Register studies of cancer in the Southern Health Care Region in Sweden

Detta är en avhandling från Department of Cancer Epidemiology, Clinical Sciences, Lund University

Sammanfattning: The overall aim was to study different aspect of health care use and health care costs on a population based level for persons with cancer and their partners, and from an individual level to explore the impact of comorbidities in incidence and survival. In the beginning of the study all persons in the Southern Health Care Region in Sweden diagnosed with colon, rectal, breast, prostate and lung cancer during the period 2000 to 2005 were identified via the Swedish Cancer Register. Lately, including the period 2006 to 2007, all persons diagnosed with cancer were analysed with specification of 18 types of cancer. The obtained information was linked to other population based registries. Comorbidity diagnoses for patients and all data for up to 8 eight control persons were also extracted from health care registries in Skåne. Results showed that the major part of health care costs for prostate and lung cancer patients occurred during the first year following the diagnosis. A clear difference was seen between costs for survivors and patients who later died. For patients with prostate cancer health care costs increased with higher Gleason score (rate of aggressiveness) in the year following the diagnosis. Higher health care costs were seen for patients treated with primary radiotherapy and costs were higher for patients with curative treatments compared to those with palliative treatments. For patients with lung cancer the costs totally were declining with higher stage. Highest health care costs were seen for patients treated with endoscopic therapy of the bronchus. Health care costs were higher for operated patients compared to those with treatments only by chemotherapy or radiotherapy. Higher survival in patients with non-small cell lung cancer (NSCLC) was explained by surgery, short waiting time, treatments by chemotherapy or radiotherapy and patients living in a specific geographic area. Lower survival was connected to no treatment, tumour stage, performance status and alcoholic related diseases. Overall a diagnosis of dementia was significantly less common among the cancer cases. Because the effect was seen for all tumour types and especially for patients older than 70 years and since the deficit was more pronounced for patients with tumours situated within the body, the data suggest that malignancies are underdiagnosed for persons with dementia. Diabetes was significantly more common prior to diagnosis in patients with liver, pancreatic, colon and urinary tract/bladder cancer and in patients with breast cancer diagnosed with diabetes 0–4 years prior to the cancer diagnosis. A lower risk of diabetes was seen in patients with prostate carcinoma among individuals with diabetes diagnosed 5–10 years prior to the cancer diagnosis. Obesity was significantly more common in patients with endometrial, colon and kidney cancer and with breast cancer above the age of 60 years in those where obesity was diagnosed close to the diagnosis of cancer. High blood lipids were significantly more common in patients with ovarian cancer and less common in patients with breast cancer. From a public health view avoiding overweight and obesity, as well as preventing type II diabetes mellitus, are important in preventing cancer and other diseases. Measures should be taken early on and should be based on healthy eating and physical activity patterns throughout life. Health care consumption and health care costs for partners increased in the years following the cancer diagnosis of the person with cancer especially for partners to colon, prostate and lung cancer patients. The number of diagnoses increased significantly among partners in the whole sample with the largest increase in psychiatric diagnoses. In the future, new treatments, especially new pharmacy, are to change the relationship between treatments, costs and survival. It is of importance further examine in what way results are affected by how the patient contacts the health care system, the patient´s lifestyle and socioeconomic background or the health care system itself (organisation, competence etc). Furthermore, the new knowledge concerning cancer and comorbidities may provide an insight into the mechanisms of tumour development. Postponing the onset of comorbidity may also prevent/postpone the diagnosis of cancer. Further research is needed to learn more about the situation of the partner and to identify persons at risk of psychiatric morbidity. Knowledge is also needed on how to support the partner in the most efficient way. When planning for care and allocation of resources for care the impact on the partner should also be considered.