a specific geographic area. Lower survival was connected to no treatment, tumour stage, performance status and alcoholic related diseases. Overall a diagnosis of dementia was significantly less common among the cancer cases. Because the effect was seen for all tumour types and especially for patients older than 70 years and since the deficit was more pronounced for patients with tumours situated within the body, the data suggest that malignancies are underdiagnosed for persons with dementia. Diabetes was significantly more common prior to diagnosis in patients with liver, pancreatic, colon and urinary tract/bladder cancer and in patients with breast cancer diagnosed with diabetes 0–4 years prior to the cancer diagnosis. A lower risk of diabetes was seen in patients with prostate carcinoma among individuals with diabetes diagnosed 5–10 years prior to the cancer diagnosis. Obesity was significantly more common in patients with endometrial, colon and kidney cancer and with breast cancer above the age of 60 years in those where obesity was diagnosed close to the diagnosis of cancer. High blood lipids were significantly more common in patients with ovarian cancer and less common in patients with breast cancer. From a public health view avoiding overweight and obesity, as well as preventing type II diabetes mellitus, are important in preventing cancer and other diseases. Measures should be taken early on and should be based on healthy eating and physical activity patterns throughout life. Health care consumption and health care costs for partners increased in the years following the cancer diagnosis of the person with cancer especially for partners to colon, prostate and lung cancer patients. The number of diagnoses increased significantly among partners in the whole sample with the largest increase in psychiatric diagnoses. <br/><br>
<br/><br>
In the future, new treatments, especially new pharmacy, are to change the relationship between treatments, costs and survival. It is of importance further examine in what way results are affected by how the patient contacts the health care system, the patient´s lifestyle and socioeconomic background or the health care system itself (organisation, competence etc). Furthermore, the new knowledge concerning cancer and comorbidities may provide an insight into the mechanisms of tumour development. Postponing the onset of comorbidity may also prevent/postpone the diagnosis of cancer. Further research is needed to learn more about the situation of the partner and to identify persons at risk of psychiatric morbidity. Knowledge is also needed on how to support the partner in the most efficient way. When planning for care and allocation of resources for care the impact on the partner should also be considered.},
  author       = {Attner, Bo},
  isbn         = {978-91-87189-34-0},
  issn         = {1652-8220},
  keyword      = {Cancer risk,epidemiology,incidence,comorbidity,survival,partner,health care costs,population-based register study},
  language     = {eng},
  pages        = {68},
  publisher    = {Department of Cancer Epidemiology, Clinical Sciences, Lund University},
  school       = {Lund University},
  series       = {Lund University, Faculty of Medicine Doctoral Dissertation Series},
  title        = {Register studies of cancer in the Southern Health Care Region in Sweden},
  volume       = {2012:71},
  year         = {2012},
}