Top

Published in:

Open Access 01-12-2018 | Study protocol

Cost of Medical Care of Patients with Advanced Serious Illness in Singapore (COMPASS): prospective cohort study protocol

Authors: Irene Teo, Ratna Singh, Chetna Malhotra, Semra Ozdemir, Rebecca A. Dent, Nesaretnam Barr Kumarakulasinghe, Wee Lee Yeo, Yin Bun Cheung, Rahul Malhotra, Ravindran Kanesvaran, Alethea Chung Pheng Yee, Noreen Chan, Huei Yaw Wu, Soh Mun Chin, Hum Yin Mei Allyn, Grace Meijuan Yang, Patricia Soek Hui Neo, Nivedita V. Nadkarni, Richard Harding, Eric A. Finkelstein

Published in: BMC Cancer | Issue 1/2018

Abstract

Background

Advanced cancer significantly impacts quality of life of patients and families as they cope with symptom burden, treatment decision-making, uncertainty and costs of treatment. In Singapore, information about the experiences of advanced cancer patients and families and the financial cost they incur for end-of-life care is lacking. Understanding of this information is needed to inform practice and policy to ensure continuity and affordability of care at the end of life. The primary objectives of the Cost of Medical Care of Patients with Advanced Serious Illness in Singapore (COMPASS) cohort study are to describe changes in quality of life and to quantify healthcare utilization and costs of patients with advanced cancer at the end of life. Secondary objectives are to investigate patient and caregiver preferences for diagnostic and prognostic information, preferences for end-of-life care, caregiver burden and perceived quality of care and to explore how these change as illness progresses and finally to measure bereavement adjustment. The purpose of this paper is to present the COMPASS protocol in order to promote scientific transparency.

Methods

This cohort study recruits advanced cancer patients (n = 600) from outpatient medical oncology clinics at two public tertiary healthcare institutions in Singapore. Patients and their primary informal caregiver are surveyed every 3 months until patients’ death; caregivers are followed until 6 months post patient death. Patient medical and billing records are obtained and merged with patient survey data. The treating medical oncologists of participating patients are surveyed to obtain their beliefs regarding care delivery for the patient.

Discussion

The study will allow combination of self-report, medical, and cost data from various sources to present a comprehensive picture of the end-of-life experience of advanced cancer patients in a unique Asian setting. This study is responsive to Singapore’s National Strategy for Palliative Care which aims to identify opportunities to meet the growing need for high quality care for Singapore’s aging population. Results will also be of interest to policy makers and researchers beyond Singapore who are interested to understand and improve the end-of-life experience of cancer patients.

Trial registration

NCT02850640 (Prospectively registered on June 9, 2016).

Singapore Ministry of Health. Principal Causes of Death. 2016.

Committee on Ageing Issues. Report on the Ageing Population. 2006.

Schmoll H, Van Cutsem E, Stein A, Valentini V, Glimelius B, Haustermans K, et al. ESMO consensus guidelines for management of patients with colon and rectal cancer. A personalized approach to clinical decision making. Ann Oncol. 2012;23(10):2479–516.CrossRefPubMed

Parkin DM, Bray F, Ferlay J, Pisani P. Estimating the world cancer burden: Globocan 2000. Int J Cancer. 2001;94(2):153–6.CrossRefPubMed

Ferlay J, Héry C, Autier P, Sankaranarayanan R. Global burden of breast cancer. In: Li C, editor. Breast Cancer epidemiology: Springer; 2010. p. 1–19.

Bradley CJ, Yabroff KR, Dahman B, Feuer EJ, Mariotto A, Brown ML. Productivity costs of cancer mortality in the United States: 2000–2020. J Natl Cancer Inst. 2008;100(24):1763–70.CrossRefPubMedPubMedCentral

Kanavos P. The rising burden of cancer in the developing world. Ann Oncol. 2006;17(suppl 8):viii15–23.CrossRefPubMed

Hong CY, Chow KY, Poulose J, Jin AZ, Devi A, Chee EM, et al. Place of death and its determinants for patients with cancer in Singapore: an analysis of data from the Singapore Cancer registry, 2000-2009. J Palliat Med. 2011;14(10):1128–34.CrossRefPubMed

Tay WK, Shaw RJ, Goh CR. A survey of symptoms in hospice patients in Singapore. Ann Acad Med Singap. 1994;23(2):191–6.PubMed

10.

Kelley AS, McGarry K, Fahle S, Marshall SM, Du Q, Skinner JS. Out-of-pocket spending in the last five years of life. J Gen Intern Med. 2013;28(2):304–9.CrossRefPubMed

11.

Kelley AS, Ettner SL, Morrison RS, Du Q, Wenger NS, Sarkisian CA. Determinants of medical expenditures in the last 6 months of life. Ann Intern Med. 2011;154(4):235–42.CrossRefPubMedPubMedCentral

12.

Fassbender K, Fainsinger RL, Carson M, Finegan BA. Cost trajectories at the end of life: the Canadian experience. J Pain Symptom Manag. 2009;38(1):75–80.CrossRef

13.

Morishima T, Lee J, Otsubo T, Imanaka Y. Association of healthcare expenditures with aggressive versus palliative care for cancer patients at the end of life: a cross-sectional study using claims data in Japan. Int J Qual Health Care. 2014;26(1):79–86.CrossRefPubMed

14.

Emanuel EJ, Young-Xu Y, Levinsky NG, Gazelle G, Saynina O, Ash AS. Chemotherapy use among Medicare beneficiaries at the end of life. Ann Intern Med. 2003;138(8):639–43.CrossRefPubMed

15.

Riley GF, Lubitz JD. Long-term trends in medicare payments in the last year of life. Health Serv Res. 2010;45(2):565–76.CrossRefPubMedPubMedCentral

16.

Morrison RS, Meier D. Clinical practice: palliative care. N Engl J Med. 2004;350(25):2582–90.CrossRefPubMed

17.

Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, et al. Early palliative care for patients with metastatic non–small-cell lung cancer. N Engl J Med. 2010;363(8):733–42.CrossRefPubMed

18.

Bakitas M, Lyons KD, Hegel MT, Balan S, Brokaw FC, Seville J, et al. Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the project ENABLE II randomized controlled trial. JAMA. 2009;302(7):741–9.CrossRefPubMedPubMedCentral

19.

Smith TJ, Temin S, Alesi ER, Abernethy AP, Balboni TA, Basch EM, et al. American Society of Clinical Oncology provisional clinical opinion: the integration of palliative care into standard oncology care. J Clin Oncol. 2012;30(8):880–7.CrossRefPubMed

20.

Morrison RS, Penrod JD, Cassel JB, Caust-Ellenbogen M, Litke A, Spragens L, et al. Cost savings associated with UeS hospital palliative care consultation programs. Arch Intern Med. 2008;168(16):1783–90.CrossRefPubMed

21.

Tai J. MOH aims to make them more affordable, encourage home care. Singapore: The Straits Times; 2017.

22.

National Strategy for Palliative Care Workgroup. Report On the National Strategy for Palliative Care. 2011.

23.

National Cancer Centre Singapore. 2017. https://www.linkedin.com/company/nationalcancercentresingapore. Accessed 13 Apr 2018.

24.

Lim G-H, Wong C-S, Chow K-Y, Bhalla V, Chia K-S. Trends in long-term cancer survival in Singapore: 1968-2002. Ann Acad Med Singap. 2009;38(2):99.PubMed

25.

Singapore Cancer Registry National Registry of Diseases Office. 2015. Cancer Survival in Singapore 1973–2012. Ministry of Health Singapore, Singapore, Singapore.

26.

Sørensen J, Klee M, Palshof T, Hansen H. Performance status assessment in cancer patients. An inter-observer variability study. Br J Cancer. 1993;67(4):773.CrossRefPubMedPubMedCentral

27.

Zubrod CG, Schneiderman M, Frei E, Brindley C, Gold GL, Shnider B, et al. Appraisal of methods for the study of chemotherapy of cancer in man: comparative therapeutic trial of nitrogen mustard and triethylene thiophosphoramide. J Chronic Dis. 1960;11(1):7–33.CrossRef

28.

Harding R. Informal caregivers in home palliative care. Progr Pallia Care. 2013;21(4):229–31.CrossRef

29.

Singapore Department of Statistics. Census of population 2010: statistical release 1: demographic characteristics, education, language, and religion. Republic of Singapore: Ministry of Trade & Industry; 2011.

30.

Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, et al. The functional assessment of Cancer therapy scale: development and validation of the general measure. J Clin Oncol. 1993;11(3):570–9.CrossRefPubMed

31.

Lyons KD, Bakitas M, Hegel MT, Hanscom B, Hull J, Ahles TA. Reliability and validity of the functional assessment of chronic illness therapy-palliative care (FACIT-pal) scale. J Pain Symptom Manag. 2009;37(1):23–32.CrossRef

32.

Cheung YB, Thumboo J, Goh C, Khoo KS, Che W, Wee J. The equivalence and difference between the English and Chinese versions of two major, cancer-specific, health-related quality-of-life questionnaires. Cancer. 2004;101(12):2874–80.CrossRefPubMed

33.

Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singapore. 1994;23(2):129–138.PubMed

34.

Fillenbaum, GG. Multidimensional functional assessment of older adults: the Duke Older Americans Resources and Services procedures. Hillsdale: Lawrence Erlbaum Associates; 1988.

35.

Yun YH, Kwon YC, Lee MK, Lee WJ, Jung KH, Do YR, et al. Experiences and attitudes of patients with terminal cancer and their family caregivers toward the disclosure of terminal illness. J Clin Oncol. 2010;28(11):1950–7.CrossRefPubMed

36.

CanCORS study components. 2017. https://www.cancors.org/public/servlets/open/home/home.cmd. Accessed 13 Apr 2018.

37.

Ayanian JZ, Zaslavsky AM, Guadagnoli E, Fuchs CS, Yost KJ, Creech CM, et al. Patients' perceptions of quality of care for colorectal cancer by race, ethnicity, and language. J Clin Oncol. 2005;23(27):6576–86.CrossRefPubMed

38.

Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–70.CrossRefPubMed

39.

Beck KR, Tan SM, Lum SS, Lim LE, Krishna LK. Validation of the emotion thermometers and hospital anxiety and depression scales in Singapore: screening cancer patients for distress, anxiety and depression. Asia-Pac J Clin Oncol. 2014;

40.

Malhotra R, Chan A, Malhotra C, Østbye T. Validity and reliability of the caregiver reaction assessment scale among primary informal caregivers for older persons in Singapore. Aging Ment Health. 2012;16(8):1004–15.CrossRefPubMed

41.

Higgins PC, Prigerson HG. Caregiver evaluation of the quality of end-of-life care (CEQUEL) scale: the caregiver's perception of patient care near death. PLoS One. 2013;8(6):e66066.CrossRefPubMedPubMedCentral

42.

Shear K, Essock S. Brief Grief Questionnaire. 2002.

43.

Ito M, Nakajima S, Fujisawa D, Miyashita M, Kim Y, Shear MK, et al. Brief measure for screening complicated grief: reliability and discriminant validity. PLoS One. 2012;7(2):e31209.CrossRefPubMedPubMedCentral

Title: Cost of Medical Care of Patients with Advanced Serious Illness in Singapore (COMPASS): prospective cohort study protocol
Authors: Irene Teo
Ratna Singh
Chetna Malhotra
Semra Ozdemir
Rebecca A. Dent
Nesaretnam Barr Kumarakulasinghe
Wee Lee Yeo
Yin Bun Cheung
Rahul Malhotra
Ravindran Kanesvaran
Alethea Chung Pheng Yee
Noreen Chan
Huei Yaw Wu
Soh Mun Chin
Hum Yin Mei Allyn
Grace Meijuan Yang
Patricia Soek Hui Neo
Nivedita V. Nadkarni
Richard Harding
Eric A. Finkelstein
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Cancer / Issue 1/2018
Electronic ISSN: 1471-2407
DOI: https://doi.org/10.1186/s12885-018-4356-z

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Discussion

Trial registration

Please log in to get access to this content

Other articles of this Issue 1/2018

Population-based phase II trial of stereotactic ablative radiotherapy (SABR) for up to 5 oligometastases: SABR-5

High expression of the p53 isoform γ is associated with reduced progression-free survival in uterine serous carcinoma

Centralising specialist cancer surgery services in England: survey of factors that matter to patients and carers and health professionals

Risk factors for erlotinib-induced hepatotoxicity: a retrospective follow-up study

Are the indications for postoperative radiotherapy in the NCCN guidelines for patients with gastric adenocarcinoma too broad? A study based on the SEER database

Decrease of 5-hydroxymethylcytosine and TET1 with nuclear exclusion of TET2 in small intestinal neuroendocrine tumors

Keynote webinar | Spotlight on antibody–drug conjugates in cancer