评估头颈癌放化疗期间及放疗后立即进行早期吞咽困难干预对患者健康益处和产生的费用的可行性。
Feasibility of assessing patient health benefits and incurred costs resulting from early dysphagia intervention during and immediately after chemoradiotherapy for head-and-neck cancer.
作者信息
Martino R, Ringash J, Durkin L, Greco E, Huang S Hui, Xu W, Longo C J
机构信息
Department of Speech-Language Pathology, University of Toronto.
Rehabilitation Sciences Institute, University of Toronto.
出版信息
Curr Oncol. 2017 Dec;24(6):e466-e476. doi: 10.3747/co.24.3543. Epub 2017 Dec 20.
BACKGROUND
Resource limitations affect the intensity of speech-language pathology (slp) dysphagia interventions for patients with head-and-neck cancer (hnc). The objective of the present study was to assess the feasibility of a prospective clinical trial that would evaluate the effects on health and patient costs of early slp dysphagia intervention for hnc patients planned for curative concurrent chemoradiotherapy (ccrt).
METHODS
Patients with hnc planned for curative ccrt were consecutively recruited and received dysphagia-specific intervention before, during, and for 3 months after treatment. Swallowing function, body mass index, health-related quality of life (qol), and out-of-pocket costs were measured before ccrt, at weeks 2 and 5 during ccrt, and at 1 and 3 months after ccrt. Actuarial percutaneous endoscopic gastrostomy (peg) removal rates and body mass index in the study patients and in a time-, age-, and disease-matched cohort were compared.
RESULTS
The study enrolled 21 patients (mean age: 54 years; 19 men). The study was feasible, having a 95% accrual rate, 10% attrition, and near completion of all outcomes. Compared with the control cohort, patients receiving dysphagia intervention trended toward a higher rate of peg removal at 3 months after ccrt [61% (32%-78%) vs. 53% (23%-71%), = 0.23]. During ccrt, monthly pharmaceutical costs ranged between $239 and $348, with work loss in the range of 18-30 days for patients and 8-12 days for caregivers.
CONCLUSIONS
We demonstrated the feasibility of comparing health and economic outcomes in patients receiving and not receiving early slp dysphagia intervention. These preliminary findings suggest that early slp dysphagia intervention for hnc patients might reduce peg dependency despite worsening health. Findings also highlight effects on financial security for these patients and their caregivers.
背景
资源限制影响了对头颈部癌（HNC）患者进行言语语言病理学（SLP）吞咽困难干预的强度。本研究的目的是评估一项前瞻性临床试验的可行性，该试验将评估早期SLP吞咽困难干预对计划进行根治性同步放化疗（CCRT）的HNC患者的健康和患者费用的影响。
方法
连续招募计划进行根治性CCRT的HNC患者，并在治疗前、治疗期间和治疗后3个月接受吞咽困难特异性干预。在CCRT前、CCRT期间的第2周和第5周以及CCRT后1个月和3个月测量吞咽功能、体重指数、健康相关生活质量（QoL）和自付费用。比较研究患者以及时间、年龄和疾病匹配队列中的精算经皮内镜下胃造口术（PEG）拔除率和体重指数。
结果
该研究纳入了21名患者（平均年龄：54岁；19名男性）。该研究是可行的，累积率为95%，损耗率为10%，并且几乎完成了所有结局。与对照组相比，接受吞咽困难干预的患者在CCRT后3个月的PEG拔除率有升高趋势[61%（32%-78%）对53%（23%-71%），P = 0.23]。在CCRT期间，每月药物费用在239美元至348美元之间，患者的工作损失为18 - 30天，护理人员的工作损失为8 - 12天。
结论
我们证明了比较接受和未接受早期SLP吞咽困难干预的患者的健康和经济结局的可行性。这些初步结果表明，尽管健康状况恶化，但对HNC患者进行早期SLP吞咽困难干预可能会降低对PEG的依赖。研究结果还突出了对这些患者及其护理人员财务安全的影响。
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