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Khorshidi HA, Marshall D, Goranitis I, Schroeder B, IJzerman M. System dynamics simulation for evaluating implementation strategies of genomic sequencing: tutorial and conceptual model. Expert Rev Pharmacoecon Outcomes Res 2024; 24:37-47. [PMID: 37803528 DOI: 10.1080/14737167.2023.2267764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 10/03/2023] [Indexed: 10/08/2023]
Abstract
INTRODUCTION Precision Medicine (PM), especially in oncology, involve diagnostic and complex treatment pathways that are based on genomic features. To conduct evaluation and decision analysis for PM, advanced modeling techniques are needed due to its complexity. Although System Dynamics (SD) has strong modeling power, it has not been widely used in PM and individualized treatment. AREAS COVERED We explained SD tools using examples in cancer context and the rationale behind using SD for genomic testing and personalized oncology. We compared SD with other Dynamic Simulation Modelling (DSM) methods and listed SD's advantages. We developed a conceptual model using Causal Loop Diagram (CLD) for strategic decision-making in Whole Genome Sequencing (WGS) implementation. EXPERT OPINION The paper demonstrates that SD is well-suited for health policy evaluation challenges and has useful tools for modeling precision oncology and genomic testing. SD's system-oriented modeling captures dynamic and complex interactions within systems using feedback loops. SD models are simple to implement, utilize less data and computational resources, and conduct both exploratory and explanatory analyses over time. If the targeted system has complex interactions and many components, deals with lack of data, and requires interpretability and clinicians' input, SD offers attractive advantages for modeling and evaluating scenarios.
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Affiliation(s)
- Hadi A Khorshidi
- Cancer Health Services Research, University of Melbourne Centre for Cancer Research, Parkville, Australia
- School of Computing and Information Systems, University of Melbourne, Carlton, Australia
- ARC Training Centre in Optimisation Technologies, Integrated Methodologies, and Applications (OPTIMA), Carlton, Australia
| | - Deborah Marshall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ilias Goranitis
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, Centre for Health Policy, Carlton, Australia
| | | | - Maarten IJzerman
- Cancer Health Services Research, University of Melbourne Centre for Cancer Research, Parkville, Australia
- Erasmus School of Health Policy & Management, Department Health Services Management & Organisation, Rotterdam, the Netherlands
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Simões Corrêa Galendi J, Yeo SY, Grüll H, Bratke G, Akuamoa-Boateng D, Baues C, Bos C, Verkooijen HM, Shukri A, Stock S, Müller D. Early economic modeling of magnetic resonance image-guided high intensity focused ultrasound compared to radiotherapy for pain palliation of bone metastases. Front Oncol 2022; 12:987546. [PMID: 36212449 PMCID: PMC9537476 DOI: 10.3389/fonc.2022.987546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/29/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Magnetic Resonance Image-guided High Intensity Focused Ultrasound (MR-HIFU) is a non-invasive treatment option for palliative patients with painful bone metastases. Early evidence suggests that MR-HIFU is associated with similar overall treatment response, but more rapid pain palliation compared to external beam radiotherapy (EBRT). This modelling study aimed to assess the cost-effectiveness of MR-HIFU as an alternative treatment option for painful bone metastases from the perspective of the German Statutory Health Insurance (SHI). Materials and methods A microsimulation model with lifelong time horizon and one-month cycle length was developed. To calculate the incremental cost-effectiveness ratio (ICER), strategy A (MR-HIFU as first-line treatment or as retreatment option in case of persistent pain or only partial pain relief after EBRT) was compared to strategy B (EBRT alone) for patients with bone metastases due to breast, prostate, or lung cancer. Input parameters used for the model were extracted from the literature. Results were expressed as EUR per quality-adjusted life years (QALYs) and EUR per pain response (i.e., months spent with complete or partial pain response). Deterministic and probabilistic sensitivity analyses (PSA) were performed to test the robustness of results, and a value of information analysis was conducted. Results Compared to strategy B, strategy A resulted in additional costs (EUR 399) and benefits (0.02 QALYs and 0.95 months with pain response). In the base case, the resulting ICERs (strategy A vs. strategy B) are EUR 19,845/QALY and EUR 421 per pain response. Offering all patients MR-HIFU as first-line treatment would increase the ICER by 50% (31,048 EUR/QALY). PSA showed that at a (hypothetical) willingness to pay of EUR 20,000/QALY, the probability of MR-HIFU being cost-effective was 52%. The expected value of perfect information (EVPI) for the benefit population in Germany is approximately EUR 190 Mio. Conclusion Although there is considerable uncertainty, the results demonstrate that introducing MR-HIFU as a treatment alternative for painful bone metastases might be cost-effective for the German SHI. The high EVPI indicate that further studies to reduce uncertainty would be worthwhile.
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Affiliation(s)
- Julia Simões Corrêa Galendi
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
- *Correspondence: Julia Simões Corrêa Galendi,
| | - Sin Yuin Yeo
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Holger Grüll
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
- Department of Chemistry, Faculty of Mathematics and Natural Sciences, University of Cologne, Cologne, Germany
| | - Grischa Bratke
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Dennis Akuamoa-Boateng
- Department of Radiation Oncology, CyberKnife and Radiotherapy, Faculty of Medicine and University Hospital Cologne, University Hospital of Cologne, Cologne, Germany
| | - Christian Baues
- Department of Radiation Oncology, CyberKnife and Radiotherapy, Faculty of Medicine and University Hospital Cologne, University Hospital of Cologne, Cologne, Germany
| | - Clemens Bos
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Helena M. Verkooijen
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Arim Shukri
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Stephanie Stock
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Dirk Müller
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
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Davidoff AJ, Akif K, Halpern MT. Research on the Economics of Cancer-Related Health Care: An Overview of the Review Literature. J Natl Cancer Inst Monogr 2022; 2022:12-20. [PMID: 35788372 DOI: 10.1093/jncimonographs/lgac011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/21/2022] [Indexed: 01/16/2023] Open
Abstract
We reviewed current literature reviews regarding economics of cancer-related health care to identify focus areas and gaps. We searched PubMed for systematic and other reviews with the Medical Subject Headings "neoplasms" and "economics" published between January 1, 2010, and April 1, 2020, identifying 164 reviews. Review characteristics were abstracted and described. The majority (70.7%) of reviews focused on cost-effectiveness or cost-utility analyses. Few reviews addressed other types of cancer health economic studies. More than two-thirds of the reviews examined cancer treatments, followed by screening (15.9%) and survivorship or end-of-life (13.4%). The plurality of reviews (28.7%) cut across cancer site, followed by breast (20.7%), colorectal (11.6%), and gynecologic (8.5%) cancers. Specific topics addressed cancer screening modalities, novel therapies, pain management, or exercise interventions during survivorship. The results indicate that reviews do not regularly cover other phases of care or topics including financial hardship, policy, and measurement and methods.
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Affiliation(s)
- Amy J Davidoff
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Kaitlin Akif
- Office of the Associate Director, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Michael T Halpern
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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Niyomsri S, Duarte RV, Eldabe S, Fiore G, Kopell BH, McNicol E, Taylor RS. A Systematic Review of Economic Evaluations Reporting the Cost-Effectiveness of Spinal Cord Stimulation. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:656-665. [PMID: 32389232 DOI: 10.1016/j.jval.2020.02.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/15/2020] [Accepted: 02/05/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Spinal cord stimulation (SCS) is a recognized treatment for chronic pain. This systematic review aims to assess economic evaluations of SCS for the management of all chronic pain conditions, summarize key findings, and assess the quality of studies to inform healthcare resource allocation decisions and future research. METHODS Economic evaluations were identified by searching general medical and economic databases complemented with screening of reference lists of identified studies. No restrictions on language or treatment comparators were applied. Relevant data were extracted. The quality of included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. RESULTS Fourteen studies met the inclusion criteria and were judged to be of acceptable quality. Economic evaluations assessed SCS for the management of refractory angina pectoris, failed back surgery syndrome (FBSS), complex regional pain syndrome (CRPS), diabetic peripheral neuropathy (DPN), and peripheral arterial disease. Model-based studies typically applied a 2-stage model, i.e. decision tree followed by Markov model. Time horizon varied from 1 year to lifetime. Cost-effectiveness ranged widely from dominant (SCS cost-saving and more effective) to incremental cost-effectiveness ratio of >£100,000 per quality-adjusted life-year. Cost-effectiveness appeared to depend on the time horizon, choice of comparator, and indication. Ten of the studies indicated SCS as cost-saving or cost-effective compared with the alternative strategies. CONCLUSION The results consistently suggest that SCS is cost-effective when considering a long-term time horizon, particularly for the management of FBSS and CRPS. Further studies are needed to assess the cost-effectiveness of SCS for ischemic pain and DPN.
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Affiliation(s)
- Siwaporn Niyomsri
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, England, UK; National Cancer Institute of Thailand, Department of Medical Service, Ministry of Public Health, Thailand
| | - Rui V Duarte
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, England, UK.
| | - Sam Eldabe
- Department of Pain Medicine, The James Cook University Hospital, Middlesbrough, England, UK
| | | | - Brian H Kopell
- Department of Neurosurgery, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ewan McNicol
- Department of Pharmacy Practice, MCPHS University, Boston, MA, USA; Department of Pain Medicine, Atrius Health, Boston, MA, USA
| | - Rod S Taylor
- Institute of Health and Well Being, University of Glasgow, Glasgow, Scotland, UK; College of Medicine and Health, University of Exeter, Exeter, England, UK
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Scimeca M, Urbano N, Bonfiglio R, Duggento A, Toschi N, Schillaci O, Bonanno E. Novel insights into breast cancer progression and metastasis: A multidisciplinary opportunity to transition from biology to clinical oncology. Biochim Biophys Acta Rev Cancer 2019; 1872:138-148. [PMID: 31348975 DOI: 10.1016/j.bbcan.2019.07.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/25/2019] [Accepted: 07/15/2019] [Indexed: 12/11/2022]
Abstract
According to the most recent epidemiological studies, breast cancer shows the highest incidence and the second leading cause of death in women. Cancer progression and metastasis are the main events related to poor survival of breast cancer patients. This can be explained by the presence of highly resistant to chemo- and radiotherapy stem cells in many breast tumor tissues. In this context, numerous studies highlighted the possible involvement of epithelial to mesenchymal transition phenomenon as biological program to generate cancer stem cells, and thus participate to both metastatic and drug resistance process. Therefore, the comprehension of mechanisms (both cellular and molecular) involved in breast cancer occurrence and progression can lay the foundation for the development of new diagnostic and therapeutical protocols. In this review, we reported the most important findings in the field of breast cancer highlighting the most recent data concerning breast tumor biology, diagnosis and therapy.
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Affiliation(s)
- Manuel Scimeca
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, Rome 00133, Italy; San Raffaele University, Via di Val Cannuta 247, 00166 Rome, Italy; Fondazione Umberto Veronesi (FUV), Piazza Velasca 5, 20122 Milano (Mi), Italy.
| | | | - Rita Bonfiglio
- Department of Experimental Medicine, University "Tor Vergata", Via Montpellier 1, Rome 00133, Italy
| | - Andrea Duggento
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, Rome 00133, Italy
| | - Nicola Toschi
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, Rome 00133, Italy; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging and Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, Rome 00133, Italy; IRCCS Neuromed, Pozzilli, Italy
| | - Elena Bonanno
- Department of Experimental Medicine, University "Tor Vergata", Via Montpellier 1, Rome 00133, Italy; Neuromed Group, "Diagnostica Medica" and "Villa dei Platani", Avellino, Italy
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Matuoka JY, Kahn JG, Secoli SR. Denosumab versus bisphosphonates for the treatment of bone metastases from solid tumors: a systematic review. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:487-499. [PMID: 30382484 DOI: 10.1007/s10198-018-1011-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 10/23/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Bone metastases are highly prevalent in breast, prostate, lung and colon cancers. Their symptoms negatively affect quality of life and functionality and optimal management can mitigate these problems. There are two different targeted agents to treat them: bisphosphonates (pamidronate and zoledronic acid) and the monoclonal antibody denosumab. Estimates of cost-effectiveness are still mixed. OBJECTIVE To conduct a systematic review of economic studies that compares these two options. METHOD Literature search comprised eight databases and keywords for bone metastases, bisphosphonates, denosumab, and economic studies were used. Data were extracted regarding their methodologic characteristics and cost-effectiveness analyses. All studies were evaluated regarding to its methodological quality. RESULTS A total of 263 unique studies were retrieved and six met inclusion criteria. All studies were based on clinical trials and other existing literature data, and they had high methodological quality. Most found unfavorable cost-effectiveness for denosumab compared with zoledronic acid, with adjusted ICERS that ranged from $4638-87,354 per SRE avoided and from US$57,274-4.81 M. per QALY gained, which varied widely according to type of tumor, time horizon, among others. Results were sensitive to drug costs, time to first skeletal-related event (SRE), time horizon, and utility. CONCLUSIONS Denosumab had unfavorable cost-effectiveness compared with zoledronic acid in most of the included studies. New economic studies based on real-world data and longer time horizons comparing these therapeutic options are needed.
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Affiliation(s)
- Jessica Y Matuoka
- School of Nursing of the University of Sao Paulo, 419, Eneas de Carvalho Aguiar Avenue, Sao Paulo, 05403-000, Brazil.
- Hospital Universitario of the University of Sao Paulo, Sao Paulo, Brazil.
| | - James G Kahn
- University of California San Francisco, San Francisco, United States
| | - Silvia R Secoli
- School of Nursing of the University of Sao Paulo, 419, Eneas de Carvalho Aguiar Avenue, Sao Paulo, 05403-000, Brazil
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Ahangar P, Aziz M, Rosenzweig DH, Weber MH. Advances in personalized treatment of metastatic spine disease. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:223. [PMID: 31297388 DOI: 10.21037/atm.2019.04.41] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The spine is one of the most common sites of bony metastases, and its involvement leads to significant patient morbidity. Surgical management in these patients is aimed at improving quality of life and functional status throughout the course of the disease. Resection of metastases often leads to critical size bone defects, presenting a challenge to achieving adequate bone regeneration to fill the void. Current treatment options for repairing these defects are bone grafting and commercial bone cements; however, each has associated limitations. Additionally, tumor recurrence and tumor-induced bone loss make bone regeneration particularly difficult. Systemic therapeutic delivery, such as bisphosphonates, have become standard of care to combat bone loss despite unfavorable systemic side-effects and lack of local efficacy. Developments from tissue engineering have introduced novel materials with osteoinductive and osteoconductive properties which also act as structural support scaffolds for bone regeneration. These new materials can also act as a therapeutic reservoir to sustainably release drugs locally as an alternative to systemic therapy. In this review, we outline recent advancements in tissue engineering and the role of translational research in developing implants that can fully repair bone defects while also delivering local therapeutics to curb tumor recurrence and improve patient quality of life.
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Affiliation(s)
- Pouyan Ahangar
- Division of Orthopedic Surgery, McGill University, Montreal, QC, Canada.,The Research Institute of the McGill University Health Centre, Injury, Repair and Recovery Program, Montreal, QC, Canada.,Montreal General Hospital C10.148.6, Montreal, QC, Canada
| | - Mina Aziz
- Division of Orthopedic Surgery, McGill University, Montreal, QC, Canada.,The Research Institute of the McGill University Health Centre, Injury, Repair and Recovery Program, Montreal, QC, Canada.,Montreal General Hospital C10.148.6, Montreal, QC, Canada.,Clinical Investigator Program, McGill University, Montreal, QC, Canada
| | - Derek H Rosenzweig
- Division of Orthopedic Surgery, McGill University, Montreal, QC, Canada.,The Research Institute of the McGill University Health Centre, Injury, Repair and Recovery Program, Montreal, QC, Canada.,Montreal General Hospital C10.148.6, Montreal, QC, Canada
| | - Michael H Weber
- Division of Orthopedic Surgery, McGill University, Montreal, QC, Canada.,The Research Institute of the McGill University Health Centre, Injury, Repair and Recovery Program, Montreal, QC, Canada.,Montreal General Hospital C10.148.6, Montreal, QC, Canada
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Toller CS, Charlesworth S, Mihalyo M, Howard P, Wilcock A. Bisphosphonates: AHFS 92:24. J Pain Symptom Manage 2019; 57:1018-1030. [PMID: 30738144 DOI: 10.1016/j.jpainsymman.2019.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 01/29/2019] [Indexed: 11/20/2022]
Abstract
Therapeutic Reviews aim to provide essential independent information for health professionals about drugs used in palliative and hospice care. Additional content is available via www.medicinescomplete.com. The series editors welcome feedback on the articles (hq@palliativedrugs.com).
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Affiliation(s)
- Claire Stark Toller
- Countess Mountbatten House (C.S.T.), University Hospital Southampton; Pharmaceutical Press (S.C.), London, United Kingdom; Mylan School of Pharmacy (M.M.), Duquesne University, Pittsburgh, Pennsylvania, USA; Mountbatten Hospice (P.H.), Isle of Wight, United Kingdom; and University of Nottingham (A.W.), Nottingham, United Kingdom
| | - Sarah Charlesworth
- Countess Mountbatten House (C.S.T.), University Hospital Southampton; Pharmaceutical Press (S.C.), London, United Kingdom; Mylan School of Pharmacy (M.M.), Duquesne University, Pittsburgh, Pennsylvania, USA; Mountbatten Hospice (P.H.), Isle of Wight, United Kingdom; and University of Nottingham (A.W.), Nottingham, United Kingdom
| | - Mary Mihalyo
- Countess Mountbatten House (C.S.T.), University Hospital Southampton; Pharmaceutical Press (S.C.), London, United Kingdom; Mylan School of Pharmacy (M.M.), Duquesne University, Pittsburgh, Pennsylvania, USA; Mountbatten Hospice (P.H.), Isle of Wight, United Kingdom; and University of Nottingham (A.W.), Nottingham, United Kingdom
| | - Paul Howard
- Countess Mountbatten House (C.S.T.), University Hospital Southampton; Pharmaceutical Press (S.C.), London, United Kingdom; Mylan School of Pharmacy (M.M.), Duquesne University, Pittsburgh, Pennsylvania, USA; Mountbatten Hospice (P.H.), Isle of Wight, United Kingdom; and University of Nottingham (A.W.), Nottingham, United Kingdom
| | - Andrew Wilcock
- Countess Mountbatten House (C.S.T.), University Hospital Southampton; Pharmaceutical Press (S.C.), London, United Kingdom; Mylan School of Pharmacy (M.M.), Duquesne University, Pittsburgh, Pennsylvania, USA; Mountbatten Hospice (P.H.), Isle of Wight, United Kingdom; and University of Nottingham (A.W.), Nottingham, United Kingdom.
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Affiliation(s)
- Siyang Leng
- Columbia University Medical Center, New York, NY
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10
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Wilcock A, Charlesworth S, Toller CS, Girish R, Mihalyo M, Howard P. Denosumab: AHFS 92:24. J Pain Symptom Manage 2018; 56:295-301. [PMID: 29864491 DOI: 10.1016/j.jpainsymman.2018.05.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 05/25/2018] [Indexed: 12/16/2022]
Abstract
Therapeutic Reviews aim to provide essential independent information for health professionals about drugs used in palliative and hospice care. Additional content is available on www.palliativedrugs.com. Country-specific books (Hospice and Palliative Care Formulary USA, and Palliative Care Formulary, British and Canadian editions) are also available and can be ordered from www.palliativedrugs.com. The series editors welcome feedback on the articles (hq@palliativedrugs.com).
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Affiliation(s)
- Andrew Wilcock
- University of Nottingham (A.W.), Nottingham, United Kingdom; University Hospitals (S.C.), Nottingham, United Kingdom; Countess Mountbatten House (C.S.T), University Hospital Southampton; University of Nottingham (R.G.), Nottingham, United Kingdom; Mylan School of Pharmacy (M.M.), Duquesne University, Pittsburgh, Pennsylvania, USA and Mountbatten Hospice (P.H.), Isle of Wight, United Kingdom.
| | - Sarah Charlesworth
- University of Nottingham (A.W.), Nottingham, United Kingdom; University Hospitals (S.C.), Nottingham, United Kingdom; Countess Mountbatten House (C.S.T), University Hospital Southampton; University of Nottingham (R.G.), Nottingham, United Kingdom; Mylan School of Pharmacy (M.M.), Duquesne University, Pittsburgh, Pennsylvania, USA and Mountbatten Hospice (P.H.), Isle of Wight, United Kingdom
| | - Claire Stark Toller
- University of Nottingham (A.W.), Nottingham, United Kingdom; University Hospitals (S.C.), Nottingham, United Kingdom; Countess Mountbatten House (C.S.T), University Hospital Southampton; University of Nottingham (R.G.), Nottingham, United Kingdom; Mylan School of Pharmacy (M.M.), Duquesne University, Pittsburgh, Pennsylvania, USA and Mountbatten Hospice (P.H.), Isle of Wight, United Kingdom
| | - Rahul Girish
- University of Nottingham (A.W.), Nottingham, United Kingdom; University Hospitals (S.C.), Nottingham, United Kingdom; Countess Mountbatten House (C.S.T), University Hospital Southampton; University of Nottingham (R.G.), Nottingham, United Kingdom; Mylan School of Pharmacy (M.M.), Duquesne University, Pittsburgh, Pennsylvania, USA and Mountbatten Hospice (P.H.), Isle of Wight, United Kingdom
| | - Mary Mihalyo
- University of Nottingham (A.W.), Nottingham, United Kingdom; University Hospitals (S.C.), Nottingham, United Kingdom; Countess Mountbatten House (C.S.T), University Hospital Southampton; University of Nottingham (R.G.), Nottingham, United Kingdom; Mylan School of Pharmacy (M.M.), Duquesne University, Pittsburgh, Pennsylvania, USA and Mountbatten Hospice (P.H.), Isle of Wight, United Kingdom
| | - Paul Howard
- University of Nottingham (A.W.), Nottingham, United Kingdom; University Hospitals (S.C.), Nottingham, United Kingdom; Countess Mountbatten House (C.S.T), University Hospital Southampton; University of Nottingham (R.G.), Nottingham, United Kingdom; Mylan School of Pharmacy (M.M.), Duquesne University, Pittsburgh, Pennsylvania, USA and Mountbatten Hospice (P.H.), Isle of Wight, United Kingdom
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Abstract
PURPOSE OF REVIEW The purpose of this review was to examine the recent changes in the surgical treatment of bone metastases and how the treatment paradigm has shifted with the improvement of adjuvant therapies. How surgery fits into the local and systemic treatment was reviewed for bone metastases in different areas. RECENT FINDINGS The more common use of targeted chemotherapies and focused high-dose radiation have altered the treatment paradigm of bone metastases. Overall changes in the surgical treatment of bone metastases have been driven by an increased multidisciplinary approach to metastatic cancer and the awareness that one type of surgery does not work for all patients. The individual patient treatment goals dictate the surgical procedures used to achieve these goals. Advancements in adjuvant therapy-like radiation and more targeted chemotherapies have allowed for less invasive surgical approaches and therefore faster recoveries and reduced surgical morbidity for patients.
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Affiliation(s)
- Geoffrey W Siegel
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
- Veterans Affairs Medical Center, Ann Arbor, MI, USA
| | - J Sybil Biermann
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Anda-Alexandra Calinescu
- Department of Neurosurgery, University of Michigan, 3552 Taubman Health Care Center, 1500 East Medical Center Drive, SPC 5338, Ann Arbor, MI, 48109-5338, USA
| | - Daniel E Spratt
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Nicholas J Szerlip
- Veterans Affairs Medical Center, Ann Arbor, MI, USA.
- Department of Neurosurgery, University of Michigan, 3552 Taubman Health Care Center, 1500 East Medical Center Drive, SPC 5338, Ann Arbor, MI, 48109-5338, USA.
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