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Subject:
sentinel node ; cost ; quality of life ; satisfaction
Abstract:
The increase in the number of cases of malignant neoplasms leads to the intensive development of medical sciences focusing on research into innovative methods of screening and treatment, which contribute to the improvement of diagnosis at an earlier stage of advancement and more effective treatment. Verification of sentinel lymph nodes in patients with breast cancer and melanoma allows to determine the regional staging of malignancy and helps to improve the effects of its treatment. The implementation of new medical procedures is associated with the need for additional funding covering the costs of their implementation, and the need to assess patient satisfaction with care and treatment used, taking into account the quality of life related to health. The aim of the dissertation was to evaluate the benefits of sentinel node biopsy in terms of financial results, satisfaction with care and quality of life. The study was carried out in the Department of General and Oncological Surgery of Frederic Chopin Clinical Provincial Hospital No. 1 in Rzeszow. 136 patients with microscopic examination which confirmed breast cancer or melanoma who underwent surgery with sentinel node biopsy were included in the study. Surveys were conducted during hospitalization for the procedure (time T1) and 6 months after sentinel node biopsy (time T2). The following tools were used in the study: an inte ; rview questionnaire, an original survey questionnaire containing elements of care satisfaction, and an EORTC QLQ-C30 questionnaire. In the next stage of the study, the patient's medical files were analyzed along with the sources of direct and indirect costs of procedures with sentinel node biopsy. The obtained data were subjected to statistical analysis. The research results confirmed that the financial resources transferred by the National Health Fund cover the costs of sparing breast cancer treatment and simple mastectomy with sentinel node biopsy, while they do not cover the cost of wide secondary excision of scar with sentinel node biopsy in patients with melanoma and lymphadenectomy performed in patients at the second stage of treatment in the case of metastases to sentinel node. Only in the case of BCT with SNB, the treatment margin in the first stage would cover the cost of lymphadenectomy. Patient satisfaction with care was determined by clinical and sociodemographic factors. Patients with breast cancer assessed the treatment as more burdensome than those with melanoma. Factors such as age below 50, secondary education had an impact on the worse assessment of the conditions of hospitalization regarding access to the media, while lower material status of patients affected a better assessment of nursing care. The patients during time T1 demonstrated worse quality of lif ; e in terms of physical functioning than during time T2 - 6 months after surgery, but better in terms of symptoms associated with the occurrence of disease symptoms and financial problems. Elderly people assessed their quality of life worse in terms of physical functioning, activities of daily living and mental functioning as well as disease symptoms. Men, people with higher education, professionally active, with higher material status assessed their quality of life better in individual areas. Patients with breast cancer rated their quality of life worse in terms of physical functioning and disease symptoms, and showed that they had greater financial problems than those with melanoma. However, assessment of quality of life in patients with melanoma additionally depended on the Clark levels of invasion and the Breslow depth. The higher the severity of the disease, the worse the quality of life was assessed, especially in terms of mental functioning and occurrence of dyspnea. There is a need to continue research on the assessment of quality of life, satisfaction with care and treatment, and continuous monitoring of the cost of procedures to ensure proper funding.
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Degree grantor:
Rada Dyscypliny Nauki o zdrowiu
Promoter:
Wysocki, Wojciech Maria ; Penar-Zadarko, Beata