Colon-rectal Cancer and Lars Management

Forecast of refundability of health services in Apulia in 2019


Authors
Pub.Info
Article Navigation
DOI
Abstract
Pub.Info

Submission Date: 2020-09-01
Review Date: 2020-09-14
Pubblication Date: 2020-09-26
Printed on: Online Issue

Abstract

Abstract:

This article, taken from the ending research thesis of the studies in Business Administration in Pegaso University, derives from the lack of detailed data on colon-rectal cancer in Apulia, in 2019. The clinical, economic and statistical study introduced has given the possibility to examine the neoplasia incidence in Apulia reality, to estimate for the first time the Lars major phenomenon (Low Anterior Resection Syndrome) after a rectum surgical treatment. These goals have been achieved starting from the national data analysis provided by Airtum and Aiom; and operating through benchmarking, among the most virtuous Italian realities, it has been possible to estimate the forecast of refundability of health services generated by the treatment of colon cancers, rectal cancers and of the Lars phenomenon management. We can see the incidence of 2,802 total cases of colon-rectal cancer so divided: 1,920 colon cancer cases and 882 rectal cancer cases. The Lars phenomenon, according to the most recent medical literature, presents 444 cases, considering that 90 % of the 882 rectum tumors will have a surgery; 56% of these develops Lars major. Assuming to treat all cases of Lars major, it would potentially be possible a refundability of 63,492 Euros. While, as regards the refundability obtained from the treatment of the 2,802 colon-rectal cancer total cases, it could be hypothesized a total refundability of 18,897,408 Euros.

The starting point has been to examine the report data by Aiom and irtum “I numeri del cancro in Italia 2019”, considering those concerning the incidence of the colon-rectal cancer diagnosis and the following variables also: sex (males and females) and geographical area (south and islands).
As a response to the first goal of the study, the data obtained have been projected into the population of Apulia in 2019.
The economic aspect of the refundability of health services disbursed has required a benchmarking between the report by the Dipartimento Interaziendale di Area Vasta Centro Prevenzione, Diagnosi e Cura delle Malattie Oncologiche, coordinated by Prof. F. Di Costanzo, year 2015 and the Apulian reality. In addition, in order to have an overview, it has been useful to consider the “Rapporto annuale sulle attività di ricovero ospedaliero (SDO)” year 2018 published by the General Directorate of Health Planning of the Ministry of Health.
Finally, to estimate the LARS phenomenon, treated in ” Linee guida di neoplasia del retto e ano 2019”, developed by AIOM, SICCR, SIMG, AIRO, SIRM and SIAPEC-IAP, concerning the estimate of the incidence of rectum cancer diagnosis in 2019, it has been necessary to focus the analysis on the latest clinical evidence published: “Role of transal irrigation the treatment of anterior resection syndrome”, year 2018.
English translation by Vittoria Patrizia Maurelli, language teacher, Lecce, Italia.

INTRODUCTION

In the years, medical scientific research has always been focused on the prevention, diagnosis and treatment of colon-rectal cancer through PDTA. The following study will provide a clinical, statistical and economic analysis regarding colon-rectal neoplasia in Apulia in 2019; this latter has never provided a detailed database concerning tumors till now; therefore it is really complex and articulated to have same complete and meticulous calculations in order to obtain a refundability estimate.
The present study, starting from national data, will provide an estimate of the Apulian reality.
According to the data provided by Associazione Italiana Registri Tumori -AIRTUM, in 2019, in Italy colon-rectal cancer ranks second by incidence in the male and female population, immediately after breast cancer. More precisely, in the male sex it occupies the third place, after prostate and lungs cancer, in the female sex it is in second place, after breast cancer. In 2019, the official reference report “I numeri del cancro in Italia 2019”, by Aiom and Airtum, reports that the estimated incidence of colon-rectal cancer diagnosis is of 49,000 cases, equal to 13.20% of the 371,000 total cancer diagnoses.
The first goal of this study is to estimate the diagnosis incidence of colon-rectal cancer in Apulia in 2019, to analyze the two components of the overall data: colon cancer, rectal cancer and finally to elaborate the incidence of the Lars phenomenon (Low Anterior Resection Syndrome), after a rectal cancer surgery.
The second goal is to calculate and to examine the refundability of health services and hospitalizations (DRG), disbursed in 2019 in Apulia, assuming that all colon-rectal cancers previously estimated have been treated.

METHODOLOGY AND MATERIALS

The starting point has been to examine the report data by Aiom and Airtum “I numeri del cancro in Italia 2019”, considering those concerning the incidence of the colon-rectal cancer diagnosis and the following variables also: sex (males and females) and geographical area (south and islands).
As a response to the first goal of the study, the data obtained have been projected into the population of Apulia in 2019.
The economic aspect of the refundability of health services disbursed has required a benchmarking between the report by the Dipartimento Interaziendale di Area Vasta Centro Prevenzione, Diagnosi e Cura delle Malattie Oncologiche, coordinated by Prof. F. Di Costanzo, year 2015 and the Apulian reality. In addition, in order to have an overview, it has been useful to consider the “Rapporto annuale sulle attività di ricovero ospedaliero (SDO)” year 2018 published by the General Directorate of Health Planning of the Ministry of Health.
Finally, to estimate the LARS phenomenon, treated in ” Linee guida di neoplasia del retto e ano 2019”, developed by AIOM, SICCR, SIMG, AIRO, SIRM and SIAPEC-IAP, concerning the estimate of the incidence of rectum cancer diagnosis in 2019, it has been necessary to focus the analysis on the latest clinical evidence published: “Role of transal irrigation the treatment of anterior resection syndrome”, year 2018.
English translation by Vittoria Patrizia Maurelli, language teacher, Lecce, Italia.

RESULTS AND DISCUSSION

According to the report by Aiom and Airtum “I numeri del cancro in Italia 2019”, the incidence of colon-rectal cancers, in the geographical area involved in the study, is equal to 85.1 cases per 100,000 inhabitants in males, and 54.8 cases per 100,000 inhabitants in females. Studying the two data, we can see that the incidence of colon neoplasia is equal to 57.0 cases per 100,000 inhabitants in males and 38.8 cases per 100,000 inhabitants in females. While rectal cancer has a lower incidence: 28.1 cases in males and 16.0 cases in females, per 100,000 inhabitants.
With this precise contextualized scenario in Apulia, considering that the Apulian population in 2019 was made of 1,959,903 males and of 2,069,150 females, we can have an overall estimate of 2,802 new cases of colon-rectal cancer; so divided: 1,668 cases in males and 1,134 in females.
The total number of 2,802 cases is divided as follows: 1,920 diagnoses of colon cancer equal to 68.53% (1,117 males, 803 females) and 882 diagnoses of rectal cancer equal to 31.47% (551 males, 331 females).

Tab. 1

Three variables are required to analyze the LARS phenomenon: the incidence of rectal tumors in Apulia in 2019, how many of these must have a surgery and how many can potentially develop the syndrome.
Let’s see these variables as numbers; we obtain that the number of rectal cancer new cases is equal to 882. The “Linee guida di neoplasia del retto e dell’ano 2019” ” state that 90% of these cases, equal to 793.8, will have a surgery, of which 56% or 444 patients, according to the most recent medical literature, could develop Lars Major.
The refundability generated by the treatment of all 444 patients with major Lars is due to DRG 465 “Rehabilitation assistance with a history of malignant neoplasm as secondary diagnosis” for a total amount of 63,492 Euros.
The percentage distribution of colon and rectal cancer in Apulia in 2019 is comparable to the distribution which is present in the report of the Area Vasta Centro of 2015, but considering that the latter does not differ primary neoplasms from relapses ones.
Therefore, assuming that the previously estimated cancer diagnoses in the Apulian population in 2019 have all really been diagnosed and treated, the 2,802 patients could generate 3,566 hospitalizations. Of these only 55.30% generate surgical DRGs, divided as follows: DRG 149 19.40%, DRG 569 6.20%, DRG 570 18.40%, DRG 146 4.80%, DRG 147 5.10%, DRG 157 0.60%, DRG 158 0.80%, for a total number of 1,972 hospitalizations.

Tab. 2

By transforming the percentages into absolute values, the following hospitalisations are obtained: DRG 149 n.692, DRG 569 n.221, DRG 570 n.657, DRG 146 n.171, DRG 147 n.182, DRG 157 n.21, DRG 158 n.28.

Tab. 3

Even if theoretical, the realistic forecast of refundability of hospitalizations would amount to 18,897,408 Euros, only considering the surgical DRGs examined.
It should be noted that in this calculation, based on benchmarking, rectum interventions are equal to 356, compared to the number of interventions equal to about 794 which are statistically obtained starting from the estimated incidence of 882 cases of rectal cancer diagnosis.
However, the estimated data are analytical calculations, which do not consider the bias that could affect the final data. Considering that not all cancers are diagnosed because not all citizens do the necessary preventive screening or because the region has not yet implemented adequate screening procedures. Regarding this last point, we must remember that Apulia has recently started an important screening process for colon-rectal cancer, which affects 1,160,000 apulian citizens. In the next few years this project will be surely able to provide more complete data than today.

References

  1. Aiom, Airo, Siapec-Iap, Siccr, Simg, & Sirm. (2019). Rectal and Anus Neoplasia Guidelines 2019.
  2. Aiom, Airtum, Passi, & Siapec-Iap (2019). The numbers of cancer in Italy 2019. Brescia: Intermedia Editore.
  3. Bohlok A., Mercier C., Bouazza F., Galdon M.G., Moretti L., Donckier V., El Nakadi I., & Liberale G. (2019). The burden of low anterior resection syndrome on quality of life in patients with mid or low rectal cancer.
  4. Vast Area Intercompany Department Center for Prevention, Diagnosis and Treatment of Oncological Diseases. (2015). Prof. F. Di Costanzo (Edited by). Epidemiological data from the Vast Center Area.
  5. Dedalus. (2020). Puglia Region: +30 LEA points thanks to the colorectal screening project. Available in: https://www.dedalus.eu/regione-puglia-30-punti-lea-grazie-al-progetto-di-screening-colon-retto/ [15 January 2020].
  6. De Simone, S., & Di Trapani, G. (2013). Patterns of international tourism organizations: the role of information technologies. International Journal of Trends in Management, Economics & Technology, II, 29–33.
  7. De Simone, S., & Di Trapani, G. (2014). The quality assessment in healthcare organizations. International Journal of Trends in Management, Economics & Technology, 3, 8–12.
  8. Sarnacchiaro, P., & Di Trapani, G. (2011). La valutazione della Patient Satisfaction nelle strutture sanitarie con tecniche statistiche di analisi multidimensionale: un caso studio. In L’azienda sanitaria. Innovazione tecnologica, evoluzione organizzativa e governo clinico (pp. 373–385). Milano: Franco Angeli – Codice editore 1862.161.
  9. Sarnacchiaro, P., Di Trapani, G., Marrone, P., Sasso, I., Sarnacchiaro, P., & Sasso, I. (2011). A Structural Equation Model to analyze the Household Budget: a case study, 113–114.
  10. Direzione Generale della Programmazione Sanitaria del Ministero della Salute. (2018). Rapporto annuale sull’attività di ricovero ospedaliero (SDO).
  11. Emmertsen K.J., & Laurberg S. (2012). Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer.
  12. I.R.C.C.S. Gastroenterologico “S. De Bellis”. (2019). Piano della Performance 2020-2022. T.A. Stallone (A cura di).
  13. J. Martellucci, A. Sturiale, C. Bergamini, L. Boni, F. Cianchi, A. Coratti, & A. Valeri. (2018). Role of transal irrigation the treatment of anterior resection syndrome. Springer Nature Switzerland.
  14. Nitti D., & Zagonel V. (2015). Stima della distribuzione del tumore colon-retto nella popolazione veneta 2005-2007.
  15. Rapporto OASI (2019). CERGAS-Bocconi (A cura di).
  16. Regione Puglia (2008). Progetto SiVeAS Sistema di Valutazione della Performance della Sanità Italiana. Laboratorio Management e Sanità Scuola Superiore Sant’Anna di Pisa (A cura di).