Osaka University, Japan
Title: Agreement between patients’ and proxies’ reports of health related quality of life in patients with end-stage lung cancer in Japan
Tomoyuki Takura, Ph.D.-medicine, now is a Professor of Health Economics and Industrial Policy Department, Program faculty of Interdisciplinary Program for Biomedical Sciences, Committee member of hospital management planning office (Osaka University hospital), Special examination committee of national insurance (Ministry of Health, Labour and Welfare), Committee of health care industrial platform (Ministry of Economy, Trade and Industry), Member of councilor (Japanese Association of Cardiac Rehabilitation and Japanese Society for Artificial Organs, etc.). He got his Engineering Master’s degree (MEng.) at Hokkaido University graduate school of engineering, Specialist in healthcare economics and technology assessment, Medicine Doctor's degree (Ph.D.) at Tokyo Women's Medical University graduate school of Medicine. And Dr. Tomoyuki Takura got the Student Entrepreneur Championship Award of Tokyo Metropolitan Government in 2003. Currently his researches focus on socioeconomic evaluation of renal transplantation and cost effectiveness analysis of revascularization for ischemic heart disease.
The number of death from lung cancer in Japan has ranked first since 1988 and tends to increase hereafter. However, there are few reports on value evaluation of palliative care for lung cancer patients with end-stage, especially the research is rare concerning medical economic evaluation related to palliative care. For performance analysis focusing on the ratio between utility and cost related to intervention of palliative care, it is indispensable to calculate Quality Adjusted Life Year that is one of outcome indexes. However, it is usually difficult to obtain data of health related quality of life (HRQoL) from the patients themselves at the end stage. Therefore, we verified appropriateness of proxy reporting of HRQoL by Health professionals (nurses). 16 lung cancer patients (aged 67.75±6.74) at the stage IV participated in the study. Euro-QoL Five-Dimension Questionnaire (EQ-5D) was reported for three days per patient. Proxy reporting of EQ-5D was executed by five certified nurses in the field of cancer nursing. Inter-rater agreement levels for the reporting of EQ-5D by patients and proxies were verified. The total score of EQ-5D was found to be statistically significant positive correlation between patients reporting and proxies reporting (Rs=0.654, p<0.01). Also, the scores for each item of EQ-5D had statistically significant positive correlation in “mobility”, “self-care”, and “pain/ discomfort” between patients and proxies (p<0.01). From the above, it is presumed that proxy reporting by nurses possesses certain explanation capability even at the end stage of lung cancer patients.