1
|
Bhuiya T, Makaryus AN. The Importance of Engaging in Scientific Research during Medical Training. Int J Angiol 2023; 32:153-157. [PMID: 37576537 PMCID: PMC10421692 DOI: 10.1055/s-0042-1759542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Many components of required skills and competencies exist, and are felt to contribute to the successful completion of training for independent practice in the medical field as a physician. These requirements are documented and detailed in a temporal fashion during the training period and used for advancement during training as well as documentation of successful completion of that training. While clinical skill development that allows optimal care and treatment of patients is of utmost importance during this training, other components of the training are important and contribute to the ideal development of a well-rounded and credentialed physician. One of these other components which is very important and needs to be recognized is the engagement of medical trainees across disciplines in academic and research scholarly activity. This engagement is an important component of medical training, and the development of skills and didactics geared toward efficient and accurate performance of research is essential.
Collapse
Affiliation(s)
- Tanzim Bhuiya
- Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Amgad N. Makaryus
- Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Department of Cardiology, Nassau University Medical Center, East Meadow, New York
| |
Collapse
|
2
|
Andanda P, Wathuta J. Human dignity as a basis for providing post-trial access to healthcare for research participants: a South African perspective. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2018; 21:139-155. [PMID: 28601920 DOI: 10.1007/s11019-017-9782-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This paper discusses the need to focus on the dignity of human participants as a legal and ethical basis for providing post-trial access to healthcare. Debate about post-trial benefits has mostly focused on access to products or interventions proven to be effective in clinical trials. However, such access may be modelled on a broad fair benefits framework that emphasises both collateral benefits and interventional products of research, instead of prescribed post-trial access alone (Legal and ethical regulation of biomedical research in developing countries p. 134, 2016). The wording of the current version of the Declaration of Helsinki could in fact be interpreted to broaden the scope to include other collateral benefits by applying such a broad fair benefits framework. We argue that this possibility should be utilised by low and middle income countries' (LMICs) health research ethics committees (RECs) in order to ensure that research participants who enrol in clinical trials so as to receive medical care continue to access care after the trial is concluded, as befits their dignity. Although each LMIC has unique concerns, nonetheless there are common challenges based especially on emerging issues, such as post-trial access to healthcare. Accordingly, the South African perspective is used to draw lessons that can benefit other LMICs.
Collapse
Affiliation(s)
- Pamela Andanda
- School of Law, University of the Witwatersrand, Johannesburg, South Africa.
- University of the Witwatersrand, Private Bag 3, WITS, Johannesburg, 2050, South Africa.
| | - Jane Wathuta
- School of Law, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
3
|
Field KM, Drummond KJ, Yilmaz M, Tacey M, Compston D, Gibbs P, Rosenthal MA. Clinical trial participation and outcome for patients with glioblastoma: multivariate analysis from a comprehensive dataset. J Clin Neurosci 2013; 20:783-9. [PMID: 23639619 DOI: 10.1016/j.jocn.2012.09.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 09/14/2012] [Indexed: 11/28/2022]
Abstract
Glioblastoma multiforme (GBM) is the most common malignant brain tumor in adults. Although multiple clinical and tumor-related variables affect survival outcomes, the effect of clinical trial participation has not been explored. The aim of this study was to determine whether clinical trial participation improves outcome for patients with GBM. Data from patients with GBM were accessed from a dataset collected over 12 years (1998-2010) at two institutions. Univariable and multivariate logistic regression analyses were performed to look for relationships between clinical trial participation, other baseline clinical and sociodemographic variables and overall survival (OS). In total, 542 patients were identified and included in the analysis; median age was 62 years. Sixty-one patients (11%) were enrolled in a clinical trial. Clinical trial enrollment was associated with improved median survival (14.5 months compared to 6.3 months, p < 0.001) and this difference remained significant in multivariate analysis (hazard ratio 0.67, p = 0.046). Age, poor performance status and operation type were also independent predictors for OS in multivariate analysis. Disease site, socioeconomic status and co-morbidity did not affect survival outcome. This is the first study in patients with GBM to suggest a survival benefit from clinical trial participation, independent of age and performance status; while also confirming the importance of other previously reported prognostic factors. This should encourage clinicians to offer trial therapies to patients with GBM and encourage patients to participate in available studies.
Collapse
Affiliation(s)
- Kathryn M Field
- Department of Medical Oncology, Royal Melbourne Hospital, Victoria, Australia.
| | | | | | | | | | | | | |
Collapse
|
4
|
Andergassen U, Kasprowicz NS, Hepp P, Schindlbeck C, Harbeck N, Kiechle M, Sommer H, Beckmann MW, Friese K, Janni W, Rack B, Scholz C. Participation in the SUCCESS-A Trial Improves Intensity and Quality of Care for Patients with Primary Breast Cancer. Geburtshilfe Frauenheilkd 2013; 73:63-69. [PMID: 24771886 DOI: 10.1055/s-0032-1328147] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 12/13/2012] [Accepted: 12/13/2012] [Indexed: 12/21/2022] Open
Abstract
The SUCCESS-A trial is a prospective, multicenter, phase III clinical trial for high-risk primary breast cancer. It compares disease-free survival after randomization in patients treated with fluorouracil, epirubicin and cyclophosphamide followed by 3 cycles of docetaxel (FEC-D) with that of patients treated with 3 cycles of FEC followed by 3 cycles of gemcitabine and docetaxel (FEC-DG). After a second randomization patients were treated with zoledronate for 2 or 5 years. A total of 251 centers took part in the trial and 3754 patients were recruited over a period of 18 months which ended in March 2007. In a questionnaire-based survey we investigated the impact of enrollment in the trial on patient care, the choice of chemotherapy protocol and access to current oncologic information as well as overall satisfaction in the respective centers. Analysis of the 78 questionnaires returned showed that 40 % of the centers had never previously enrolled patients with these indications in clinical studies. Prior to participating in the study, 4 % of the centers prescribed CMF or other protocols in patients with high-primary breast cancer risk, 46 % administered anthracycline-based chemotherapy and 50 % gave taxane-based chemotherapy. Around half of the participating centers noted that intensity of care and overall quality of care became even better and that access to breast cancer-specific information improved through participation in the trial. After their experience with the SUCCESS-A trial, all of the centers stated that they were prepared to enroll patients in clinical phase III trials again in the future. These data indicate that both patients and physicians benefit from clinical trials, as enrollment improves treatment strategies and individual patient care, irrespective of study endpoints.
Collapse
Affiliation(s)
- U Andergassen
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, München
| | - N S Kasprowicz
- Frauenklinik, Klinikum der Heinrich-Heine-Universität Düsseldorf, Düsseldorf
| | - P Hepp
- Frauenklinik, Klinikum der Heinrich-Heine-Universität Düsseldorf, Düsseldorf
| | | | - N Harbeck
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, München ; Brustzentrum der Universität, Klinikum der Ludwig-Maximilians-Universität, München
| | - M Kiechle
- Frauenklinik, Klinikum rechts der Isar der TU München, München
| | - H Sommer
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, München
| | | | - K Friese
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, München
| | - W Janni
- Frauenklinik, Klinikum der Universität Ulm, Ulm
| | - B Rack
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, München
| | - C Scholz
- Frauenklinik, Klinikum der Universität Ulm, Ulm
| | | |
Collapse
|
5
|
BEADLE G, MENGERSEN K, MOYNIHAN S, YATES P. Perceptions of the ethical conduct of cancer trials by oncology nurses. Eur J Cancer Care (Engl) 2011; 20:585-92. [DOI: 10.1111/j.1365-2354.2011.01251.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
6
|
Lemieux J, Amireault C, Camden S, Poulin J. Evaluation of factors associated with recruitment in hematological clinical trials: a retrospective cohort study. ACTA ACUST UNITED AC 2011; 15:373-7. [PMID: 21114898 DOI: 10.1179/102453310x12719010991623] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The objectives of this study were to measure the recruitment, to study characteristics associated with recruitment, and to explore reasons for non-recruitment in clinical trials for malignant hematological diseases. Trials opened between 2002 and 2008 were selected. If the patient fulfilled the main criteria of the protocol, all eligibility criteria of the protocol were assessed. A total of 1394 patients-protocol were identified in 17 protocols (697 patients, since a patient could have been eligible for more than one protocol) and 195 patients-protocol (186 patients) of these fulfilled the main criteria of the protocol. Among the 195 patients-protocol, 133 (68·2%) fulfilled all the eligibility criteria and 45 (23·1%) were recruited. Patients, physicians, and protocol characteristics were not associated with recruitment. The most common reasons for not being recruited were as follow: 40·7%, not fulfilling all eligibility criteria; 31·3%, protocol not being proposed according to the chart; and 22·7%, patients' refusal.
Collapse
|
7
|
Schaapveld M, Visser O, Siesling S, Schaar CG, Zweegman S, Vellenga E. Improved survival among younger but not among older patients with Multiple Myeloma in the Netherlands, a population-based study since 1989. Eur J Cancer 2010; 46:160-9. [PMID: 19682891 DOI: 10.1016/j.ejca.2009.07.006] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Revised: 07/15/2009] [Accepted: 07/17/2009] [Indexed: 10/20/2022]
Abstract
UNLABELLED This study assesses whether new treatment strategies developed in clinical trials translate into improved survival for multiple myeloma (MM) patients in the Netherlands. All patients diagnosed with MM in the Northern part of the Netherlands between 1989 and 2005 were retrieved from two regional population-based cancer registries. Information on study participation was derived from linkage with trial information systems. The effect of period of diagnosis (1989-1992, 1993-1996, 1997-2000, 2001-2005), age (<50, 50-65, 66-74, 75), gender, Salmon-Durie (SD) stage, trial participation and treatment on relative survival were studied. In total 4985 patients were included. When trial participation was analysed for exact periods in which trials were open, 16% of patients aged 65 years with SD-stage I and 38% with SD-stage II or III were enrolled compared to 2% of patients aged >65 years with SD-stage I and 5% with SD-stage II or III. Relative survival decreased with age (p<.001), with advanced stage (p<.001) and was better for patients enrolled in trials (p<.001). Five-year relative survival increased from 34% (95% confidence interval (95% CI) 28-39%) in 1989-1992 to 56% (95% CI 50-61%) in 2001-2005 for patients 65 years. The excess mortality was 37% lower in 2001-2005 than in 1989-1992 for these patients, adjusted for age, stage, trial participation and gender (p<.001). Survival did not improve for older patients. IN CONCLUSION MM survival improved among younger but not among older patients since the mid-1990s. The improved survival of younger patients coincided with increasing trial participation and increasing use of high-dose chemotherapy and autologous stem-cell transplantation.
Collapse
Affiliation(s)
- Michael Schaapveld
- Comprehensive Cancer Center Amsterdam, PO Box 9236, 1006 AE Amsterdam, The Netherlands.
| | | | | | | | | | | |
Collapse
|
8
|
The effects of study participation in the Familial Intracranial Aneurysm Study on cigarette smoking. J Stroke Cerebrovasc Dis 2009; 17:370-2. [PMID: 18984429 DOI: 10.1016/j.jstrokecerebrovasdis.2008.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Accepted: 04/21/2008] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Cigarette smoking is the most modifiable risk factor for the formation and rupture of intracranial aneurysm (IA). This study examined the impact of participation in the Familial IA study on smoking behavior. METHODS On entry into the study, a baseline smoking history was obtained. At follow-up visits, subjects were surveyed concerning their current smoking status. Risk reduction education was site specific and the study did not include a standard approach. RESULTS Of participants, 66% had a history of cigarette smoking, with 33.1% being current smokers. There was a significant reduction in the proportion of current smokers by the third yearly follow-up visit (26.7%, P < .001). There was a significant reduction in the daily amount of cigarettes smoked (17.7-11.5, P < .001), with the most significant reduction at the first follow-up visit. Current smokers given the diagnosis of an IA before entry or during the course of the study were more likely to decrease their smoking (19.4-9.8 cigarettes/day, P < .001) than those not given a diagnosis of an IA (16.0-13.3, P = .002). Individuals older then 51 years had a greater reduction in the amount of cigarettes smoked per day compared with those younger than 51 years (2.3 cigarettes/day reduction v 1.5, P = .002). CONCLUSION Subjects who entered into the Familial IA study had a significant decrease in their smoking by the end of 3 years. Factors associated with decreased smoking were diagnosis of IA and older age.
Collapse
|
9
|
Tan JOA, Koelch M. The ethics of psychopharmacological research in legal minors. Child Adolesc Psychiatry Ment Health 2008; 2:39. [PMID: 19063724 PMCID: PMC2614961 DOI: 10.1186/1753-2000-2-39] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Accepted: 12/08/2008] [Indexed: 11/25/2022] Open
Abstract
Research in psychopharmacology for children and adolescents is fraught with ethical problems and tensions. This has practical consequences as it leads to a paucity of the research that is essential to support the treatment of this vulnerable group. In this article, we will discuss some of the ethical issues which are relevant to such research, and explore their implications for both research and standard care. We suggest that finding a way forward requires a willingness to acknowledge and discuss the inherent conflicts between the ethical principles involved. Furthermore, in order to facilitate more, ethically sound psychopharmacology research in children and adolescents, we suggest more ethical analysis, empirical ethics research and ethics input built into psychopharmacological research design.
Collapse
Affiliation(s)
- Jacinta OA Tan
- The Ethox Centre, University of Oxford, Badenoch Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Michael Koelch
- Department of Child and Adolescent Psychiatry/Psychotherapy at the University Hospital Ulm, Ulm, Germany
| |
Collapse
|
10
|
Heidenreich A, Finke F. [Clinical network structures in uro-oncology. A model for the future?]. Urologe A 2008; 47:1128-32. [PMID: 18651123 DOI: 10.1007/s00120-008-1823-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Systemic medical treatment (androgen deprivation, immunomodulatory therapy, and cytotoxic therapy) is an integral part of urology when managing patients with advanced or metastatic cancer of the urogenital tract. In the past, however, an increasing number of urologists in private practice and urological institutions have transferred this competence to neighbouring disciplines, so a thorough education of the young urologist in the field of uro-oncology is highly jeopardized. We present a regional, cooperative network structure between urologists in private practice and in hospitals, which has resulted in a standardization of indication, realization, documentation, quality control, and supportive strategies for systemic medical treatment of patients with metastatic urologic cancer. Furthermore, a well-functioning and cooperative platform was established for the recruitment and realization of clinical trials, which could serve as a model for the structure of future cooperation among German urologists in private practice and in hospitals.
Collapse
Affiliation(s)
- A Heidenreich
- Bereich Urologische Onkologie, Klinik und Poliklinik für Urologie, Universität, Köln, Deutschland.
| | | |
Collapse
|
11
|
Bedlack RS, Pastula DM, Welsh E, Pulley D, Cudkowicz ME. Scrutinizing enrollment in ALS clinical trials: room for improvement? ACTA ACUST UNITED AC 2008; 9:257-65. [PMID: 18608092 DOI: 10.1080/17482960802195913] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Enrollment in ALS trials has not been systematically studied. We surveyed the ALS Research Group (ALSRG) to learn their impressions of enrollment at ALS clinics across North America. We also reviewed completed ALS trials to determine an enrollment rate (subjects per site per month), its variability across trials, whether it is changing over time, and whether it is influenced by 'trial factors'. ALSRG members were polled via an online survey. ALS trials were identified by literature review and investigator contact. Enrollment rate versus publication year was plotted for each trial. Models were created to examine how 'trial factors' were associated with enrollment rate. By survey, percent enrollment is 25% and highly variable (range 0-75%). By literature review, enrollment rate is 2.2 participants/site/month and highly variable (range 0.1-7.5). Enrollment is not improving over time; no 'trial factor' explains the variability in enrollment across trials. Behaviors among clinic directors and patients were identified that may influence enrollment. In conclusion, ALS trial enrollment rate is low, highly variable and not influenced by trial design factors. 'Patient factors' and 'physician factors' may play more important roles in influencing enrollment, as in oncology trials. Our survey data support this idea, and provide potential mechanisms for improving enrollment.
Collapse
|
12
|
Management and survival trends in advanced colorectal cancer. Clin Oncol (R Coll Radiol) 2008; 20:626-30. [PMID: 18524553 DOI: 10.1016/j.clon.2008.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Revised: 03/31/2008] [Accepted: 04/01/2008] [Indexed: 11/21/2022]
Abstract
AIMS Significant improvements in the outcome for patients with advanced colorectal cancer (CRC) have been achieved. The median survival for advanced CRC reported in clinical trials now approaches 2 years, but there is often a question as to whether this partly represents patient selection. We aimed to explore whether the availability of new chemotherapy drugs (irinotecan and oxaliplatin) and surgical advances have affected survival in a normal clinical setting. MATERIALS AND METHODS A review of the Queen Elizabeth and Lyell McEwin health service prospective CRC database from 1992 to 2004 was carried out to assess outcome differences between two time cohorts (1 January 1992-31 December 1997 and 1 January 1998-31 December 2004). RESULTS For all patients (n = 744) overall survival was seen to improve over time and is maintained out to 5 years. There have been a number of trends over time (1992-1997 vs 1998-2004) that have probably contributed to this gain; increased overall chemotherapy use (33% vs 43%); use of combination chemotherapy (i.e. oxaliplatin and irinotecan regimens); increased hepatic resection rates (1.9% vs 10.8%) and increased clinical trial uptake (0.6% vs 14.5%). CONCLUSION This current analysis confirms an improvement in survival over time for advanced CRC and this is seen in unselected patients including those over 70 years of age.
Collapse
|
13
|
Bérubé S, Provencher L, Robert J, Jacob S, Hébert-Croteau N, Lemieux J, Duchesne T, Brisson J. Quantitative exploration of possible reasons for the recent improvement in breast cancer survival. Breast Cancer Res Treat 2007; 106:419-31. [PMID: 17268811 DOI: 10.1007/s10549-007-9503-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2006] [Accepted: 01/01/2007] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Breast cancer mortality has been declining in many countries including Canada because of improvements in survival. This study attempts to explain observed trends in breast cancer survival with special attention given to the role of improvements in early detection and treatment. METHODS This study is based on 4,312 women diagnosed with primary invasive breast carcinoma treated in a Canadian breast center between 1976 and 2000 and followed to the end of 2001. Observed and relative survival rates were calculated. Multivariate relative survival regression models were used to assess trends in breast cancer survival over the study period. RESULTS The proportion of women with small tumors (< or = 10 mm) was higher in late 1990s, while that of women with regional involvement was lower compared to earlier periods. Adjuvant chemotherapy or endocrine therapy use increased steadily from 6.6% to 84.0% during the study period. Five-year relative survival rates ranged between 82.1% and 83.7% between 1976 and 1990, and increased thereafter to reach 87.6% in 1991-95, and 92.1% in 1996-2000. During the first five years after diagnosis, women diagnosed in 1991-95 and 1996-2000 experienced a reduction in breast cancer mortality of 28% (Relative Risk (RR)= 0.72; 95% CI: 0.59-0.89) and 49% (RR = 0.51; 95% CI: 0.39-0.68) respectively compared to women diagnosed in 1976-90. Improvement in breast cancer survival in 1990's could not be explained by characteristics of women, biology of the tumor, advancements in early detection and type of initial treatments. CONCLUSION A substantial increase in breast cancer survival was observed in the 1990s but the reasons for this improvement remain elusive. Better knowledge of these reasons could help not only to further reduce the burden related to breast cancer but also the burden related to other major cancer sites.
Collapse
Affiliation(s)
- Sylvie Bérubé
- Unité de recherche en santé des populations, Hôpital St-Sacrement du Centre hospitalier affilié universitaire de Québec, 1050 Chemin Sainte-Foy, Québec, Qc, Canada, G1S 4L8
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Abstract
Increasing age is the major risk factor for breast cancer. About half of all new breast cancers and more than half of breast cancer deaths in affluent nations occur in women 65 years and older. Endocrine therapy with aromatase inhibitors or tamoxifen is appropriate adjuvant therapy for older women with life expectancies of greater than 5 years and hormone receptor positive tumors. The greatest benefit of adjuvant chemotherapy is in elders with hormone receptor negative, node positive, or high-risk node negative tumors. The effect of co-morbidity on survival must be factored into all adjuvant therapy decisions and newer validated tools can accurately estimate non-breast cancer related survival. Age bias still exists and results in frequent undertreatment of older women and compromised survival. Elders remain under-represented in clinical trials and should be encouraged to participate. Health care providers as well as government leaders and patients need to be educated on cancer in elders.
Collapse
Affiliation(s)
- H B Muss
- Vermont Cancer Center, University of Vermont College of Medicine, 89 Beaumont Avenue, Given Building E214, Burlington, VT 05405, USA.
| |
Collapse
|
15
|
Hébert-Croteau N, Roberge D, Brisson J. Provider’s volume and quality of breast cancer detection and treatment. Breast Cancer Res Treat 2006; 105:117-32. [PMID: 17186361 DOI: 10.1007/s10549-006-9439-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2006] [Accepted: 10/24/2006] [Indexed: 11/26/2022]
Abstract
For many health conditions, the process or result of medical procedures improves with increasing caseload. The evidence about breast cancer has not been thoroughly assessed. This review synthesizes the literature about provider's volume and performance in either breast cancer screening with mammography or treatment. Articles published in English between 1990 and 2006 were identified by a computerized search and by review of reference lists. In screening with mammography, the reading volume of the radiologist and the screening volume of the facility influence different components of performance. The most conclusive evidence for breast cancer treatment concerns the association between the surgeon's caseload and the process or end-results of therapeutic interventions. Although the mechanisms of these associations still need to be clarified, large provider's volume in screening mammography or breast cancer treatment is often related to the quality of medical interventions.
Collapse
Affiliation(s)
- Nicole Hébert-Croteau
- Direction des Systèmes de Soins et Services, Institut National de Santé Publique du Québec, 190 Boul. Crémazie Est, Bureau 2.24, Montréal, Quebec, Canada.
| | | | | |
Collapse
|
16
|
Mano MS, Rosa DD, Dal Lago L. Multinational clinical trials in oncology and post-trial benefits for host countries: where do we stand? Eur J Cancer 2006; 42:2675-7. [PMID: 16962315 DOI: 10.1016/j.ejca.2006.02.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2006] [Accepted: 02/28/2006] [Indexed: 11/25/2022]
Abstract
International collaboration has undoubtedly played a key role in the extraordinary progress we have witnessed in some areas of oncology in recent years. It has allowed us, for instance, to design trials large enough to depict very small benefits, as well as high-quality trials in less incident types of cancer. For different reasons, developing countries have also shown growing interest in this international effort and have been participating in many international trials. However, the ever-growing costs of novel anti-cancer treatments and technologies have created unprecedented difficulties for health economies in developing countries. Although the issue of individual benefit for patients must also be taken into account, the actual benefit for their society may be minimal. This paper discusses the ethics of including patients from non-developed countries in clinical trials evaluating the role of treatments that are unlikely to be made available to them after the trial because of prohibitive costs. Upfront arrangements ensuring post-trial access to interventions that have been proven successful might be the best alternative to exclusion from the research.
Collapse
Affiliation(s)
- Max S Mano
- Institut Jules Bordet, Unité d'Oncologie Médicale, Rue Héger-Bordet 01, 1000 Brussels, Belgium.
| | | | | |
Collapse
|