Survival of Women With Breast Cancer in Kaunas Region, Lithuania

Objective. The assessment of breast cancer survival rates and comparison with those of other countries may help to deepen knowledge among decision makers in the health care system and to improve the inequalities in accessibility to early detection and effective treatment. The aim of this study was to evaluate breast cancer survival rates in Kaunas region, Lithuania, and to compare them with those in the selected European countries. Material and Methods. A retrospective study was carried out using medical records and data gathered from the Lithuanian Cancer Registry. A group of 240 patients with primary breast cancer diagnosed in 2008 in Kaunas region was analyzed. All causes of death were included in the analysis. The closing date of follow-up was September 30, 2010. Survival was determined using the life-table method and the Kaplan-Meier method. Cox proportional hazard models were used to estimate the effects of prognostic risk factors on survival. Results. The median age of the patients was 63 years (range, 28–95). The 1-year and 2-year cumulative survival for breast cancer patients in Kaunas region, Lithuania, was 94.2% and 90.1%, respectively. As expected, the survival of patients with diagnosed advanced disease (stage III and IV) was significantly worse than that of patients with stage I (P<0.001) and II (P=0.003) disease. The screening group (aged 50–69 years) showed better survival in comparison with the group older than 69 years. Age, T4 tumor, and distant metastasis were the prognostic factors significantly associated with an increased relative mortality risk of breast cancer. Conclusions. Compared to the European survival rates, the 1-year and 2-year survival of patients with breast cancer in Lithuania was found to be similar to most European countries

Evaluation of health-related quality of life in patients with breast cancer

Background. Breast cancer is the most common cancer among women, comprising about 23% of all cancer types. About 1300 new cases of breast cancer are registered in Lithuania annually. During the last decade, health-related quality of life has become an important part of breast cancer treatment. Pain, fatigue, and sleep disorders are important aspects of health-related quality of life. The aim of the study was to evaluate health-related quality of life (HRQL) among patients with breast cancer in Lithuania. The main tasks were to analyze HRQL in sociodemographic and clinical aspects, and to determine symptoms that have the greatest impact on HRQL . Material and methods. A cross-sectional study was carried out in four major Lithuanian hospitals. An EORTC QLQ-C30 (version 3) questionnaire with general demographic and medical information was distributed among 318 patients. A total of 284 patients were included in the analysis. Results. The response rate was 89%. The mean age of patients was 55.9 years (SD, 10.1 years), and the mean time from diagnosis – 2.36 years (SD, 3.2 years). A greater part (65%) of the studied women lived in a family or with a partner. Women reported high level of functioning across several standardized HRQOL scales: cognitive functioning, everyday activity, and physical functioning. Fatigue and sleeping disorders were the most commonly indicated symptoms in the symptom scale. Fatigue and pain were the most important factors affecting general HRQOL. Conclusions. Our results emphasize that the general HRQOL of the studied women is fair, but poorer than that of the corresponding population in other countries. Women living in a family or partnership experienced fewer financial troubles and had higher HRQOL scores across several standardized measures compared to those who were single. Women with late stages of breast cancer felt worse and were less socially active compared to women who were diagnosed with early-stage breast cancer

Sergančiųjų krūties vėžiu gyvenimo kokybės vertinimas

Background. Breast cancer is the most common cancer among women, comprising about 23% of all cancer types. About 1300 new cases of breast cancer are registered in Lithuania annually. During the last decade, health-related quality of life has become an important part of breast cancer treatment. Pain, fatigue, and sleep disorders are important aspects of health-related quality of life. The aim of the study was to evaluate health-related quality of life (HRQL) among patients with breast cancer in Lithuania. The main tasks were to analyze HRQL in sociodemographic and clinical aspects, and to determine symptoms that have the greatest impact on HRQL . Material and methods. A cross-sectional study was carried out in four major Lithuanian hospitals. An EORTC QLQ-C30 (version 3) questionnaire with general demographic and medical information was distributed among 318 patients. A total of 284 patients were included in the analysis. Results. The response rate was 89%. The mean age of patients was 55.9 years (SD, 10.1 years), and the mean time from diagnosis – 2.36 years (SD, 3.2 years). A greater part (65%) of the studied women lived in a family or with a partner. Women reported high level of functioning across several standardized HRQOL scales: cognitive functioning, everyday activity, and physical functioning. Fatigue and sleeping disorders were the most commonly indicated symptoms in the symptom scale. Fatigue and pain were the most important factors affecting general HRQOL. Conclusions. Our results emphasize that the general HRQOL of the studied women is fair, but poorer than that of the corresponding population in other countries. Women living in a family or partnership experienced fewer financial troubles and had higher HRQOL scores across several standardized measures compared to those who were single. [...]

Direct cost of patients with type 2 diabetes mellitus healthcare and its complications in Lithuania

Objective: The main objective of this study was to estimate the annual direct healthcare cost of type 2 diabetes mellitus healthcare and its complications in Lithuanian population. Material and methods: The study uses a prevalence-based top-down approach. The random sample of study participants was formed using the database of the National Health Insurance Fund under the Lithuanian Ministry of Health. 762 patients with diabetes mellitus type 2 data were analyzed in this research. The data on healthcare costs was recorded between January 1, 2011 and December 31, 2011. Results: Ambulatory care cost mean per patients with diabetes mellitus type 2 in 2011 was EUR 156.14 (95% CI, 147.05–165.24). 34.4% patients had at least one hospitalization during the 2011 year. Mean annual cost per patients of hospitalization was EUR 1160.16 (95% CI, 1019.60–1300.73). Covered drugs and diabetes supplies annual direct cost mean per patients was EUR 448.34 (95% CI, 411.14–485.54). The more expensive treatment was with oral and non-insulin injectable hypoglycemic medications (P < 0.001). 65.1% participants were diagnosed one or more diabetes-related chronic complications. Average annual cost per person, increased gradually with the numbers of complications from EUR 671.94 (95% CI, 575.03–768.86) in patients without complications to EUR 1588.98 (95% CI, 1052.09–2125.86) in patients with 3 and more complications (P < 0.001). Conclusions: The largest part of direct costs in diabetes mellitus healthcare composes hospital inpatient care and covered drugs expenditures. In our study we observed that the presence of microvascular, macrovascular chronic complication increased the direct cost per patient, compared with patients without complications

The Cost-Effectiveness analysis of cervical cancer screening using a systematic invitation system in Lithuania

In Lithuania, cytological screening of cervical cancer (CC) is largely opportunistic. Absence of standardized systematic invitation practice might be the reason for low participation rates. The study aimed to assess the cost-effectiveness of systematic invitation approach in CC screening programme from the perspective of a healthcare provider. A decision tree was used to compare an opportunistic invitation by a family doctor, a personal postal invitation letter with appointment time and place, and a personal postal invitation letter with appointment time and place with one reminder letter. Cost-effectiveness was defined as an incremental cost-effectiveness ratio (ICER) per one additionally screened woman and per one additional abnormal Pap smear test detected. The ICER of one personal postal invitation letter was €9.67 per one additionally screened woman and €55.21 per one additional abnormal Pap smear test detected in comparison with the current screening practice. The ICER of a personal invitation letter with an additional reminder letter compared to one invitation letter was €13.47 and €86.88 respectively. Conclusions: A personal invitation letter approach is more effective in increasing the participation rate in CC screening and the number of detected abnormal Pap smears; however, it incurs additional expenses compared with current invitation practice

The cost of newly diagnosed breast cancer in Lithuania, 2011

Background and objective: Although the cost of treating women with breast cancer (BC) is an important component for cost saving and effectiveness in relation to the benefits of BC treatment interventions, there is limited information on the direct cost reported for BC in Lithuania. Therefore the aim of this study was to evaluate annual direct medical cost for newly diagnosed BC in Lithuania in the year 2011. Materials and methods: The retrospective incidence-based top-down direct cost analysis was used. From January 1 to December 31, 2011 incident cases of BC (N = 1142) registered by the National Health Insurance Fund, the stage determined by Lithuanian Cancer Registry were included in the study. Results: The total average direct cost of BC amounted per patient was2580 (95% CI 2444–2752) EUR in 2011. The main cost driver per BCpatients was the inpatient hospital stay, respectively 1655 (95% CI 1478–2334) EUR. The average outpatient cost for one BC patient was 564 (95% CI 547–898) EUR. The dominant proportion of inpatient expenditureswas assigned to BC surgery and chemotherapy treatment. The BC direct medical cost increased according to the diagnosed stage of diseases from2409 (95% CI 2196–2621) EUR in stage 1 to3688 (95% CI 2703–4672) EUR in stage 4. The direct medical cost was inversely proportional to age. Conclusions: The direct BC medical cost estimates provided by this analysis can be used to determine priorities for the future research on BC treatment interventions

Assessing formation of evidence based tobacco and alcohol control policy in Lithuania: the retrospective analysis of voting of the members of parliament

Goal. To develop the instrument for monitoring and assessment of the Members of Parliament (MP) voting patterns on tobacco and alcohol control policy and present main results of the changes in voting indicator (rating) during 2012–2015. Methodology. Analysis was conducted using statistical data of MP voting on the issues of the tobacco and alcohol control policy publicly available on the internet page of the Parliament of the Republic of Lithuania. Final analysis included 57 law amendments voted on between 16th of November, 2012 and 30th of June, 2015, after assessment of their potentially positive or negative impact on public health. The instrument is used to assess individual MPs and political parliamentary factions based on their votes on the issues of tobacco and alcohol control policy. The final rating was based on calculating weight coefficient depending of the MP vote having the potentially positive or negative impact on public health. A sum of each MPs positive and negative votes was then converted into 10 point scoring system, with the worst assessment of 0 and best – 10. Overall assessment of each Parliamentary faction was calculated as an average of the scores of individual faction members. Results. The instrument for assessment of the Republic of Lithuania MPs voting patterns has been developed and implemented for the six Parliamentary sessions during 2012– 2016. On average 75 MPs voted per voting round (min. 38; max. 114) through 57 voting rounds included in the final analysis. Out of 146 current and former MPs assessed with this instrument 58 percent received less than 5 points (negative assessment), 27 percent were assessed 5-7 points, 13 percent received 8 points and 2 percent – 9-10 points. The assessment of the Parliamentary factions revealed differences between individual voting pattern and that of a political group to which MP belongs. Highest assessments were received by the Lithuanian Polish Election Action and Lithuanian Homeland Union and Lithuanian Christian Democratic political groups (accordingly 6.3 and 5.9 points). Labour party and Order and Justice political groups received barely positive assessment (accordingly 5.1 and 5.3 point). Negative assessments were received by the Liberal Movement political group (2.3 points), the Lithuanian Socialdemocratic Party political group (4.4 point) and the Mixed parliament political group (4.6 point). Conclusions. Assessment of the MP voting patterns has revealed differences between individual MPs and political factions voting rating, also large differences within factions. Over half of the MPS received negative rating assessments. Non-attendance of the Parliamentary meetings by MPs had a significant impact on their negative rating. Instrument is suitable for monitoring individual MPs and political factions inclination to favour public heath interest.Tikslas. Sukurti LR Seimo narių balsavimo tabako ir alkoholio kontrolės politikos srityje vertinimo instrumentą bei pristatyti pagrindinius balsavimo rodiklio (reitingo) rezultatus, apibendrinančius 2012–2015 m. LR Seimo narių balsavimus. Tyrimo metodika. Remiantis LR Seimo interneto svetainėje pateikiama balsavimų tabako ir alkoholio kontrolės politikos klausimais statistika, analizuoti 57 visuomenės sveikatos požiūriu teigiami ir neigiami balsavimai, vykę nuo 2012 m. lapkričio 16 d. iki 2015 m. birželio 30 d. Tyrime vystomas metodinis instrumentas, kuris padeda įvertinti tabako ir alkoholio kontrolės politikos klausimais balsuojančius LR Seimo narius ir frakcijas. LR Seimo narių įvertinimai skaičiuoti sumuojant kiekvieną balsą, prilygintą atitinkamam svorio koeficientui, atsižvelgiant į tai, ar balsuota teigiamai, neigiamai, susilaikyta arba iš viso nedalyvauta posėdžio balsavime. Susumuota kiekvieno LR Seimo nario teigiamų ir neigiamų balsų (svorio koeficientų) suma buvo paversta į 10 balų vertinimo sistemą, kur blogiausias įvertinimas yra 0 balų, o geriausias – 10. Bendras LR Seimo frakcijų įvertinimas gautas išvedant vidurkį iš tabako ir alkoholio srities įvertinimų. Rezultatai. Sukūrus ir pritaikius LR Seimo narių balsavimų vertinimo instrumentą šešių 2012–2016 m. LR Seimo kadencijos sesijų laikotarpiui, nustatyta, kad viso per 57 balsavimus tabako ir alkoholio kontrolės politikos klausimais vidutiniškai balsavo 75 LR Seimo nariai (mažiausiai – 38; daugiausia – 114). Iš 146 įvertintų buvusių ir esamų LR Seimo narių 58 proc. buvo įvertinti mažiau nei 5 balais (neigiami įvertinimai), 27 proc. įvertinti 5–7 balais, 13 proc. – 8 balais ir 2 proc. – 9–10 balų. LR Seimo frakcijų įvertinimai atspindi įvertinimų sklaidą tarp joms priklausančių LR Seimo narių. Aukščiausi įvertinimai teko Lietuvos lenkų rinkimų akcijos ir Tėvynės sąjungos-Lietuvos krikščionių demokratų frakcijoms (atitinkamai 6,3 ir 5,9 balo). Darbo partijos bei „Tvarka ir teisingumas“ frakcijos vos viršijo teigiamo įverčio ribą (atitinkamai 5,1 ir 5,3 balo). Neigiami įvertinimai skirti Liberalų sąjūdžio frakcijai (2,3 balo), Lietuvos socialdemokratų partijos frakcijai (4,4 balo) bei Mišriai Seimo narių grupei (4,6 balo). Išvados. Įvertinus LR Seimo narių balsavimus, matyti dideli skirtumai tarp individualių LR Seimo narių balsų, priklausančių toms pačioms frakcijoms. Daugiau kaip pusė LR Seimo narių gavo neigiamus įvertinimus, kuriuos lėmė dažnas nedalyvavimas LR Seimo posėdžių balsavimuose

Assessing formation of evidence based tobacco and alcohol control policy in Lithuania: the retrospective analysis of voting of the Members of Parliament

Goal. To develop the instrument for monitoring and assessment of the Members of Parliament (MP) voting patterns on tobacco and alcohol control policy and present main results of the changes in voting indicator (rating) during 2012–2015. Methodology. Analysis was conducted using statistical data of MP voting on the issues of the tobacco and alcohol control policy publicly available on the internet page of the Parliament of the Republic of Lithuania. Final analysis included 57 law amendments voted on between 16th of November, 2012 and 30th of June, 2015, after assessment of their potentially positive or negative impact on public health. The instrument is used to assess individual MPs and political parliamentary factions based on their votes on the issues of tobacco and alcohol control policy. The final rating was based on calculating weight coefficient depending of the MP vote having the potentially positive or negative impact on public health. A sum of each MPs positive and negative votes was then converted into 10 point scoring system, with the worst assessment of 0 and best – 10. Overall assessment of each Parliamentary faction was calculated as an average of the scores of individual faction members. Results. The instrument for assessment of the Republic of Lithuania MPs voting patterns has been developed and implemented for the six Parliamentary sessions during 2012– 2016. On average 75 MPs voted per voting round (min. 38; max. 114) through 57 voting rounds included in the final analysis. Out of 146 current and former MPs assessed with this instrument 58 percent received less than 5 points (negative assessment), 27 percent were assessed 5–7 points, 13 percent received 8 points and 2 percent – 9-10 points. The assessment of the Parliamentary factions revealed differences between individual voting pattern and that of a political group to which MP belongs.Highest assessments were received by the Lithuanian Polish Election Action and Lithuanian Homeland Union and Lithuanian Christian Democratic political groups (accordingly 6.3 and 5.9 points). Labour party and Order and Justice political groups received barely positive assessment (accordingly 5.1 and 5.3 point). Negative assessments were received by the Liberal Movement political group (2.3 points), the Lithuanian Socialdemocratic Party political group (4.4 point) and the Mixed parliament political group (4.6 point). Conclusions. Assessment of the MP voting patterns has revealed differences between individual MPs and political factions voting rating, also large differences within factions. Over half of the MPS received negative rating assessments. Non-attendance of the Parliamentary meetings by MPs had a significant impact on their negative rating. Instrument is suitable for monitoring individual MPs and political factions inclination to favour public heath interest