M. van der Pol

Community photo-triage for skin cancer referrals: an aid to service delivery

Background.  We wished to investigate the potential for extending the capacity of the specialist service by using community‐based photo‐triage for suspected skin cancers.

Cost-effectiveness of non-consensus double reading

Abstract This study examines radiologist reading policies with breast screening; specifically it estimates the incremental cost-effectiveness of non-consensus double reading compared to single reading. Cost-effectiveness is measured in terms of the cost per cancer detected. Data on effectiveness from a study of 255 000 women attending five Scottish centres, over the period 1992–1996, are combined with cost data from a recent study of eight UK screening centres. The incremental costs per cancer detected by double reading compared to single reading range from £1162 (US

Assessing the resource implications of extending routine invitation to breast screening to women aged 65–67 years

1859) to £2221 (US

Economic analysis of outreach assessment clinics in breast screening programmes.

3554) depending on assumptions with respect to screening and assessment costs.

OP30 Exploring Reasons for Different Health Outcomes between Identically Deprived Post-Industrial UK Cities

UK breast screening policy currently restricts routine 3-yearly invitation to screening to 50-64 year olds. However, it is likely that routine invitation will be extended to 65-67 year olds in 2001. This paper first predicts the additional demand for breast screening as a result of this new policy by modelling the response to the 1998 invitation of women eligible for screening in 2001. The independent variables include (i) the womans characteristics: her screening history; the deprivation score of the area she lives in; and (ii) the characteristics of the screening: whether the screening took place in a mobile van or at a static site; and time of the year. The modelling of attendance is quite successful in that most hypothesised variables have the expected sign. It is estimated that an additional 10829 women will be screened per annum. The additional invitation, screening and assessment costs are expected to be approximately pound350000 in 2001.

The PRIME (Post-Operative Radiotherapy in Minimum-Risk Elderly) Breast Cancer Trial of Adjuvant Radiotherapy after Breast Conserving Surgery: Impact on Quality of Life and Cost-Effectiveness at Three Years.

A model is developed for the economic evaluation of outreach assessment clinics following screening and used to identify the cost-minimizing strategy for assessing women from three island communities in the Scottish Breast Screening Programme (SBSP). There are four options of interest depending on: whether the women are assessed on the mainland or at outreach assessment clinics; and whether all women have two view screening rather than only those being screened for the first time. The benefits of outreach assessment are assumed to be solely in terms of convenience to women and reductions in the time and travel costs of women recalled for assessment. The costs are modelled in order to compare outreach and no outreach options. The results show that for the numbers of women currently screened outreach assessment is the cost-minimizing strategy. The model provides useful guidance with respect to screening policy and is readily applied to the case of outreach assessment in mainland communities outwith major population centres and to breast and other screening programmes in other countries.

A randomised controlled trial of postoperative radiotherapy following breast-conserving surgery in a minimum-risk older population. The PRIME trial.

Background Research has shown that Glasgow has an almost identical deprivation profile to Liverpool and Manchester. However, premature mortality is 30% higher, with mortality at all ages almost 15% higher. Many hypotheses have been proposed to explain this phenomenon: for many, however, no data have been available by which their plausibility could be properly assessed. Methods A representative population survey of Glasgow, Liverpool and Manchester was undertaken. Data for various hypotheses were collected from 3,600 respondents (1,200 in each city): a 55% response rate was achieved. The hypotheses included: lower ‘sense of coherence’ (SoC) in Glasgow; lower social capital; the effects of historical government policy; different individual ‘values’ (e.g. psychological outlook (optimism, aspirations)), hedonism; lower social mobility. Wherever possible, previously validated questions and scales were used (e.g. Antonovski’s SoC Scale, Schwartz’s Human Values Scale, Life Orientation Test). Multivariate linear and logistic regression analyses were employed to assess whether any differences existed between the cities for these topics (after adjustment for age, gender, ethnicity, social class, area deprivation, education etc). Results Aspects of social capital (trust & reciprocity, social participation) were significantly lower in Glasgow. For example: respondents in Liverpool and Manchester were more than twice as likely to have volunteered in the previous year compared to those in Glasgow (fully adjusted ORs Liverpool 2.6 [2.0, 3.4], p<0.0001; Manchester 2.5 [1.9, 3.3], p<0.0001); Liverpool and Manchester respondents were significantly more likely to report that ‘most people in their neighbourhood could be trusted’ (odds ratios: Liverpool 1.71 [1.4, 2.09], p<0.0001; Manchester 1.45 [1.18, 1.78], p<0.0001). However, SoC was shown to be significantly higher in Glasgow: Liverpool and Manchester respondents were associated, respectively, with fully adjusted mean SoC scores of -4.99 (-5.95, -4.03), p<0.0001 and -8.10 (-9.06, -7.14), p<0.0001 compared to those in Glasgow. The Glasgow sample was not associated with more negative individual values (e.g. lower optimism, hedonism), nor by motivations for social mobility. No clear ‘city’ differences emerged from the political effects questions. Conclusion These new data suggest that some of the hypotheses proposed to explain higher mortality in Glasgow are plausible (social capital), and others less plausible (e.g. lower ‘sense of coherence’, different ‘values’). Others (e.g. political effects) remain less clear and require different methodological approaches. These analyses add focus to future research needs to help better understand reasons for excess levels of poor health seen in Glasgow compared to these two very similar post-industrial cities.

A randomised controlled trial of post-operative radiotherapy following breast-conserving surgery in a minimum-risk population. Quality of life at 5 years in the PRIME trial.

Background:Breast cancer in older women is a major and rising health care burden, due to demographic changes in the population. This places increasing pressure on the finite resources of radiotherapy treatment centres.If local recurrence rates in older ‘low risk’ patients were sufficiently low with the omission of radiotherapy (RT) following breast conserving surgery and adjuvant endocrine therapy, decisions on treatment might be influenced by considerations of Quality of Life (QoL) and cost-effectiveness.Methods: Patients over the age of 65 with a ‘low risk’ breast cancer (T0-2,N0,M0) were randomised to receive whole breast RT (40-50 Gy in 15-25 fractions) or no further treatment. All patients received endocrine therapy.Participants completed a questionnaire at baseline (before randomisation), two weeks after the end of RT (or equivalent time), and then at nine, 15 and 36 months after surgery. QoL was measured by the EORTC QLQ-C30 and -BR23 modules. The Hospital Anxiety and Depression Scale was included to measure mental health, and the EuroQol was used to calculate QALYs for the assessment of cost-effectiveness. Some open-ended questions were included to capture items of potential importance to the patients.Results: Although no differences in the overall QoL scores were detected, there were statistically significant differences between the irradiated and non-irradiated groups in insomnia (higher in the no RT group, p=0.01), breast symptoms (higher in the RT group, p Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 958.