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Supportive care in head and neck cancer patients

Jansen, F.

2018

document version

Publisher's PDF, also known as Version of record

Link to publication in VU Research Portal

citation for published version (APA)

Jansen, F. (2018). Supportive care in head and neck cancer patients: Patient-reported needs and costs.

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'ĞŶĞƌĂůŝŶƚƌŽĚƵĐƟŽŶĂŶĚŽƵƚůŝŶĞŽĨƚŚŝƐƚŚĞƐŝƐ

ϭϭ

1

ƵĞ ƚŽ ĐĂŶĐĞƌ ĂŶĚ ŝƚƐ ƚƌĞĂƚŵĞŶƚ͕ ĐĂŶĐĞƌ ƉĂƟĞŶƚƐ ŵĂLJ ĨĂĐĞ ƐĞǀĞƌĂů ƉŚLJƐŝĐĂů ĂŶĚ

ƉƐLJĐŚŽůŽŐŝĐĂůƐLJŵƉƚŽŵƐĂƐǁĞůůĂƐĂĚũƵƐƚŵĞŶƚƐŝŶĚĂŝůLJůŝǀŝŶŐ͘dŽĂĚĚƌĞƐƐƚŚĞƐĞƐLJŵƉƚŽŵƐ

ĂŶĚƚŽŚĞůƉƉĂƟĞŶƚƐƚŽĂĚũƵƐƚƚŽƚŚĞŝƌŶĞǁƐŝƚƵĂƟŽŶ͕ƐƵƉƉŽƌƟǀĞĐĂƌĞŝƐŽŌĞŶŶĞĞĚĞĚ͘

KƉƟŵĂůƐƵƉƉŽƌƟǀĞĐĂƌĞŝƐƚĂŝůŽƌĞĚƚŽƚŚĞŶĞĞĚƐŽĨƚŚĞŝŶĚŝǀŝĚƵĂůƉĂƟĞŶƚ;ƉĂƟĞŶƚͲĐĞŶƚĞƌĞĚ

ĐĂƌĞͿ͕ŝƐĞīĞĐƟǀĞ;ƋƵĂůŝƚLJĐĂƌĞͿ͕ĂŶĚŝƐĐŽƐƚͲĞīĞĐƟǀĞ;ĂīŽƌĚĂďůĞĐĂƌĞͿ͘dŚŝƐƚŚĞƐŝƐĨŽĐƵƐĞƐ

ŽŶƐƵƉƉŽƌƟǀĞĐĂƌĞŝŶŚĞĂĚĂŶĚŶĞĐŬĐĂŶĐĞƌ;,EͿƉĂƟĞŶƚƐ͕ĞƐƉĞĐŝĂůůLJŽŶƉĂƟĞŶƚƐ͛ŶĞĞĚ

ĨŽƌƐƵƉƉŽƌƟǀĞĐĂƌĞĂŶĚŝƚƐĐŽƐƚͲĞīĞĐƟǀĞŶĞƐƐŽƌĐŽƐƚͲƵƟůŝƚLJ͘

/Ŷ ƚŚŝƐ ĮƌƐƚ ĐŚĂƉƚĞƌ͕ ďĂĐŬŐƌŽƵŶĚ ŝŶĨŽƌŵĂƟŽŶ ŽŶ ,E ĂŶĚ ŝƚƐ ƚƌĞĂƚŵĞŶƚ ŝƐ ŽƵƚůŝŶĞĚ͕

ĨŽůůŽǁĞĚďLJĐƵƌƌĞŶƚŬŶŽǁůĞĚŐĞŽŶ,EƉĂƟĞŶƚƐ͛ŶĞĞĚĨŽƌƐƵƉƉŽƌƟǀĞĐĂƌĞĂŶĚŝŶŶŽǀĂƟǀĞ

ƐƵƉƉŽƌƟǀĞ ĐĂƌĞ ŝŶƚĞƌǀĞŶƟŽŶƐ͘ /Ŷ ĂĚĚŝƟŽŶ͕ ĂŶ ĞĐŽŶŽŵŝĐ ƉĞƌƐƉĞĐƟǀĞ ŽŶ ĐĂŶĐĞƌ ĂŶĚ

ƐƵƉƉŽƌƟǀĞĐĂƌĞŝƐƉƌŽǀŝĚĞĚ͕ŝŶĐůƵĚŝŶŐŝŶĨŽƌŵĂƟŽŶŽŶƚŚĞĞĐŽŶŽŵŝĐďƵƌĚĞŶŽĨĐĂŶĐĞƌ͕

ĂŶĚƚŚĞĐŽƐƚͲĞīĞĐƟǀĞŶĞƐƐŽƌĐŽƐƚͲƵƟůŝƚLJŽĨƐƵƉƉŽƌƟǀĞĐĂƌĞŝŶƚĞƌǀĞŶƟŽŶƐ͘dŚŝƐĐŚĂƉƚĞƌ

ĮŶŝƐŚĞƐǁŝƚŚƉƌĞƐĞŶƟŶŐƚŚĞĂŝŵĂŶĚŽƵƚůŝŶĞŽĨƚŚŝƐƚŚĞƐŝƐ͘

HEAD AND NECK CANCER

ϭϯ

1

dŽƚĂůůĂƌLJŶŐĞĐƚŽŵLJŝƐƉĞƌĨŽƌŵĞĚĂďŽƵƚϭϱϬƟŵĞƐĂLJĞĂƌŝŶƚŚĞEĞƚŚĞƌůĂŶĚƐ

ϭϭ

_{͘WĂƟĞŶƚƐ}

ƚƌĞĂƚĞĚǁŝƚŚĂƚŽƚĂůůĂƌLJŶŐĞĐƚŽŵLJĂƌĞŽŌĞŶƐĞĞŶĂƐĂĚŝƐƟŶĐƚƐƵďŐƌŽƵƉŽĨ,EƉĂƟĞŶƚƐ͕

ĚƵĞƚŽƚŚĞƐƉĞĐŝĮĐĂĚũƵƐƚŵĞŶƚƐŝŶŶŽƌŵĂůĚĂŝůLJĨƵŶĐƟŽŶŝŶŐƚŚĞLJĞŶĐŽƵŶƚĞƌ͕ŝŶĐůƵĚŝŶŐ

ĐŚĂŶŐĞƐƌĞŐĂƌĚŝŶŐďƌĞĂƚŚŝŶŐ͕ƐƉĞĞĐŚ͕ƐǁĂůůŽǁŝŶŐĂŶĚƐŵĞůů

ϭϮͲϭϱ

_͘

džƉĞƌŝĞŶĐĞĚƐLJŵƉƚŽŵƐĂŶĚŚĞĂůƚŚͲƌĞůĂƚĞĚƋƵĂůŝƚLJŽĨůŝĨĞ

ƵĞ ƚŽ ƚŚĞ ĐĂŶĐĞƌ ĂŶĚ ŝƚƐ ƚƌĞĂƚŵĞŶƚ͕ ,E ƉĂƟĞŶƚƐ ŽŌĞŶ ĞdžƉĞƌŝĞŶĐĞ ŐĞŶĞƌŝĐ ĂŶĚ

,EͲƐƉĞĐŝĮĐƐLJŵƉƚŽŵƐ͘^LJŵƉƚŽŵƐƚŚĂƚĂƌĞŽŌĞŶƌĞƉŽƌƚĞĚĂƌĞĨĂƟŐƵĞ͕ŝŶƐŽŵŶŝĂ͕ĚƌLJ

ŵŽƵƚŚ;džĞƌŽƐƚŽŵŝĂͿ͕ĚŝĸĐƵůƚLJƐǁĂůůŽǁŝŶŐ;ĚLJƐƉŚĂŐŝĂͿ͕ĐŚĂŶŐĞŝŶƐŵĞůů͕ƉƌŽďůĞŵƐǁŝƚŚ

ŶƵƚƌŝƟŽŶ͕ƐƉĞĞĐŚƉƌŽďůĞŵƐ͕ŚĞĂƌŝŶŐĚŝĸĐƵůƟĞƐĂŶĚŶĞĐŬĂŶĚƐŚŽƵůĚĞƌƉƌŽďůĞŵƐ

ϭϲͲϮϬ

_{͘ůƐŽ͕}

ƉƐLJĐŚŽůŽŐŝĐĂůƐLJŵƉƚŽŵƐĂƌĞŽŌĞŶƌĞƉŽƌƚĞĚ͕ŝŶĐůƵĚŝŶŐƉƐLJĐŚŽůŽŐŝĐĂůĚŝƐƚƌĞƐƐ͕ĚĞƉƌĞƐƐŝŽŶ͕

ĂŶdžŝĞƚLJ͕ĂŶĚĨĞĂƌŽĨĐĂŶĐĞƌƌĞĐƵƌƌĞŶĐĞ

ϮϭͲϮϯ

_͘

dŚĞƐĞ ŐĞŶĞƌĂů ĂŶĚ ,EͲƐƉĞĐŝĮĐ ƐLJŵƉƚŽŵƐ ĐĂŶ ŚĂǀĞ Ă ŵĂũŽƌ ŝŶŇƵĞŶĐĞ ŽŶ ƉĂƟĞŶƚƐ͛

ŚĞĂůƚŚͲƌĞůĂƚĞĚƋƵĂůŝƚLJŽĨůŝĨĞ;,ZYK>Ϳ

ϭϲ͕ϭϵ

_{͘,ZYK>ŝƐĂŵƵůƟĚŝŵĞŶƐŝŽŶĂůĐŽŶĐĞƉƚĂŶĚ}

ĞŶĐŽŵƉĂƐƐĞƐƉŚLJƐŝĐĂů͕ƌŽůĞĨƵŶĐƟŽŶŝŶŐ͕ƐŽĐŝĂů͕ĂŶĚƉƐLJĐŚŽůŽŐŝĐĂůĂƐƉĞĐƚƐŽĨǁĞůůͲďĞŝŶŐ

ĂŶĚĨƵŶĐƟŽŶŝŶŐ

Ϯϰ

_{͘,EƉĂƟĞŶƚƐ͛,ZYK>ŚĂƐďĞĞŶĨŽƵŶĚƚŽĚĞĐůŝŶĞǁŝƚŚƚƌĞĂƚŵĞŶƚ͕ďƵƚ}

ŽŌĞŶƌĞĐŽǀĞƌƐƚŽďĂƐĞůŝŶĞ,ZYK>ůĞǀĞů;ŝ͘Ğ͕͘ůĞǀĞůĂƚĐĂŶĐĞƌĚŝĂŐŶŽƐŝƐͿĂƚŵĞĚŝƵŵͲƚĞƌŵ

ĨŽůůŽǁͲƵƉ

Ϯϱ͕Ϯϲ

_{͘^ŽŵĞƐƉĞĐŝĮĐ,ZYK>ĚŽŵĂŝŶƐ͕ŚŽǁĞǀĞƌ͕ŵĂLJďĞŝŵƉĂŝƌĞĚƵƉƚŽůŽŶŐͲ}

ƚĞƌŵĨŽůůŽǁͲƵƉ͕ŝŶĐůƵĚŝŶŐĨŽƌĞdžĂŵƉůĞ͕džĞƌŽƐƚŽŵŝĂĂŶĚĚLJƐƉŚĂŐŝĂ

Ϯϱ͕Ϯϲ

_{͘ůƐŽ͕ǁŽƌŬĨŽƌĐĞ}

ƉĂƌƟĐŝƉĂƟŽŶŵĂLJďĞŝŵƉĂŝƌĞĚƵƉƚŽůŽŶŐͲƚĞƌŵĨŽůůŽǁͲƵƉ

Ϯϳ

_͘

SUPPORTIVE CARE TARGETING HEAD AND NECK CANCER PATIENTS

dŽŝŵƉƌŽǀĞƐLJŵƉƚŽŵƐĂŶĚ,ZYK>ĂŶĚƚŽĂĚĂƉƚƚŽĐŚĂŶŐĞƐŝŶĚĂŝůLJůŝǀŝŶŐ͕ƐƵƉƉŽƌƟǀĞ

ĐĂƌĞŝƐŽŌĞŶƉƌŽǀŝĚĞĚƚŽ,EƉĂƟĞŶƚƐ͘^ƵƉƉŽƌƟǀĞĐĂƌĞŝƐĚĞĮŶĞĚĂƐƚŚĞƉƌĞǀĞŶƟŽŶ

ĂŶĚŵĂŶĂŐĞŵĞŶƚŽĨĂĚǀĞƌƐĞĞīĞĐƚƐŽĨĐĂŶĐĞƌĂŶĚŝƚƐƚƌĞĂƚŵĞŶƚ

Ϯϴ

_{͕ĂŶĚĞŶĐŽŵƉĂƐƐĞƐ͕ĨŽƌ}

ŝŶƐƚĂŶĐĞ͕ŝŶĨŽƌŵĂƟŽŶĂŶĚĐĂƌĞƌĞůĂƚĞĚƚŽƉŚLJƐŝĐĂůĨƵŶĐƟŽŶŝŶŐ͕ĚĂŝůLJůŝǀŝŶŐ͕ƉƐLJĐŚŽůŽŐŝĐĂů

ĨƵŶĐƟŽŶŝŶŐ͕ƐĞdžƵĂůŝƚLJ͕ĂŶĚůŝĨĞƐƚLJůĞ

ϮϵͲϯϭ

_{͘/ŶŽƌĚĞƌƚŽƉƌŽǀŝĚĞŽƉƟŵĂůƐƵƉƉŽƌƟǀĞĐĂƌĞ͕ŝŶƐŝŐŚƚ}

ŝŶƚŽ,EƉĂƟĞŶƚƐ͛ƐƵƉƉŽƌƟǀĞĐĂƌĞŶĞĞĚƐŝƐƌĞƋƵŝƌĞĚ͘

^ƵƉƉŽƌƟǀĞĐĂƌĞŶĞĞĚƐ

WƌĞǀŝŽƵƐƐƚƵĚŝĞƐĨŽƵŶĚƚŚĂƚϲϬйƚŽϳϰйŽĨ,EƉĂƟĞŶƚƐĞdžƉĞƌŝĞŶĐĞƵŶŵĞƚƐƵƉƉŽƌƟǀĞ

care needs

ϯϮͲϯϱ

_{͘KŌĞŶƌĞƉŽƌƚĞĚ;ƵŶŵĞƚͿƐƵƉƉŽƌƟǀĞĐĂƌĞŶĞĞĚƐĂŵŽŶŐ,EƉĂƟĞŶƚƐ}

ϭϱ

1

ǀĞƌƐŝŽŶƐŽĨƚŚĞ^E^ĞdžŝƐƚ͗ĂůŽŶŐͲĨŽƌŵ;^E^Ͳ>&ϱϵͿ

ϲϭ

_{͕ĂƐŚŽƌƚͲĨŽƌŵ;^E^Ͳ^&ϯϰͿ}

ϯϭ

_{͕ĂŶĚĂ}

ƐĐƌĞĞŶŝŶŐƚŽŽů;^E^Ͳ^dϵͿ

ϲϮ

_{͕ŽĨǁŚŝĐŚƚŚĞ^E^Ͳ^&ϯϰŝƐŵŽƐƚŽŌĞŶƵƐĞĚ͘dŚĞ^E^Ͳ^&ϯϰ}

ŵĞĂƐƵƌĞƐϯϰĚŝīĞƌĞŶƚƐƵƉƉŽƌƟǀĞĐĂƌĞŶĞĞĚƐƌĞůĂƚĞĚƚŽƉƐLJĐŚŽůŽŐŝĐĂůĨƵŶĐƟŽŶŝŶŐ͕ŚĞĂůƚŚ

ƐLJƐƚĞŵĂŶĚŝŶĨŽƌŵĂƟŽŶ͕ƉĂƟĞŶƚĐĂƌĞĂŶĚƐƵƉƉŽƌƚ͕ƉŚLJƐŝĐĂůĂŶĚĚĂŝůLJůŝǀŝŶŐ͕ĂŶĚƐĞdžƵĂůŝƚLJ

ϯϭ

_͘

dƌĂŶƐůĂƟŽŶƐŽĨƚŚĞ^E^Ͳ^&ϯϰĂƌĞĂǀĂŝůĂďůĞŝŶŶŐůŝƐŚ

ϯϭ͕ϲϰ

_{͕&ƌĞŶĐŚ}

ϲϱ

_{͕'ĞƌŵĂŶ}

ϲϲ

_{͕/ƚĂůŝĂŶ}

ϲϳ

_͕

DĞdžŝĐĂŶ

ϲϴ

_{͕ŚŝŶĞƐĞ}

ϲϵ͕ϳϬ

_{͕ĂŶĚ:ĂƉĂŶĞƐĞ}

ϳϭ

_{͘/ŶĂĚĚŝƟŽŶ͕ƐĞǀĞƌĂůƐƵƉƉůĞŵĞŶƚĂƌLJŵŽĚƵůĞƐĨŽƌ}

ƵƐĞŝŶĐŽŶũƵŶĐƟŽŶǁŝƚŚƚŚĞ^E^Ͳ^&ϯϰ͕ƐƵĐŚĂƐĂďƌĞĂƐƚĐĂŶĐĞƌŵŽĚƵůĞ

ϳϮ͕ϳϯ

_{or prostate}

cancer module

ϳϰ

_{͕ŚĂǀĞďĞĞŶĚĞǀĞůŽƉĞĚ͘^ŽĨĂƌ͕ŶŽƵƚĐŚƚƌĂŶƐůĂƟŽŶŽĨƚŚĞ^E^Ͳ^&ϯϰŚĂƐ}

ϭϲ

ECONOMIC PERSPECTIVE ON CANCER AND SUPPORTIVE CARE IN

Έ,EE<ΉEZWd/Ed^

^ĞǀĞƌĂůƐƵƉƉŽƌƟǀĞĐĂƌĞŝŶƚĞƌǀĞŶƟŽŶƐŚĂǀĞƚŚƵƐďĞĞŶĚĞǀĞůŽƉĞĚƚĂƌŐĞƟŶŐƐƵƉƉŽƌƟǀĞĐĂƌĞ

ŶĞĞĚƐŽĨ,EƉĂƟĞŶƚƐ

ϴϮͲϴϵ

_{͘ĞƐŝĚĞƐŝŵƉƌŽǀŝŶŐƉĂƟĞŶƚƐ͛ŽƵƚĐŽŵĞƐ͕ŽƉƟŵĂůƐƵƉƉŽƌƟǀĞ}

ĐĂƌĞŶĞĞĚƐƚŽƉƌŽǀŝĚĞŐŽŽĚǀĂůƵĞĨŽƌŵŽŶĞLJ͕ĂƐƚŚĞĞĐŽŶŽŵŝĐďƵƌĚĞŶŽĨĐĂŶĐĞƌŝƐŚŝŐŚ͘

The economic burden of cancer

dŽƚĂůŚĞĂůƚŚĐĂƌĞĞdžƉĞŶĚŝƚƵƌĞƐŝŶƚŚĞEĞƚŚĞƌůĂŶĚƐŚĂǀĞŝŶĐƌĞĂƐĞĚĨƌŽŵϭϬ͘ϵйŽĨƚŚĞŐƌŽƐƐ

ĚŽŵĞƐƟĐƉƌŽĚƵĐƚ;'WͿŝŶϮϬϬϭƚŽϭϮ͘ϮйŝŶϮϬϬϳƚŽϭϰ͘ϬйŝŶϮϬϭϱ

ϵϮ

_{͘/ŶĐŽŵƉĂƌŝƐŽŶ͕ŝŶ}

ϮϬϬϳ͕ƚŽƚĂůŚĞĂůƚŚĐĂƌĞĞdžƉĞŶĚŝƚƵƌĞĂƐƉĞƌĐĞŶƚĂŐĞŽĨƚŚĞ'WǁĂƐϴ͘ϰйŝŶƚŚĞhŶŝƚĞĚ

<ŝŶŐĚŽŵ͕ϭϬ͘ϰйŝŶ'ĞƌŵĂŶLJ͕ϭϭ͘ϬйŝŶ&ƌĂŶĐĞ͕ĂŶĚϭϱ͘ϳйŝŶƚŚĞhŶŝƚĞĚ^ƚĂƚĞƐ

ϵϯ

_{͘dŚĞƚŽƚĂů}

ŚĞĂůƚŚĐĂƌĞĐŽƐƚƐŽĨĐĂŶĐĞƌĂƌĞĞƐƟŵĂƚĞĚƚŽďĞĂĐĐŽƵŶƚĂďůĞĨŽƌŽŶĂǀĞƌĂŐĞϰйŽĨƚŚĞ

ƚŽƚĂůŚĞĂůƚŚĐĂƌĞĞdžƉĞŶĚŝƚƵƌĞƐ

ϵϰ

_{͘/ŶƚŚĞEĞƚŚĞƌůĂŶĚƐ͕ƚŽƚĂůŚĞĂůƚŚĐĂƌĞĐŽƐƚƐŽĨĐĂŶĐĞƌĂƌĞ}

ĂĐĐŽƵŶƚĂďůĞĨŽƌϱйŽĨƚŚĞƚŽƚĂůŚĞĂůƚŚĐĂƌĞĞdžƉĞŶĚŝƚƵƌĞƐ

ϵϱ

_{͘/ŶĐŽŵƉĂƌŝƐŽŶ͕ĐĂƌĚŝŽǀĂƐĐƵůĂƌ}

ĚŝƐĞĂƐĞƐĂƌĞĂĐĐŽƵŶƚĂďůĞĨŽƌϴйĂŶĚĞŶĚŽĐƌŝŶĞĚŝƐŽƌĚĞƌƐ;Ğ͘Ő͕͘ĚŝĂďĞƚĞƐͿĨŽƌϮйŽĨƚŚĞ

ƚŽƚĂůŚĞĂůƚŚĐĂƌĞĞdžƉĞŶĚŝƚƵƌĞƐ

ϵϱ

_{͘,EĂůƐŽŝŶǀŽůǀĞƐŚŝŐŚŚĞĂůƚŚĐĂƌĞĞdžƉĞŶĚŝƚƵƌĞƐ}

ϵϲ͕ϵϳ

_͘

ĞƐŝĚĞƐŝƚƐŝŶŇƵĞŶĐĞŽŶŚĞĂůƚŚĐĂƌĞĞdžƉĞŶĚŝƚƵƌĞƐ͕ĐĂŶĐĞƌĂŶĚŝƚƐƚƌĞĂƚŵĞŶƚĂůƐŽŝŵƉĂĐƚŽŶ

ŽƚŚĞƌƚLJƉĞƐŽĨĐŽƐƚƐ͕ĨŽƌĞdžĂŵƉůĞƉƌŽĚƵĐƟǀŝƚLJůŽƐƐĞƐŽƌŝŶĨŽƌŵĂůĐĂƌĞĐŽƐƚƐ

ϵϰ͕ϵϴ

_{͘ůƚŚŽƵŐŚ}

ĐůĞĂƌŝŶƐŝŐŚƚŝŶƚŽĞŵƉůŽLJŵĞŶƚƌĂƚĞƐŽĨ,EƉĂƟĞŶƚƐĂƚƟŵĞŽĨĚŝĂŐŶŽƐŝƐĂƌĞŵŝƐƐŝŶŐ͕ŝƚŝƐ

ĞƐƟŵĂƚĞĚƚŚĂƚĂďŽƵƚϯϬйƚŽϰϳйŽĨ,EƉĂƟĞŶƚƐĂƌĞĞŵƉůŽLJĞĚĂƚƟŵĞŽĨĚŝĂŐŶŽƐŝƐ

Ϯϳ͕ϵϬ

_͘

ƉƌĞǀŝŽƵƐƐƚƵĚLJĂŵŽŶŐƵƚĐŚ,EƉĂƟĞŶƚƐĞŵƉůŽLJĞĚĂƚƟŵĞŽĨĚŝĂŐŶŽƐŝƐĨŽƵŶĚƚŚĂƚ

ŵĞĚŝĂŶƐŝĐŬůĞĂǀĞĂŌĞƌĐĂŶĐĞƌĚŝĂŐŶŽƐŝƐǁĂƐϲŵŽŶƚŚƐ

ϵϵ

_{͘DŽƌĞƚŚĂŶŚĂůĨ;ϱϯйͿŽĨƚŚĞƐĞ}

ĞŵƉůŽLJĞĚƉĂƟĞŶƚƐƌĞƚƵƌŶĞĚƚŽƚŚĞƐĂŵĞǁŽƌŬĂŌĞƌƚƌĞĂƚŵĞŶƚ͕ϯϬйƌĞƚƵƌŶĞĚƚŽĐŚĂŶŐĞĚ

ǁŽƌŬ͕ĂŶĚϭϳйĚŝĚŶŽƚƌĞƚƵƌŶƚŽǁŽƌŬĂƚĂůů͘/ŶĂƐƚƵĚLJĂŵŽŶŐ,EƉĂƟĞŶƚƐĨƌŽŵ/ƌĞůĂŶĚ͕

ŝƚǁĂƐĨŽƵŶĚƚŚĂƚϳϳйŽĨƉĂƟĞŶƚƐĞŵƉůŽLJĞĚĂƚƟŵĞŽĨ,EĚŝĂŐŶŽƐŝƐƚŽŽŬƟŵĞŽīǁŽƌŬ

ĂŌĞƌĚŝĂŐŶŽƐŝƐ͕ŽĨǁŚŝĐŚϯϮйŚĂĚŶŽƚƐƚĂƌƚǁŽƌŬŝŶŐĂŐĂŝŶĂƚƟŵĞŽĨƚŚĞƐƵƌǀĞLJ;ǁŚŝĐŚǁĂƐ

ŽŶĂǀĞƌĂŐĞϲLJĞĂƌƐƉŽƐƚͲĚŝĂŐŶŽƐŝƐͿ

Ϯϳ͕ϭϬϬ

_{͘WƌŽĚƵĐƟǀŝƚLJůŽƐƐĞƐŝŶ,EƉĂƟĞŶƚƐĐĂŶƚŚƵƐďĞ}

ŚŝŐŚ

ϭϬϬ

_{͘ůƐŽ͕ƚŚĞƉŽƚĞŶƟĂůĐŽƐƚƐĚƵĞƚŽƚŚĞďƵƌĚĞŶƉůĂĐĞĚŽŶŝŶĨŽƌŵĂůĐĂƌĞŐŝǀĞƌƐŽĨ,E}

ƉĂƟĞŶƚƐŝƐĞƐƟŵĂƚĞĚƚŽďĞŚŝŐŚ͘/ŶĂƉƌĞǀŝŽƵƐƐƚƵĚLJďLJ,ĂŶůLJĞƚĂů͘

ϭϬϭ

_{it was found that}

ϭϳ

1

ŽƐƚͲĞīĞĐƟǀĞŶĞƐƐĂŶĚĐŽƐƚͲƵƟůŝƚLJŽĨƐƵƉƉŽƌƟǀĞĐĂƌĞŝŶƚĞƌǀĞŶƟŽŶƐ

ƐƚŚĞĞĐŽŶŽŵŝĐďƵƌĚĞŶŽĨĐĂŶĐĞƌŝƐƚŚƵƐŚŝŐŚĂŶĚƚŚĞƚŽƚĂůŚĞĂůƚŚĐĂƌĞĞdžƉĞŶĚŝƚƵƌĞƐ

ĂƌĞŝŶĐƌĞĂƐŝŶŐ͕ĐŚŽŝĐĞƐŚĂǀĞƚŽďĞŵĂĚĞƌĞŐĂƌĚŝŶŐƌĞƐŽƵƌĐĞĂůůŽĐĂƟŽŶ͘^ƵƉƉŽƌƟǀĞĐĂƌĞ

ŝŶƚĞƌǀĞŶƟŽŶƐĂƌĞĞdžƉĞĐƚĞĚƚŽŚĂǀĞƚŚĞƉŽƚĞŶƟĂůƚŽƉƌŽǀŝĚĞŐŽŽĚǀĂůƵĞĨŽƌŵŽŶĞLJ͕ĂŶĚ

ƐŽŵĞƐƵƉƉŽƌƟǀĞĐĂƌĞŝŶƚĞƌǀĞŶƟŽŶƐĂƌĞŚLJƉŽƚŚĞƐŝnjĞĚƚŽĞǀĞŶŚĞůƉƌĞĚƵĐĞƚŚĞƚŽƚĂů

costs of cancer

ϭϬϮͲϭϬϰ

_{͘ĂƌůƐŽŶĞƚĂů͘ŚLJƉŽƚŚĞƐŝnjĞĚƚŚĂƚƉƐLJĐŚŽƐŽĐŝĂůŽŶĐŽůŽŐLJĐĂƌĞŵĂLJ͕}

ďĞƐŝĚĞƐŝŵƉƌŽǀŝŶŐƉĂƟĞŶƚŽƵƚĐŽŵĞƐ͕ƌĞĚƵĐĞƚŽƚĂůĐŽƐƚƐ͕ĚƵĞƚŽůŽŶŐͲƚĞƌŵĐŽƐƚƐĂǀŝŶŐƐ

ĂƐĂĐŽŶƐĞƋƵĞŶĐĞŽĨůĞƐƐƵƟůŝnjĂƟŽŶŽĨŽƚŚĞƌƚLJƉĞƐŽĨĐĂƌĞ

ϭϬϮ͕ϭϬϯ

_{͘ůƐŽƐĞůĨͲŵĂŶĂŐĞŵĞŶƚ}

ŝŶƚĞƌǀĞŶƟŽŶƐƚĂƌŐĞƟŶŐƉĂƟĞŶƚƐǁŝƚŚůŽŶŐͲƚĞƌŵĐŽŶĚŝƟŽŶƐŚĂǀĞďĞĞŶƌĞƉŽƌƚĞĚƚŽŚĂǀĞ

ƚŚĞƉŽƚĞŶƟĂůƚŽƌĞĚƵĐĞƚŽƚĂůĐŽƐƚƐǁŝƚŚŽƵƚŚĂƌŵŝŶŐƉĂƟĞŶƚŽƵƚĐŽŵĞƐ

ϭϬϰ

_͘

dŽŝŶǀĞƐƟŐĂƚĞǁŚĞƚŚĞƌƐƉĞĐŝĮĐƐƵƉƉŽƌƟǀĞĐĂƌĞŝŶƚĞƌǀĞŶƟŽŶƐƉƌŽǀŝĚĞŐŽŽĚǀĂůƵĞĨŽƌ

ŵŽŶĞLJ͕ ĞĐŽŶŽŵŝĐ ĞǀĂůƵĂƟŽŶƐ ;Ğ͘Ő͕͘ ĐŽƐƚͲĞīĞĐƟǀĞŶĞƐƐ ĂŶĚ ĐŽƐƚͲƵƟůŝƚLJ ĂŶĂůLJƐĞƐͿ ĂƌĞ

ƉĞƌĨŽƌŵĞĚ͘/ŶĐŽƐƚͲĞīĞĐƟǀĞŶĞƐƐĂŶĚĐŽƐƚͲƵƟůŝƚLJĂŶĂůLJƐĞƐƚŚĞĚŝīĞƌĞŶĐĞŝŶƚŽƚĂůĐŽƐƚƐ

ďĞƚǁĞĞŶĚŝīĞƌĞŶƚŝŶƚĞƌǀĞŶƟŽŶƐ͕ŽƌĂŶĞǁŝŶƚĞƌǀĞŶƟŽŶĂŶĚĐĂƌĞͲĂƐͲƵƐƵĂů͕ĂƌĞǁĞŝŐŚƚĞĚ

ĂŐĂŝŶƐƚƚŚĞĚŝīĞƌĞŶĐĞŝŶĞīĞĐƚƐ

ϭϬϱ͕ϭϬϲ

_{͘tŚĞŶŚĞĂůƚŚĞīĞĐƚƐ͕ƐƵĐŚĂƐůŝĨĞLJĞĂƌƐŐĂŝŶĞĚ}

ŽƌŝŵƉƌŽǀĞŵĞŶƚŝŶƉƐLJĐŚŽůŽŐŝĐĂůĚŝƐƚƌĞƐƐ͕ĂƌĞĐŽŵƉĂƌĞĚƚŚĞĂŶĂůLJƐĞƐĂƌĞĐĂůůĞĚĐŽƐƚͲ

ĞīĞĐƟǀĞŶĞƐƐĂŶĂůLJƐĞƐ͘tŚĞŶĂƵƟůŝƚLJŵĞĂƐƵƌĞŝƐƵƐĞĚ͕ƐƵĐŚĂƐƋƵĂůŝƚLJͲĂĚũƵƐƚĞĚůŝĨĞLJĞĂƌƐ

;Y>zƐͿ͕ŝƚŝƐĐĂůůĞĚĂĐŽƐƚͲƵƟůŝƚLJĂŶĂůLJƐŝƐ͘^ŽĨĂƌ͕ŚŽǁĞǀĞƌ͕ŽŶůLJĨĞǁƐƚƵĚŝĞƐŚĂǀĞŝŶǀĞƐƟŐĂƚĞĚ

ƚŚĞĐŽƐƚͲĞīĞĐƟǀĞŶĞƐƐŽƌĐŽƐƚͲƵƟůŝƚLJŽĨƐƵƉƉŽƌƟǀĞĐĂƌĞŝŶƚĞƌǀĞŶƟŽŶƐƚĂƌŐĞƟŶŐĐĂŶĐĞƌ

ƉĂƟĞŶƚƐ

ϭϬϳ͕ϭϬϴ

_{͘DŽƌĞƐƚƵĚŝĞƐĨŽĐƵƐŝŶŐŽŶƚŚĞĐŽƐƚͲĞīĞĐƟǀĞŶĞƐƐŽƌĐŽƐƚͲƵƟůŝƚLJŽĨƐƵƉƉŽƌƟǀĞ}

ĐĂƌĞŝŶƚĞƌǀĞŶƟŽŶƐƚĂƌŐĞƟŶŐ,EƉĂƟĞŶƚƐĂƌĞ͕ƚŚĞƌĞĨŽƌĞ͕ǁĂƌƌĂŶƚĞĚ͘

AIM OF THIS THESIS

ϭϵ

1

REFERENCES

ϭ͘ EĞƚŚĞƌůĂŶĚƐŽŵƉƌĞŚĞŶƐŝǀĞĐĂŶĐĞƌKƌŐĂŶŝƐĂƟŽŶ;/<E>Ϳ͕dŚĞEĞƚŚĞƌůĂŶĚƐĂŶĐĞƌZĞŐŝƐƚƌLJ͗ ǁǁǁ͘ĐŝũĨĞƌƐŽǀĞƌŬĂŶŬĞƌ͘Ŷů;ĂĐĐĞƐƐĞĚDĂƌĐŚϭϱ͕ϮϬϭϳͿ͘ Ϯ͘ &ĞƌůĂLJ:͕^ƚĞůŝĂƌŽǀĂͲ&ŽƵĐŚĞƌ͕>ŽƌƚĞƚͲdŝĞƵůĞŶƚ:͕ĞƚĂů͗ĂŶĐĞƌŝŶĐŝĚĞŶĐĞĂŶĚŵŽƌƚĂůŝƚLJƉĂƩĞƌŶƐ ŝŶƵƌŽƉĞ͗ĞƐƟŵĂƚĞƐĨŽƌϰϬĐŽƵŶƚƌŝĞƐŝŶϮϬϭϮ͘Ƶƌ:ĂŶĐĞƌϰϵ͗ϭϯϳϰͲϭϰϬϯ͕ϮϬϭϯ

ϮϮ