Table of Contents
RESEARCH PROPOSAL.. 2
BACKGROUND /LITERATURE REVIEW… 4
AIM OF THE STUDY.. 6
OBJECTIVES OF THE STUDY.. 6
LITERATURE REVIEW… 6
TARGETS TO BE FULFILLED.. 8
SECOND APPROACH –RETROSPECTIVE COHORT STUDY. 8
TARGET OR OBJECTIVES TO BE FULFILLED.. 9
ECONOMICS APPROACH FOR COST ESTIMATION.. 9
TARGETS TO BE ACHIEVED.. 9
DATA ANALYSIS. 10
RESULTS EXPECTED.. 10
ECONOMIC COST OF THE DISEASE.. 10
BUDGET AND TIMELIMIT.. 10
ETHICAL CONSIDERATION.. 11
PREVALENCE OF NON-MELANOMA SKIN CANCER IN AUSTRALIA AS A NEGLECTED ISSUE AND FORMULATION OF AN EFFECTIVE MANAGEMENT STRATEGY
Skin cancer has been reported as the most common form of cancer that is prevalent around the globe (Ferley et al., 2010; AIHW 2012). The major cause of skin cancer is the ultraviolet rays from Sun and exposure to such rays (Madan, Lear, and Szeimis, 2010). But the critical fact due to which the above study was proposed is the incidence of skin cancer is highest in Australia and New Zealand where, out of every five individuals two are most likely to be diagnosed with skin cancer. On the contrary Cancer Australia inquiry report on skin cancer say’s irrespective of incidence rate the death was just 543 i.e. 1.3% of all cancer deaths. Australia being considered as a healthy nation among OECD countries, such numbers are still of primary concern, and there is no assurance that these figures won’t rise in future. Genetic and hereditary role in such scenario can’t be ignored, and high incidence just complements such action. Another concern is the age that shares a positive correlation with non-melanoma skin cancer (NMSC), and as Australia’s population is getting older, slowly the translations of incidence to deaths will not take much time (Fransen et al., 2012).
The patients who develop nodal metastasis have a high chance of cutaneous squamous cell carcinoma a(cSCC) and currently the number of patients diagnosed with cSCC is increasing worldwide making it a major issue of public health (Jameson et al., 2015). The Australian dying of skin cancer are most prone to this disease, and a Western Australia study report says nearly 120 patients have died in cSCC within a span of five years accounting for 1% of all cancer deaths. The cost incurred in treating this disease is significant that includes surgery followed by six weeks of radiotherapy. Literature has shown the current best practice is inefficient as compared to outcomes and the five-year disease survival rate is 70-75% (Nolan, Chan, and Heenan, 2005). Irrespective of best practice guidelines and low death numbers as compared to other cancers, the cost of treating NMSC is high as the persons who have suffered from NMSC tend to experience multiple times. On the contrary, the Australian Institute of Health takes the only incidence into account to calculate the cost and it takes single diagnosis per year as a parameter (Perrera et al., 2015).
It is noteworthy that the patients with NMSC have less chance of morbidity and mortality, but survey and statistics have shown an increasing number of patients are suffering from an advanced form of NMSC. An advance form of NMSC is defined as a type of cSCC where the chances of metastasis in regional lymph nodes are high. The other two sets are all people diagnosed with Merkel cell carcinoma, a small section of people with basal cell carcinoma. The research aims to find out the prevalence of the NMSC through retrospective study and take an economics approach to formulating a better management strategy for control and prevention of non-melanoma skin cancer.
In Australia basal, cell carcinoma is the most common form of skin cancer that is followed by Squamous cell carcinoma. Both these diseases together contribute majorly towards non-melanoma skin cancer. With comparison to non-malignant skin cancer, malignant skin cancer is less than 5% of total skin cancer cases, but the deaths caused by malignant skin cancer is high (Cakir, Adamson, and Singi, 2012). The rate at which the incidence of the non-melanoma skin cancer is increasing, and it is a primary concern with it the impact of this cancer is greater than other cancers combined such as breast, lungs, colon and kidney, etc. Concerning prevalence it has broken the records of other diseases in last three decades 9AIHW, 2012).
In the general management of skin cancer comprises of three stages such as diagnosis, treatment and follows up management. But the diagnosis of skin cancer remains accidental in nature compared to other cancer. Since the disease is mostly asymptomatic, it is diagnosed during routine health check-up or a dermatology check up (Vajdic et al., 2014). According to Australian guidelines, surgery is the recommended treatment for skin cancer lesions and according to 2002 survey, nearly 70% of BCC cases have been surgically treated. One of the most important criteria of management is confirmation of the total removal of lesions in the case of BCC (Pilgrim et al., 2012).
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In cases of cancer, the primary factor is the post-treatment follow-up and further care required as the chances of relapse might exist. Australian institute of health and welfare recommends an intensive follow-up treatment that comprises of check up by every sixth month and continue this till five years. This is recommended for patients with stage I disease, but patients with stage II disease the check-up has to be done for every three to four months, and it has to be continued for five years. Post five years it is recommended for yearly check up for all patients (Fong and Tanabe, 2014).
This raises a very simple question with such stringent guidelines; it is expected to have less incidence of this disease. But statistics says something different that implies there exist particular loophole in the system, and it is still getting neglected. The costs involved in the treatment of non-melanoma skin cancer put pressure on individual sufferers, their families and the total health care system. Indirectly it has also affected the economy of the country with the loss of productivity (early retirement, disabilities, sick leave, etc.) (Guy and Ekwueme, 2011). So combining the fiscal problems with the high incidence rate it can be concluded there is a grave need of an efficient management strategy to control this disease through early diagnosis and prevention and also reducing the cost of treatment in this case. The primary objective of this research is to find out the prevalence of non-melanoma skin cancer in New South Wales region and try to figure out what policy changes are required to early diagnose the disease and reduce the cost of treatment. The outcome expected is the formulation of a management model that reduces the high incidence as well as reduces the cost of treatment and post follow up treatment.
The primary aim of the study is to propose a management plan for non-melanoma skin cancer that will be effective in reducing the incidence and cost of treatment.
To achieve the aim of the study, the following objectives are set
- To find out the prevalence of non-melanoma skin cancer in New South Wales population
- To identify the major risk factors for the non-melanoma skin cancer for the target region and correlation of each factor with the outcome
- What are the current management strategies employed by the Australian health Institute and Cancer Australia
- Estimation of current treatment cost
- Combining cost, risk factor and economic factor into account designing a management model to reduce the incidence and cost of the treatment.
The study methodology includes both primary and secondary research methods to achieve the objectives of the study. The objectives “an” and “b” will be carried out through an extensive literature search from both national research and worldwide database (Lomas, Bee, and Hextall, 2012).
The following strategy will be maintained for database searching and literature review.
Databases to be searched: – Medline (OVID/PUBMED), EMBASE, CINAHL AND GOOGLE SCHOLAR.
Inclusion criteria – The articles must be published in English and must be written in the Australian context.
Reports on the prevalence of skin cancer in New South Wales region are given priority. Both primary and secondary research material are taken into consideration in case the research is focused on the target area.
Articles addressing cost issues from early diagnosis to follow-up treatment are also included in the study. The cost estimation reports or studies from other parts of Australia if linked to skin cancer (non-melanoma) are taken into account.
Web site reports, stakeholders need reports, government white papers, and reports from non-government organizations concerning non-melanoma skin cancer studies in Australia are also taken into account.
Exclusion Criteria – Articles or research papers addressing biological or biophysical aspects of the condition are excluded from the study.
Articles that do not define non-melanoma skin cancer in precise terms are excluded from the studies.
Articles published on or after 2008 is taken into consideration.
A through literature study will be carried out to find out the prevalence of the disease, the risk factors associated, the correlation of each risk factor with the outcome i.e. non-melanoma skin cancer.
- Prevalence can be estimated
- Risk factors can be identified
- Correlation between risk factors and mode of diagnosis of NMSC in the affected population.
The second approach to the study is to carry out a retrospective cohort study with a minimum sample size of 100 (Woodword, 2013). The historical data will be collected from four public hospitals at the different region of New South Wales where the number of the skin cancer patient visit is high. The data will be taken for a fixed period of 2009-2014. The independent variables for the study will be Age, Gender, Sun-exposure, Occupation, and previous treatment of cancer through radiotherapy. It must be noted, and the above independent variables are taken based on studies and literature that shows these factors can attribute towards the development of NMSC in favorable condition.
The dependent variable will be NMSC and types and stages. The data collected will be subjected to statistical intervention. The statistical methods to be followed are – correlational analysis, regression analysis, and multiple variable analyzes. Similarly, pairwise correlational analysis will be carried out to find out the relationship between the taken independent variables and how it is related to NMSC.
Data analysis will be performed through SPSS.
The major risk factor for NMSC can be identified and how they are correlated with NMSC can be established. The primary data can be associated with secondary data obtained from literature study to find the gap and carry out an unbiased study. The study data will help in designing the proper management strategy that address the diagnosis, treatment and follow-up.
The third approach for cost estimation of the diagnosis, treatment and follow-up treatment will follow an economics approach (Barnet et al., 2012). For cost calculation, one approach will be followed i.e. incidence-based approach. Through this, the lifetime economic costs of the disease can be estimated. This lifetime cost estimation will help in the determination of cost-effective strategies and compare it with currently followed procedures. The total economic costs for the year will be calculated by taking some incidence in the same year multiplied by both direct and indirect cost of the rates for the same year.
The cost estimation strategy and calculation will help in determining the direct and indirect costs involved in the management of non-melanoma skin cancer from diagnosis to follow-up treatment. The details of the calculation strategy, parameters followed, epidemiological data taken will be discussed in detail in the full extensive research proposal.
The data analysis will be done through statistics and economic calculations. The rationale for each method will be provided.
The above methodological approaches will help in enriching our current knowledge on NMSC in New South Wales, costs, and better management strategy. The first result expected from the study is epidemiological data that is the prevalence and different risk factors associated with the disease. The productive life lost, age and gender correlation data can be obtained.
The cost economy is critical from study health perspective. This study will help in providing an excellent platform for cost estimation, regulation and future strategies framing for the study.
The current study will be a big one that is divided into three parts. The first part deals with literature review, the second part deals with epidemiological data collection and analysis and the third part deals with economics approach for cost estimation.
|Work Types||Time limit||Budget|
|Literature review (Through University database)||3 weeks||$500 (for printing)|
|Epidemiological data collection (Getting data from cancer registry, retrospective cohort data collection reports, data from Australian Bureau of Statistics ) and analysis||1.5 months||$5000|
|Cost Estimation||1 month||$2000|
|Human resources involved||$8000|
|Contingency and Miscellaneous||$3000|
The university ethical committee permission, as well as the New South Wales health department approval, must be made for the comprehensive research to be completed. The ethical guidelines will be maintained from starting to end of the research. Care must be taken to keep the confidentiality of participants in the study (Creswell, 2013).
The high incidence rate of NMSC in Australia irrespective of extensive management guidelines implicates particular gap to be present in the strategy. With an aging population, the incidence will increase in near future. In such situation, it demands such mixed methodology research must be done to link cost with epidemiology and management data. The high prevalence studies have been done earlier, but the exact reason and inadequate diagnosis is yet to be revealed that suggest this issue is a neglected one and demands more research.
Australian Institute of Health and Welfare. Cancer in Australia: an overview, 2012. Cancer series no. 74. Cat. No. CAN 70. Canberra: AIHW; 2012.
Barnett, K., Mercer, S. W., Norbury, M., Watt, G., Wyke, S., & Guthrie, B. (2012). Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. The Lancet, 380(9836), 37-43.
Cakir, B. Ö., Adamson, P., & Cingi, C. (2012). Epidemiology and economic burden of nonmelanoma skin cancer. Facial plastic surgery clinics of North America, 20(4), 419-422.
Creswell, J. W. (2013). Research design: Qualitative, quantitative, and mixed methods approaches. Sage publications.
Ferlay, J., Shin, H. R., Bray, F., Forman, D., Mathers, C., & Parkin, D. M. (2010). Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 10 [Internet]. International Agency for Research on Cancer.
Fong, Z. V., & Tanabe, K. K. (2014). Comparison of melanoma guidelines in the USA, Canada, Europe, Australia and New Zealand: a critical appraisal and comprehensive review. British Journal of Dermatology, 170(1), 20-30.
Fransen, M., Karahalios, A., Sharma, N., English, D. R., Giles, G. G., & Sinclair, R. D. (2012). Non-melanoma skin cancer in Australia. Med J Aust, 197(10), 565-8.
Guy Jr, G. P., & Ekwueme, D. U. (2011). Years of potential life lost and indirect costs of melanoma and non-melanoma skin cancer. Pharmacoeconomics, 29(10), 863-874.
Lomas, A., Leonardi‐Bee, J., & Bath‐Hextall, F. (2012). A systematic review of worldwide incidence of nonmelanoma skin cancer. British Journal of Dermatology, 166(5), 1069-1080.
Madan, V., Lear, J. T., & Szeimies, R. M. (2010). Non-melanoma skin cancer. The Lancet, 375(9715), 673-685.
Nolan, R. C., Chan, M. T. L., & Heenan, P. J. (2005). A clinicopathologic review of lethal nonmelanoma skin cancers in Western Australia. Journal of the American Academy of Dermatology,52(1), 101-108.
Perera, E., Gnaneswaran, N., Staines, C., Win, A. K., & Sinclair, R. (2015). Incidence and prevalence of non‐melanoma skin cancer in Australia: A systematic review. Australasian Journal of Dermatology.
Pilgrim, W., Hayes, R., Hanson, D. W., Zhang, B., Boudreau, B., & Leonfellner, S. (2014). Skin Cancer (Basal Cell Carcinoma, Squamous Cell Carcinoma, and Malignant Melanoma): New Cases, Treatment Practice, and Health Care Costs in New Brunswick, Canada, 2002–2010. Journal of cutaneous medicine and surgery, 18(5), 320-331.
Vajdic, C. M., Stavrou, E. P., Ward, R. L., Falster, M. O., & Pearson, S. A. (2014). Minimal excess risk of cancer and reduced risk of death from cancer in Australian Department of Veterans’ Affairs clients: a record linkage study. Australian and New Zealand journal of public health, 38(1), 30-34
Woodward, M. (2013). Epidemiology: study design and data analysis. CRC Press.
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