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Zhang X, Shi JF, Liu GX, Ren JS, Guo LW, Huang WD, Shi LM, Ma Y, Huang HY, Bai YN, Liao XZ, Mao AY, Sun XJ, Zhu XY, Zhou Q, Gong JY, Zhou JY, Liu YQ, Mai L, Song BB, Zhu L, Xing XJ, Du LB, Qi X, Sun XH, Wu SL, Ren Y, Cao R, Lan L, Lou PA, Zhang K, He J, Dai M. Medical expenditure for lung cancer in China: a multicenter, hospital-based retrospective survey. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2021; 19:53. [PMID: 34404418 PMCID: PMC8371812 DOI: 10.1186/s12962-021-00306-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 08/09/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Lung cancer is the most prevalent cancer, and the leading cause of cancer-related deaths in China. The aim of this study was to estimate the direct medical expenditure incurred for lung cancer care and analyze the trend therein for the period 2002-2011 using nationally representative data in China METHODS: This study was based on 10-year, multicenter retrospective expenditure data collected from hospital records, covering 15,437 lung cancer patients from 13 provinces diagnosed during the period 2002-2011. All expenditure data were adjusted to 2011 to eliminate the effects of inflation using China's annual consumer price index. RESULTS The direct medical expenditure for lung cancer care (in 2011) was 39,015 CNY (US$6,041) per case, with an annual growth rate of 7.55% from 2002 to 2011. Drug costs were the highest proportionally in the total medical expenditure (54.27%), followed by treatment expenditure (14.32%) and surgical expenditure (8.10%). Medical expenditures for the disease varied based on region, hospital level, type, and stage. CONCLUSION The medical expenditure for lung cancer care is substantial in China. Drug costs and laboratory test are the main factors increasing medical costs.
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Affiliation(s)
- Xin Zhang
- School of Health Management, Harbin Medical University, 194 Xuefu Road, Nangang District, Harbin, 150081, China
| | - Ju-Fang Shi
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan South Lane, Chaoyang District, Beijing, 100021, China
| | - Guo-Xiang Liu
- School of Health Management, Harbin Medical University, 194 Xuefu Road, Nangang District, Harbin, 150081, China.
| | - Jian-Song Ren
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan South Lane, Chaoyang District, Beijing, 100021, China.
| | - Lan-Wei Guo
- Department of Cancer Epidemiology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Wei-Dong Huang
- School of Health Management, Harbin Medical University, 194 Xuefu Road, Nangang District, Harbin, 150081, China
| | - Lin-Mei Shi
- School of Health Management, Harbin Medical University, 194 Xuefu Road, Nangang District, Harbin, 150081, China
| | - Yi Ma
- School of Health Management, Harbin Medical University, 194 Xuefu Road, Nangang District, Harbin, 150081, China
| | - Hui-Yao Huang
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan South Lane, Chaoyang District, Beijing, 100021, China
| | - Ya-Na Bai
- Institute of Epidemiology and Health Statistics, Lanzhou University, Lanzhou, 730000, China
| | - Xian-Zhen Liao
- Hunan Office for Cancer Control and Research, Hunan Provincial Cancer Hospital, Changsha, 410006, China
| | - A-Yan Mao
- Public Health Information Research Office, Institute of Medical Information, Chinese Academy of Medical Sciences, Beijing, 100020, China
| | - Xiao-Jie Sun
- Center for Health Management and Policy, Key Lab of Health Economics and Policy, Shandong University, Jinan, 250012, China
| | - Xin-Yu Zhu
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan South Lane, Chaoyang District, Beijing, 100021, China
- Institute of Epidemiology and Health Statistics, Lanzhou University, Lanzhou, 730000, China
| | - Qi Zhou
- Chongqing Office for Cancer Control and Research, Chongqing Cancer Hospital, Chongqing, 400030, China
| | - Ji-Yong Gong
- Science and Education Department of Public Health Division, Shandong Tumor Hospital, Jinan, 250117, China
| | - Jin-Yi Zhou
- Jiangsu Provincial Center for Disease Control and Prevention, Institute of Chronic Non-Communicable Diseases Prevention and Control, Nanjing, 210009, China
| | - Yu-Qin Liu
- Cancer Epidemiology Research Center, Gansu Provincial Cancer Hospital, Lanzhou, 730050, China
| | - Ling Mai
- Department of Institute of Tumor Research, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Bing-Bing Song
- Heilongjiang Office for Cancer Control and Research, Affiliated Cancer Hospital of Harbin Medical University, Harbin, 150081, China
| | - Lin Zhu
- Teaching and Research Department, Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi, 830011, China
| | - Xiao-Jing Xing
- Liaoning Office for Cancer Control and Research, Liaoning Cancer Hospital & Institute, Shenyang, 110042, China
| | - Ling-Bin Du
- Zhejiang Office for Cancer Control and Research, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Xiao Qi
- Department of Occupational Medicine, Tangshan People's Hospital, Tangshan, 063001, China
| | - Xiao-Hua Sun
- Ningbo Clinical Cancer Prevention Guidance Center, Ningbo NO.2 Hospital, Ningbo, 315010, China
| | - Shou-Ling Wu
- Health Department of Kailuan Group, Kailuan General Hospital, Tangshan, 063000, China
| | - Ying Ren
- Urban Office of Cancer Early Detection and Treatment, Tieling Central Hospital, Tieling, 112000, China
| | - Rong Cao
- Department of Health Policy and Economic Research, Guangdong Provincial Institute of Public Health, Guangzhou, 511430, China
| | - Li Lan
- Institute of Chronic Disease Prevention and Control, Harbin Center for Disease Control and Prevention, Harbin, 150056, China
| | - Pei-An Lou
- Department of Control and Prevention of Chronic Non-Communicable Diseases, Xuzhou Center for Disease Control and Prevention, Xuzhou, 221006, China
| | - Kai Zhang
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan South Lane, Chaoyang District, Beijing, 100021, China
| | - Jie He
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan South Lane, Chaoyang District, Beijing, 100021, China
| | - Min Dai
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan South Lane, Chaoyang District, Beijing, 100021, China
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Langer CJ, Gajra A, Gridelli C, Konduri K, Morgensztern D, Spigel D, Talbot D, Thomas M, Weiss J, Pilot R, Bhore R, Wolfsteiner M, Ong TJ, Socinski M. nab-Paclitaxel/Carboplatin in Vulnerable Populations With Advanced Non-Small Cell Lung Cancer: Pooled Analysis. Front Oncol 2021; 10:485587. [PMID: 33575203 PMCID: PMC7871002 DOI: 10.3389/fonc.2020.485587] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/29/2020] [Indexed: 02/05/2023] Open
Abstract
Introduction Despite improvements in the treatment of advanced non-small cell lung cancer (NSCLC), certain patient populations remain underrepresented in clinical trials. Many patients have benefited from platinum doublets, including nab-paclitaxel-based regimens, but there are patients with comorbidities who particularly require careful balancing of efficacy and safety. Clinical trial data are limited for patients who are elderly or have renal impairment, diabetes, or impaired performance status. Methods To better understand outcomes in these patient populations, we performed a pooled analysis using data from the ABOUND clinical trial program (ABOUND.SQM, ABOUND.PS2, ABOUND.70+) and the key phase III trial of nab-paclitaxel/carboplatin in advanced NSCLC. The populations included in this pooled analysis consisted of elderly patients (≥ 70 years) and patients with renal impairment (eGFR < 60 ml/min/1.73 m2), diabetes, or poor performance status (ECOG PS 2). Results Median progression-free survival (PFS) ranged from 4.1 months in patients with ECOG PS 2 (95% CI, 2.04-5.09 months) to 7.7 months in patients with diabetes (95% CI, 5.88-10.12 months). PFS for elderly patients and patients with renal impairment was 6.9 months each (95% CI, 6.01-7.98 months and 4.47-9.79 months, respectively). Median overall survival (OS) was 18.2 months (95% CI, 10.94-28.22 months), 17.4 months (95% CI, 14.59-20.14 months), and 16.1 months (95% CI, 14.09-18.50 months) in patients with renal impairment, patients with diabetes, and elderly patients, respectively. Patients with ECOG PS 2 exhibited the shortest median OS: 5.6 months (95% CI, 3.98-11.37 months). Overall response rates were 56.9%, 54.6%, 45.9%, and 29.4% in patients with diabetes, elderly patients, patients with renal impairment, and patients with ECOG PS 2, respectively. Most treatment-related adverse events were hematologic. The most common grade 3/4 hematologic adverse events in patients with renal impairment, elderly patients, patients with diabetes, and patients with poor performance status included neutropenia, anemia, and thrombocytopenia. Conclusions Although survival data in patients with ECOG PS 2 were notably inferior to the other cohorts, our findings are consistent with those previously reported in the population-specific studies of the ABOUND trials and lend additional support for the use of nab-paclitaxel-based regimens in historically understudied and vulnerable populations.
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Affiliation(s)
- Corey J Langer
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, United States
| | - Ajeet Gajra
- SUNY Upstate Medical University, Department of Medicine, Syracuse, NY, United States
| | - Cesare Gridelli
- S.G. Moscati Hospital, Division of Medical Oncology, Avellino, Italy
| | - Kartik Konduri
- Baylor Charles A. Sammons Cancer Center, Texas Oncology PA, Dallas, TX, United States
| | - Daniel Morgensztern
- Washington University School of Medicine in St Louis, St Louis, MO, United States
| | - David Spigel
- Sarah Cannon Research Institute, Lung Cancer Research Program, Nashville, TN, United States
| | - Denis Talbot
- Churchill Hospital-Oxford University Hospitals, Oxford, United Kingdom
| | - Michael Thomas
- Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Heidelberg, Germany
| | - Jared Weiss
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States
| | | | - Rafia Bhore
- Bristol Myers Squibb, Princeton, NJ, United States
| | | | - Teng Jin Ong
- Bristol Myers Squibb, Princeton, NJ, United States
| | - Mark Socinski
- AdventHealth Cancer Institute, Thoracic Cancer, Orlando, FL, United States
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Wang JS, Wang MJ, Lu X, Zhang J, Liu QX, Zhou D, Dai JG, Zheng H. Artesunate inhibits epithelial-mesenchymal transition in non-small-cell lung cancer (NSCLC) cells by down-regulating the expression of BTBD7. Bioengineered 2020; 11:1197-1207. [PMID: 33108235 PMCID: PMC8291784 DOI: 10.1080/21655979.2020.1834727] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/06/2020] [Accepted: 10/06/2020] [Indexed: 12/13/2022] Open
Abstract
In recent years, more and more studies have shown that antiparasitic drugs can affect a variety of biological processes of tumor cells and exhibit a potential anti-tumor activity. Although artesunate (ART), a strong bioactive derivative of artemisinin and widely used clinically against malaria, was found to have an inhibitory effect on tumor cells, it is still unclear whether ART could regulate the tumor malignancy of non-small-cell lung cancer (NSCLC) cells. In this study, we aimed to investigate the effect of ART on migration capacities in NSCLC cell lines of A549 and H1975. Cell migration capacity was remarkably inhibited by ART treatment. The expression of epithelial marker E-cadherin was upregulated, while mesenchymal markers (N-cadherin, vimentin and FN1) were inhibited by ART in both protein and mRNA levels in A549 and H1975 cells, indicating ART could suppress the epidermal interstitial transformation (EMT) of NSCLC cells. Meanwhile, BTBD7 was found highly expressed in tumor tissues of NSCLC patient and associated with poor prognosis. The anti-migration activity of ART was found to be mediated by the inhibition of BTBD7 mRNA expression and was reversed when the cells were transiently transfected with the BTBD7 overexpression plasmid. Our study demonstrated the potent anti-migratory activity of ART, thereby presenting it as a new candidate for clinical therapy in NSCLC.
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Affiliation(s)
- Jing-Si Wang
- Department of Thoracic Surgery, Xinqiao Hospital, Army (Third) Military Medical University, Chongqing, China
| | - Ming-Juan Wang
- Department of Anesthesiology, Chonggang General Hospital, Chongqing, China
| | - Xiao Lu
- Department of Thoracic Surgery, Xinqiao Hospital, Army (Third) Military Medical University, Chongqing, China
| | - Jiao Zhang
- Department of Thoracic Surgery, Xinqiao Hospital, Army (Third) Military Medical University, Chongqing, China
| | - Quan-Xing Liu
- Department of Thoracic Surgery, Xinqiao Hospital, Army (Third) Military Medical University, Chongqing, China
| | - Dong Zhou
- Department of Thoracic Surgery, Xinqiao Hospital, Army (Third) Military Medical University, Chongqing, China
| | - Ji-Gang Dai
- Department of Thoracic Surgery, Xinqiao Hospital, Army (Third) Military Medical University, Chongqing, China
| | - Hong Zheng
- Department of Thoracic Surgery, Xinqiao Hospital, Army (Third) Military Medical University, Chongqing, China
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4
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Li M, Lakdawalla DN, Goldman DP. Association Between Spending and Outcomes for Patients With Cancer. J Clin Oncol 2020; 38:323-331. [PMID: 31804868 PMCID: PMC6994252 DOI: 10.1200/jco.19.01451] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2019] [Indexed: 12/19/2022] Open
Affiliation(s)
- Meng Li
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA
| | - Darius N. Lakdawalla
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA
- School of Pharmacy, University of Southern California, Los Angeles, CA
| | - Dana P. Goldman
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA
- School of Pharmacy, University of Southern California, Los Angeles, CA
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5
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Chen AJ, Hu X, Conti RM, Jena AB, Goldman DP. Trends in the Price per Median and Mean Life-Year Gained Among Newly Approved Cancer Therapies 1995 to 2017. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:1387-1395. [PMID: 31806195 PMCID: PMC7589784 DOI: 10.1016/j.jval.2019.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 07/22/2019] [Accepted: 08/19/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The prices of newly approved cancer drugs have risen over the past decades. A key policy question is whether the clinical gains offered by these drugs in treating specific cancer indications justify the price increases. OBJECTIVES To evaluate the price per median and mean life year gained among newly approved cancer therapies from 1995 to 2017. METHODS We collected data on the price (in 2017 USD) per life-year gained among cancer drug-indication pairs approved by the US Food and Drug Administration (FDA) between 1995 and 2017. We modeled trends using fractional polynomial and linear spline regression models that controlled for route of administration and cancer type fixed effects. RESULTS We found that between 1995 and 2012, price increases outstripped median survival gains, a finding consistent with previous literature. Nevertheless, price per mean life-year gained increased at a considerably slower rate, suggesting that new drugs have been more effective in achieving longer-term survival. Between 2013 and 2017, price increases reflected equally large gains in median and mean survival, resulting in a flat profile for benefit-adjusted launch prices in recent years. CONCLUSIONS Although drug costs have been rising more rapidly than median survival gains, they have been rising at about the same rate as mean survival gains. This suggests that when accounting for longer-term survival gains, the benefits of new drugs are roughly keeping pace with their costs, despite rapid cost growth.
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Affiliation(s)
- Alice J Chen
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA; Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA.
| | - Xiaohan Hu
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
| | - Rena M Conti
- Questrom School of Business, Boston University, Boston, MA, USA
| | - Anupam B Jena
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA; National Bureau of Economic Research, Cambridge, MA, USA
| | - Dana P Goldman
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA; Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA; National Bureau of Economic Research, Cambridge, MA, USA
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BTBD7 Downregulates E-Cadherin and Promotes Epithelial-Mesenchymal Transition in Lung Cancer. BIOMED RESEARCH INTERNATIONAL 2019; 2019:5937635. [PMID: 31886230 PMCID: PMC6900955 DOI: 10.1155/2019/5937635] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/22/2019] [Indexed: 12/22/2022]
Abstract
Metastasis is the leading cause of lung cancer-associated death. Downregulated expression of E-cadherin followed by epithelial-mesenchymal transition (EMT) is critical for metastasis initiation in lung cancer. BTBD7 plays essential roles in lung cancer metastasis, but the mechanisms remain unknown. This study aimed to investigate the relationship between BTBD7 and E-cadherin in lung cancer and explore the role of BTBD7 in EMT. Fresh lung cancer and paracancer tissue specimens were collected from 30 patients, and the expression of BTBD7, E-cadherin, N-cadherin, fibronectin, and vimentin was analyzed by qRT-PCR, western blotting, and immunohistochemistry. A549 and HBE cells were cultured and treated with TGF-β1 for 72 h to induce EMT. Western blotting and qRT-PCR were performed to evaluate the expression of BTBD7, E-cadherin, N-cadherin, fibronectin, and vimentin. Then, A549 cells were treated separately with the BTBD7-ENTER plasmid, BTBD7-siRNA, and paclitaxel. After TGF-β1-induced EMT, the abovementioned markers were analyzed by western blotting and qRT-PCR. Wound healing assays were applied to assess the migration ability of cells in different groups. For animal experiments, A549 cells transfected with the BTBD7-ENTER plasmid were transplanted into BALB/c nude mice. After 4 weeks, all nude mice were sacrificed, and tumor tissues were harvested for qRT-PCR, western blot, and immunohistochemical analyses of the abovementioned markers. All experimental results showed that the levels of BTBD7, N-cadherin, fibronectin, and vimentin were increased in lung cancer tissues and cells, while the E-cadherin level was decreased. Transfection experiments showed that BTBD7 inhibited E-cadherin expression and enhanced EMT. Moreover, the migration capacity of lung cancer cells was increased by the high level of BTBD7. We concluded that BTBD7 is highly expressed during lung cancer development and metastasis and can inhibit the expression of E-cadherin and promote EMT in lung cancer. BTBD7 may thus be a therapeutic target for lung cancer.
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Howard DH, Chernew ME, Abdelgawad T, Smith GL, Sollano J, Grabowski DC. New Anticancer Drugs Associated With Large Increases In Costs And Life Expectancy. Health Aff (Millwood) 2018; 35:1581-7. [PMID: 27605636 DOI: 10.1377/hlthaff.2016.0286] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Spending on anticancer drugs has risen rapidly over the past two decades. A key policy question is whether new anticancer drugs offer value, given their high cost. Using data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, we assessed the value of new cancer treatments in routine clinical practice for patients with metastatic breast, lung, or kidney cancer or chronic myeloid leukemia in the periods 1996-2000 and 2007-11. We found that there were large increases in medical costs, but also large gains in life expectancy. For example, among patients with breast cancer who received physician-administered drugs, lifetime costs-including costs for outpatient and inpatient care-increased by $72,000 and life expectancy increased by thirteen months. Changes in life expectancy and costs were much smaller among patients who did not receive these drugs.
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Affiliation(s)
- David H Howard
- David H. Howard is an associate professor in the Department of Health Policy and Management at Emory University, in Atlanta, Georgia
| | - Michael E Chernew
- Michael E. Chernew is a professor in the Department of Health Care Policy at Harvard Medical School, in Boston, Massachusetts
| | - Tamer Abdelgawad
- Tamer Abdelgawad is a senior director of global health economics and outcomes resaerch at Pfizer Inc. in New York City
| | - Gregory L Smith
- Gregory L. Smith is a senior director of global health economics and outcomes research at Pfizer Inc
| | - Josephine Sollano
- Josephine Sollano is a senior director of global health economics and outcomes research at Pfizer Inc
| | - David C Grabowski
- David C. Grabowski is a professor in the Department of Health Care Policy at Harvard Medical School
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Increase EGFR Mutations Detection Rate in Lung Adenocarcinoma by Real-Time PCR Screening Followed by Direct Sequencing. Appl Immunohistochem Mol Morphol 2016; 23:343-8. [PMID: 25961746 DOI: 10.1097/pdm.0000000000000037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Recently, a number of small-molecule tyrosine kinase inhibitors (TKIs) have been developed to target the ATP-binding cleft of the epidermal growth factor receptor (EGFR). The presence of EGFR mutations in non-small cell lung cancer (NSCLC) correlates with the responsiveness to TKIs. Therefore, the identification of EGFR mutations before the administration of TKIs of NSCLC has become important. The aim of the present study was to investigate the occurrence of EGFR mutations in the southern Taiwanese population with NSCLC using a combination of real-time polymerase chain reaction (PCR) kit and direct sequencing. METHODS In the present study, DNAs were extracted from 249 cases of formalin-fixed, paraffin-embedded NSCLC samples for clinical EGFR mutational analysis by real-time PCR kit and direct sequencing. RESULTS The results showed that the frequency of EGFR mutations is 63% in the southern Taiwanese population. Most of the EGFR mutations are located at exons 19 and 21. In addition, we indicated that a combination of real-time PCR kit and direct sequencing increases the rate of mutation by 4%. Direct sequencing revealed 9 EGFR mutations including 6 reported EGFR mutations and 3 novel EGFR mutations. CONCLUSIONS In the present study, we have demonstrated that a combination of real-time PCR kit and direct sequencing increases the detection rate of EGFR mutations. Therefore, our proposed EGFR mutation detection strategy could be applied in clinical settings. In addition, our results indicated the prevalence of EGFR mutational status in the southern Taiwanese population.
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Costs of non-small cell lung cancer in the Netherlands. Lung Cancer 2015; 91:79-88. [PMID: 26589654 DOI: 10.1016/j.lungcan.2015.10.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 06/24/2015] [Accepted: 10/12/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Real-world resource use and cost data on non-small cell lung cancer (NSCLC) are scarce. This data is needed to inform health-economic modelling to assess the impact of new diagnostic and/or treatment technologies. This study provides detailed insight into real-world medical resource use and costs of stage I-IV NSCLC in the Netherlands. MATERIALS AND METHODS A random sample of patients newly diagnosed with NSCLC (2009-2011) was selected from four Dutch hospitals. Data was retrospectively collected from patient charts. This data included patient characteristics, tumour characteristics, treatment details, adverse events, survival and resource use. Resource use was multiplied by Dutch unit costs expressed in EUR 2012. Total mean costs were corrected for censoring using the Bang and Tsiatis weighted complete-case estimator. Furthermore, costs of adverse events, costs per phase of NSCLC management and costs of second opinions are presented. RESULTS Data was collected on 1067 patients. Total mean costs for NSCLC diagnosis, treatment and follow-up are €28,468 during the study period and €33,143 when corrected for censoring. Adverse events were recorded in the patient charts for 369 patients (41%) and 82 patients (9%) experienced an adverse event of grade III or higher. For these patients, adverse event-related hospital admissions cost on average €2,091. Mean total costs are €1,725 for the diagnostic period, €17,296 for first treatment line, and €13,236 for each later treatment line. Costs of providing a second opinion are €2,580 per patient. CONCLUSIONS Total mean hospital costs per NSCLC patient are €33,143 for the total duration of the disease. Ignoring censoring in our data underestimates these costs by 14%. Main limitations of the study relate to the short follow-up time, staging difficulties and missing data. Its main strength is that it provides highly detailed, real-world data on the costs of NSCLC.
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Anti-tumor activity of fenretinide complexed with human serum albumin in lung cancer xenograft mouse model. Oncotarget 2015; 5:4811-20. [PMID: 25015569 PMCID: PMC4148101 DOI: 10.18632/oncotarget.2038] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Sufficient knowledge regarding cellular and molecular basis of lung cancer progression and metastasis would help in the development of novel and effective strategies for the treatment of lung cancer. 4HPR is a synthetic retinoid with potential anti-tumor activity but is still limited because of its poor bioavailability. The use of albumin as a complexing agent for a hydrophobic drug is expected to improve the water solubility and consequently their bioavailability.This study investigated the antitumor activity of a novel complex between albumin and 4-HPR in a mouse model of human lung cancer and focuses on role and mechanism of Cav-1 mainly involved in regulating cancer and Acsvl3 mainly connected with tumor growth. Their expressions were assayed by immunohistochemistry and qRT-PCR, to demonstrate the reduction of the tumor growth following the drug treatment. Our results showed a high antitumor activity of 4HPR-HSA by reduction of the volume of tumor mass and the presence of a high level of apoptotic cell by TUNEL assay. The downregulation of Cav-1 and Acsvl3 suggested a reduction of tumor growth. In conclusion, we demonstrated the great potential of 4HPR-HSA in the treatment of lung cancer. More data about the mechanism of drug delivery the 4HPR-HSA are necessary.
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Wang H, Zhuo Y, Hu X, Shen W, Zhang Y, Chu T. CD147 deficiency blocks IL-8 secretion and inhibits lung cancer-induced osteoclastogenesis. Biochem Biophys Res Commun 2015; 458:268-73. [DOI: 10.1016/j.bbrc.2015.01.097] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 01/21/2015] [Indexed: 12/28/2022]
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Howard DH, Bach PB, Berndt ER, Conti RM. Pricing in the Market for Anticancer Drugs. THE JOURNAL OF ECONOMIC PERSPECTIVES : A JOURNAL OF THE AMERICAN ECONOMIC ASSOCIATION 2015; 29:139-62. [PMID: 28441702 DOI: 10.1257/jep.29.1.139] [Citation(s) in RCA: 286] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
In 2011, Bristol-Myers Squibb set the price of its newly approved melanoma drug ipilimumab—brand name Yervoy—at $120,000 for a course of therapy. The drug was associated with an incremental increase in life expectancy of four months. Drugs like ipilimumab have fueled the perception that the launch prices of new anticancer drugs and other drugs in the so-called “specialty” pharmaceutical market have been increasing over time and that increases are unrelated to the magnitude of the expected health benefits. In this paper, we discuss the unique features of the market for anticancer drugs and assess trends in the launch prices for 58 anticancer drugs approved between 1995 and 2013 in the United States. We restrict attention to anticancer drugs because the use of median survival time as a primary outcome measure provides a common, objective scale for quantifying the incremental benefit of new products. We find that the average launch price of anticancer drugs, adjusted for inflation and health benefits, increased by 10 percent annually—or an average of $8,500 per year—from 1995 to 2013. We argue that the institutional features of the market for anticancer drugs enable manufacturers to set the prices of new products at or slightly above the prices of existing therapies, giving rise to an upward trend in launch prices. Government-mandated price discounts for certain classes of buyers may have also contributed to launch price increases as firms sought to offset the growth in the discount segment by setting higher prices for the remainder of the market.
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Affiliation(s)
- David H Howard
- Department of Health Policy and Management, Rollins School of Public Health and Department of Economics, Emory University, Atlanta, Georgia.
| | - Peter B Bach
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York City, New York
| | - Ernst R Berndt
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Rena M Conti
- Departments of Pediatrics and Public Health Sciences, University of Chicago, Chicago, Illinois
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Acksteiner C, Steinke K. Percutaneous microwave ablation for early-stage non-small cell lung cancer (NSCLC) in the elderly: A promising outlook. J Med Imaging Radiat Oncol 2014; 59:82-90. [DOI: 10.1111/1754-9485.12251] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 09/02/2014] [Indexed: 11/29/2022]
Affiliation(s)
| | - Karin Steinke
- Department of Medical Imaging; Royal Brisbane and Women's Hospital; University of Queensland School of Medicine; Brisbane Queensland Australia
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14
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Affiliation(s)
- Jae Hoon Chung
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Gao L, Li Q, Jiang M, Liu C, Song Z, Bao X, Shen Y, Liu G, Hu K. Combined therapy of percutaneous cryoablation and traditional Chinese medicine can be a promising strategy for elderly or advanced lung cancer patients based on a retrospective clinical study. Cryobiology 2014; 69:174-7. [PMID: 24859157 DOI: 10.1016/j.cryobiol.2014.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 04/23/2014] [Accepted: 05/14/2014] [Indexed: 12/17/2022]
Abstract
Presently, elderly and advanced lung cancer patients have very limited treatment options. With no promising therapy, treatment of these patients is challenging. We have reviewed 119 primary lung cancer patients who received a combined percutaneous cryoablation and traditional Chinese medicine therapy (Cryo-TCM therapy) between 2005 and 2013. Out of 119 patients, 84.1% patients were elderly or advanced lung cancer when receiving cryoablation. Overall Survival time from the time of Diagnosis (DOS) and Cryoablation (COS) was 19 and 10 months respectively, which were longer than data previously published. Patients who accepted only Cryo-TCM therapy got similar DOS as those who were treated with Cryo-TCM and other classic anticancer therapies. Thus, Cryo-TCM therapy can prolong the survival time and can be used as the main therapy for the elderly or advanced lung cancer patients in China both in quality of life and cost effectiveness.
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Affiliation(s)
- Lei Gao
- Oncology Department, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China
| | - Quanwang Li
- Oncology Department, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China
| | - Min Jiang
- Oncology Department, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China
| | - Chuanbo Liu
- Oncology Department, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China
| | - Zilin Song
- Oncology Department, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China
| | - Xiaoling Bao
- Oncology Department, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China
| | - Yang Shen
- Oncology Department, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China
| | - Guijian Liu
- Laboratory Department, Guanganmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Kaiwen Hu
- Oncology Department, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China.
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Karimi-Busheri F, Rasouli-Nia A, Zadorozhny V, Fakhrai H. CD24+/CD38- as new prognostic marker for non-small cell lung cancer. Multidiscip Respir Med 2013; 8:65. [PMID: 24094028 PMCID: PMC3844723 DOI: 10.1186/2049-6958-8-65] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 07/31/2013] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Lung cancer is the leading cause of death among cancers in the world. The annual death toll due to this disease exceeds the combined deaths caused by colon, breast, prostate, and pancreatic cancers. As a result, there has been a tremendous effort to identify new biomarkers for early detection and diagnosis of lung cancer. METHODS In this study we report the results of screening a panel of eight non-small cell lung cancer (NSCLC) cell lines originating from different subtypes of lung cancer in an attempt to identify potential biomarkers unique to this disease. We used real-time polymerase chain reaction and flow cytometry techniques to analyze the expression of ALDHA1, EpCAM, CD133, CD24, and CD38 in this panel. RESULTS We demonstrate for the first time that the majority of NSCLC cells do not express levels of CD38 that would qualify it as a new biomarker for the disease. In contrast, we found that CD24 is over-expressed in 6 out of 8 of the cell lines. The combined CD24+/CD38-/low phenotype was detected in 50% of the cell lines that are also positive for CD133 and EpCAM. CONCLUSIONS We report that CD24+/CD38-/low signature could potentially be used as a new biomarker for the early detection of NSCLC.
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Shin JY, Kim SY, Lee KS, Lee SI, Ko Y, Choi YS, Seo HG, Lee JH, Park JH. Costs during the first five years following cancer diagnosis in Korea. Asian Pac J Cancer Prev 2013; 13:3767-72. [PMID: 23098469 DOI: 10.7314/apjcp.2012.13.8.3767] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES We estimated the total medical costs incurred during the 5 years following a cancer diagnosis and annual medical use status for the six most prevalent cancers in Korea. METHODS From January 1 to December 31, 2006, new patients registered with the six most prevalent cancers (stomach, liver, lung, breast, colon, and thyroid) were randomly selected from the Korea Central Cancer Registry, with 30% of patients being drawn from each cancer group. For the selected patients, cost data were generated using National Health Insurance claims data from the time of cancer diagnosis in 2006 to December 31, 2010. The total number of patients selected was 28,509. Five-year total medical costs by tumor site and Surveillance, Epidemiology, and End Results (SEER) stage at the time of diagnosis, and annual total medical costs from diagnosis, were estimated. All costs were calculated as per-patient net costs. RESULTS Mean 5-year net costs per patient varied widely, from $5,647 for thyroid cancer to $20,217 for lung cancer. Advanced stage at diagnosis was associated with a 1.8-2.5-fold higher total cost, and the total medical cost was highest during the first year following diagnosis and decreased by the third or fourth year. CONCLUSIONS The costs of cancer care were substantial and varied by tumor site, annual phase, and stage at diagnosis. This indicates the need for increased prevention, earlier diagnosis, and new therapies that may assist in reducing medical costs.
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Affiliation(s)
- Ji-Yeon Shin
- National Cancer Control Research Institute, Goyang, Republic of Korea
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Alexander ES, Machan JT, Ng T, Breen LD, DiPetrillo TA, Dupuy DE. Cost and effectiveness of radiofrequency ablation versus limited surgical resection for stage I non-small-cell lung cancer in elderly patients: is less more? J Vasc Interv Radiol 2013; 24:476-82. [PMID: 23462066 DOI: 10.1016/j.jvir.2012.12.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 12/18/2012] [Accepted: 12/18/2012] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To retrospectively evaluate cost and mortality in 84 patients older than 65 years of age with stage IA or IB non-small-cell lung cancer treated with radiofrequency (RF) ablation or limited surgical resection (ie, wedge resection or segmentectomy) from the perspective of the payer, Medicare. MATERIALS AND METHODS From August 2000 to November 2009, 56 patients were treated with RF ablation and 28 with surgery who met the inclusion criteria. Patient health histories and billing charges from initial treatment to the study endpoint were collected. Charges were converted to 2009 Medicare reimbursement fees and cumulated by month. Time-event data were analyzed by using the Kaplan-Meier method. Survival functions and median survival estimates were reported with standard errors. Patient cohorts' survival functions were compared based on the Wilcoxon weighted χ(2) statistic. RESULTS Group demographics were comparable with the exception of age, with patients treated with RF ablation an average of 4 years older (95% confidence interval, 0.85-6.76). The overall mortality rate was lower in patients treated with surgery than in those treated with RF ablation (χ(2) = 8.0225, P = .0046), with a median cost per month lived for RF ablation recipients of $620.74, versus $1,195.92 for those treated with surgery (P = .0002, Wilcoxon rank-sum test). CONCLUSIONS Patients treated with surgery showed a significant increase in survival; however, those treated with RF ablation were significantly older. For patients who are not surgical candidates, RF ablation provides an alternative treatment option at a significantly lower cost.
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Affiliation(s)
- Erica S Alexander
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, USA
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Baldi I, Pagano E, Berchialla P, Desideri A, Ferrando A, Merletti F, Gregori D. Modeling healthcare costs in simultaneous presence of asymmetry, heteroscedasticity and correlation. J Appl Stat 2013. [DOI: 10.1080/02664763.2012.740628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Hyaluronan synthesis inhibitor supplements the inhibitory effects of zoledronic acid on bone metastasis of lung cancer. Clin Exp Metastasis 2013; 30:595-606. [PMID: 23288481 DOI: 10.1007/s10585-012-9563-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 12/27/2012] [Indexed: 12/27/2022]
Abstract
Hyaluronan is known to have pivotal roles in the growth, migration and invasion of malignant tumors. Bone metastases are critical lesions greatly impairing the quality of patients with malignancies. We investigated whether hyaluronan synthesis inhibitor supplements the inhibitory effects of zoledronic acid, which is a conventional therapeutic agent for bone metastasis. We examined the effects of methylumbelliferone, an inhibitor of hyaluronan synthesis and/or ZA on the tumorigenicity of one murine lung carcinoma and two human (A549, SK-MES-1) lung cancer cell lines in vitro. The interaction between methylumbelliferone and zoledronic acid was analyzed using Calcucyn software. With a murine bone metastasis model of lung cancer in vivo, we investigated the inhibitory effects and interaction of the two drugs on the progression of metastatic bone lesions. Methylumbelliferone or zoledronic acid treatment individually suppressed proliferation, migration and invasion of 3 cell lines, and combination treatment showed synergistic effects. Although methylumbelliferone as a single agent did not enhance apoptotic activity, it showed additive effects on apoptotic activity to those of zoledronic acid. Co-localization of CD44 and ezrin, which might be a pathway of hyaluronan signaling, was abrogated by methylumbelliferone treatment. Combination therapy showed additive inhibitory effects on metastatic bone lesions in vivo, which paralleled the inhibition of hyaluronan accumulation by methylumbelliferone, and inhibition of osteoclastogenesis. Although the detailed mechanisms underlying the synergistic or additive inhibitory effects of these two drugs should be further analyzed, inhibition of hyaluronan synthesis by methylumbelliferone is a promising novel therapeutic candidate for bone metastasis of lung cancer in addition to zoledronic acid.
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Liu HC, Huang WC, Wu CL, Huang JT, Chen CH, Chen YJ. Surgery for Elderly Lung Cancer. Ann Thorac Cardiovasc Surg 2013; 19:416-22. [DOI: 10.5761/atcs.oa.12.02040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Zhang Y, Ying X, Han S, Wang J, Zhou X, Bai E, Zhang J, Zhu Q. Autoantibodies against insulin-like growth factor‑binding protein-2 as a serological biomarker in the diagnosis of lung cancer. Int J Oncol 2012; 42:93-100. [PMID: 23165420 PMCID: PMC3583617 DOI: 10.3892/ijo.2012.1699] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 10/26/2012] [Indexed: 11/24/2022] Open
Abstract
Insulin-like growth factor-binding protein-2 (IGFBP-2) is considered to be a human tumor antigen, and the tumor-specific immunity of IGFBP-2 has been reported in several types of cancer. The purpose of this study was to evaluate whether autoantibodies to IGFBP-2 can be used as diagnostic markers in lung cancer. The results demonstrated that serum anti-IGFBP-2 autoantibody levels were significantly elevated in lung cancer (mean, 1,633.318 ng/ml; median, 1,651.462 ng/ml; range, 342.732–4932.582 ng/ml) compared with benign lung disease (1,210.139, 1,035.900, 547.596–2,331.167 ng/ml) and normal controls (1,303.369, 1,194.800, 528.200–2140.500 ng/ml). The sensitivity and specificity of anti-IGFBP-2 autoantibodies in diagnosing lung cancer was 73.2 and 60.6%, respectively. When serum IGFBP-2 and anti-IGFBP-2 autoantibody were used together in the diagnosis of lung cancer, it can increase the discriminative power for lung cancer with a sensitivity of 85.7% and a specificity of 57.5%. In conclusion, this study demonstrates that circulating anti-IGFBP-2 autoantibodies can be used as a potential biomarker in diagnosing lung cancer.
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Affiliation(s)
- Ying Zhang
- Department of Oncology, The First Affiliated Hospital of Xi'an Jiao Tong University Medical Center, Shaanxi, People's Republic of China
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Suchy SL, Landreneau RJ, Schuchert MJ, Wang D, Ervin PR, Brower SL. Adaptation of a chemosensitivity assay to accurately assess pemetrexed in ex vivo cultures of lung cancer. Cancer Biol Ther 2012; 14:39-44. [PMID: 23114649 DOI: 10.4161/cbt.22622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Pemetrexed is the only FDA approved treatment for mesothelioma and is a second line agent for treatment of non-small cell lung carcinoma (NSCLC). Pemetrexed is inhibited by folate and its analogs, which are components of many culture media, making it challenging to study pemetrexed in vitro. In order to accurately evaluate pemetrexed's effects in vitro, the protocol for a standard chemosensitivity assay, the ChemoFx drug response marker, had to be modified. EXPERIMENTAL DESIGN Novel rinse and media change steps were assessed and then added to the assay protocol in order to observe pemetrexed activity. The intraday and interday stability of pemetrexed were also established under the adapted protocol. Then, the modified protocol was used to examine pemetrexed in 65 ex vivo lung cancer specimens. RESULTS Substituting 5% RPMI + EGF for BEGM allowed pemetrexed to exert its anticancer activity in the ChemoFx DRM. ChemoFx classified 6.2% of the lung specimens as responsive, 9.2% as intermediate responsive and 84.6% as non-responsive to pemetrexed. CONCLUSIONS Adapting the ChemoFx protocol allowed for the accurate evaluation of pemetrexed anticancer activity in ex vivo lung specimens. ChemoFx evaluation may provide an indication of a patient's clinical response to the drug prior to pemetrexed treatment. Having this information when treatment options are being considered could avoid wasted time, unnecessary costs and needless side effects that are the result of an inappropriate chemotherapy regimen.
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Zeng X, Karnon J, Wang S, Wu B, Wan X, Peng L. The cost of treating advanced non-small cell lung cancer: estimates from the chinese experience. PLoS One 2012; 7:e48323. [PMID: 23118985 PMCID: PMC3485140 DOI: 10.1371/journal.pone.0048323] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 09/24/2012] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Because of the potentially significant economic burden of healthcare costs associated with many diseases, it is critical that regulatory and medical insurance organisations collect and utilise data on the cost-effectiveness of care provision to make rational policy decisions. However, little is known about healthcare costs in China. METHODOLOGY/PRINCIPAL FINDINGS Based on health expenditure data for 253 cases of advanced non-small cell lung cancer (NSCLC) registered at the Second Xiangya Hospital of Central South University in China between 2006 and 2010, the cost of care provision was analysed. The monthly and aggregate annual medical costs were estimated for patients who were in either a progression-free state (PFS) or a disease-progression state (DPS). Monthly healthcare costs accumulated during the terminal 3 months were collected separately. The mean cost of treatment for PFS and DPS patients over one year was approximately US$11,566 and $14,519, respectively. The monthly costs for all patients were higher initially than in the subsequent months (PFS: $2,490; DPS: $2,503). For PFS patients, healthcare expenditures stabilised after the 7th month, with a mean monthly medical expenditure of $82.49. For DPS patients, expenditures stabilised after the 9th month, and the mean expenditure during the 9th month was $307.9. Medical care costs in the three successive months prior to death were $3,754, $5,829 and $7,372, respectively. CONCLUSIONS/SIGNIFICANCE The economic evaluation of health care technologies is becoming ever more important in China, especially in disease areas for which new and expensive therapies are being introduced on a regular basis. This is first paper to present empirically estimated China-specific costs associated with the treatment of NSCLC. The cost estimates are presented in a format that is specifically intended to inform cost-effectiveness analyses of treatments for NSCLC, and hence, contribute to the more efficient allocation of limited healthcare resources in China.
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Affiliation(s)
- Xiaohui Zeng
- Department of Pharmacy, the Second Xiangya Hospital of Central South University, Changsha Hunan, People’s Republic of China
- School of Pharmaceutical Sciences, Central South University, Changsha Hunan, PR China
| | - Jonathan Karnon
- Department of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Siying Wang
- Department of Pharmacy, the Second Xiangya Hospital of Central South University, Changsha Hunan, People’s Republic of China
- School of Pharmaceutical Sciences, Central South University, Changsha Hunan, PR China
| | - Bin Wu
- Department of Pharmacy, School of Medicine, Shanghai Jiaotong University, Renji Hospital, Shanghai, People’s Republic of China
| | - Xiaomin Wan
- Department of Pharmacy, the Second Xiangya Hospital of Central South University, Changsha Hunan, People’s Republic of China
- School of Pharmaceutical Sciences, Central South University, Changsha Hunan, PR China
| | - Liubao Peng
- Department of Pharmacy, the Second Xiangya Hospital of Central South University, Changsha Hunan, People’s Republic of China
- School of Pharmaceutical Sciences, Central South University, Changsha Hunan, PR China
- * E-mail: .
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Vera-Llonch M, Weycker D, Glass A, Gao S, Borker R, Barber B, Oster G. Healthcare costs in patients with metastatic lung cancer receiving chemotherapy. BMC Health Serv Res 2011; 11:305. [PMID: 22074001 PMCID: PMC3239411 DOI: 10.1186/1472-6963-11-305] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 11/10/2011] [Indexed: 11/11/2022] Open
Abstract
Background To characterize healthcare resource utilization and costs in patients with metastatic lung cancer receiving chemotherapy in the US. Methods Using data from a large private multi-payer health insurance claims database (2000-2006), we identified all patients beginning chemotherapy for metastatic lung cancer. Healthcare resource use (inpatient, outpatient, medications) and costs were tallied over time from date of therapy initiation ("index date") to date of disenrollment from the health plan (in most instances, presumably due to death) or the end of the study period, whichever occurred first. Healthcare utilization and costs were characterized using Kaplan-Meier sample average methods. Results The study population consisted of 4068 patients; mean (SD) age was 65 (11) years. Over a median follow-up of 334 days, study subjects averaged 1.5 hospital admissions, 8.9 total inpatient days, and 69 physician office and hospital outpatient visits. Mean (95% CI) cumulative total healthcare costs were $125,849 ($120,228, $131,231). Costs of outpatient medical services and inpatient care constituted 34% and 20% of total healthcare costs, respectively; corresponding estimates for outpatient chemotherapy and other medication were 22% and 24%. Conclusion Our study sheds additional light on the burden of metastatic lung cancer among patients receiving chemotherapy, in terms of total cost thru end of life as well as component costs by setting and type of service, and may be useful in informing medical resource allocation in this patient population.
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Yabroff KR, Lund J, Kepka D, Mariotto A. Economic burden of cancer in the United States: estimates, projections, and future research. Cancer Epidemiol Biomarkers Prev 2011; 20:2006-14. [PMID: 21980008 PMCID: PMC3191884 DOI: 10.1158/1055-9965.epi-11-0650] [Citation(s) in RCA: 333] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The economic burden of cancer in the United States is substantial and expected to increase significantly in the future because of expected growth and aging of the population and improvements in survival as well as trends in treatment patterns and costs of care following cancer diagnosis. In this article, we describe measures of the economic burden of cancer and present current estimates and projections of the national burden of cancer in the United States. We discuss ongoing efforts to characterize the economic burden of cancer in the United States and identify key areas for future work including developing and enhancing research resources, improving estimates and projections of economic burden, evaluating targeted therapies, and assessing the financial burden for patients and their families. This work will inform efforts by health care policy makers, health care systems, providers, and employers to improve the cancer survivorship experience in the United States.
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Affiliation(s)
- K Robin Yabroff
- Health Services and Economics Branch/Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892, USA.
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Brody JS, Steiling K. Interaction of cigarette exposure and airway epithelial cell gene expression. Annu Rev Physiol 2011; 73:437-56. [PMID: 21090967 DOI: 10.1146/annurev-physiol-012110-142219] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cigarette smoking is responsible for lung cancer and chronic obstructive pulmonary disease (COPD), the leading cause of death from cancer and the second-leading cause of death in the United States. In the United States, 46 million people smoke, with an equal number of former smokers. Moreover, 20-25% of current or former smokers will develop either disease, and smokers with one disease are at increased risk for developing the other. There are no tools for predicting risk of developing either disease; no accepted tools for early diagnosis of potentially curable lung cancer; and no tools for defining molecular pathways or molecular subtypes of these diseases, for predicting rate of progression, or for assessing response to therapy at a biochemical or molecular level. This review discusses current studies and the future potential of measuring global gene expression in epithelial cells that are in the airway field of injury and of using the genomic information derived to begin to answer some of the above questions.
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Affiliation(s)
- Jerome S Brody
- Pulmonary Center, Boston University School of Medicine, Massachusetts 02218, USA.
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Abstract
A lung cancer diagnosis and associated therapeutic management is associated with unique and varying degrees of adverse physical/functional impairments that dramatically reduce a patient's ability to tolerate exercise. Poor exercise tolerance predisposes to increased susceptibility to other common age-related diseases, poor quality of life (QOL), and likely premature death. Here we review the putative literature investigating the role of exercise as an adjunct therapy across the lung cancer continuum (i.e., diagnosis to palliation). The current evidence suggests that exercise training is a safe and feasible adjunct therapy for operable lung cancer patients both before and after pulmonary resection. Among patients with inoperable disease, feasibility and safety studies of carefully prescribed exercise training are warranted. Preliminary evidence in this area supports that exercise therapy may be an important consideration in multidisciplinary management of patients diagnosed with lung cancer.
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Affiliation(s)
- Lee W Jones
- Department of Surgery, Duke University Medical Center, 3085, Durham, NC 27710, USA.
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Cipriano LE, Romanus D, Earle CC, Neville BA, Halpern EF, Gazelle GS, McMahon PM. Lung cancer treatment costs, including patient responsibility, by disease stage and treatment modality, 1992 to 2003. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2011; 14:41-52. [PMID: 21211485 PMCID: PMC3150743 DOI: 10.1016/j.jval.2010.10.006] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVES The objective of this analysis was to estimate costs for lung cancer care and evaluate trends in the share of treatment costs that are the responsibility of Medicare beneficiaries. METHODS The Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 1991-2003 for 60,231 patients with lung cancer were used to estimate monthly and patient-liability costs for clinical phases of lung cancer (prediagnosis, staging, initial, continuing, and terminal), stratified by treatment, stage, and non-small- versus small-cell lung cancer. Lung cancer-attributable costs were estimated by subtracting each patient's own prediagnosis costs. Costs were estimated as the sum of Medicare reimbursements (payments from Medicare to the service provider), co-insurance reimbursements, and patient-liability costs (deductibles and "co-payments" that are the patient's responsibility). Costs and patient-liability costs were fit with regression models to compare trends by calendar year, adjusting for age at diagnosis. RESULTS The monthly treatment costs for a 72-year-old patient, diagnosed with lung cancer in 2000, in the first 6 months ranged from $2687 (no active treatment) to $9360 (chemo-radiotherapy); costs varied by stage at diagnosis and histologic type. Patient liability represented up to 21.6% of care costs and increased over the period 1992-2003 for most stage and treatment categories, even when care costs decreased or remained unchanged. The greatest monthly patient liability was incurred by chemo-radiotherapy patients, which ranged from $1617 to $2004 per month across cancer stages. CONCLUSIONS Costs for lung cancer care are substantial, and Medicare is paying a smaller proportion of the total cost over time.
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MESH Headings
- Aged
- Aged, 80 and over
- Carcinoma, Non-Small-Cell Lung/economics
- Carcinoma, Non-Small-Cell Lung/pathology
- Carcinoma, Non-Small-Cell Lung/therapy
- Case-Control Studies
- Costs and Cost Analysis
- Deductibles and Coinsurance/economics
- Deductibles and Coinsurance/trends
- Financing, Personal/economics
- Financing, Personal/trends
- Health Care Costs/trends
- Humans
- Insurance, Health, Reimbursement/economics
- Insurance, Health, Reimbursement/trends
- Longitudinal Studies
- Lung Neoplasms/economics
- Lung Neoplasms/pathology
- Lung Neoplasms/therapy
- Medicare/economics
- Small Cell Lung Carcinoma/economics
- Small Cell Lung Carcinoma/pathology
- Small Cell Lung Carcinoma/therapy
- Terminal Care/economics
- United States
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Affiliation(s)
- Lauren E. Cipriano
- Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Dorothy Romanus
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Craig C. Earle
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Bridget A. Neville
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Elkan F. Halpern
- Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - G. Scott Gazelle
- Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Radiology, Harvard Medical School, Boston, MA
- Department of Health Policy and Management, Harvard School of Public Health, Boston, MA
| | - Pamela M. McMahon
- Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Radiology, Harvard Medical School, Boston, MA
- Corresponding author, Institute for Technology Assessment, 101 Merrimac Street 10th floor, Boston, MA, 02114. Tel. 617-724-4445, Fax 617-726-9414,
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Jones LW, Eves ND, Kraus WE, Potti A, Crawford J, Blumenthal JA, Peterson BL, Douglas PS. The lung cancer exercise training study: a randomized trial of aerobic training, resistance training, or both in postsurgical lung cancer patients: rationale and design. BMC Cancer 2010; 10:155. [PMID: 20409311 PMCID: PMC2888787 DOI: 10.1186/1471-2407-10-155] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Accepted: 04/21/2010] [Indexed: 11/24/2022] Open
Abstract
Background The Lung Cancer Exercise Training Study (LUNGEVITY) is a randomized trial to investigate the efficacy of different types of exercise training on cardiorespiratory fitness (VO2peak), patient-reported outcomes, and the organ components that govern VO2peak in post-operative non-small cell lung cancer (NSCLC) patients. Methods/Design Using a single-center, randomized design, 160 subjects (40 patients/study arm) with histologically confirmed stage I-IIIA NSCLC following curative-intent complete surgical resection at Duke University Medical Center (DUMC) will be potentially eligible for this trial. Following baseline assessments, eligible participants will be randomly assigned to one of four conditions: (1) aerobic training alone, (2) resistance training alone, (3) the combination of aerobic and resistance training, or (4) attention-control (progressive stretching). The ultimate goal for all exercise training groups will be 3 supervised exercise sessions per week an intensity above 70% of the individually determined VO2peak for aerobic training and an intensity between 60 and 80% of one-repetition maximum for resistance training, for 30-45 minutes/session. Progressive stretching will be matched to the exercise groups in terms of program length (i.e., 16 weeks), social interaction (participants will receive one-on-one instruction), and duration (30-45 mins/session). The primary study endpoint is VO2peak. Secondary endpoints include: patient-reported outcomes (PROs) (e.g., quality of life, fatigue, depression, etc.) and organ components of the oxygen cascade (i.e., pulmonary function, cardiac function, skeletal muscle function). All endpoints will be assessed at baseline and postintervention (16 weeks). Substudies will include genetic studies regarding individual responses to an exercise stimulus, theoretical determinants of exercise adherence, examination of the psychological mediators of the exercise - PRO relationship, and exercise-induced changes in gene expression. Discussion VO2peak is becoming increasingly recognized as an outcome of major importance in NSCLC. LUNGEVITY will identify the optimal form of exercise training for NSCLC survivors as well as provide insight into the physiological mechanisms underlying this effect. Overall, this study will contribute to the establishment of clinical exercise therapy rehabilitation guidelines for patients across the entire NSCLC continuum. Trial Registration NCT00018255
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Affiliation(s)
- Lee W Jones
- Duke University Medical Center, Durham, NC, USA.
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Lam B, Lam SY, Wong MP, Ooi CG, Fong DY, Lam DC, Lai AY, Tam CM, Pang CB, Ip MS, Lam WK. Sputum cytology examination followed by autofluorescence bronchoscopy: A practical way of identifying early stage lung cancer in central airway. Lung Cancer 2009; 64:289-94. [PMID: 19010567 DOI: 10.1016/j.lungcan.2008.09.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2008] [Revised: 09/30/2008] [Accepted: 09/30/2008] [Indexed: 10/21/2022]
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Sato A, Sueoka-Aragane N, Saitoh J, Komiya K, Hisatomi T, Tomimasu R, Hayashi S, Sueoka E. Establishment of a new method, transcription-reverse transcription concerted reaction, for detection of plasma hnRNP B1 mRNA, a biomarker of lung cancer. J Cancer Res Clin Oncol 2008; 134:1191-7. [PMID: 18461365 DOI: 10.1007/s00432-008-0402-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Accepted: 04/21/2008] [Indexed: 10/22/2022]
Abstract
PURPOSE Development of an early detection marker is one of the most important strategies for improving overall prognosis in lung cancer patients. We previously reported that hnRNP B1--an RNA binding protein--is overexpressed in lung cancer tissue from the early stage of cancer, and found that hnRNP B1 mRNA is detectable in the plasma of lung cancer patients using real-time RT-PCR. The purpose of this study was to establish a quick and simple method for detecting plasma hnRNP B1mRNA for use in screening for lung cancer. METHODS TRC, a homogenous method for fluorescence real-time monitoring of isothermal RNA amplification using intercalation activating fluorescence DNA probe, was used to detect plasma hnRNP B1 mRNA. RESULTS The detection limit of hnRNP B1 mRNA by TRC using synthetic control RNA or total RNA derived from a lung cancer cell line was 25 or 8.65 x 10(2) copies, respectively. Using total RNA extracted from 600 mul of plasma, we detected hnRNP B1 mRNA in 39.1% (9/23) of lung cancer patients, with levels ranging from 1.9 to 19,045.5 copies/100 ng RNA, and in 5.2% (5/97) of healthy volunteers. Copy numbers were not associated with age, gender, smoking status, or histological type of cancer. TRC could detect 10(3) copies of hnRNP B1 mRNA in 10 min. CONCLUSION Detection of plasma hnRNP B1 mRNA by TRC is a quick, easy, and non-invasive method suitable for lung cancer screening.
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Affiliation(s)
- Akemi Sato
- Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, 849-8501, Japan
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Yabroff KR, Lamont EB, Mariotto A, Warren JL, Topor M, Meekins A, Brown ML. Cost of care for elderly cancer patients in the United States. J Natl Cancer Inst 2008; 100:630-41. [PMID: 18445825 DOI: 10.1093/jnci/djn103] [Citation(s) in RCA: 546] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Timely estimates of the costs of care for cancer patients are an important element in the formulation of national cancer programs and policies. We estimated net costs of care for elderly cancer patients in the United States for the 18 most prevalent cancers and for all other tumor sites combined. METHODS We used Surveillance, Epidemiology, and End Results-Medicare files to identify 718,907 cancer patients and 1,623,651 noncancer control subjects. Within each tumor site, noncancer control subjects were matched to patients by sex, age group, geographic location, and phase of care (ie, initial, continuing, and last year of life). Costs of care were estimated for each phase by use of Medicare claims data from January 1, 1999, through December 31, 2003. Per-patient net costs of care were applied to the 5-year survival of cancer patients by phase of care to estimate 5-year costs of care and extrapolated to the elderly US Medicare population diagnosed with cancer in 2004. RESULTS Across tumor sites, mean net costs of care were highest in the initial and last year of life phases of care and lowest in the continuing phase. Mean 5-year net costs varied widely, from less than $20,000 for patients with breast cancer or melanoma of the skin to more than $40,000 for patients with brain or other nervous system, esophageal, gastric, or ovarian cancers or lymphoma. For elderly cancer patients diagnosed in 2004, aggregate 5-year net costs of care to Medicare were estimated to be approximately $21.1 billion. Costs to Medicare were highest for lung, colorectal, and prostate cancers, reflecting underlying incidence, stage distribution at diagnosis, survival, and phase-specific costs for these tumor sites. CONCLUSIONS The costs of cancer care to Medicare are substantial and vary by tumor site, phase of care, stage at diagnosis, and survival.
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Affiliation(s)
- K Robin Yabroff
- Health Services and Economics Branch/Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Executive Plaza North, Rm 4005, 6130 Executive Blvd, MSC 7344, Bethesda, MD 20892-7344, USA.
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Jeong JS, Park JW, Yoon SW, Choi WC. Carcinostatic effect of allergen removed Rhus Verniciflua stokes based Traditional Korean Medicine on a patient with lung adenocarcinoma; single case report. ACTA ACUST UNITED AC 2008. [DOI: 10.3742/opem.2008.7.5.573] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Cutler DM. Are we finally winning the war on cancer? THE JOURNAL OF ECONOMIC PERSPECTIVES : A JOURNAL OF THE AMERICAN ECONOMIC ASSOCIATION 2008; 22:3-26. [PMID: 19768842 DOI: 10.1257/jep.22.4.3] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
President Nixon declared what came to be known as the “war on cancer” in 1971 in his State of the Union address. At first the war on cancer went poorly: despite a substantial increase in resources, age-adjusted cancer mortality increased by 8 percent between 1971 and 1990, twice the increase from 1950 through 1971. However, between 1990 and 2004, age-adjusted cancer mortality fell by 13 percent. This drop translates into an increase in life expectancy at birth of half a year—roughly a quarter of the two-year increase in life expectancy over this time period and a third of the increase in life expectancy at age 45. The decline brings cancer mortality to its lowest level in 60 years. In the war on cancer, optimism has replaced pessimism. In this paper, I evaluate the reasons for the reduction in cancer mortality. I highlight three factors as leading to improved survival. Most important is cancer screening: mammography for breast cancer and colonoscopy for colorectal cancer. These technologies have had the largest impact on survival, at relatively moderate cost. Second in importance are personal behaviors, especially the reduction in smoking. Tobacco-related mortality reduction is among the major factors associated with better health, likely at a cost worth paying. Third in importance, and more controversial, are treatment changes. Improvements in surgery, radiation, and chemotherapy have contributed to improved survival for a number of cancers, but at high cost. The major challenge for cancer care in the future is likely to be the balancing act between what we are able to do and what it makes sense to pay for.
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Affiliation(s)
- David M Cutler
- Department of Economics and Kennedy School of Government, Harvard University, and National Bureau of Economic Research, Cambridge, Massachusetts, USA.
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