Evaluating the supportive care costs of severe radiochemotherapy‐induced mucositis and pharyngitis

Abstract

BACKGROUND. Few studies have examined the costs of supportive care for radiochemotherapy-induced mucosits/pharyngitis among patients with head and neck cancer (HNC) or lung cancers despite the documented negative clinical impact of these complications. METHODS.The authors identified a retrospective cohort of patients with HNC or nonsmall lung cancer (NSCLC) who had received radiochemotherapy at 1 of 3 Chicago hospitals (a Veterans Administration hospital, a county hospital, or a tertiary care hospital). Charts were reviewed for the presence/absence of severe mucositis/pharyngitis and the medical resources that were used. Resource estimates were converted into cost units obtained from standard sources (hospital bills, Medicare physician fee schedule, Red Book). Estimates of resources used and direct medical costs were compared for patients who did and patients who did not develop severe mucositis/pharyngitis. RESULTS.Severe mucositis/pharyngitis occurred in 70.1% of 99 patients with HNC and in 37.5% of 40 patients with NSCLC during radiochemotherapy. The total median medical costs per patient were $39,313 for patients with mucositis/ pharyngitis and $20,798 for patients without mucositis/pharyngitis (P 5 .007).Extended inpatient hospitalization accounted for $12,600 of the increased medical costs (median 14 days [$19,600] with severe mucositis/pharyngitis vs 5 days [$7000] without; P 5 .017). For patients who had HNC with mucositis/pharyngitis, incremental inpatient hospitalization costs were $14,000, and total medical costs were $17,244. For patients who had NSCLC with mucositis/pharyngitis, these costs were $11,200 and $25,000, respectively.CONCLUSIONS. In the current study, the medical costs among the patients with HNC and NSCLC who received radiochemotherapy were greater for those who developed severe mucositis/pharyngitis than for those who did not. Cancer

Severe oral mucositis associated with cancer therapy: impact on oral functional status and quality of life

“…A recent report in which mouth and throat soreness data were collected in HNC patients revealed 80% incidence of severe OM [12]. A recent retrospective chart review found a 70% incidence of severe OM for HNC patients receiving radiochemotherapy [13]. One probable explanation of the high incidence is the effect of direct oral mucosal injury from irradiation per se.…”

Burden of Oral Mucositis: A Systematic Review and Implications for Future Research

“…Incidence of OM was investigated in patients with hematopoietic stem cell transplantation (HSCT) in 14 studies (32.6%) [3,5,14,17,19,28,31,36,37,39,44,56,62,67], in head and neck cancer (HNC) patients in 13 studies (30.2%) [18,21,29,40,50,51,55,59,60,61,63,70,73], in patients with chemotherapy in 13 studies (30.2%) [15,16,22,23,24,25,30,34,38,46,48,58,71], with mixed tumor types and treatment in 1 study (2.3%) [13] and with palliative care in 2 studies (4.7%) [32,57]. Cost related to OM in patients undergoing HSCT was the focus in 4 studies [7,14,17,54], in HNC patients in 2 studies [43,47], in patients with chemotherapy in 6 studies [9,10,11,12,42,49,68], and in patients with mixed tumor types and treatment in 2 studies [20,45]. Resource use associated with OM was reported in 3 studies concerning patients with HSCT [3,7,17], 2 studies with HNC [4,43] and 1 study with chemotherapy [42] and 1 study with mixed tumor types and treatment [45].…”

“…Resource use was reported in 7 studies [3,4,7,17,42,43,45,] 2 of which did not include cost data [3,45]. Resource use comprised length of hospital stay (LOS), emergency department visits, hospital admission due to OM, number of clinic visits, nutritional visits, total parenteral nutrition (TPN), feeding tube, gastrostomy tube, use of opioids, and use of oral or intravenous antibiotics.…”

“…There were 7 studies covering 2 topics each [3,13,14,15,16,17,18] and 7 meta-analyses [19,20,21,22,23,24,25]. 20 studies (29.4%) were from Europe [3,5,9,10,11,12,15,22,26,27,28,29,30,31,32,33,34,35,36,37,38,] 20 from the US [4,14,17,19,20,24,39,40,41,42,43,44,45,46,47,48,49,50,51,52], 3 studies (4.4%) from US plus Europe [23,53,54], 6 studies (8.8%) from Japan [16,55,56,57,58,59], 6 studies (8.8%) from China [18,25,60,61,62,63], 2 studies (3.0%) from Hong Kong [13,64,65], 3 studies (4.4%) from Canada [66,67,68], 3 studies (4.4%) from India [21,69,70] and 5 studies (7.4%) from other countries [7,71,72,73,74]. 21 studies (30.9%) used the National Cancer Institute - Common Terminology Criteria for Adverse Events (NCI-CTCAE) scale for assessment of OM.…”

“…Cost related to OM in patients undergoing HSCT was the focus in 4 studies [7,14,17,54], in HNC patients in 2 studies [43,47], in patients with chemotherapy in 6 studies [9,10,11,12,42,49,68], and in patients with mixed tumor types and treatment in 2 studies [20,45]. Resource use associated with OM was reported in 3 studies concerning patients with HSCT [3,7,17], 2 studies with HNC [4,43] and 1 study with chemotherapy [42] and 1 study with mixed tumor types and treatment [45]. The impact of OM on health-related quality of life (HRQoL) was investigated in 1 study in patients with HSCT [35], 5 studies with HNC [18,52,53,66,72], 6 studies with chemotherapy [15,16,26,27,41,74], and 4 studies with mixed tumor types and treatment [13,33,64,65,69].…”