2024
Anxiety and depression in cancer patients and survivors in the context of restrictions in contact and oncological care during the COVID-19 pandemic.
International Journal of Cancer (2024), DOI: 10.1002/ijc.35204 (Online ahead of print).
Treatment modifications and contact restrictions were common during the COVID-19 pandemic and can be stressors for mental health. There is a lack of studies assessing pandemic-related risk factors for anxiety and depression of cancer patients and survivors systematically in multifactorial models. A total of 2391 participants, mean age 65.5 years, ≤5 years post-diagnosis of either lung, prostate, breast, colorectal cancer, or leukemia/lymphoma, were recruited in 2021 via the Baden-Württemberg Cancer Registry, Germany. Sociodemographic information, pandemic-related treatment modifications, contact restrictions, and anxiety/depression (Hospital Anxiety and Depression Scale, HADS) were assessed via self-administered questionnaire. Clinical information (diagnosis, stage, and treatment information) was obtained from the cancer registry. Overall, 22% of participants reported oncological care modifications due to COVID-19, mostly in follow-up care and rehabilitation. Modifications of active cancer treatment were reported by 5.8%. Among those, 50.5% had subclinical anxiety and 55.4% subclinical depression (vs. 37.4% and 45.4%, respectively, for unchanged active treatment). Age <60 years, female sex, lung cancer, low income, and contact restrictions to peer support groups or physicians were identified as independent risk factors for anxiety. Risk factors for depression were lung cancer (both sexes), leukemia/lymphoma (females), recurrence or palliative treatment, living alone, low income, and contact restrictions to relatives, physicians, or caregivers. The study demonstrates that changes in active cancer treatment and contact restrictions are associated with impaired mental well-being. The psychological consequences of treatment changes and the importance for cancer patients to maintain regular contact with their physicians should be considered in future responses to threats to public health.
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Health economics and resource allocation at the end of life.
Zeitschrift für medizinische Ethik (2024); 70, 303–326. DOI: 10.30965/29498570-20240079.
Health economic evaluations of medical care at the end of life, which fulfill established quality standards of the discipline, have remained scarce. While the literature points to potential cost savings, evidence on cost effectiveness is mixed. It will be argued that the underlying logic of conventional cost benefit and cost effectiveness analyses, which are inspired by utilitarian thought, may result in conclusions that are inconsistent with prevailing social norms and preferences, and may be less than convincing from an ethical perspective.
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The Use of a Comprehensive Concept of Capability for Wellbeing Assessment: A Best-Fit Framework Synthesis.
Health Care Anal. (2024), DOI: 10.1007/s10728-024-00488-w (Online ahead of print).
Developing an instrument with the capability approach can be challenging, since the capability concept of Sen is ambiguous concerning the burdens that people experience whilst achieving their capabilities. A solution is to develop instruments with a comprehensive concept of capability, such as the concept of 'option-freedom'. This study aims to develop a theoretical framework for instrument development with the concept of option-freedom. A best-fit framework synthesis was conducted with seven qualitative papers by one researcher. Two researchers supported the synthesis by discussing interim results during the synthesis. A priori concepts of option-freedom were used to deductively code against. Themes and subthemes were developed inductively when data did not match a priori themes. Seven paper were identified that fulfilled the eligibility criteria. Four themes emerged from the synthesis. (1) Option Wellbeing represents a range of options that need to be satisfied for individuals to experience wellbeing. (2) Self-Realization represents that there are experiences in an individual's life that have value beyond realizing options. (3) Perceived Access to Options represents the perceived ability of individuals to realize freedoms. (4) Perceived Control represents the experience of having control. Developing an instrument with the proposed framework has two benefits. First, it acknowledges the importance of assessing impediments in realizing capabilities for wellbeing assessment. Secondly, the themes form a broad informational base by including themes related to subjective wellbeing. Future research should study the feasibility of implementing the framework for instrument development.
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Medizinischer Fortschritt im Zeichen von „Degrowth“?
Frankfurter Allgemeine Zeitung (May 06, 2024), Newspaper Article, Opinion Editorial.
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The socioeconomic impact of cancer on patients and their relatives: Organisation of European Cancer Institutes task force consensus recommendations on conceptual framework, taxonomy, and research directions.
Lancet Oncology (2024), DOI: 10.1016/S1470-2045(23)00636-8 (Online ahead of print).
(Article available on request)
Loss of income and out-of-pocket expenditures are important causes of financial hardship in many patients with cancer, even in high-income countries. The far-reaching consequences extend beyond the patients themselves to their relatives, including caregivers and dependents. European research to date has been limited and is hampered by the absence of a coherent theoretical framework and by heterogeneous methods and terminology. To address these shortages, a task force initiated by the Organisation of European Cancer Institutes (OECI) produced 25 recommendations, including a comprehensive definition of socioeconomic impact from the perspective of patients and their relatives, a conceptual framework, and a consistent taxonomy linked to the framework. The OECI task force consensus statement highlights directions for future research with a view towards policy relevance. Beyond descriptive studies into the dimension of the problem, individual severity and predictors of vulnerability should be explored. It is anticipated that the consensus recommendations will facilitate and enhance future research efforts into the socioeconomic impact of cancer and cancer care, providing a crucial reference point for the development and validation of patient-reported outcome instruments aimed at measuring its broader effects.
Would initiating colorectal cancer screening from age of 45 be cost-effective in Germany? An individual-level simulation analysis.
Front. Public Health (2024), DOI: 10.3389/fpubh.2024.1307427 (Online ahead of print).
Colorectal cancer (CRC) screening has been shown to be effective and cost-saving. However, the trend of rising incidence of early-onset CRC challenges the current national screening program solely for people ≥50 years in Germany, where extending the screening to those 45–49 years might be justified. This study aims to evaluate the cost-effectiveness of CRC screening strategies starting at 45 years in Germany.
DECAS, an individual-level simulation model accounting for both adenoma and serrated pathways of CRC development and validated with German CRC epidemiology and screening effects, was used for the cost-effectiveness analysis. Four CRC screening strategies starting at age 45, including 10-yearly colonoscopy (COL), annual/biennial fecal immunochemical test (FIT), or the combination of the two, were compared with the current screening offer starting at age 50 years in Germany. Three adherence scenarios were considered: perfect adherence, current adherence, and high screening adherence. For each strategy, a cohort of 100,000 individuals with average CRC risk was simulated from age 20 until 90 or death. Outcomes included CRC cases averted, prevented death, quality-adjusted life-years gained (QALYG), and total incremental costs considering both CRC treatment and screening costs. A 3% discount rate was applied and costs were in 2023 Euro.
Initiating 10-yearly colonoscopy-only or combined FIT + COL strategies at age 45 resulted in incremental gains of 7–28 QALYs with incremental costs of €28,360–€71,759 per 1,000 individuals, compared to the current strategy. The ICER varied from €1,029 to €9,763 per QALYG, and the additional number needed for colonoscopy ranged from 129 to 885 per 1,000 individuals. Among the alternatives, a three times colonoscopy strategy starting at 45 years of age proves to be the most effective, while the FIT-only strategy was dominated by the currently implemented strategy. The findings remained consistent across probabilistic sensitivity analyses.
The cost-effectiveness findings support initiating CRC screening at age 45 with either colonoscopy alone or combined with FIT, demonstrating substantial gains in quality-adjusted life-years with a modest increase in costs. Our findings emphasize the importance of implementing CRC screening 5 years earlier than the current practice to achieve more significant health and economic benefits.
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