SUMMARY AimTo provide estimates of actual costs to deliver health care to patients with functional bowel disorders, and to assess the cost impact of symptom severity, recency of onset, and satisfaction with treatment. MethodsWe enrolled 558 irritable bowel (IBS), 203 constipation, 243 diarrhoea and 348 abdominal pain patients from primary care and gastroenterology clinics at a health maintenance organization within weeks of a visit. Costs were extracted from administrative claims. Symptom severity, satisfaction with treatment and out-of-pocket expenses were assessed by questionnaires. ResultsAverage age was 52 years, 27% were males, and 59% participated. Eighty percent were seen in primary care clinics. Mean annual direct health care costs were $5049 for IBS, $6140 for diarrhoea, $7522 for constipation and $7646 for abdominal pain. Annual out-of-pocket expenses averaged $406 for treatment of IBS symptoms, $294 for diarrhoea, $390 for constipation and $304 for abdominal pain. Lower gastrointestinal costs comprised 9% of total costs for IBS, 9% for diarrhoea, 6.5% for constipation and 9% for abdominal pain. In-patient care accounted for 17.5% of total costs (15.2% IBS). ConclusionCosts were affected by disease severity (increased), recent exacerbation of bowel symptoms (increased), and whether the patient was consulting for the first time (decreased).
Background: Most breast cancer cases diagnosed among postmenopausal women are hormone receptor positive (HR+); standard adjuvant endocrine treatment usually includes an aromatase inhibitor (AI). Joint pain/stiffness/achiness (arthralgia) is a common AI side-effect, and AI discontinuation due to this side-effect is an estimated 20-32%. There is a need for effective alternative or adjunctive approaches to arthralgia management that enable survivors to remain on AI therapy while optimizing as pain-free a life as possible. This pilot study investigates the feasibility of a highly scalable 6-week self-directed physical activity (PA) program – Walk With Ease (WWE) – among elderly female breast cancer survivors on AIs who report joint pain. WWE goal: minimum of 30 minutes of walking 5 days a week (150 minutes/week). Methods: Recruitment: BC survivors age 65+ were recruited through the oncology clinic of a university-affiliated hospital. Eligibility: age 65+; Stage I-III breast cancer; currently on AI therapy; self-reported joint pain/stiffness; physician permission to engage in PA; English speaking. Measures: (1) walking – number of days per week and number of minutes per walk, (2) visual analog scales (VAS) for joint pain, fatigue and stiffness, and (3) arthritis self-efficacy (ASE) to manage joint pain and fatigue. Statistics: t-test evaluation of changes in mean values. Results: Sample (N = 20) – mean age 71 (65-87), 85% Caucasian, 35% < high school, mean BMI 29. 63% chemotherapy, 61% radiation therapy. 90% completed the 6-week intervention. Compared to baseline, total minutes of walking per week increased from 95 (0-450) to 172 (45-700) (p<.001) and mean joint pain decreased 10% (p = 0.63), fatigue decreased 19% (p = 0.31), and joint stiffness decreased 32% (p = 0.07). Post-intervention, 71% of participants were “fairly” or “extremely” confident they would continue walking; 100% would recommend WWE to other breast cancer survivors experiencing joint pain or stiffness; 100% thought they had learned how joint pain or stiffness could be lessened by physical activity, and how to safely engage in moderate-intensity physical activity; 90% thought WWE had motivated them to become more physically active, and how to overcome physical and mental barriers to walking; and 90% were fairly to extremely confident they would continue walking. Conclusions: A moderate-intensity self-directed walking program is feasible for older breast cancer patients on AI therapy and almost doubled the total time of walking per week over a 6 week period. Joint pain, stiffness, and fatigue decreased, and the walking program was perceived as informative and motivational. These data are promising and the WWE intervention warrants testing in a larger randomized trial of breast cancer survivors on AI therapy. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-08-10.
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