Objective The main objective of the present study was to estimate the annual treatment costs of invasive cervical cancer (ICC) per patient at an oncology center in Brazil from a societal perspective by considering direct medical, direct nonmedical, and indirect costs. Methods A cost analysis descriptive study, in which direct medical, direct nonmedical, and indirect costs were collected using a microcosting approach, was conducted between May 2014 and July 2016 from a societal perspective. The study population consisted of women diagnosed with ICC admitted to a tertiary hospital in Recife, state of Pernambuco, Brazil. The annual cost per patient was estimated in terms of the value of American Dollars (US$) in 2016. Results From a societal perspective, the annual ICC treatment cost per patient was US$ 2,219.73. Direct medical costs were responsible for 81.2% of the total value, of which radiotherapy and outpatient chemotherapy had the largest share. Under the base-case assumption, the estimated cost to the national budget of a year of ICC treatment in the Brazilian population was US$ 25,954,195.04. Conclusion We found a high economic impact of health care systems treating ICC in a poor region of Brazil. These estimates could be applicable to further evaluations of the cost-effectiveness of preventing and treating ICC.
Introduction: Ultrasound-guided fine needle aspiration cytology (US-FNAC) in breast cancer has been suggested as a cost-effective exam and of quick performance to detect axillary involvement. However, the efficacy of ultrasound-guided biopsy can vary in distinct centers because the accuracy of ultrasound examination is operator- dependent. Objective: To report the accuracy of US-FNAC to detect axillary involvement in breast cancer and to compare with other methods of axilla assessment: Axillary palpation (AP) and isolated axillary ultrasound (A-US) in our institution. Method: An accuracy study was carried out, using data of breast cancer patients assisted at a mastology service, between 2013 and 2017 in Recife, Brazil. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of the AP, the A-US and US-FNAC. A histopathological result (sentinel lymph node and/or axillary dissection) was adopted as a gold standard. This study was approved by the Research Ethics Committee of the institution. Results: 206 tumors were analyzed. The US-FNAC was performed in 142 (49.5%) cases and positive for malignancy in 74 (25.6%). AP presented the lowest sensitivity (58.3%, 95%CI 49-67.3), however, with an accuracy of 69.9%, better than the A-US, whose accuracy was 68%. The US-FNAC showed high specificity (100%) with PPV of 100%, but with low NPV (53.6%). The best NPV was AP (59.7%), followed by A-US (59.1%). The US-FNAC accuracy was 83.5%. Table - Sensitivity, specificity, accuracy and predictive values of the AP, A-US and US-FNAC with a gold standard (histopathology) in the diagnosis of axillary involvement in breast cancer in women assisted at the mastology service at IMIP, Recife, Brazil, 2013- 2017. ExamSensitivity % (95% CI)Specificity % (95% CI)Accuracy % (95% CI)PPV % (95% CI)NPV % (95% CI)AP (n=206)58.3 (49.0-67.3)86.0 (76.9-92.6)69.9 (63.1-76.1)85.4 (75.9-92.2)59.7 (50.5-68.4)A-US (n=206)62.5 (53.2-71.2)75.6 (65.1-84.2)68.0 (61.1-74.3)78.1 (68.5-85.9)59.1 (49.3-68.4)US-FNAC (n=79)79.7 (67.8-88.7)100.0 (81.9-100.0)83.5 (73.5-91.0)100.0 (94.3-100.0)53.6 (33.9-72.5) AP = axillary palpation, A-US=axillary ultrasound, US-FNAC= ultrasound-guided fine needle aspiration cytology, PPV=positive predictive value, NPV=negative predictive value. Conclusion: The good accuracy associated to the high specificity and the PPV of the US-FNAC suggests US-FNAC to be a good exam in the diagnosis of axillary involvement in breast cancer and an ally to better define therapeutic management. Keywords: Breast Neoplasms; Biopsy, Fine-Needle; Neoadjuvant Therapy; Sentinel Lymph Node; Ultrasonography, Mammary. Citation Format: Maria Carolina Gouveia, Candice Lima Santos, Isabel Cristina Pereira, Jose Natal Figueiroa, Ariani Impieri Souza. Accuracy of ultrasound-guided fine needle aspiration citology (US-FNAC) to detect axillary involvement in breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-02-15.
To determine risk factors for early death identified the Comprehensive Geriatric Assessment (CGA) in elderly patients with gynecological cancer (EPGC) Methods:
e13628 Background: Cervical cancer (CC) is the second most incident and the most deadly among women from the Northeast’S Brazil and RECIFE-Pernambuco and the third most incident in Brazil. The occurrence of CC expresses a reality of inequality and inequity and should be understood not only as an oncological indicator, but essentially as an indicator of social vulnerability and health care needs. Its distribution occurs heterogeneously. Methods: Determine the geolocation of areas of greatest risk of occurrence of SC from the social and health determinants Considering the high incidence and mortality related to cervical cancer between 2006-2015, in the city of Recife, we used the spatialization technique to identify the most vulnerable territories for our intervention in the city of Recife. Results: 3,844 Cervical Cancer notifications AND 276 OBITUATIONS registered in the period 2006-2015 and the number of deaths in the period from 2009 to 2018, as a result, there are five areas of high influence. from spatialization, the heat zone generated by the 47 deaths that occurred in the north of the city of Recife WAS DETERMANED. Regarding the cytopathological supply, the ratio in 2018 was 0.37, being below the state average, which is 0.41. With a deficit of 45,041 screening cytopathological exams in the age group 25-64 years.the III Health Region was identified, based on the analysis of information from the State Health Secretary, which shows to be one of the areas of great social vulnerability, since 63% of the 22 municipalities that make up this health region and its population is in extreme poverty, according to IBGE (2010). Conclusions: The occurrence of deaths and new cases of cervical cancer in the city of Recife occurs geographically unequally and is associated with indicators of social vulnerability. IS IT POSSIBLE to identify a priority region to intensify public actions for prevention and early diagnosis. A challenging scenario has been found and must be actively addressed.
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