| Objective: In recent years,the overall incidence of global cancer has shown a rising trend.Chronic non-communicable diseases have become the second leading cause of death in the world,such as cancer.In 2010,the burden of diseases caused by cancer accounted for 7.6% of the total disease burden in the world.While the disease burden caused by cancer in China accounted for 16.8% of the total disease burden,which was significantly higher than the global level.The incidence rate of cancers in China ranks among the highest in the world,with an annual increase of 3%-5%,which is prominent in the digestive tumors.Colorectal cancer is the third most common cancer and the second cause of death of cancer worldwide.It is one of the heaviest burden of disease of digestive tumors in our country,and the morbidity and mortality are on the rise.Colorectal cancer has entered a period of high incidence in our country.The hospitalization expenses of colorectal cancer is on the rise,and it is predicted that the burden of colorectal cancer in China may become more and more serious.Colorectal cancer has become a major malignant disease that seriously affects the life expectancy of Chinese population,and the burden of diseases in the family and society is heavier.The burden of disease refers to the loss of health,economy,resources and the biological,and psychological and social harm caused by the diseases,as well as the consequences and effects of the disease outcome.According to the form of the burden,it can be divided into the economic burden,the deterioration of quality of life and the loss of life years.The economic burden of disease includes both direct and indirect economic burden,while direct medical expenses and direct non-medical expenses constitute the direct economic burden,with hospitalization expenses accounting for the largest proportion of medical expenses.The cure of cancers is difficult and the cost of treatment is high,which brings great economic burden to families and society.With the change of disease spectrum and modern medical model,the quality of life is gradually used to evaluate the treatment of cancer patients and the outcome of the disease.Quality of life is multidimensional,subjective experience that is generally evaluated using a quality of life measurement scale.Colorectal cancer is one of the top five causes of deaths of malignant tumors among residents in Liaoning Province.It has seriously threatened the physical and mental health and quality of life of residents.However,there is no relevant literature on the study of the burden of colorectal cancer in Liaoning Province.This study conducted a preliminary study on the burden of colorectal cancer in Liaoning Province from the aspects of hospitalization expenses and quality of life,and explored its influence factors.It provides theoretical and practical basis for rational allocation of limited health resources,increasing the benefits of health investment,and improving residents' healthy living standards.At the same time,it can also provide reference for studying the disease burden of other tumors in Liaoning province in the future.Methods: 1?This study used Gray relevancy analysis to analyze the correlation between hospitalization expenses factors and average hospitalization expenses of patients with primary colorectal cancer who were admitted to the cancer hospital in Liaoning province for the first time in each year from 2013 to 2015,and Degree of structure variation analysis to analyze the structural changing trend and the influencing factors of the structural change of hospitalization expenses,and the method of single factor analysis and path analysis to analyze the first hospitalization expenses of patients with primary colorectal cancer in each year from 2013 to 2015.2?This study used FACT-C(V4.0)and QLICP-CR(V1.0)to evaluate quality of life of patients with primary colorectal cancer who were hospitalized and received treatment from November 2016 to January 2017.Every patient was measured quality of life on admission,2-3 days later,and at discharge.The FACT-C and QLICP-CR were evaluated by reliability,validity and responsiveness.3?This study evaluated quality of life of patients who accepted measuring for the third time with QLICP-CR,and analyzed factors affecting quality of life of colorectal cancer patients from demographic factors,relevant disease factors and individual behavior factors by univariate analysis and multivariate analysis.Results: 1?The results of the analysis of the hospitalization expenses of 1765 patients with colorectal cancer showed that the other expenses,medicine expenses,operation expenses and treatment expenses were highly correlated with hospitalization expenses.Operation expenses,other expenses and test laboratory expenses were the main expenses items leading structural changes of hospitalization expense in 2013-2015.In the direction of structural change,medical expenses,operation expenses and nursing expenses were negatively changed,while test laboratory expenses and other expenses were positively changed.Nursing expenses have less impact on changes in the structure of hospitalization expenses.The result of path analysis showed that hospital stay had the greatest influence on hospitalization expenses,the longer hospital stay,the higher hospitalization expenses.Stage T,main treatment solutions and medical results both directly and indirectly influenced hospitalization expenses,while the year of admission had only direct impact,and professional,clinical diagnosis and stage M had only indirect impact.2?152 patients completed the first survey,150 patients completed the second survey,and 145 patients completed the third survey.The results of the survey showed that Cronbach's alpha were greater than 0.6 in various domains of FACT-C and QLICP-CR,the test-retest reliability were all above 0.7,and paired Student's tests showed that there were no statistically significant differences in quality of life between the first and the second measurements.The inter–item correlation coefficients among each domain in the common module were positive.The correlation coefficients of items with their own domains were all greater than the coefficients with other domains.Exploratory factor analysis revealed that the contribution rates of cumulative variance were both greater than 70%.There was significant difference in quality of life between the first and the third measurements,with SRM values mostly near the 0.5 to 0.9.Related domains of FACT-C and QLICP-CR had certain correlations,but they didn't completely coincide.3?The analysis of the quality of life of 102 patients with colorectal cancer who had undergone surgery showed that the quality of life in patients with postoperative chemoradiation was not as good as that of patients with other treatment in the psychological function.The quality of life of urban workers and urban residents with medical insurance was better than that of patients with rural cooperative medical insurance.The quality of life of patients with laparoscopic surgery in specific modules and the overall was better than that of patients with traditional laparotomy.No colostomy patients' quality of life in social function,the specific module and overall was good.Stage N was more earlier,the quality of life in the patient's psychological function was the better.Stage T was more earlier,the quality of life in the patient's common symptoms and side effects was the better.The quality of life of patients in early stage was better than that of patients in late stage.Urban workers with medical insurance and no colostomy who had higher family per capita income,the quality of life in the social function was relatively good.The quality of life of patients with regular diet,early stage and no colostomy was relatively good.Conclusion: 1?The hospitalization expense of colorectal cancer patients was slowly growth from 2013 to 2015.Other expenses and medicine expenses were highly correlated with hospitalization expenses,and were the main expenses items affecting the hospitalization expenses.Operation expenses,other expenses and test laboratory expenses were the main expenses items that caused changes in the structure of hospitalization expenses.Other expenses and test laboratory expenses had led to an increase in the structure of hospitalization expenses.Hospitalization stay,main treatment solutions and medical results were the main factors influenced the hospitalization expenses of colorectal cancer patients.Hospitalization stay had the greatest effect on hospitalization expenses,and was positively correlated to hospitalization expenses.2?FACT-C(V4.0)and QLICP-CR(V1.0)had good reliability,validity and responsiveness,which can be used to measure the quality of life of colorectal cancer patients in China.The content of FACT-C was relatively short,easy statistics and suitable for using in a cross-sectional study.The content of QLICP-CR covered widely,and the problem was more refined,more in line with Chinese cultural characteristics,and more effective and practical.Moreover,the responsiveness was good,and it was suitable for measuring the quality of life of patients with colorectal cancer and comparing the effects of different treatments on the quality of life of colorectal cancer patients,et al.QLICP-CR was more suitable for evaluating the quality of life of colorectal cancer patients in China.3?Quality of life is an important evaluation method for treatment results of colorectal cancer patients.The quality of life of patients with colorectal cancer was affected by many factors.Stage N and stage T affected the quality of life of colorectal cancer patients in psychological function and common symptoms and side effects,respectively.The form of payment,colostomy and the monthly income of the family per capita affected the quality of life of colorectal cancer patients in social function.Colostomy and the form of surgery affected the quality of life of patients with colorectal cancer in the specific module.Stage,dietary patterns and colostomy were factors influencing the quality of life of patients with colorectal cancer. |
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