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Nieto-Gómez P, Castaño-Amores C. Factors influencing the reimbursement of cancer drugs in Europe: A scoping review. J Eval Clin Pract 2024. [PMID: 38959379 DOI: 10.1111/jep.14080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/10/2024] [Accepted: 06/20/2024] [Indexed: 07/05/2024]
Abstract
RATIONALE Reimbursement process of oncology drugs in Europe occurs within a complex decision-making process that varies between Member States. Distinctions between the States trigger societal debates since it is necessary to balance access to medicines and health systems sustainability. AIMS AND OBJECTIVES We aimed to review the evidence concerning factors associated with the reimbursement decision or Health Technology Agency recommendation of oncology drugs in Europe. METHODS A systematic literature search was performed in two databases from inception to august 2023. Screening and data extraction were performed by pairs. RESULTS Thirteen articles were included and encompassed data from 11 nations. Seven articles showed that cost-effective (C-E) drugs and lower Incremental Cost-Effectiveness Ratios (ICERs) had higher likelihood of reimbursement. Disease severity might influence the reimbursement decision with financial agreements. Improvement in clinical outcomes, substantial clinical benefit (p < 0.01) or overall survival gains (p < 0.05) were positively associated. Orphan drug designation impact varies between countries but positive decisions are usually achieved under specific conditions. Clinical and C-E uncertainty frequently led to reimbursement with financial agreements or outcomes-based conditions. Sociodemographic factors as: social health insurance system, higher Gross Domestic Product and larger elderly population were positively associated with reimbursement (p < 0.01). CONCLUSION There is a need for further research into key determinants of reimbursement decisions in Europe and the development of drug access models that can effectively address and overcome costs and effectiveness uncertainties.
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Shi Y, Chen G, Wang X, Liu Y, Wu L, Hao Y, Liu C, Zhu S, Zhang X, Li Y, Liu J, Cao L, Cheng Y, Zhao H, Zhang S, Zang A, Cui J, Feng J, Yang N, Hu J, Liu F, Jiang Y, Ge N. Patient-reported outcomes for the phase 3 FURLONG study of furmonertinib versus gefitinib as first-line therapy for Chinese patients with locally advanced or metastatic EGFR mutation-positive non-small cell lung cancer. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 48:101122. [PMID: 38993541 PMCID: PMC11238182 DOI: 10.1016/j.lanwpc.2024.101122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/02/2024] [Accepted: 06/04/2024] [Indexed: 07/13/2024]
Abstract
Background Furmonertinib showed superior efficacy compared with gefitinib as first-line therapy in patients with epidermal growth factor receptor (EGFR) mutation-positive non-small cell lung cancer (NSCLC) in the FURLONG study. Here we present prespecified secondary endpoints of patient-reported outcomes (PRO). Methods In this multicentre, double-blind, double-dummy, randomised phase 3 study, patients were 1:1 randomly assigned to receive furmonertinib 80 mg once daily or gefitinib 250 mg once daily. PROs assessed by the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Core 30 and Quality-of-Life Questionnaire Lung Cancer 13 were analysed using a mixed model for repeated measures and time-to-event analyses. A difference in score of 10 points or more was deemed clinically relevant. Findings Three hundred and fifty-seven patients (furmonertinib group, n = 178; gefitinib group, n = 179) received at least one dose of the study drug, all of whom completed at least one PRO assessment. Statistically significant difference of overall score changes from baseline favoured furmonertinib in physical functioning (between-group difference 2.14 [95% CI 0.25-4.04], p = 0.027), nausea/vomiting (-1.56 [95% CI -2.62 to -0.49], p = 0.004), appetite loss (-2.24 [95% CI -4.26 to -0.23], p = 0.029), diarrhoea (-3.36 [95% CI -5.19 to -1.54], p < 0.001), alopecia (-2.62 [95% CI -4.54 to -0.71], p = 0.007), and pain in other parts (-4.55 [95% CI -7.37 to -1.74], p = 0.002), but not reached clinical relevance. Time to deterioration in physical functioning (hazard ratio 0.63 [95% CI 0.42-0.94], p = 0.021), cognitive functioning (0.73 [95% CI 0.54-0.98], p = 0.034), nausea/vomiting (0.64 [95% CI 0.41-0.99], p = 0.042), appetite loss (0.63 [95% CI 0.43-0.92], p = 0.016), diarrhoea (0.63 [95% CI 0.46-0.85], p = 0.002), dyspnoea (0.72 [95% CI 0.53-0.98], p = 0.034), cough (0.67 [95% CI 0.44-1.00], p = 0.049), dysphagia (0.54 [95% CI 0.35-0.83], p = 0.004), and alopecia (0.62 [95% CI 0.42-0.90], p = 0.012) was longer with furmonertinib versus gefitinib. Interpretation In patients with locally advanced or metastatic EGFR mutation-positive NSCLC, furmonertinib showed improved scores and delayed deterioration in several functioning and symptoms compared to gefitinib. Funding Shanghai Allist Pharmaceutical Technology Co., Ltd and the National Science and Technology Major Project for Key New Drug Development (2017ZX09304015).
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Affiliation(s)
- Yuankai Shi
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, the People's Republic of China
| | - Gongyan Chen
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, 150081, the People's Republic of China
| | - Xiang Wang
- Department of Medical Oncology, Xuzhou Central Hospital, Xuzhou, Jiangsu, 221009, the People's Republic of China
| | - Yunpeng Liu
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, the People's Republic of China
| | - Lin Wu
- Thoracic Medicine Department II, Hunan Cancer Hospital, Changsha, Hunan, 410013, the People's Republic of China
| | - Yanrong Hao
- Department of Medical Oncology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, the People's Republic of China
| | - Chunling Liu
- Department of Pulmonary Medicine, Cancer Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830000, the People's Republic of China
| | - Shuyang Zhu
- Department of Respiratory Medicine, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu, 221006, the People's Republic of China
| | - Xiaodong Zhang
- Department of Medical Oncology, Nantong Cancer Hospital, Nantong, Jiangsu, 226361, the People's Republic of China
| | - Yuping Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, the People's Republic of China
| | - Jiwei Liu
- Department of Oncology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, 116011, the People's Republic of China
| | - Lejie Cao
- Department of Respiratory Medicine, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, 230001, the People's Republic of China
| | - Ying Cheng
- Department of Oncology, Jilin Cancer Hospital, Changchun, Jilin, 130021, the People's Republic of China
| | - Hui Zhao
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Anhui University, Hefei, Anhui, 230601, the People's Republic of China
| | - Shucai Zhang
- Department of Medical Oncology, Beijing Tuberculosis and Thoracic Tumor Research Institute/Beijing Chest Hospital, Capital Medical University, Beijing, 101149, the People's Republic of China
| | - Aimin Zang
- Department of Medical Oncology, Affiliated Hospital of Hebei University, Baoding, Hebei, 071000, the People's Republic of China
| | - Jiuwei Cui
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, 130021, the People's Republic of China
| | - Jian Feng
- Department of Respiratory Medicine, Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, the People's Republic of China
| | - Nong Yang
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital, Changsha, Hunan, 410013, the People's Republic of China
| | - Jie Hu
- Shanghai Allist Pharmaceutical Technology Co., Ltd, Shanghai, 201318, the People's Republic of China
| | - Fei Liu
- Shanghai Allist Pharmaceutical Technology Co., Ltd, Shanghai, 201318, the People's Republic of China
| | - Yong Jiang
- Shanghai Allist Pharmaceutical Technology Co., Ltd, Shanghai, 201318, the People's Republic of China
| | - Nan Ge
- Shanghai Allist Pharmaceutical Technology Co., Ltd, Shanghai, 201318, the People's Republic of China
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Osipenko L, Ul-Hasan SA, Winberg D, Prudyus K, Kousta M, Rizoglou A, Rustignoli I, van der Maas L. Assessment of quality of data submitted for NICE technology appraisals over two decades. BMJ Open 2024; 14:e074341. [PMID: 38351112 PMCID: PMC10870012 DOI: 10.1136/bmjopen-2023-074341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 11/17/2023] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND The National Institute for Health and Care Excellence (NICE) pioneered the Health Technology Assessment (HTA) processes and methodologies. Technology appraisals (TAs) focus on pharmaceutical products and clinical and economic data, which are presented by the product manufacturers to the NICE appraisal committee for decision-making. Uncertainty in data reduces the chance of a positive outcome from the HTA process or requires a higher discount. OBJECTIVE To investigate the quality of clinical data (comparator, quality of life (QoL), randomised controlled trials (RCTs) and overall quality of evidence) submitted by the manufacturers to NICE. DESIGN This retrospective evaluation analysed active TAs published between 2000 and 2019 (up to TA600). METHODS For all TAs, we extracted data from the Assessment Group and Evidence Review Group reports and Final Appraisal Determinations on (1) the quality of submitted RCTs and (2) the overall quality of evidence submitted for decision-making. For single TAs, we also extracted data and its critique on QoL and comparators. Each category was scored for quality and analysed using descriptive statistics. RESULTS 409 TAs were analysed (multiple technology appraisals (MTA)=104, single technology appraisal (STA)=305). In two-thirds of TAs, the overall quality of evidence was either poor (n=224, 55%) or unacceptable (n=41, 10%). In 39% (n=119) of the STAs, the quality of comparative evidence was considered poor, and in 17% (n=51) unacceptable. In 44% (n=135) of STAs, the quality of QoL data was considered poor, 15% (n=47) unacceptable, 33% (n=102) acceptable and 7% (n=21) as good. Over 20 years of longitudinal analysis did not show improvements in the quality of evidence submitted to NICE. CONCLUSION We found that the primary components of clinical evidence influencing NICE's decision-making framework were of poor quality. It is essential to continue to generate robust clinical data for premarket and postmarket introduction of medicines into clinical practice to ensure they deliver benefits to patients.
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Affiliation(s)
- Leeza Osipenko
- The London School of Economics and Political Science, London, UK
- Consilium Scientific, London, UK
| | - Saba Ajwat Ul-Hasan
- The London School of Economics and Political Science, London, UK
- Consilium Scientific, London, UK
| | - Debra Winberg
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Kseniia Prudyus
- The London School of Economics and Political Science, London, UK
| | | | - Artemis Rizoglou
- The London School of Economics and Political Science, London, UK
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Yue X, Ling Ma N, Zhong J, Yang H, Chen H, Yang Y, Lam SS, Yan L, Styrishave B, Ciesielski TM, Peng WX, Sonne C. Ancient forest plants possess cytotoxic properties causing liver cancer HepG2 cell apoptosis. ENVIRONMENTAL RESEARCH 2024; 241:117474. [PMID: 37879390 DOI: 10.1016/j.envres.2023.117474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 10/20/2023] [Accepted: 10/21/2023] [Indexed: 10/27/2023]
Abstract
Here, we collected 154 plant species in China ancient forests looking for novel efficient bioactive compounds for cancer treatments. We found 600 bioactive phyto-chemicals that induce apoptosis of liver cancer cell in vitro. First, we screen the plant extract's in vitro cytotoxicity inhibition of cancer cell growth using in vitro HepG2 cell lines and MTT cytotoxicity. The results from these initial MTT in vitro cytotoxicity tests show that the most efficient plants towards hepatoma cytoxicity is Cephalotaxus sinensis, mint bush (Elsholtzia stauntonii) and winged spindle tree (Euonymus alatus). We then used in cell-counting kit-8 (CCK-8) to further understand in vivo tumor growth using nude mice and GC-MS and LC-QTOF-MS to analyze the composition of compounds in the extracts. Extracted chemically active molecules analyzed by network pharmacology showed inhibition on the growth of liver cancer cells by acting on multiple gene targets, which is different from the currently used traditional drugs acting on only one target of liver cancer cells. Extracts from Cephalotaxus sinensis, mint bush (Elsholtzia stauntonii) and winged spindle tree (Euonymus alatus) induce apoptosis in hepatoma cancer cell line HepG2 with a killing rate of more than 83% and a tumor size decrease by 62-67% and a killing rate of only 6% of normal hepatocyte LO2. This study highlight efficient candidate species for cancer treatment providing a basis for future development of novel plant-based drugs to help meeting several of the UN SDGs and planetary health.
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Affiliation(s)
- Xiaochen Yue
- Henan Province Engineering Research Center for Biomass Value-added Products, Forestry College, Henan Agricultural University, Zhengzhou, 450002, China
| | - Nyuk Ling Ma
- BIOSES Research Interest Group, Faculty of Science & Marine Environment, Universiti Malaysia Terengganu, 21030, Kuala Nerus, Terengganu, Malaysia; Center for Global Health Research (CGHR), Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, India
| | - Jiateng Zhong
- Department of Pathology, Xinxiang Medical University, Xinxiang, China
| | - Han Yang
- Henan Province Engineering Research Center for Biomass Value-added Products, Forestry College, Henan Agricultural University, Zhengzhou, 450002, China
| | - Huiling Chen
- Henan Province Engineering Research Center for Biomass Value-added Products, Forestry College, Henan Agricultural University, Zhengzhou, 450002, China
| | - Yafeng Yang
- Henan Province Engineering Research Center for Biomass Value-added Products, Forestry College, Henan Agricultural University, Zhengzhou, 450002, China
| | - Su Shiung Lam
- Higher Institution Centre of Excellence (HICoE), Institute of Tropical Aquaculture and Fisheries (AKUATROP), Universiti Malaysia Terengganu, 21030, Kuala Nerus, Terengganu, Malaysia; Department of Chemical Engineering and Materials Science, Yuan Ze University, Taoyuan, Taiwan
| | - Lijun Yan
- Henan Province Engineering Research Center for Biomass Value-added Products, Forestry College, Henan Agricultural University, Zhengzhou, 450002, China
| | - Bjarne Styrishave
- Toxicology and Drug Metabolism Group, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Universitetsparken 2, DK-2100, Denmark
| | - Tomasz Maciej Ciesielski
- Department of Biology, Norwegian University of Science and Technology, Høgskoleringen 5, NO-7491, Trondheim, Norway; Department of Arctic Technology, The University Center in Svalbard, 9171, Longyearbyen, Norway
| | - Wan-Xi Peng
- Henan Province Engineering Research Center for Biomass Value-added Products, Forestry College, Henan Agricultural University, Zhengzhou, 450002, China.
| | - Christian Sonne
- Aarhus University, Department of Ecoscience, Arctic Research Centre (ARC), Frederiksborgvej 399, PO Box 358, DK-4000, Roskilde, Denmark; Sustainability Cluster, School of Engineering, University of Petroleum & Energy Studies, Dehradun, Uttarakhand, 248007, India.
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Erickson N, Sullivan ES, Kalliostra M, Laviano A, Wesseling J. Nutrition care is an integral part of patient-centred medical care: a European consensus. Med Oncol 2023; 40:112. [PMID: 36881207 PMCID: PMC9992033 DOI: 10.1007/s12032-023-01955-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/18/2023] [Indexed: 03/08/2023]
Abstract
While healthcare is becoming more patient-centred, evidence-based nutrition interventions are still not accessible to all patients with cancer. As nutrition interventions directly improve clinical and socioeconomic outcomes, patient-centred care is not complete without nutrition care. While awareness of the negative impact of malnutrition on clinical outcomes, quality of life, and functional and emotional wellbeing in cancer is growing, there is relatively poor awareness amongst patients, clinicians, policymakers, and payers that nutrition interventions -particularly those begun in the early stages of the disease course- are an effective method for improving such outcomes. The European Beating Cancer Plan recognises the need for a holistic approach to cancer but lacks actionable recommendations to implement integrated nutrition cancer care at member state level. When considering nutrition care as a human right, the impact on quality of life and functional status must be prioritized, as these may be equally as important to patients, especially in advanced cancer where improvements in clinical outcomes such as survival or tumour burden may not be attainable. We formulate actions needed at the regional and the European level to ensure integrated nutrition care for all patients with cancer. The 4 main Take Home Messages are as follows: 1. The goals of Europe's Beating Cancer Plan cannot be achieved without integrating nutrition across the cancer care continuum. 2. Malnutrition negatively impacts clinical outcomes and has socioeconomic consequences for patients and healthcare systems. 3. Championing integrating nutrition care into cancer care is therefore the duty and ethical responsibility of clinicians (Hippocratic Oath-primum non nocere) and 4. Nutrition care is a cost effective, evidence-based therapy.
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Affiliation(s)
- Nicole Erickson
- Comprehensive Cancer Center Munich, Ludwig Maximilian University of Munich Hospital, Munich, Germany.
- Writing Group, The European Union Thematic Network on Integrated Nutrition in Cancer Care (INC2), Croydon, UK.
- European Federation of the Associations of Dietitians (EFAD), Naarden, The Netherlands.
| | - Erin Stella Sullivan
- Writing Group, The European Union Thematic Network on Integrated Nutrition in Cancer Care (INC2), Croydon, UK
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Marianna Kalliostra
- Writing Group, The European Union Thematic Network on Integrated Nutrition in Cancer Care (INC2), Croydon, UK
- European Federation of the Associations of Dietitians (EFAD), Naarden, The Netherlands
- The European Nutrition for Health Alliance, London, UK
| | - Alessandro Laviano
- Writing Group, The European Union Thematic Network on Integrated Nutrition in Cancer Care (INC2), Croydon, UK
- The European Nutrition for Health Alliance, London, UK
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Joost Wesseling
- Writing Group, The European Union Thematic Network on Integrated Nutrition in Cancer Care (INC2), Croydon, UK
- The European Nutrition for Health Alliance, London, UK
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Antela A, Bernardino JI, de Quirós JCLB, Bachiller P, Fuster-RuizdeApodaca MJ, Puig J, Rodríguez S, Castrejón I, Álvarez B, Hermenegildo M. Patient-Reported Outcomes (PROs) in HIV Infection: Points to Consider and Challenges. Infect Dis Ther 2022; 11:2017-2033. [PMID: 36066841 DOI: 10.1007/s40121-022-00678-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/21/2022] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION The aim of this study was to reach consensus on the use of PROs (patient-reported outcome measures) in people living with HIV (PLHIV). METHODS A scientific committee of professionals with experience in PROMs methodology issued recommendations and defined the points to support by evidence. A systematic review of the literature identified the coverage, utility, and psychometric properties of PROMs used in PLHIV. A Delphi survey was launched to measure the degree of agreement with the recommendations of a group of practicing clinicians and a group of patient representatives. RESULTS Four principles and ten recommendations were issued; however, the results of the Delphi showed significant differences in the opinion between health professionals and PLHIV, and polarization within collectives, hampering consensus. CONCLUSIONS Despite a wealth of evidence on the benefit of PROMs, there are clear barriers to their use by healthcare professionals in HIV care. Intervention on these barriers is paramount to allow truly patient-centered care.
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Affiliation(s)
- Antonio Antela
- Infectious Diseases Unit, Complejo Hospitalario Universitario de Santiago (CHUS), Santiago de Compostela, Spain.
| | | | | | - Pablo Bachiller
- Internal Medicine Department, Complejo Asistencial de Segovia, Segovia, Spain
| | | | - Jordi Puig
- Hospital Universitario Germans Trias I Pujol, Fundació Lluita Contra La Sida I Les Malalties Infeccioses, Badalona, Spain
| | | | - Isabel Castrejón
- Rheumatology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Beatriz Álvarez
- HIV and Infectious Diseases Unit, Hospital Fundación Jiménez Díaz, Madrid, Spain
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Nicod E, Meregaglia M, Whittal A, Upadhyaya S, Facey K, Drummond M. Consideration of quality of life in the health technology assessments of rare disease treatments. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:645-669. [PMID: 34714428 DOI: 10.1007/s10198-021-01387-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/30/2021] [Indexed: 05/27/2023]
Abstract
OBJECTIVES Challenges with patient-reported outcome (PRO) evidence and health state utility values (HSUVs) in rare diseases exist due to small, heterogeneous populations, lack of disease knowledge and early onset. To better incorporate quality of life (QoL) into Health Technology Assessment, a clearer understanding of these challenges is needed. METHODS NICE appraisals of non-oncology treatments with an EMA orphan designation (n = 24), and corresponding appraisals in the Netherlands, France, and Germany were included. Document analysis of appraisal reports investigated how PROs/HSUVs influenced decision-making and was representative of QoL impact of condition and treatment. RESULTS PRO evidence was not included in 6/24 NICE appraisals. When included, it either failed to demonstrate change, capture domains important for patients, or was uncertain. In the other countries, little information was reported and evidence largely did not demonstrate change. In NICE appraisals, HSUVs were derived through the collection of EQ-5D data (7/24 cases), mapping (6/24), vignettes (5/24), and published literature or other techniques (6/24). The majority did not use data collected alongside clinical trials. Few measures demonstrated significant change due to lack of sensitivity or face validity, short-term data, or implausible health states. In 8/24 NICE appraisals, patient surveys or input during appraisal committee meetings supported the interpretation of uncertainty or provided evidence about QoL. CONCLUSIONS This study sheds light on the nature of PRO evidence in rare diseases and associated challenges. Results emphasise the need for improved development and use of PRO/HSUVs. Other forms of evidence and expert input are crucial to support better appraisal of uncertain or missing evidence.
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Affiliation(s)
- Elena Nicod
- Research Centre on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Via Sarfatti 10, 20136, Milan, Italy.
| | - Michela Meregaglia
- Research Centre on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Via Sarfatti 10, 20136, Milan, Italy
| | - Amanda Whittal
- Research Centre on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Via Sarfatti 10, 20136, Milan, Italy
| | | | - Karen Facey
- University of Edinburgh, Usher Institute for Population Health Sciences and Informatics, Edinburgh, UK
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Patient Selection for Local Aggressive Treatment in Oligometastatic Non-Small Cell Lung Cancer. Cancers (Basel) 2021; 13:cancers13246374. [PMID: 34944994 PMCID: PMC8699700 DOI: 10.3390/cancers13246374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/12/2021] [Accepted: 12/14/2021] [Indexed: 12/20/2022] Open
Abstract
Simple Summary Since the first introduction of the oligometastatic state with a low burden of metastases in non-small cell lung cancer, accumulating evidence from retrospective and prospective studies has shown that a local aggressive, multimodality treatment may significantly improve the prognosis in these patients. Local aggressive treatment includes a systemic therapy of micrometastatic disease, as well as a radical resection of the primary tumor and surgical resection and/or radiation therapy of distant metastases. However, patient selection and treatment allocation remain a central challenge in oligometastatic disease. In this review, we aimed to address the current evidence on criteria for patient selection for local aggressive treatment in non-small cell lung cancer. Abstract One-fourth of all patients with metastatic non-small cell lung cancer presents with a limited number of metastases and relatively low systemic tumor burden. This oligometastatic state with limited systemic tumor burden may be associated with remarkably improved overall and progression-free survival if both primary tumor and metastases are treated radically combined with systemic therapy. This local aggressive therapy (LAT) requires a multidisciplinary approach including medical oncologists, radiation therapists, and thoracic surgeons. A surgical resection of the often advanced primary tumor should be part of the radical treatment whenever feasible. However, patient selection, timing, and a correct treatment allocation for LAT appear to be essential. In this review, we aimed to summarize and discuss the current evidence on patient selection criteria such as characteristics of the primary tumor and metastases, response to neoadjuvant or first-line treatment, molecular characteristics, mediastinal lymph node involvement, and other factors for LAT in oligometastatic NSCLC.
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Kalf RRJ, Delnoij DMJ, Ryll B, Bouvy ML, Goettsch WG. Information Patients With Melanoma Spontaneously Report About Health-Related Quality of Life on Web-Based Forums: Case Study. J Med Internet Res 2021; 23:e27497. [PMID: 34878994 PMCID: PMC8693198 DOI: 10.2196/27497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 08/27/2021] [Accepted: 09/25/2021] [Indexed: 01/22/2023] Open
Abstract
Background There is a general agreement on the importance of health-related quality of life (HRQoL). This type of information is becoming increasingly important for the value assessment of health technology assessment agencies in evaluating the benefits of new health technologies, including medicines. However, HRQoL data are often limited, and additional sources that provide this type of information may be helpful. Objective We aim to identify the HRQoL topics important to patients with melanoma based on web-based discussions on public social media forums. Methods We identified 3 public web-based forums from the United States and the United Kingdom, namely the Melanoma Patient Information Page, the Melanoma International Forum, and MacMillan. Their posts were randomly selected and coded using qualitative methods until saturation was reached. Results Of the posts assessed, 36.7% (150/409) of posts on Melanoma International Forum, 45.1% (198/439) on MacMillan, and 35.4% (128/362) on Melanoma Patient Information Page focused on HRQoL. The 2 themes most frequently mentioned were mental health and (un)certainty. The themes were constructed based on underlying and more detailed codes. Codes related to fear, worry and anxiety, uncertainty, and unfavorable effects were the most-often discussed ones. Conclusions Web-based forums are a valuable source for identifying relevant HRQoL aspects in patients with a given disease. These aspects could be cross-referenced with existing tools and they might improve the content validity of patient-reported outcome measures, including HRQoL questionnaires. In addition, web-based forums may provide health technology assessment agencies with a more holistic understanding of the external aspects affecting patient HRQoL. These aspects might support the value assessment of new health technologies and could therefore help inform topic prioritization as well as the scoping phase before any value assessment.
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Affiliation(s)
- Rachel R J Kalf
- Department of Pharmacoepidemiology and Clinical Pharmacology, University Utrecht, Utrecht, Netherlands.,National Health Care Institute, Diemen, Netherlands
| | - Diana M J Delnoij
- National Health Care Institute, Diemen, Netherlands.,Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Bettina Ryll
- Melanoma Patient Network Europe, Uppsala, Sweden
| | - Marcel L Bouvy
- Department of Pharmacoepidemiology and Clinical Pharmacology, University Utrecht, Utrecht, Netherlands
| | - Wim G Goettsch
- Department of Pharmacoepidemiology and Clinical Pharmacology, University Utrecht, Utrecht, Netherlands.,National Health Care Institute, Diemen, Netherlands
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10
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Law E, Gavanji R, Walsh S, Haltner A, McTavish R, Cameron C. Palbociclib versus abemaciclib in HR+/HER2- advanced breast cancer: an indirect comparison of patient-reported end points. J Comp Eff Res 2021; 11:109-120. [PMID: 34751591 DOI: 10.2217/cer-2021-0221] [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: 11/21/2022] Open
Abstract
Aim: To assess the relative impact of palbociclib plus fulvestrant (PAL + FUL) and abemaciclib plus fulvestrant (ABEM + FUL) on patient-reported outcomes in patients with hormone receptor-positive, HER2-negative (HR+/HER2-) advanced breast cancer. Patients & methods: Anchored matching-adjusted indirect comparisons were conducted using individual patient data from PALOMA-3 (PAL + FUL) and summary-level data from MONARCH-2 (ABEM + FUL). Outcomes included the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 items (EORTC QLQ-C30) and its breast cancer-specific module (QLQ-BR23). Results: Significantly different changes from baseline favoring PAL + FUL compared with ABEM + FUL were observed in global quality of life (6.95 [95% CI: 2.19-11.71]; p = 0.004) and several functional/symptom scales, including emotional functioning, nausea/vomiting, appetite loss, diarrhea and systemic therapy side effects. Conclusion: PAL + FUL was associated with more favorable patient-reported outcomes than ABEM + FUL in patients with HR+/HER2- advanced breast cancer.
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Affiliation(s)
| | | | - Sarah Walsh
- EVERSANA, Sydney, Nova Scotia B1P 1C6, Canada
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11
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Can Multi-Attribute Utility Instruments Adequately Capture Net Health Gains in Vision-Related Quality of Life (QoL)? JOURNAL OF HEALTH MANAGEMENT 2021. [DOI: 10.1177/09720634211035264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Health states/outcomes evaluation is an integral part of medical economics. Generic utility instruments compare quality of life (QoL) effects of healthcare interventions across a wide spectrum of diseases and patient populations. This study seeks to determine whether these generic instruments are sensitive to ocular diseases, where expected QoL effects of treatment are patient comfort and symptoms relief, rather than additional quality-adjusted life years (QALYs). Methods: Targeted search and systematic review of refereed studies on dry eye therapy with omega-3 fatty acids (omega-3s) were performed across four databases to identify clinical effectiveness parameters and outcomes. An alternative utility instrument for measuring comparative vision/opthalmic-related QoL effects of pharmaceutical-grade fish oils is used for illustration. Results: Most studies utilise common parametric indices of omega-3 therapy in dry eye. VisQoL appears sufficiently sensitive and customisable to a QoL impact assessment of omega-3s. Clinical outcomes and covariates can be matched to VisQoL in capturing aspects of vision functioning that are vital for patient daily performance and well-being, U = x / n. In contrast, generic measures tend to be content-insensitive to changes in vision/opthalmic-related QoL. Conclusions: Relevance, reliability and validity of multi-attribute utility measures in ocular conditions, like dry eye, can be assessed in terms of four key factors addressed by VisQoL: (a) sensitivity to ocular condition; (b) correlation with clinical parametric data; (c) customisability based on presenting symptoms; and (d) suitability to comparative investigations of intervention effectiveness relative to vision-related QoL.
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12
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Gadgeel SM. Patient-Reported Outcomes in the Era of Immunotherapy Trials. J Thorac Oncol 2021; 16:516-518. [PMID: 33781441 DOI: 10.1016/j.jtho.2021.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Shirish M Gadgeel
- Division of Hematology/Oncology, Department of Internal Medicine, Henry Ford Cancer Institute, Henry Ford Health System, Detroit, Michigan.
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13
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He Q, Zeng Q, Shao Y, Zhou H, Li T, Song F, Liu W. Anti-cervical cancer activity of secondary metabolites of endophytic fungi from Ginkgo biloba. Cancer Biomark 2021; 28:371-379. [PMID: 32508319 DOI: 10.3233/cbm-190462] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The purpose of this study was to isolate the secondary metabolites of endophytic fungi from Ginkgo biloba (SMEFGB) and investigate their anti-cervical cancer activity. METHODS SMEFGB were cultured. The secondary metabolites of endophytic fungi was extracted, purified and identified. The effects of secondary metabolites on proliferation, apoptosis and migration of human cervical cancer HeLa cells were determined. In addition, the effects of SMEFGB on growth of Hela implanted tumor in mice were investigated. RESULTS In 9 stains of endophytic fungi successfully isolated from the leaves of Ginkgo biloba, the stain J-1, J-2 and J-3 could produce podophyllotoxin. These 3 stains were identified by molecular biology. The secondary metabolites of stain J-1, J-2 and J-3 markedly inhibited the proliferation of HeLa cells, promoted their apoptosis and blocked their migration. In addition, the secondary metabolites of stain J-1, J-2 and J-3 significantly attenuated the growth of HeLa implanted tumor in mice. CONCLUSIONS Our results indicated that SMEFGB had obvious anti-cervical cancer activity in vitro and in vivo.
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Affiliation(s)
- Qing He
- Shandong Key Laboratory in University of Functional Bioresource Utilization, College of Life Science, Dezhou University, Dezhou, Shandong, China.,Shandong Provincial Key Laboratory of Biophysics, Dezhou University, Dezhou, Shandong, China
| | - Qiangcheng Zeng
- Shandong Key Laboratory in University of Functional Bioresource Utilization, College of Life Science, Dezhou University, Dezhou, Shandong, China.,Shandong Provincial Key Laboratory of Biophysics, Dezhou University, Dezhou, Shandong, China
| | - Yibo Shao
- Shandong Key Laboratory in University of Functional Bioresource Utilization, College of Life Science, Dezhou University, Dezhou, Shandong, China
| | - Haixia Zhou
- Shandong Key Laboratory in University of Functional Bioresource Utilization, College of Life Science, Dezhou University, Dezhou, Shandong, China
| | - Tianjiao Li
- Shandong Key Laboratory in University of Functional Bioresource Utilization, College of Life Science, Dezhou University, Dezhou, Shandong, China
| | - Fang Song
- Shandong Key Laboratory in University of Functional Bioresource Utilization, College of Life Science, Dezhou University, Dezhou, Shandong, China
| | - Wei Liu
- Shandong Key Laboratory in University of Functional Bioresource Utilization, College of Life Science, Dezhou University, Dezhou, Shandong, China
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14
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Wasalski E, Mehta S. Health-Related Quality of Life Data in Cancer Clinical Trials for Drug Registration: The Value Beyond Reimbursement. JCO Clin Cancer Inform 2021; 5:112-124. [PMID: 33492993 DOI: 10.1200/cci.20.00100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE A review of the literature was performed to evaluate how quality of life measures are collected, analyzed, and reported in cancer clinical trials intended to support drug registration.Health-related quality of life (HRQoL) data points are one of the patient-reported outcome (PRO) assessments used in clinical trials to evaluate the effects of treatments from the patient perspective. The use of PROs has gained focus in cancer clinical trials as more options become available for greater longevity of patients on treatment. Standardization of PRO data is evolving and involves unique challenges when used for assessing biologic and chemotherapeutic agents for the treatment of cancer. METHODS In this study, a review of literature published between 2009 and 2019 was conducted using PubMed, COCHRANE Library, and Medline. The research focus was on the current guidance, implementation, and reporting as well as highlighting the issues, and recommendations for the inclusion of HRQoL end points in cancer clinical trials intended for use in drug registration. RESULTS Although there exist many levels of guidance for HRQoL measures in cancer drug trials, challenges to operational implementation, the current inconsistent adherence to reporting standards, and the lack of consensus and understanding of analyses limit the value and potential of the resulting data collected. CONCLUSION The results of HRQoL data collected from cancer clinical trials can be difficult to interpret and apply to inform clinical decision making. Increased reporting and access to these data can provide opportunities for potential applications to improve translatability of HRQoL data collected in clinical trials into practice.
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Affiliation(s)
- Erinne Wasalski
- Rutgers The State University of New Jersey, School of Health Professions, Department of Interdisciplinary Studies, 65 Bergen Street, Newark, NJ 07107-1709
| | - Shashi Mehta
- Rutgers The State University of New Jersey, School of Health Professions, Department of Clinical Laboratory and Medical Imaging Sciences, 65 Bergen Street, Newark, NJ 07107-1709
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15
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Reck M, Ciuleanu TE, Lee JS, Schenker M, Audigier-Valette C, Zurawski B, Linardou H, Otterson GA, Salman P, Nishio M, de la Mora Jimenez E, Lesniewski-Kmak K, Albert I, Ahmed S, Syrigos K, Penrod JR, Yuan Y, Blum SI, Nathan FE, Sun X, Moreno-Koehler A, Taylor F, O'Byrne KJ. First-Line Nivolumab Plus Ipilimumab Versus Chemotherapy in Advanced NSCLC With 1% or Greater Tumor PD-L1 Expression: Patient-Reported Outcomes From CheckMate 227 Part 1. J Thorac Oncol 2021; 16:665-676. [PMID: 33485960 DOI: 10.1016/j.jtho.2020.12.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/21/2020] [Accepted: 12/29/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION In CheckMate 227 (NCT02477826), patients with treatment-naive stage IV or recurrent NSCLC and 1% or greater tumor programmed death ligand 1 expression had significantly improved overall survival with nivolumab plus ipilimumab versus chemotherapy. We present the patient-reported outcomes (PROs). METHODS Patients (N = 1189) were randomized to nivolumab plus ipilimumab, nivolumab, or chemotherapy. PROs were exploratory. Changes in Lung Cancer Symptom Scale (LCSS) average symptom burden index, LCSS 3-item global index, EQ-5D visual analog scale (VAS), and EQ-5D utility index were analyzed descriptively. Mixed-effect model repeated measures and time-to-first deterioration and improvement analyses were conducted. RESULTS PRO completion rates were generally greater than 80%. On-treatment improvements from baseline in LCSS measures of symptom burden and global health status with nivolumab plus ipilimumab generally met or exceeded the minimal important difference (smallest clinically meaningful change) from weeks 24 and 30, respectively; improvements with chemotherapy generally remained below the minimal important difference. Mean on-treatment EQ-5D VAS scores for both treatments approached the U.K. population norm at week 24, remaining so throughout the treatment period. Mixed-effect model repeated measures analyses revealed numerically greater improvements from baseline with nivolumab plus ipilimumab versus chemotherapy across LCSS average symptom burden index and 3-item global index, and EQ-5D VAS and utility index. Nivolumab plus ipilimumab had delayed time-to-first deterioration (hazard ratio [95% confidence interval] 0.74 [0.56 to 0.98]) and a trend for more rapid time-to-first improvement (1.24 [0.98 to 1.59]) versus chemotherapy. CONCLUSIONS Nivolumab plus ipilimumab revealed delayed deterioration and numerical improvement in symptoms and health-related quality of life versus chemotherapy in patients with advanced NSCLC and 1% or greater programmed death ligand 1 expression.
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Affiliation(s)
- Martin Reck
- LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany.
| | - Tudor-Eliade Ciuleanu
- Institutul Oncologic Prof. Dr. Ion Chiricuta and UNF Iulia Hatieganu, Cluj-Napoca, Romania
| | - Jong-Seok Lee
- Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | | | | | | | | | | | | | - Makoto Nishio
- The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | | | | | - Samreen Ahmed
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Konstantinos Syrigos
- Sotiria General Hospital, National and Kaposistrian University of Athens, Athens, Greece
| | | | - Yong Yuan
- Bristol Myers Squibb, Princeton, New Jersey
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16
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Akinosoglou K, Antonopoulou S, Katsarolis I, Gogos CA. Patient-reported outcomes in HIV clinical trials evaluating antiretroviral treatment: a systematic review. AIDS Care 2020; 33:1118-1126. [PMID: 33267620 DOI: 10.1080/09540121.2020.1852160] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We aimed to assess patterns of patient-reported outcomes (PRO) instruments' utilization in HIV clinical trials in relation to antiretroviral therapy (ART). PubMed/MEDLINE, Scopus, and EMBASE were searched using the terms "Patient-Reported Outcomes" and "HIV/AIDS" or "Antiretroviral Treatment" or "ART" or "Antiretroviral Therapy" from 1 January 1990 until 1 December 2019. In total, 173 studies were identified and 26 were directly related to ART. Study population included treatment-naïve patients (n = 4), treatment-experienced (n = 20), or both (n = 2). Instruments were implemented to assess general experience with ART (n = 3), single-tablet regimens (STR) (n = 2), monotherapy (n = 4), regimen switch (n = 9), or regimen comparison (n = 8). The most commonly used instruments were Medical Outcomes Study-HIV Health Survey (MOS-HIV, n = 8), HIV Symptom Index (HIV-SI, n = 7) and unstructured self-reports (n = 5) followed by others. MOS-HIV was used mainly in comparative (n = 4) and monotherapy (n = 3) trials, HIV-SI in switch (n = 4) and STR (n = 2) trials, and self-reports in comparative trials (n = 3). Even though, the implementation of PRO tools is increasing with time, reporting of PRO in HIV clinical trials remains limited.
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Affiliation(s)
- Karolina Akinosoglou
- Department of Internal Medicine, University General Hospital of Patras, Patras, Greece.,Department of Infectious Diseases, University General Hospital of Patras, Patras, Greece
| | | | | | - Charalambos A Gogos
- Department of Internal Medicine, University General Hospital of Patras, Patras, Greece.,Department of Infectious Diseases, University General Hospital of Patras, Patras, Greece
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17
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Vila MM, Barco Berron SD, Gil-Gil M, Ochoa-Arnedo C, Vázquez RV. Psychosocial aspects and life project disruption in young women diagnosed with metastatic hormone-sensitive HER2-negative breast cancer. Breast 2020; 53:44-50. [PMID: 32623094 PMCID: PMC7375669 DOI: 10.1016/j.breast.2020.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/18/2020] [Accepted: 06/25/2020] [Indexed: 01/17/2023] Open
Abstract
Metastatic breast cancer (MBC) diagnosis in young women negatively impacts on quality of life (QoL) and daily activities, disrupting their life project and forcing them to face new psychosocial challenges. The recently published results on the improvement of the overall survival of pre- or perimenopausal women with hormone-receptor-positive, HER2-negative MBC treated with CDK4/6 inhibitors plus endocrine therapy, while preserving, and in some items improving their QoL, will change the landscape of the management of this patient population. Their extended survival and potential improvement in QoL will, therefore, modify their specific needs in terms of psychosocial support. The complexity of the care of young women with MBC is described herein, based on an extensive literature review. Further research about the specific psychosocial requirements of these women and a new multidisciplinary holistic approach is paramount to properly address their concerns and preferences. The communication with and support of their partners, parents and children is an important factor affecting the QoL of these patients. Altogether, a multidisciplinary care, open communication and personalized support is required to address the psychosocial implications of the new prognostic expectations on these patients with the incorporation of new targeted therapies. Life project disruption in young women with metastatic breast cancer. Scarce research and lack of specific QoL questionnaires. Multidisciplinary holistic approach key to address concerns of young MBC patients. New therapies extend survival and improve quality of life of MBC patients. Psychosocial support needs to be adapted to these new prognostic expectations.
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Affiliation(s)
- Mireia Margelí Vila
- B-ARGO Group, Institut Català D'Oncologia, Medical Oncology Service, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Sonia Del Barco Berron
- Breast Cancer Unit. Institut Català D'Oncologia, Hospital Universitari Josep Trueta, Girona, Spain
| | - Miguel Gil-Gil
- Medical Oncology Unit. Institut Català D'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; Institut D'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Cristian Ochoa-Arnedo
- Psycho-Oncology Unit. Institut Català D'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; Clinical Psychology and Psychobiology Department, Universitat de Barcelona, Spain; Institut D'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Rafael Villanueva Vázquez
- Medical Oncology Unit. Institut Català D'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; Breast Cancer Unit. Institut Català D'Oncologia, Hospital Moisès Broggi. Sant Joan Despí, Barcelona, Spain.
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18
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Grössmann N, Robausch M, Rothschedl E, Wild C, Simon J. Publicly accessible evidence of health-related quality of life benefits associated with cancer drugs approved by the European Medicines Agency between 2009 and 2015. Eur J Cancer 2020; 129:23-31. [PMID: 32120272 DOI: 10.1016/j.ejca.2020.01.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/15/2020] [Accepted: 01/17/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Health-related quality of life (HRQoL) is one of the most important patient-relevant study end-points for the direct measurement of the benefit of cancer drugs. Therefore, our aim is to detect cancer indications with no published information on HRQoL at the time of European Medicines Agency (EMA) approval and monitor any reported HRQoL evidence updates after at least three years of follow-up. METHODS We included all cancer indications that were approved by the EMA between January 2009 and October 2015. Our main sources of information were the EMA website, clinicaltrials.gov and a systematic literature search in PubMed. Information on HRQoL outcomes was extracted alongside evidence on median overall survival. RESULTS In total, we identified 110 indications, of which more than half (n = 58, 53%) were lacking available information on HRQoL assessments at the time of EMA approval. After a monitoring period of at least three years, 24 updates were identified, resulting in 34 (31%) therapies where information on HRQoL was still not available. For the 76 therapies with reported information on HRQoL, cancer-specific instruments were mostly used (n = 49/76). Regarding cumulative evidence on median overall survival and HRQoL, 33 (n = 33/110, 30%) as well as 15 (n = 15/110, 14%) cancer drugs were lacking information on both study end-points at the time of approval and after monitoring, respectively. CONCLUSION Our results demonstrate that there is an urgent need of routine re-evaluation of reimbursed cancer drugs with initially missing information on major outcomes. Standardisation of the typology and quality of HRQoL assessments need to be improved to allow better comparability of results.
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Affiliation(s)
- Nicole Grössmann
- Ludwig Boltzmann Institute for Health Technology Assessment, Vienna, Austria; Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria.
| | - Martin Robausch
- Ludwig Boltzmann Institute for Health Technology Assessment, Vienna, Austria; Lower Austrian Sickness Fund, St. Pölten, Austria
| | - Eleen Rothschedl
- Ludwig Boltzmann Institute for Health Technology Assessment, Vienna, Austria
| | - Claudia Wild
- Ludwig Boltzmann Institute for Health Technology Assessment, Vienna, Austria
| | - Judit Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute Applied Diagnostics, Vienna, Austria
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Vreman RA, Mantel-Teeuwisse AK, Hövels AM, Leufkens HGM, Goettsch WG. Differences in Health Technology Assessment Recommendations Among European Jurisdictions: The Role of Practice Variations. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:10-16. [PMID: 31952664 DOI: 10.1016/j.jval.2019.07.017] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 04/02/2019] [Accepted: 07/15/2019] [Indexed: 05/25/2023]
Abstract
BACKGROUND Health technology assessment (HTA) plays an important role in reimbursement decision-making in many countries, but recommendations vary widely throughout jurisdictions, even for the same drug. This variation may be due to differences in the weighing of evidence or differences in the processes or procedures, which are known as HTA practices. OBJECTIVE To provide insight into the effects of differences in practices on interpretation of intercountry differences in HTA recommendations for conditionally approved drugs. METHODS HTA recommendations for conditionally approved drugs (N = 27) up until June 2017 from England/Wales, France, Germany, the Netherlands, and Scotland were included. Recommendations and practice characteristics were extracted from these five jurisdictions and this data was validated. The effect of nonsubmissions, resubmissions, and reassessments; cost-effectiveness assessments; and price negotiations on changes in the percentage of negative recommendations and the interpretation of intercountry differences in HTA outcomes were analyzed using Fisher exact tests. RESULTS The inclusion of cost-effectiveness assessments led to significant increases in the proportion of negative recommendations in England/Wales (from 4% to 50%, P<.01) and Scotland (from 21% to 71%, P<.01). The subsequent inclusion of price negotiations led to significant reductions in the proportion of negative recommendations in England/Wales (from 50% to 14%, P<.01), France (from 31% to 3%, P=.012), and Germany (from 34% to 0%, P<.01). Results indicated that the inclusion of nonsubmissions and resubmissions might affect Scottish negative HTA recommendations (from 7% to 21%), but this effect was not significant. No significant effects were observed in the Netherlands, possibly owing to sample size. CONCLUSION Variations in HTA practices between international jurisdictions can have a substantial and significant impact on conclusions about recommendations by HTA bodies, as exemplified in this cohort of conditionally approved products. Studies comparing international HTA recommendations should carefully consider possible practice variations between jurisdictions.
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Affiliation(s)
- Rick A Vreman
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands; The National Healthcare Institute, Diemen, The Netherlands
| | | | - Anke M Hövels
- The National Healthcare Institute, Diemen, The Netherlands
| | | | - Wim G Goettsch
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands; The National Healthcare Institute, Diemen, The Netherlands.
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20
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Skovlund E, Leufkens H, Smyth J. The use of real-world data in cancer drug development. Eur J Cancer 2018; 101:69-76. [DOI: 10.1016/j.ejca.2018.06.036] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 06/23/2018] [Indexed: 01/15/2023]
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