Abstract
BackgroundAging population and other factors have led to a rapid rise in cancer incidence in China. However, under the influence of traditional perception of diseases, deaths and economic factors, many patients who are unresponsive to radical treatment are still adherent to excessive and unnecessary treatment, which may lead to poor quality of life (QoL) and increase unnecessary medical burden.AimCompare the difference of the quality of life and cost-utility value between patients who received palliative care (PC) and patients who were adherent to conventional anticancer treatment (CAT) and provides empirical evidence of clinical and economic value for hospital-based PC.MethodsChinese Quality of Life Questionnaire (CQLQ) Scale was used to collect advanced cancer patients’ QoL on admission and discharge days. Paired and independent samples’ statistical analysis were used to compare inter- and intra- QoL between PC and CAT group. Delphi and Analytic Hierarchy Process were used to weight QoL scores and converted the QoL to quality-adjusted life years (QALYs). Propensity Score Matching (PSM) for 1:1 was used to compare average hospitalization expenses between two groups. The expense per QALYs was used for Cost-Utility analysis between the two treatments.ResultsA total of 248 hospitalized patients diagnosed with metastatic disease at stage IV were recruited from West China Fourth Hospital between January 2018 and August 2018, including 128 patients receiving PC and 120 patients receiving CAT. Although both treatments had positive effects on improving QoL for patients, the QoL in the PC group were significantly higher than that in the CAT group (55.90 ± 18.80 vs 24.00 ± 8.60, t = 7.51, p < 0.05). The QALY (days) of pre- and post- treatment increased by 55.9 and 24.0 days in PC and CAT group respectively. Compared average hospitalization expense in 613 pairs of advanced cancer inpatients after PSM 1:1, the per capita expense of PC group was higher (13,743.5 ± 11,574.1 vs 11,689.0 ± 8876.8, t = 3.44, p < 0.05), while each unit of QALYs paid by PC group was only 50% of that paid by those receiving CAT.ConclusionsPC played a positive role in improving the QoL for patients diagnosed with advanced cancer and alleviating economic burdens of both patient families and the society from the viewpoint of cost-utility. Our findings imply that PC should be recognized as a proactive care model in China that helps patients with some terminal diseases.
Highlights
Aging population and other factors have led to a rapid rise in cancer incidence in China
Palliative care (PC) played a positive role in improving the quality of life (QoL) for patients diagnosed with advanced cancer and alleviating economic burdens of both patient families and the society from the viewpoint of cost-utility
Medical institutions paid little attention to PC at the institutional level, and there was a lack of adequate knowledge of PC among patients and their families at the public level, which led to oncologists and healthcare professionals were not actively in introducing PC to patients with necessary indications, and patients and their families had a bias against to PC [13]
Summary
Aging population and other factors have led to a rapid rise in cancer incidence in China. For advanced cancer patients who are unresponsive to radical treatment, adherence to anti-cancer therapy fails to effectively prolong patients’ survival time, and aggravates their pains brought by excessive and unnecessary treatments, even brings a heavy economic burden to both families and the society under the co-payment mechanism [3,4,5,6]. This vulnerable population is worthy of attention and should be properly guided to seek adequate medical treatment and make reasonable medical decisions. The processes of PC system construction and development were slow, and the contradiction between supply and demand was obvious [14]
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