Examination of clinical and economic outcomes of anal cancer treatment

Ashish A Deshmukh, The University of Texas School of Public Health


Micro-invasive squamous cell carcinoma of the anus (SCCA) is defined as a tumor less than 2 cm in diameter with no regional lymph node metastasis, also known as T1N0 cancer. There is inconsistency in the literature regarding the optimal treatment choice for T1N0 SCCA. Additionally, the economic burden of anal cancer management in the US is unknown. For the first aim of this study, we conducted a systematic literature review of T1N0 SCCA treatment. We found that the term micro-invasive has been used inconsistently in the literature, and there is need to standardize the terminology for T1N0 tumors. In the review, no randomized clinical trials evaluating treatment alternatives for T1N0 anal cancer were identified. Surgical treatment of T1N0 anal cancer tumor is associated with excellent clinical outcomes and low toxicity. Moreover, we found that the dose for chemoradiotherapy regimen is not well established, and increase in dose is associated with increased treatment related toxicity. The second aim was to estimate the economic and clinical outcomes associated with the T1N0 SCCA treatment, i.e., to estimate whether the survival and costs differ for the patients treated with the three treatment strategies – surgery, chemoradiotherapy, and radiotherapy. We found no statistically significant difference in the survival comparing three treatment strategies; this might be due to low sample size that may have led to insufficient statistical power. In the cost-effectiveness analysis, chemoradiotherapy was determined to be the most cost-effective alternative. For the third aim, we estimated the economic burden associated with anal cancer. We determined the lifetime and phase-specific costs of anal cancer treatment using survival analysis techniques. We found that cost of anal cancer treatment vary by the phase – initial, continuation, and terminal – of cancer care. The mean lifetime anal cancer related cost was $50,150. The estimated anal cancer-related economic burden in the elderly patients is approximately $143 million. The costs of cancer care were higher among men than among women. With increase in age and stage, the cost of cancer-related care increased.

Subject Area

Public health

Recommended Citation

Deshmukh, Ashish A, "Examination of clinical and economic outcomes of anal cancer treatment" (2014). Texas Medical Center Dissertations (via ProQuest). AAI3643601.