Journal of Preventive Medicine and Public Health

The Korean Society for Preventive Medicine (대한예방의학회)
권호 표지
DOI QR코드

DOI QR Code

Strategies for Appropriate Patient-centered Care to Decrease the Nationwide Cost of Cancers in Korea

국가 암 비용 감소를 위한 환자중심 진료의 적정성 확보 전략

  • Bae, Jong-Myon (Department of Preventive Medicine, Jeju National University School of Medicine)
  • 배종면 (제주대학교 의학전문대학원 예방의학교실)
  • Received : 2017.04.26
  • Accepted : 2017.06.16
  • Published : 2017.07.31
Download PDF
⟨ Previous Next ⟩

Abstract

In terms of years of life lost to premature mortality, cancer imposes the highest burden in Korea. In order to reduce the burden of cancer, the Korean government has implemented cancer control programs aiming to reduce cancer incidence, to increase survival rates, and to decrease cancer mortality. However, these programs may paradoxically increase the cost burden. For examples, a cancer screening program for early detection could bring about over-diagnosis and over-treatment, and supplying medical services in a paternalistic manner could lead to defensive medicine or futile care. As a practical measure to reduce the cost burden of cancer, appropriate cancer care should be established. Ensuring appropriateness requires patient-doctor communication to ensure that utility values are shared and that autonomous decisions are made regarding medical services. Thus, strategies for reducing the cost burden of cancer through ensuring appropriate patient-centered care include introducing value-based medicine, conducting cost-utility studies, and developing patient decision aids.

Keywords

References

  1. Williams A. Calculating the global burden of disease: time for a strategic reappraisal? Health Econ 1999;8(1):1-8. https://doi.org/10.1002/(SICI)1099-1050(199902)8:1<1::AID-HEC399>3.0.CO;2-B
  2. Meropol NJ, Schulman KA. Cost of cancer care: issues and implications. J Clin Oncol 2007;25(2):180-186. https://doi.org/10.1200/JCO.2006.09.6081
  3. Yoon SJ, Lee H, Shin Y, Kim YI, Kim CY, Chang H. Estimation of the burden of major cancers in Korea. J Korean Med Sci 2002; 17(5):604-610. https://doi.org/10.3346/jkms.2002.17.5.604
  4. Yoon SJ, Bae SC. Current scope and perspective of burden of disease study based on health related quality of life. J Korean Med Assoc 2004;47(7):600-602 (Korean). https://doi.org/10.5124/jkma.2004.47.7.600
  5. Gong YH, Yoon SJ, Jo MW, Kim A, Kim YA, Yoon J, et al. The burden of cancer in Korea during 2012: findings from a prevalence-based approach. J Korean Med Sci 2016;31 Suppl 2: S168-S177. https://doi.org/10.3346/jkms.2016.31.S2.S168
  6. Yoon SJ, Bae SC, Lee SI, Chang H, Jo HS, Sung JH, et al. Measuring the burden of disease in Korea. J Korean Med Sci 2007; 22(3):518-523. https://doi.org/10.3346/jkms.2007.22.3.518
  7. Yoon J, Oh IH, Seo H, Kim EJ, Gong YH, Ock M, et al. Disabilityadjusted life years for 313 diseases and injuries: the 2012 Korean Burden of Disease Study. J Korean Med Sci 2016;31 Suppl 2:S146-S157. https://doi.org/10.3346/jkms.2016.31.S2.S146
  8. Soerjomataram I, Lortet-Tieulent J, Ferlay J, Forman D, Mathers C, Parkin DM, et al. Estimating and validating disability-adjusted life years at the global level: a methodological framework for cancer. BMC Med Res Methodol 2012;12:125. https://doi.org/10.1186/1471-2288-12-125
  9. Jung KW, Won YJ, Oh CM, Kong HJ, Lee DH, Lee KH, et al. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2014. Cancer Res Treat 2017;49(2):292-305. https://doi.org/10.4143/crt.2017.118
  10. Jung KW, Shin HR, Kong HJ, Park S, Won YJ, Choi KS, et al. Long-term trends in cancer mortality in Korea (1983-2007): a joinpoint regression analysis. Asian Pac J Cancer Prev 2010; 11(6):1451-1457.
  11. Kim YA, Oh IH, Yoon SJ, Kim HJ, Seo HY, Kim EJ, et al. The economic burden of breast cancer in Korea from 2007-2010. Cancer Res Treat 2015;47(4):583-590. https://doi.org/10.4143/crt.2014.143
  12. Schnipper LE, Meropol NJ, Brock DW. Value and cancer care: toward an equitable future. Clin Cancer Res 2010;16(24):6004-6008. https://doi.org/10.1158/1078-0432.CCR-10-1643
  13. Ljung R, Peterson S, Hallqvist J, Heimerson I, Diderichsen F. Socioeconomic differences in the burden of disease in Sweden. Bull World Health Organ 2005;83(2):92-99.
  14. Savage P, Mahmoud S. Development and economic trends in cancer therapeutic drugs: a 5-year update 2010-2014. Br J Cancer 2015;112(6):1037-1041. https://doi.org/10.1038/bjc.2015.56
  15. Farmer P, Frenk J, Knaul FM, Shulman LN, Alleyne G, Armstrong L, et al. Expansion of cancer care and control in countries of low and middle income: a call to action. Lancet 2010; 376(9747):1186-1193. https://doi.org/10.1016/S0140-6736(10)61152-X
  16. Steenland K, Armstrong B. An overview of methods for calculating the burden of disease due to specific risk factors. Epidemiology 2006;17(5):512-519. https://doi.org/10.1097/01.ede.0000229155.05644.43
  17. Kim EJ, Yoon SJ, Jo MW, Kim HJ. Measuring the burden of chronic diseases in Korea in 2007. Public Health 2013;127(9): 806-813. https://doi.org/10.1016/j.puhe.2012.12.024
  18. Suh M, Choi KS, Park B, Lee YY, Jun JK, Lee DH, et al. Trends in cancer screening rates among Korean men and women: results of the Korean National Cancer Screening Survey, 2004-2013. Cancer Res Treat 2016;48(1):1-10. https://doi.org/10.4143/crt.2014.204
  19. Loberg M, Lousdal ML, Bretthauer M, Kalager M. Benefits and harms of mammography screening. Breast Cancer Res 2015; 17:63. https://doi.org/10.1186/s13058-015-0525-z
  20. Gotzsche PC, Jorgensen KJ. Screening for breast cancer with mammography. Cochrane Database Syst Rev 2013;(6):CD00 1877.
  21. Bae JM. Overdiagnosis: epidemiologic concepts and estimation. Epidemiol Health 2015;37:e2015004. https://doi.org/10.4178/epih/e2015004
  22. Bae JM. Epidemiological evidences on overdiagnosis of prostate and kidney cancers in Korean. Epidemiol Health 2015;37: e2015015. https://doi.org/10.4178/epih/e2015015
  23. Welch HG, Black WC. Overdiagnosis in cancer. J Natl Cancer Inst 2010;102(9):605-613. https://doi.org/10.1093/jnci/djq099
  24. Bae JM. It needs adaptation to the 2015 Korean guideline for breast cancer screening. J Korean Med Assoc 2015;58(9):833-837 (Korean). https://doi.org/10.5124/jkma.2015.58.9.833
  25. Jameson JL, Longo DL. Precision medicine: personalized, problematic, and promising. N Engl J Med 2015;372(23):2229-2234. https://doi.org/10.1056/NEJMsb1503104
  26. Carlson RW, Allred DC, Anderson BO, Burstein HJ, Carter WB, Edge SB, et al. Breast cancer. Clinical practice guidelines in oncology. J Natl Compr Canc Netw 2009;7(2):122-192. https://doi.org/10.6004/jnccn.2009.0012
  27. Studdert DM, Mello MM, Sage WM, DesRoches CM, Peugh J, Zapert K, et al. Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. JAMA 2005; 293(21):2609-2617. https://doi.org/10.1001/jama.293.21.2609
  28. Earle CC, Landrum MB, Souza JM, Neville BA, Weeks JC, Ayanian JZ. Aggressiveness of cancer care near the end of life: is it a quality-of-care issue? J Clin Oncol 2008;26(23):3860-3866. https://doi.org/10.1200/JCO.2007.15.8253
  29. Brook RH. Assessing the appropriateness of care--its time has come. JAMA 2009;302(9):997-998. https://doi.org/10.1001/jama.2009.1279
  30. Dalton WS, Sullivan DM, Yeatman TJ, Fenstermacher DA. The 2010 Health Care Reform Act: a potential opportunity to advance cancer research by taking cancer personally. Clin Cancer Res 2010;16(24):5987-5996. https://doi.org/10.1158/1078-0432.CCR-10-1216
  31. Bae JM. Value-based medicine: concepts and application. Epidemiol Health 2015;37:e2015014. https://doi.org/10.4178/epih/e2015014
  32. Bae JM. Development and application of patient decision aids. Epidemiol Health 2015;37:e2015018. https://doi.org/10.4178/epih/e2015018
  33. Bae JM. Academic strategies based on evidence-practice gaps. Hanyang Med Rev 2015;35(1):3-8 (Korean). https://doi.org/10.7599/hmr.2015.35.1.3
  34. Fujimori M, Uchitomi Y. Preferences of cancer patients regarding communication of bad news: a systematic literature review. Jpn J Clin Oncol 2009;39(4):201-216. https://doi.org/10.1093/jjco/hyn159
  35. Grunfeld E, Folkes A, Urquhart R. Do available questionnaires measure the communication factors that patients and families consider important at end of life? J Clin Oncol 2008;26 (23):3874-3878. https://doi.org/10.1200/JCO.2007.15.8006
  36. Pollak KI, Arnold RM, Jeffreys AS, Alexander SC, Olsen MK, Abernethy AP, et al. Oncologist communication about emotion during visits with patients with advanced cancer. J Clin Oncol 2007;25(36):5748-5752. https://doi.org/10.1200/JCO.2007.12.4180
  37. McFarlane J, Riggins J, Smith TJ. SPIKE$: a six-step protocol for delivering bad news about the cost of medical care. J Clin Oncol 2008;26(25):4200-4204. https://doi.org/10.1200/JCO.2007.15.6208
  38. Meropol NJ, Schrag D, Smith TJ, Mulvey TM, Langdon RM Jr, Blum D, et al. American Society of Clinical Oncology guidance statement: the cost of cancer care. J Clin Oncol 2009;27(23): 3868-3874. https://doi.org/10.1200/JCO.2009.23.1183
  39. Brown MM, Brown GC, Sharma S, Landy J. Health care economic analyses and value-based medicine. Surv Ophthalmol 2003;48(2):204-223. https://doi.org/10.1016/S0039-6257(02)00457-5
  40. Brown MM, Brown GC, Sharma S, Stein JD, Roth Z, Campanella J, et al. The burden of age-related macular degeneration: a value-based analysis. Curr Opin Ophthalmol 2006;17(3):257-266.
  41. Neumann PJ, Palmer JA, Nadler E, Fang C, Ubel P. Cancer therapy costs influence treatment: a national survey of oncologists. Health Aff (Millwood) 2010;29(1):196-202. https://doi.org/10.1377/hlthaff.2009.0077
  42. Lenz M, Buhse S, Kasper J, Kupfer R, Richter T, Muhlhauser I. Decision aids for patients. Dtsch Arztebl Int 2012;109(22-23):401-408.
  43. Trevena LJ, Zikmund-Fisher BJ, Edwards A, Gaissmaier W, Galesic M, Han PK, et al. Presenting quantitative information about decision outcomes: a risk communication primer for patient decision aid developers. BMC Med Inform Decis Mak 2013;13 Suppl 2:S7.
  44. Stacey D, Legare F, Lewis K, Barry MJ, Bennett CL, Eden KB, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2017;4:CD001431.
  45. O'Connor AM, Llewellyn-Thomas HA, Flood AB. Modifying unwarranted variations in health care: shared decision making using patient decision aids. Health Aff (Millwood) 2004;Suppl Variation:VAR63-VAR72.
  46. Doring AC, Hageman MG, Mulder FJ, Guitton TG, Ring D; Science of Variation Group, et al. Trigger finger: assessment of surgeon and patient preferences and priorities for decision making. J Hand Surg Am 2014;39(11):2208-2213.e2. https://doi.org/10.1016/j.jhsa.2014.08.010
  47. O'Connor AM, Wennberg JE, Legare F, Llewellyn-Thomas HA, Moulton BW, Sepucha KR, et al. Toward the 'tipping point': decision aids and informed patient choice. Health Aff (Millwood) 2007;26(3):716-725. https://doi.org/10.1377/hlthaff.26.3.716

Cited by

  1. Ethical, pedagogical, socio-political and anthropological implications of quaternary prevention vol.13, pp.40, 2017, https://doi.org/10.5712/rbmfc13(40)1860
  2. 보건의료체계 지속가능성의 필수 조건들 vol.16, pp.2, 2017, https://doi.org/10.22730/jmls.2019.16.2.52