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Purpose@#Due to improved therapy, early diagnosis, and growing incidence rates, the number of long-term breast cancer survivors is increasing. Survivors can still be affected by aftercare, resulting in reduced quality of life (QoL). Thus, in this study, we investigated possible predictors of decreased physical and social functioning in breast cancer survivors. @*Methods@#In a German multicenter prospective study, we enrolled 759 female patients with breast cancer before surgery (t1), and contacted them again 5 years after surgery (t4). Data on QoL were assessed at t4 using the European Organization for Research and Treatment of Cancer QoL Core Questionnaire (EORTC QLQ-C30) and its breast cancer module EORTC QLQ-BR23.Predictors of decreased physical and social functioning were analyzed using logistic regression with odds ratios as effect estimates and 95% confidence intervals. Thresholds for the clinical importance of detrimental effects on QoL were defined according to Giesinger. @*Results@#Questionnaires from 759 patients were retrieved at t1. Of these, 456 participated in the study at t4. Poor QoL 5 years after diagnosis was reported by 20%–50% of the participants. Age, mastectomy, chemotherapy, education, employment, cohabitation, psychiatric comorbidities at t1, anxiety, depression, and intensity of physical activity emerged as predictors of decreased physical and social functioning 5 years after diagnosis. @*Conclusion@#Relief of symptoms and improvement in the QoL should be priorities in aftercare. Detecting patients with a decreased QoL is a rising challenge. Healthcare providers should take special care of patients aged 50–59 years, patients with psychiatric comorbidities and depression, and patients who have undergone mastectomy.
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PURPOSE: The number of total hip (THA) and knee arthroplasties (TKA) grows constantly which causes enormously rising costs for healthcare systems. The aim of this systematic literature review was to evaluate whether a cost reduction can be achieved by THA or TKA fast-track protocols, which is a multidisciplinary approach aiming at faster recovery. METHODS: A systematic literature research was undertaken for the timeframe from 2007/01/01 to 2019/03/04 in PubMed. Abstracts and title of the identified records were checked for eligible criteria and afterward the full text was assessed. RESULTS: Seven studies were included in the review. All studies showed a reduction in the total cost for fast-track THA and TKA. Most studies based their cost calculations on the amount of days the patients spend in the hospital. CONCLUSION: Using a fast-track protocol can significantly reduce the overall costs of the treatment.
Asunto(s)
Artroplastia de Reemplazo de Cadera/economía , Artroplastia de Reemplazo de Cadera/métodos , Artroplastia de Reemplazo de Rodilla/economía , Artroplastia de Reemplazo de Rodilla/métodos , Costos de la Atención en Salud , Tiempo de Internación/economía , Anciano , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Ahorro de Costo , Análisis Costo-Beneficio , Femenino , Alemania , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Cadera/diagnóstico por imagen , Osteoartritis de la Cadera/cirugía , Osteoartritis de la Rodilla/diagnóstico por imagen , Osteoartritis de la Rodilla/cirugía , Complicaciones Posoperatorias/economía , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/cirugíaRESUMEN
OBJECTIVE: The objective of this study is to examine the course of fatigue in female cancer patients during the first months after treatment. METHODS: We examined a sample of 110 patients suffering from gynecological or breast cancer. Fatigue was assessed with two questionnaires, the Multidimensional Fatigue Inventory (MFI) and the fatigue scale of the quality of life questionnaire European Organisation for Research and Treatment of Cancer (EORTC QLQ-C30). Participants were tested during their stay in the hospital (t1), two weeks after discharge (t2), and three months after discharge (t3). RESULTS: Fatigue in the patients' sample was markedly higher than the general population reference values. At t1, the effect sizes are d=0.81 (MFI) and d=1.21 (EORTC QLQ-C30 fatigue scale). Age and tumor stage had no significant influence on fatigue, but patients with a long time since diagnosis had higher fatigue levels than patients with a shorter time since diagnosis. From t1 to t3, fatigue mean scores decreased. The correlations between the t1 and the t3 fatigue scores were weak, with correlation coefficients of only about 0.30. CONCLUSION: Though the mean scores of fatigue, averaged across all patients, decreased over the first three months, the individual courses could not be predicted from the t1 score.