1396P - Lung cancer in homeless people: Clinical outcomes and cost analysis in a single institute

Date 28 September 2014
Event ESMO 2014
Session Poster Display session
Topics Bioethics, Legal, and Economic Issues
Cancer in Special Situations
Lung and other Thoracic Tumours
Presenter Koung Jin Suh
Citation Annals of Oncology (2014) 25 (suppl_4): iv486-iv493. 10.1093/annonc/mdu353
Authors K.J. Suh1, K.H. Kim2, J. Im1, J.H. Park2, J. Kim2, I.S. Choi2
  • 1Internal Medicine, Seoul National University Hospital, 110-744 - Seoul/KR
  • 2Internal Medicine, Seoul National University Boramae Medical Center, Seoul/KR

Abstract

Aim

Homeless people have limited access to medical care despite their higher risk for medical illnesses. The aim of our study was to describe the demographic and clinical features as well as the outcomes of lung cancer in homeless people and to calculate the costs for the treatment.

Methods

We retrospectively analyzed 22 homeless patients diagnosed with lung cancer between 2005 and 2013 at a single center in Seoul metropolitan city, South Korea. Costs were calculated referring to health care claims obtained from the Seoul National University Boramae Medical Center.

Results

The median age of patients was 62 years and all patients were male. 68% were current or ex-smoker. Histologic diagnoses were as follows: non-small cell lung cancer (n = 16), small cell lung cancer (n = 3) or unknown (n = 3). Most of the patients (78%) had an advanced disease (stage IIIB; n = 2, stage IV; n = 15); five patients (23%) died during their initial hospitalization with a median survival of 1.5 months (0.4-2.4 months); seven (32%) were lost to follow-up after an initial outpatient visit or discharge from initial admission, with a median follow-up duration of 14 days (1-30 days) and only five patients (23%) received an appropriate treatment for their lung cancer (palliative chemotherapy and/or tyrosine kinase inhibitor, n = 3; whole-brain radiation therapy, n = 1; craniotomy and tumor removal, n = 1), with a median follow-up duration of 12.6 months (1.3-19.7 months). In contrast, four of five patients with an early stage of disease (22%, stage I; n = 4, stage IIA; n = 1), received a curative surgery. Their median follow-up duration was 25.9 months (2.5-77.3 months). In total, median follow up duration and days of hospitalization were 30 days and 26 days, respectively. The median treatment costs amounted to €8,922 (based on an exchange rate of Korean Won 1440 = Euro €1), constituting 47.3% of the per capita income in 2013. 98% of the costs were attributed to the inpatient treatment. The National Health Insurance paid 85% of the costs and the remainder was financed by the homeless shelter in which the patient lived or by the Seoul Metropolitan Government if the patient lived on the streets.

Conclusions

Among the homeless, lung cancer is associated with a poor prognosis and substantial costs during the relatively short follow-up and survival period.

Disclosure

All authors have declared no conflicts of interest.