Tran Thu Ngan. In other words, patient-level costing allows the comparison of costs between subgroups (defined by stage at diagnosis and treatment options) as well as the identification of cost drivers. Being married and frequent migration were two contributing factors, with marital status strongly linked to poor treatment success rates. Our Board Certified surgeons specializes in testing, diagnosis and treatment of all types of breast cancer and breast disease. Our focus related to health system organisation, service availability and readiness, technology, human resources, financing and patient management as identified by the WHO Health Systems Framework [8]. Variation in costs may be influenced by types of health services related to BC D&T and the utilisation of SHI for each service. Costs of breast cancer treatment incurred by women in Vietnam, https://doi.org/10.1186/s12889-021-12448-3, https://data.worldbank.org/indicator/SH.XPD.OOPC.CH.ZS, https://doi.org/10.1007/s11136-021-02997-w, https://www.imf.org/external/pubs/ft/weo/2019/01/weodata/index.aspx, http://www.cancercontrol.info/cc2016/cancer-control-in-vietnam-where-we-are/, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. Background: Breast cancer incidence has been increasing consistently in Vietnam. Individual-level data about out-of-pocket (OOP) expenditures on use of services were collected from women treated for BC (n=202) using an online survey and a face-to-face interview at two tertiary hospitals in 2019. Our surgical oncologists treat the full range of adult cancers tumor, with specialties in: Breast Cancer Age, household monthly income, and reimbursement rate of SHI were not significantly associated with costs, similar to the previous study in Vietnam [11]. Policies that help downstaging BC at diagnosis will lessen the costs of treatment borne by the patients and their financial toxicity as well as increase the access to care and outcomes of treatment. This work was supported by a British Council Newton Grant (Institutional Links) under Grant number: 216383378. 2021. https://doi.org/10.1007/s11136-021-02997-w. Epub 2021 Sep 20. Immediate Reconstruction -While a patient is in the operating room receiving surgical treatment for breast cancer, the breast plastic surgeon performs reconstructive breast surgery using tissue obtained from another part of the body (flap) (a)bdomen or inner thigh or with an implant. For each of the utilised services, respondents reported how much was the OOP expense by answering the question What were the costs you paid for that service?. A systematic review of health economic evaluation studies using the patients perspective. In one study of 129 eligible patients, 56.6% were diagnosed at Stage II, 27.1% at Stage III and 9.3% at Stage IV. 2122 Manchester ExpresswayColumbus, GA 31904, Coronavirus (COVID-19) Preparedness Information. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Preoperative chemotherapy is the preferred primary treatment for locally advanced breast cancer because it allows an early assessment of sensitivity to treatment as well as breast conservation [10]. Radiation therapies should be available, given their efficacy in treating early-stage breast cancer and as breast conservation treatment [10]. Our Board Certified surgeons specializes in testing, diagnosis and treatment of all types of breast cancer and breast disease. Data on treatment outcomes would be useful within an audit, and as a measure of success within any evaluation. All costs were self-reported by respondents and were subject to recall bias though by cross-checking information with service price lists in hospitals or regulated by thegovernment and market price of drugs, no unreasonable or inconsistent data were flagged. The excess costs of breast cancer health care in Hispanic and non-Hispanic female members of a managed care organization. There has been limited research published on breast cancer services in Vietnam. Hoang VM, Pham CP, Vu QM, Ngo TT, Tran DH, Bui D, et al. For example, research from Vietnamese women living in the United States shows that they are less likely to undergo CBE or mammography than American women [40]. It is recommended that by 45 years of age, women start having annual mammograms. Our Board Certified surgeons specializes in testing, diagnosis and treatment of all types of breast cancer and breast disease. The trend is similar though higher than the pooled result from a systematic review of global treatment costs of BC by stage in which the rate was 32 and 95% respectively [13]. Lumpectomy preserves the breasts exterior and shape, while removing cancerous tissue along with a thin margin of healthy tissue to help ensure cancer eradication. ESMO Open. In: Son NT, Khue LN, Khoa MT, editors. The Ministry of Health has developed long-term goals, including the extension of screening programmes and building systemic capacity for diagnosis and treatment (both in facilities and in human resources) [16], but, as highlighted by Trieu et al., In Vietnam, despite increased health care and public awareness, a breast cancer national control program as recommended by the WHO has not yet been established [21]. Before The authors declare that they have no competing interests. Hanoi: Statistical Publishing House; 2016. Liao XZ, Shi JF, Liu JS, Huang HY, Guo LW, Zhu XY, et al. Vietnam was ranked 46/186 countries in terms of the share of healthexpenditure from OOP which was higher than the 30% upper bound recommended by the World Health Organization (WHO) [2, 3]. Breast Cancer Res Treat. 2004;19(1):6377. There are very few studies and trials on detection of breast cancer. Population factsheets: Vietnam [Internet], Scoping studies: towards a methodological framework. Costs were presented with and without outliers. Compared to stage 0/I, the proportion of patients in stage II/III that utilised mastectomy, chemotherapy, and radiotherapy was significantly higher (Fig. Thus, studys results have good generalisability. Health service utilisation (related to breast cancer) and the corresponding utilisation of SHI to pay for any part of the cost, among respondents who used such services are presented in Fig. The ordering provider examines the DEXA results and manages the care. About one-third (36.4%) of the women were diagnosed between the ages of 4049years, and another 32.6% between 50 and 59years of age [27]. travel, accommodation and time) and indirect costs (lost income). The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. Amendements to the Law on health insurance, Pub. official website and that any information you provide is encrypted In one study, although no significant difference was found for cost of treatment between those diagnosed at an early versus late stage of disease, the survival times were significantly longer for those women diagnosed at an earlier stage [27]. 706.257.7700. 20132015 [Internet]. 2015. Stereotactic breast biopsy is a minimally-invasive way to biopsy a breast abnormality identified through mammography. Mean total OOP cost related to diagnosis and initial BC treatment (excluding targeted therapy cost) was 61.8 million VND ($2667). Public support for breast cancer awareness and research funding has helped improve diagnosis and treatment methods. Respondents identified the treatments that they received from a list including lumpectomy, mastectomy, breast reconstruction surgery, chemotherapy, radiotherapy, hormone therapy, and targeted therapy. For oestrogen-receptor positive cancers, five years of endocrine drug therapy is recommended. Survival probability and prognostic factors for breast cancer patients in Vietnam. Several studies have investigated the impact of the time interval between the onset of breast cancer symptoms and the start of cancer treatment on prognosis and showed that delays in diagnosis and treatment increased the chances of cancer diagnosis at a late stage, which led to more aggressive treatment and poor survival. Lymph node dissection, performed during lumpectomy or mastectomy, primary breast lymph nodes located in the armpit area are dissected and biopsied to see if cancer has spread to other parts of the body. However, the nature and extent to which there is a good match between guideline recommendations, planned activities and service provision are not clear. Breast Surgery & Breast Care | hartfordhealthcaremedicalgroup.org Centre for Population Health Sciences, Hanoi University of Public Health, Hanoi, Vietnam, d Breast cancer also accounts for the second-highest rate of cancer-related deaths in the state. A study in Portugal found that systemic therapy (targeted therapy + chemotherapy) accounted for 69.2% of the total treatment cost of HER2+ patients which, in turn, was four times higher than patients with other BC subtype [36]. Breast Surgery & Breast Care Hartford HealthCare Medical Group is a leader in breast care and the treatment of breast disease. In the 1990s, the most common site-cancer was cervical/uterus, Breast cancer is commonly diagnosed at later stages (Stage II=61.2%) and in women between the ages of 45 and 55, Geographical variations. Breast Biopsy (Stereotactic, Ultrasound or MRI)A breast biopsy is recommended when a suspicious finding is identified on a mammogram or breast ultrasound. Cancer prevention in Asia: resource-stratified guidelines from the Asian oncology summit 2013. All respondents (100%) used SHI to pay for targeted therapy cost. Breast cancer stages range from early to metastatic, with a variety of treatment options available at each stage. Cite this article. Trieu PDY, Mello-Thoms C, Brennan PC. The We Care For Her campaign additionally reported providing free breast screening for an estimated 4000 women across five provinces in 20132014. Breast cancer services in Vietnam: a scoping review - PMC In comparison with higher income contexts, incidence remains quite low. Call (309) 683-5522. Female breast cancer in Vietnam: a comparison across Asian specific regions. This study presents patient-reported direct payment to health care providers at time-of-service use (excluding the amount covered by SHI, if any) which is the costs of BC D&T from a patient perspective. It outlines areas for future focus for policy makers and researchers with the objective of strengthening service provision to women with breast cancer across the country while also providing a methodological example for how to conduct a collaborative scoping review. Boca Raton: CRC Press, Taylor & Francis Group; 2012. Generally, there is a need to improve our understanding about how women with breast cancer seek help and interact with the health care system. This would allow forward planning by placing such data in the context of evaluating the capacity of the system to treat women with chemotherapy and radiotherapy. . Breast cancer treatment costs in younger, privately insured women. Component costs contained outliers and missing data (666% depending on the specific treatment concerned). English. Ultrasound can help a radiologist determine whether the abnormality on the mammogram is cystic or solid. The mean OOP costs of BC D&T at stage II and III were, respectively, 66 and 148% higher than stage 0/I. 2018;14(1):315. It is unclear to what extent this approach has been implemented in Vietnam. 3-D mammography is the most effective breast cancer screening tool today. TTN, MD, and CON contributed to the study conception and design. Maintaining a healthy weight through proper nutrition and exercise is critical to a womans health. Targeted therapy for HER2+ patients does not tend to be prescribed in Vietnam when it is known that patients cannot afford the treatment (personal communication). Due to the COVID-19 pandemic, the symptomatic breast clinic at St. Vincent's University Hospital had to cancel both follow up and non-urgent new referral appointments from mid-March 2020. The provision of good-quality, safe and timely surgery is the primary breast cancer treatment recommendation for countries with resource limitations [14,37]. Kleinke K. Multiple imputation by predictive mean matching when sample size is small. However, due to inadequate monitoring and inspection as well as enforcement, the population coverage stood at 81.7% in 2016 [7, 14]. Hormone therapy was offered to 75% of the group finishing the study over the five years after receiving their primary treatment [28]. St. Francis Cancer Center | Colorado Springs | Centura - Centura Health Chad Barrett Johnson M.D. Breast Center | St. Francis Center for Breast Health We're Located At. It includes surgery (e.g., lumpectomy, mastectomy, breast reconstruction surgery), radiotherapy, and systemic therapies (e.g., chemotherapy, hormone therapy, targeted therapy) [11, 12]. Responsible Editor Stig Wall, Ume University, Sweden. When the outliers were removed, diagnosis was the cheapest service with mean cost at 2.6 million VND ($112). Due to risk of recall bias and difficulties in measurement, we could not collect the costs of follow-up treatment; direct non-medical costs (i.e., transportation, meal, accommodation) and indirect costs (i.e., lost income, premature death) were also not gathered. Thus, using patient-level data in the calculation of costs (rather than calculating according to clinical guideline-informed treatment pathways) can reveal between-patient heterogeneity [13]. 2019;19(1):318. She graduated from VANDERBILT UNIV SCH OF MED|Vanderbilt University in 1999. They are able to do that with the most advanced tools in the area and in a brand new facility. Buuren Sv. 6 , 8 , 13 Our study . Surgery. CHE occurred more often among households with breast cancer patients compared with households of patients with other cancer types (72% vs 57%, respectively) [ 5 ]. Outliers were defined as values which fell more than 1.5 times the interquartile range (IQR) above the third quartile (Q3) or below the first quartile (Q1) (outliers if value > Q3+1.5IQR orThe Cancer Institute at St. Francis Hospital The Pearlie Harris Center for Breast Health is located in Suite 220 on the second floor of Building 131 on the campus of St. Francis Eastside. We are accredited by the American College of Radiology and have an array of diagnostic tools available, including 3D mammography, Automated Breast Ultrasound, Nuclear Breast Imaging, and Breast MRI. This cost composition is consistent with the previously noted study in Vietnam [11]. Available from: https://www.imf.org/external/pubs/ft/weo/2019/01/weodata/index.aspx. 2016; Available from: http://www.cancercontrol.info/cc2016/cancer-control-in-vietnam-where-we-are/. Directions. Cancer Control. We extracted relevant details (including contextual information such as socio-economic data, demographics and incidence rates) and charted them to assist with our analysis of the findings. Patients have access to education and other resources, support and specialists from a multidisciplinary team of experts. After diagnosis, breast cancer treatment quickly follows at the Cancer Institute at Saint Francis Medical Center. Questions used to estimate the cost of BC D&T are presented in the supplementary material. 2001;66(1):2531. Received 2017 Dec 7; Accepted 2018 Jan 24. Glob Health Action. Closing these knowledge gaps would contribute to research-informed planning and resource allocation. We Know Cancer. It is likely that economic barriers such as the role of health insurance and the capacity to make co-payments play a role in late detection, but there is a need for empirical studies to investigate this issue. Gelband H, Sankaranarayanan R, Gauvreau CL, et al. Find a Doctor Request an Appointment. Costs of follow-up treatment is difficult to precisely estimate given recall bias and unknown compliance [11] and costs of initial treatment were unknown for those had not yet completed this treatment. Respondents were asked What was their stage of cancer at diagnosis with simplified options of stage 0, stage I, stage II, stage III, stage IV, and do not know/do not remember to minimise recall bias. [27] did not account for direct non-medical costs (e.g. This review shows the need for further research dedicated to the strengthening of breast cancer services. St. Francis Breast Surgery provides comprehensive breast care, including high-risk screening, breast biopsies, and breast surgeries. Mammograms are available at St. Francis Center for Breast Health. All respondents in the study had SHI and the majority (82%) had SHI with 80% reimbursement rate (co-payment=20%). Thus far, there have been no analytical reviews of research produced within this area. Screening with BSGI takes about 45-60 minutes, and unlike a mammogram, there is a small amount of compression. Journal for Scientific Research (Vietnamese). Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012, GLOBOCAN 2012: estimated cancer incidence mortality and prevalence worldwide in 2012. The average OOP for D&T of BC in Vietnam was 61.8 million VND ($2667) which is substantially higher than previous estimates based on costs incurred bythe government and indicates the considerable financial burden associated with BC to the patients and their families. Breast cancer (BC) is the most common cancer among Vietnamese women with increasing incidence over time and the highest number of cancer-related deaths [6, 7]. Terms and Conditions, Int J Equity Health. Mastectomy remains the most available, effective basic surgery option in low-income countries. The scope and range of the articles in this review show that there is a relative lack of data related to detection, diagnostic and treatment services for breast cancer in Vietnam. We focused specifically on research discussing the health system and service provision. Trastuzumab is not generally considered a cost-effective option in low-resource settings [13], a conclusion that is contrary to one of the articles returned in our literature search [32]. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, Review all available published and grey litera-ture on the organisation of breast cancer services in Vietnam, Chart data related to detection, diagnosis and treatment, Identify themes relevant to systems strength-ening, breast cancer, cancer, Vietnam, health systems, scoping review, NCDs. These include trastuzumab, which can cost between 200million and 800million VND per year for individual treatment (US$10,00040,000). Out-of-pocket expenditure (% of current health expenditure). Breast MRIAn advanced imaging tool aiding in the early diagnosis of breast disease and breast cancer. Our review showed that there has been no review of levels of awareness among health professionals about breast cancer symptoms in relation to whether health care professionals are able to conduct CBEs and appropriately refer women with abnormal lumps and other symptoms for diagnostic confirmation. These surgeons perform the full range of breast cancer procedures, including lumpectomies to remove cancer tumors, mastectomies for more extensive cancer, and reconstructive surgery. By using this website, you agree to our The work reported in this paper was undertaken during TTNs PhD studies which is funded by the Profs Murray-Yarnell PhD studentship from Faculty of Medicine and Health Sciences, Queens University Belfast (United Kingdom). Chad Barrett Johnson M.D. Our Board Certified surgeons specializes in testing, diagnosis and treatment of all types of breast cancer and breast disease. Margaret West Comprehensive Breast Center - West - West Cancer Center 2017;2017:9350147. https://doi.org/10.1155/2017/9350147. Treatment options across the country widely vary depending on geographic location, with a strong rural/urban difference [21], and while most provincial hospitals officially provide surgical services, as of 2008 (more recent information not found), 10 of them stated that they could not offer this service and regularly referred patients elsewhere [33]. Another study revealed that 79% of the 948 women completing the study received surgery, while 10% received chemotherapy (primary treatment) [28]. Greenup RA, Rushing C, Fish L, Campbell BM, Tolnitch L, Hyslop T, et al. Participants of the originalstudy included both women who were receiving initial treatment and those who had finished initial treatment and were discharged from hospital. Surgery, either stand-alone or in combination with other treatment modalities, represented the most common form of treatment for breast cancer in the studies examined. Total expenditures on diagnosis and initial BC treatment were presented in terms of the mean, standard deviation, and range for each type of service use. For certain drugs, only 50% of costs are reimbursed. 2014;33(11):205763. Global cancer surgery: delivering safe, affordable, and timely cancer surgery, Cancer control in Vietnam. These drugs include Trastuzumab and other specialist drugs for the treatment of cancers and breast cancer, Intersectoral Circular No. Our patient-centered approach means that our entire team works together to make sure everyone involved in your care is on the same page. The first draft of the manuscript was written by TTN. Salampessy BH, Alblas MM, Portrait FRM, Koolman X, van der Hijden EJE. PMM randomly draws an imputed value from a set in the donor pool (observations with the closest value predicted by linear regression model for the missing one) [25, 26, 28]. Columbus, GA 31904, Phone: We identified grey literature through an online search. CON, MD, and HVM provided supervisory support and reviewed this paper. However, women at a higher risk of breast cancer due to familial history, genetic predisposition or other factors may need to start screenings much earlier. What are outliers in the data? The National Cancer Control Programme offers free screening for all women [clinical breast examination (CBE), ultrasound, and mammography in case of referral], but information was not found on either its broader coverage or strategies for scaling up existing programmes. Secondly, costs were calculated from the public payers perspective using unit costs which, in Vietnam, are much lower than the real cost of the resources used due to underestimation of health workforce remuneration and capital depreciation [11, 32].

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