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Costs and effectiveness in the care of patients with oral and pharyngeal cancer: analysis of a paradox

Mignogna, M D1; Fedele, S1; Lo Russo, L1; Ruoppo, E1; Lo Muzio, L2

European Journal of Cancer Prevention: June 2002 - Volume 11 - Issue 3 - p 205-208

Oropharyngeal cancer is estimated to be the ninth most common cancer worldwide. Its prognosis is largely dependent upon tumour-stage at the time of diagnosis. Stage I and II oropharyngeal cancers are characterized by a 5-year survival rate ranging from 70% to 90%, and the management of these early carcinomas is usually of short duration, easy and very cost-effective. On the other hand, the diagnostic evaluation, treatment and management of complications and recurrences of advanced stage oral tumours (stage III and IV) are often very long, complex and costly. They also have very poor prognosis with survival figures dropping to about 20%. Nowadays, most oropharyngeal cancers are detected at a late stage with an overall 5-year survival rate of around 45–50%, and with a conspicuous increase in treatment costs and a worsening of prognosis. Even if formal and comprehensive cost-effectiveness and cost-benefit analyses are not currently available in the oropharyngeal cancer literature, it seems clear that, in the care of these patients, the enormous consumption of resources is not associated with acceptable outcomes. New initiatives should be evaluated, planned and developed for the care of patients with oral and pharyngeal cancer. These strategies should be directed at prevention and early diagnosis in order to increase patient survival and quality of life and decrease the consumption of health care resources.

1Division of Oral Medicine, Department of Odontostomatological and Maxillo-Facial Sciences, University of Naples “Federico II”, Italy

2Institute of Odontostomatology, School of Dentistry, University of Ancona, Italy

Correspondence to: MDMignogna, Via Domenico Fontana 81, pal. 10, 80128, Naples, Italy. Fax: (+39) 081 7462 197. E-mail:

Received 11 August 2001 accepted 22 November 2001

© 2002 Lippincott Williams & Wilkins, Inc.