Hoidon vaikuttavuuden arviointi 15D-mittarilla

English summaryPeer reviewe

Tyytyväinen potilas = laadukas terveydenhuolto?

Hoidon laadun luotettava mittaaminen on laadun kehittämisen ja hoitolaitosten välisten vertailujen edellytys. Kokonaispotilas­tyytyväisyys ei sovellu yksinään hoidon laadun sijaismuuttujaksi

Breast Reconstruction-Prospective Follow up on Breast Cancer Patients' Health-Related Quality of Life

Background Analysing the results of breast reconstruction is important both in terms of oncological safety and health-related quality of life (HRQoL). Immediate breast reconstruction (IBR) is thought to be prone to complications and heavy for patients with no time to adapt to having cancer. Delayed reconstruction (DR) is an option after primary surgery and oncological treatments, but requires patients to go through two recovery periods after surgery. Methods A prospective study of 1065 breast cancer patients with repeated measurement of HRQoL with both generic (15D) and disease specific (EORTC QLQ C-30 BR23) measuring tools included 51 IBR patients and 41 DR patients. These patients' HRQoL and reconstruction methods were studied in more detail alongside with clinical data to determine HRQoL levels for patients with IBR and those with mastectomy and DR during a 24-month follow-up. Measuring points were baseline, 3, 6, 12 and 24 months. Results Most frequent techniques used were abdominal flaps (IBR n = 16, DR n = 14), latissimus dorsi flaps (LD) (IBR n = 19, DR n = 10), implants (IBR n = 12) and fat grafting (DR n = 6). Smaller groups were excluded from group comparisons. Approximately one third of the patients encountered complications. Symptom scores did not differ between reconstruction methods. DR patients had better overall HRQoL at 12 months, but at 24 months the situation had changed in favour of IBR. Both approaches of reconstructive surgery produced good HRQoL with no significant differences between the approaches studied.Peer reviewe

Paternity, erectile function, and health-related quality of life in patients operated for pediatric testicular torsion

Introduction Spermatic cord torsion (SCT) may lead to organ loss and can potentially influence fertility. Long-term effects of SCT are not fully investigated. Objective The purpose was to evaluate paternity rates in adults who have had SCT in childhood and to compare the results to those of a control population. The secondary purposes were to compare paternity rates after testis-preserving surgery with those after orchiectomy and to evaluate erectile function and health-related quality of life (HRQoL). Study design Questionnaires concerning paternity, erectile function (International Index of Erectile Function [IIEF]-5 questionnaire), and HRQoL (15D questionnaire) were mailed to 74 men who had been treated for SCT and to 92 controls treated for testicular appendage torsion in 1977-1995 and who were currently older than 30 years. Results Thirty-five of the 74 (47%) patients with SCT and 58 of the 92 (63%) controls responded. A same-aged control was selected for each patient with SCT. The median age at investigation was 41 (interquatile range [IQR]: 36 to 46) years in the SCT group and 41 (IQR: 38 to 46) years in the control group (p = 0.81). The paternity rate was 23 of 35 (66%) in the SCT group and 26 of 34 (76%) in the control group (p = 0.43). Nine percent of patients and controls suffered from infertility. Of the 30- to 50-year-old patients with SCT, 9 of 16 (56%) had children after orchiectomy, and 13 of 16 (81%), after detorsion (p = 0.25). Significant or moderate erectile dysfunction (IIEF-5 total score Discussion Paternity, erectile function, or HRQoL was not impaired in the general level in the patients with SCT in comparison with controls. Both the modes of treatment, orchiectomy or detorsion, had no significant impact on the results. However, the results cannot be generalized to the individual level. The limitations were a small sample size and inability to investigate maternal factors to the paternity. However, the results are encouraging for the patients and families. Conclusion Paternity rate and HRQoL were similar in patients with SCT and controls. The type of surgery (orchiectomy vs. detorsion) did not affect paternity rates statistically. Moderate or significant erectile dysfunction was rare in both groups.Peer reviewe

The Cost of Breast Cancer Surgery - Is the Money Spent Reflected on Health-related Quality of Life?

Background/Aim: Different treatment options of breast cancer (BC) are dependent on certain cancer- and patient-related features. The cost of treatment varies among patients. This study describes the cost distribution in the treatment of Finnish patients with BC for two years and relates the costs to important outcomes of modern BC treatment. Patients and Methods: Health-related quality of life (HRQoL) of 1,065 patients was measured prospectively at baseline, and 3, 6, 12, and 24 months thereafter with a generic (15D) and a disease-specific (EORTC QLQ C-30 BR23) HRQoL-instrument. Clinical data and costs of care were collected from hospital records. Patients were divided into four groups according to the surgical approach: breastconserving surgery (BCS n=661), mastectomy (n=319), immediate reconstruction (IBR n=51), and delayed reconstruction (DR n=34), and the costs according to the clinic responsible for treatment: oncological-, breast surgery-, and plastic surgery unit. Total costs of care during follow-up are presented groupwise alongside HRQoL results. Results: The mean total cost for BC surgery was 6,015 Euros for BCS, 8,114 euros for mastectomy, 18,217 Euros for IBR, and 19,041 Euros for DR. BCS, IBR, and DR produced good HRQoL. Mastectomy patients had the lowest overall HRQoL and highest cost accumulation at the oncology unit. HRQoL of IBR and DR patients was similar. Conclusion: DR produces good HRQoL but generates the highest costs of care. If patients that require reconstruction could be identified earlier and offered IBR instead of mastectomy followed by later DR, the costs of care might be reduced.Peer reviewe

Surgery and health-related quality of life-A prospective follow up study on breast cancer patients in Finland

Introduction: The influence of different surgical approaches on breast cancer patients' Health-related Quality of life (HRQoL) is an important determinant when making decisions on the choice of treat-ment. Knowledge on how patients actually perceive different surgical treatments regarding long-term HRQoL is still scarce. Materials & methods: 1065 patients with primary breast cancer operated on from 2008 to 2015 at Helsinki University Hospital, Finland were prospectively followed-up for two years. They filled in two HRQoL questionnaires, the EORTC QLQ C30 -BR 23 and the 15D, at baseline and at 3, 6, 12 and 24 months after surgery. Clinical data on treatments given and the course of recovery were collected from patient records. Patients were divided into four mutually exclusive groups according to surgical method: breast resection (n = 415), oncoplastic resection (n = 248), mastectomy (n = 351) and immediate reconstruction (n = 51). Clinical data were combined with HRQoL scores and analysed as multivariate modelling. Results: All groups experienced initially worsening overall HRQoL after baseline. Oncoplastic resection patients had the best body image and their HRQoL reached the highest level after treatments at 12 months whereas the reconstruction patients reached the highest HRQoL level first at 24 months. Mas-tectomy patients had the lowest scores throughout the 24-month follow-up. Conclusion: Extensive surgery, in terms of immediate reconstruction, led to slower HRQoL recovery than oncoplastic techniques. Mastectomy patients are at risk of having the lowest HRQoL scores throughout their recovery after surgery. (c) 2021 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).Peer reviewe

Diagnostiset virheet

Diagnos­tiset vir­heet ovat var­sin taval­lisia, vaik­ka ei­vät usein paljas­tukaan po­tilaan eli­nai­kana, vaan vas­ta ruumii­na­vauksen yhtey­dessä. Lää­käri voi har­hautua seu­raamaan lii­kaa jon­kin aikai­semman poti­las­ta­pauk­sensa an­tamaa diagnos­tista esi­merkkiä tai ei osaa luo­pua diag­noosia koske­vasta ensiar­viostaan, vaik­ka tosi­seikat viittai­si­vatkin jo­honkin muu­hun. Yh­teen oi­reeseen tai löy­dökseen taker­tu­minen tai so­kea luot­to labo­ra­to­rio­tu­loksiin voi hel­posti joh­taa virhe­diag­noosiin

Diagnostiset virheet

Diagnos­tiset vir­heet ovat var­sin taval­lisia, vaik­ka ei­vät usein paljas­tukaan po­tilaan eli­nai­kana, vaan vas­ta ruumii­na­vauksen yhtey­dessä. Lää­käri voi har­hautua seu­raamaan lii­kaa jon­kin aikai­semman poti­las­ta­pauk­sensa an­tamaa diagnos­tista esi­merkkiä tai ei osaa luo­pua diag­noosia koske­vasta ensiar­viostaan, vaik­ka tosi­seikat viittai­si­vatkin jo­honkin muu­hun. Yh­teen oi­reeseen tai löy­dökseen taker­tu­minen tai so­kea luot­to labo­ra­to­rio­tu­loksiin voi hel­posti joh­taa virhe­diag­noosiin

Costs in Different States of Breast Cancer

Background/Aim: This cross-sectional study estimated direct cancer-related health care, productivity and informal care costs for a six-month period for different states of breast cancer (BC). Patients and Methods: A total of 827 BC patients answered a questionnaire enquiring about informal care, work capacity, and demographic factors. Direct health care resource use and productivity costs were obtained from registries. Mutually exclusive groups were formed based on disease state and time from diagnosis: primary treatment (first six months after diagnosis), rehabilitation (>six months after diagnosis), remission (>1.5 years after diagnosis), and metastatic. Results: Mean total costs were: primary treatment (sic)22,876, rehabilitation (sic)3,456, remission (sic)1,728, and metastatic (sic)24,320. Mean direct health care costs were: primary treatment (sic)11,798, rehabilitation (sic)2,398, remission (sic)1,147, and metastatic (sic)13,923. Mean productivity costs varied between 18-39% and indirect costs (productivity and informal care costs) between 31-48% of the total costs. Conclusion: Direct medical costs were highest, but indirect costs constituted up to half of the total costs and are essential when estimating the total cost burden, as many patients are of working age.Peer reviewe