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Affiliation(s)
- Bengt Glimelius
- Department of Immunology Genetics and Pathology, Uppsala University, Uppsala, Sweden
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Zhou Q, Wu X, Wen C, Wang H, Wang H, Liu H, Peng J. Toosendanin induces caspase-dependent apoptosis through the p38 MAPK pathway in human gastric cancer cells. Biochem Biophys Res Commun 2018; 505:261-266. [DOI: 10.1016/j.bbrc.2018.09.093] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 09/14/2018] [Indexed: 01/19/2023]
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Palazzi MF, Soatti C, Jereczek-Fossa BA, Cazzaniga LF, Antognoni P, Gardani G, Amadori M, Baio A, Beltramo G, Bignardi M, Bracelli S, Buffoli A, Castiglioni S, Catalano G, Di Muzio N, Fallai C, Fariselli L, Frata P, Gramaglia A, Italia C, Ivaldi G, Lombardi F, Magrini SM, Nava S, Sarti E, Scandolaro L, Scorsetti M, Stiglich F, Tortini R, Valdagni R, Valvo F, Vavassori V, Sbicego EL, Tonoli S, Orecchia R. Equipment, staffing, and provision of radiotherapy in Lombardy, Italy: Results of three surveys performed between 2012 and 2016. TUMORI JOURNAL 2018; 104:352-360. [PMID: 29986637 DOI: 10.1177/0300891618784800] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION: Several efforts are being implemented at the European level to measure provision of up-to-date radiation treatments across the continent. METHODS: A snapshot survey involving all radiation oncology centers within Lombardy, Italy, was performed in 2012 and repeated in 2014 and 2016, in cooperation with regional governmental officers. Centers were asked to provide detailed information concerning all individual patients being treated on the index day, and to report data on available local resources. RESULTS: We observed an increase in the number of centers and of megavoltage units (MVU) (from 76 to 87, i.e., 8.7 MVU per million inhabitants in 2016). Mean number of MVU per center was 2.5. Average age of MVU increased from 5.3 to 7.5 years and patients on the waiting list also increased. Conformal 3D radiotherapy (RT) treatments decreased from 56% to 42% and were progressively replaced by intensity-modulated RT treatments (from 39% to 49%). Waiting times were overall satisfactory. Radiation oncologists treated on average 152 and radiation therapists 100 RT courses per year. Average reimbursement per course was €4,879 (range €2,476-€8,014). CONCLUSIONS: The methodology of snapshot survey proved feasible and provided valuable information about radiation oncology provision and accessibility in Lombardy.
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Affiliation(s)
- Mauro F Palazzi
- 1 Radiation Oncology Center, Grande Ospedale Metropolitano Niguarda Milan, Italy
| | - Carlo Soatti
- 2 Radiation Oncology Center, Ospedale Manzoni, Lecco, Italy
| | - Barbara A Jereczek-Fossa
- 3 Department of Oncology and Hemato‑oncology, University of Milan, and Division of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Luigi F Cazzaniga
- 4 Radiation Oncology Center, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Paolo Antognoni
- 5 Radiation Oncology Center, Ospedale di Circolo e Fondazione Macchi, ASST dei Sette Laghi, Varese, Italy
| | | | | | - Ambrogia Baio
- 8 Radiation Oncology Center, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Giancarlo Beltramo
- 9 Radiation Oncology Center, Centro Diagnostico Italiano (CDI), Milan, Italy
| | - Mario Bignardi
- 10 Radiation Oncology Center, Fondazione Poliambulanza, Brescia, Italy
| | | | - Alberto Buffoli
- 12 Radiation Oncology Center, Istituto Clinico S. Anna, Brescia, Italy
| | | | - Gianpiero Catalano
- 14 Radiation Oncology Center, IRCCS Ospedale Multimedica, Sesto San Giovanni/Castellanza, Italy
| | - Nadia Di Muzio
- 15 Radiation Oncology Center, IRCCS Ospedale S. Raffaele, Milano, Italy
| | - Carlo Fallai
- 16 Radiation Oncology Center, Istituto Nazionale Tumori, Milan, Italy
| | - Laura Fariselli
- 17 Radiation Oncology Center, Fondazione Istituto Neurologico Besta, Milan, Italy
| | - Paolo Frata
- 18 Radiation Oncology Center, Ospedale di Esine, ASST di Valcamonica, Esine, Italy
| | | | - Corrado Italia
- 20 Radiation Oncology Center, Istituti Ospedalieri Bergamaschi, Ponte S. Pietro, Zingonia (BG), Italy
| | - Giovanni Ivaldi
- 21 Radiation Oncology Center, Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Fabrizio Lombardi
- 22 Radiation Oncology Center, Ospedale San Donato, San Donato Milanese, Italy
| | - Stefano M Magrini
- 23 Radiation Oncology Center, Brescia University Radiation Oncology Department, O. Alberti Radium Institute, Spedali Civili Hospital, Brescia, Italy
| | - Simonetta Nava
- 24 Radiation Oncology Center, Istituti Clinici di Pavia e Vigevano, Vigevano, Italy
| | - Enrico Sarti
- 25 Radiation Oncology Center, Ospedale, Treviglio, Italy
| | - Luciano Scandolaro
- 26 Radiation Oncology Center, Ospedale Sant'Anna, ASST Lariana, Como, Italy
| | - Marta Scorsetti
- 27 Radiation Oncology Center, Humanitas Clinical and Research Center and Humanitas University, Milano-Rozzano, Italy
| | | | - Roberto Tortini
- 29 Radiation Oncology Center, Presidio di Casalpusterlengo, ASST Lodi, Italy
| | - Riccardo Valdagni
- 30 Radiation Oncology Center, Istituto Nazionale Tumori and Università degli Studi di Milano, Milan, Italy
| | | | - Vittorio Vavassori
- 32 Radiation Oncology Center, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - Elena L Sbicego
- 33 Radiation Oncology Center, Istituto Clinico S. Ambrogio, Milan, Italy
| | - Sandro Tonoli
- 34 Radiation Oncology Center, Ospedale, Cremona, Italy
| | - Roberto Orecchia
- 35 Radiation Oncology Center, IEO Scientific Direction, Milan, Italy
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Aeckerle S, Moor M, Pilz LR, Gencer D, Hofheinz RD, Hofmann WK, Buchheidt D. Characteristics, treatment and prognostic factors of patients with gynaecological malignancies treated in a palliative care unit at a university hospital. Oncol Res Treat 2013; 36:642-8. [PMID: 24192768 DOI: 10.1159/000355642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Limited clinical data have been published on patients suffering from advanced gynaecological malignancies treated in palliative care units, and little is known about prognostic factors. METHODS In a retrospective study, the data of 225 patients with breast, ovarian and cervical cancer treated in the palliative care unit of a university hospital between 1998 and 2009 were assembled. Clinical aspects and baseline symptoms, laboratory parameters, the clinical course, and outcome were evaluated. RESULTS 225 patients (497 cases; cancer diagnoses: breast 79%, ovarian 13%, and cervix 8%) were included in the analysis. The main symptoms were weakness/fatigue (71%), pain (65%), anorexia/nausea (62%), and dyspnea (46%). Pain control was achieved in 85% of all cases, satisfying control of other symptoms in 80%. The median overall survival (OS) was 59 days. 53% of the patients died at the palliative care unit. In the Cox proportional hazards model, 8 parameters indicated an unfavourable outcome: anorexia/nausea, disordered mental status, elevated lactate dehydrogenase, γ-glutamyltransferase, leukocyte count, hypoalbuminaemia, anaemia and hypercalcaemia. Based on these parameters 3 risk groups were defined: low risk (0-2 factors), intermediate risk (3-5 factors), and high risk (6-8 factors). Median survival for high-risk group was 13 days, for intermediate group 61 days, and for low-risk patients 554 days (p < 0.0001). CONCLUSION Weakness/fatigue, pain and anorexia were the main symptoms leading to the hospitalisation of patients with gynaecological malignancies. Symptom and pain control was accomplished in 80% of cases. 8 parameters were identified as indicating a poor outcome, and patients showing at least 6 or more of these factors had a very limited prognosis. Although studied retrospectively, these results may be helpful for individual treatment decisions in patients with advanced gynaecological malignancies. Prospective data and the introduction of documentation systems could help to gain more powerful knowledge about the quality of palliative care.
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Affiliation(s)
- Samantha Aeckerle
- III. Medizinische Klinik, Hämatologie und Onkologie, Universitätsmedizin Mannheim, Universität Heidelberg, Germany
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Quality assurance and quality control for radiotherapy/medical oncology in Europe: guideline development and implementation. Eur J Surg Oncol 2013; 39:938-44. [PMID: 23830983 DOI: 10.1016/j.ejso.2013.06.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 05/22/2013] [Accepted: 06/06/2013] [Indexed: 11/22/2022] Open
Abstract
The past two decades have brought tremendous changes to the practice of radiation oncology and medical oncology. To manage all the complexities related to the new technologies and the new drugs, the radiation and medical oncologists have to enhance their clinical action and professional skill profile. To accomplish this they have to find reliable tools in the quality of their medical practice and in future research activities. Quality assurance (QA) and quality control (QC) for radiation and medical oncologists mean to clarify the different components of the clinical decision, to supervise with proper methodology the required steps needed to accomplish the agreed outcomes and to control them. Quality for radiation and medical oncology means to supervise each clinical and technical component of the whole process to guarantee that all steps together will arrive at the final and best possible outcome. Key components are guidelines, specialization and a multidisciplinary approach. The research of global quality could represent a further complexity, but it is the best tool to give a perspective and a chance to further improvements of our disciplines and to promote better outcome in all cancer patients.
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Leung HWC, Chan ALF. Direct medical cost of radiation therapy for cancer patients in Taiwan. Health (London) 2013. [DOI: 10.4236/health.2013.56131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Wettergren L, Lindblad AK, Glimelius B, Ring L. Comparing two versions of the Schedule for Evaluation of Individual Quality of Life in patients with advanced cancer. Acta Oncol 2011; 50:648-52. [PMID: 21323492 DOI: 10.3109/0284186x.2011.557088] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim was to compare two individualized patient reported outcomes or the Schedule for the Evaluation of Individual Quality of Life - Direct Weighting (SEIQoL-DW) measuring quality of life in general, and the disease-related version (SEIQoL-DR) measuring quality of life related to disease. Both instruments have been used in clinical practice settings within oncology. The instruments were compared with regard to feasibility, the areas nominated by patients as important and patients' ratings of how they were doing in these areas (Index scores). MATERIAL AND METHODS The study included 40 patients with gastrointestinal cancer. All patients completed both versions of the instrument on a touch screen computer in relation to a medical consultation. Firstly, the participants were invited to nominate the five domains she/he currently considered to be most important in life. Secondly, they were asked to rate how they were doing in each of these domains. Finally, they were asked to quantify the relative importance of each area. Cohen's effect sizes were calculated to illuminate the clinical importance of mean value differences. RESULTS Both instruments took less than ten minutes to complete and the procedure was considered feasible by both patients and interviewers. The proportion of patients nominating the same areas in the two versions did not differ, however, the SEIQoL-DW Index score was significantly higher than the corresponding score for the SEIQoL-DR. The detected difference in the mean score measured by effect size was medium. CONCLUSION The magnitude of the effect size of the difference in Index score imply that the two versions tap into different constructs, i.e. quality of life (QoL) versus health-related QoL (HRQL), supporting the construct validity of the two versions of the instrument. The SEIQoL-DW and the SEIQoL-DR should be considered as complementary rather than interchangeable when used in patients with cancer.
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Affiliation(s)
- Lena Wettergren
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
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Conde García M, Fernández Feijoo M, Calleja Hernández M. Estudio de adecuación a la ficha técnica, efectividad, seguridad y coste del rituximab en un hospital de tercer nivel. FARMACIA HOSPITALARIA 2009. [DOI: 10.1016/s1130-6343(09)72973-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Lindholm C, Cavallin-Ståhl E, Ceberg J, Frödin JE, Littbrand B, Möller TR. Radiotherapy practices in Sweden compared to the scientific evidence. Acta Oncol 2009; 42:416-29. [PMID: 14596504 DOI: 10.1080/02841860310012941] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A systematic assessment of radiotherapy for cancer was conducted by The Swedish Council on Technology Assessment in Health Care (SBU) in 2001. The assessment included a critical review of the literature on radiotherapy for cancer published in 1994-2001 and a prospective survey of radiotherapy practice in Sweden during 12 weeks in the autumn of 2001. The results of the survey were compared with the evidence derived from the scientific literature, and the following conclusions could be drawn: Radiotherapy is currently given to approximately 47% of new cancer cases This figure is on a par with rates reported from other countries. For most tumour types, curative radiotherapy practices in Sweden are generally supported by the literature. Interstitial brachytherapy has been included in the treatment of non-gynaecological malignancies, and prostate cancer is now the most common indication. Palliative radiotherapy has increased and is today given in a more rational way using single or few fractions However, it still seems to be under-utilized in Sweden. The need for radiotherapy can be expected to increase until the year 2010.
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Glimelius B, Steineck G. Low evidence of radiation therapy in prostate cancer--a plea for intensified scientific activity. Acta Oncol 2009; 43:311-5. [PMID: 15303498 DOI: 10.1080/02841860410032867] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
A systematic assessment of radiotherapy for cancer was conducted by The Swedish Council on Technology Assessment in Health Care (SBU) in 2001. The assessment included an overview of the capacity for radiotherapy in terms of infrastructure of cancer care and an estimation of the costs of radiotherapy in Sweden. A postal questionnaire distributed to all 16 centres of radiotherapy in Sweden showed the following results: In 2000 there were 57 accelerators with complementary equipment in operation, 24 of which had been installed 10 or more years ago earlier. The total cost of external radiation therapy was estimated at SEK 427 million in the year 2000, or approximately 5% of the estimated total cost of oncology care in Sweden. The total cost of brachytherapy was estimated at SEK 43 million or about one-tenth of that of external radiotherapy. The total cost of external radiotherapy has increased since the last inquiry (1991) by about 16% more than the general inflation in Sweden, but at the same time the volume of fractions has increased by about 37%. Thus, an increase in the efficiency of external radiotherapy, calculated per fraction, was achieved in the 1990s. At the department level, there was a clear correlation between cost of salaries and output of fractions of external radiotherapy, thus indicating the adaptation of manpower to the volume of patients. There was an even higher correlation between the number of accelerators and the volume of fractions of radiotherapy, which suggests the occurrence of certain economies of scale in Swedish external radiotherapy.
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Glimelius B. Expert opinions--consensus documents--systematic overviews--is the value for clinicians increasing? Acta Oncol 2009; 44:201-2. [PMID: 16076690 DOI: 10.1080/02841860510029842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Talbäck M, Stenbeck M, Rosén M, Barlow L, Glimelius B. Cancer survival in Sweden 1960-1998--developments across four decades. Acta Oncol 2009; 42:637-59. [PMID: 14690151 DOI: 10.1080/02841860310013391] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This paper summarizes a comprehensive study of cancer survival in Sweden from 1960 to 1998. A total of 1021421 persons and 40 different cancer sites were included in the analyses. The main outcome measure is the relative survival rate (RSR) for different sites and follow-up times after diagnosis. The 10-year RSR for all sites combined has increased steadily-from 26.6% among men and 41.8% among women in the 1960s, to 44.6% (men) and 57.6% (women) in the 1990s. The expectation of life for a person diagnosed with cancer today is about 7 years longer than that of one diagnosed during the mid-1960s. About 3 years are gained due to changes in the relative distribution of various cancer types and about 4 years due to improved relative survival. During the 1990s substantial survival improvements were observed not only for uncommon types, such as testicular cancer, Hodgkin's lymphoma and some other haematologic malignancies, but also for cancer of the rectum, kidney and malignant melanoma. Survival for breast and cervical cancer also improved during the 1990s, but not that for pancreatic, liver or lung cancer.
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Affiliation(s)
- Mats Talbäck
- Centre for Epidemiology, The National Board of Health and Welfare, Stockholm, Sweden.
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15
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Glimelius PNB. The Swedish Council on Technology Assessment in Health Care (SBU) Report on Cancer Chemotherapy - Project Objectives, the Working Process, Key Definitions and General Aspects on Cancer Trial Methodology and Interpretation. Acta Oncol 2009. [DOI: 10.1080/02841860151116187] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Hutchinson J, Lloyd A, Gray A, Gale R, Hancock B. Costs of chemotherapy for indolent follicular non-Hodgkin's lymphoma in the UK: an observational study. Acta Haematol 2006; 115:28-34. [PMID: 16424646 DOI: 10.1159/000089462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2005] [Accepted: 07/14/2005] [Indexed: 11/19/2022]
Abstract
Non-Hodgkin's lymphoma (NHL) is the sixth most common cancer in the United Kingdom (UK). This analysis assessed the health service costs of patients receiving chemotherapy for indolent follicular NHL based on a retrospective analysis of patient records in the UK. Each patient was followed up for a period of 3 years or until death. The analysis included 181 patients, who received a total of 187 treatment periods. Costs were estimated from the perspective of the UK National Health Service. The study found the cost of providing treatment with CHOP (cyclophosphamide, doxorubicin, vincristine, prednisolone) or fludarabine to patients with indolent follicular NHL to be lower than previously reported.
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Norum J, Holtmon M. Adjuvant fluorouracil, epirubicin and cyclophosphamide in early breast cancer: is it cost-effective? Acta Oncol 2006; 44:735-41. [PMID: 16227165 DOI: 10.1080/02841860500247503] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Adjuvant chemotherapy (ACT) in breast cancer exposes patients to morbidity, but improves survival. The FEC (fluorouracil, epirubicin, cyclophosphamide) regimen has taken over the prior role of CMF (cyclophosphamide, methotrexate, fluorouracil). In this model, efficacy, tolerability and quality of life (QoL) data from the literature were incorporated with Norwegian practice and cost data in a cost-effectiveness approach. The FEC efficacy was calculated 3-7% superior CMF. There was no difference in quality of life. An 80-100% dose intensity range was employed, one Euro was calculated NOK 8.78 and a 3% discount rate was used. The total cost of FEC employing the friction cost method on production loss, including amount spent on drugs, administration and travelling ranged between 3,278-3,850 Euros (human capital approach 12,143-12,715 Euros). Money spent on drugs alone constituted 15-48%, depending on method chosen. A cost-effectiveness analysis revealed a cost per life year (LY) saved replacing FEC by CMF of 3,575-15,125 Euros. Adjuvant FEC is cost effective in Norway.
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Affiliation(s)
- Jan Norum
- Department of Oncology, University Hospital of North Norway, Norway.
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Abstract
The widening gap between available resources and increasing possibilities to diagnose and treat different medical conditions has resulted in new attention to priority setting. The issue is complicated and harbours several obstacles because of different valuations concerning the needs of patient groups, the true results (patient benefit) of medical actions, and also important ethical considerations. Earlier attempts have been unsuccessful in introducing a prioritization milieu into the medical profession, probably due to vague requests for an open and sharp prioritization process. With a sharpened competition of allocating resources for different medical actions, the medical profession of the cancer sector needs to have a tool for explaining consequences for the different cancer patient groups and what is achieved by the cancer treatments and the care. A model for ranking lists consisting of pairs of patient conditions and medical actions is presented, and the principle for using these lists for priority setting in medical society is discussed.
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Goor KM, Schaafsma MR, Huijgens PC, van Agthoven M. Economic assessment on the management of chronic lymphocytic leukaemia. Expert Opin Pharmacother 2005; 6:1179-89. [PMID: 15957971 DOI: 10.1517/14656566.6.7.1179] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In the last decade, several new promising treatments for chronic lymphocytic leukaemia (CLL) have been developed. Healthcare costs are increasing and new treatments tend to be very expensive; therefore, information about the cost effectiveness in treatments for CLL is urgently needed. The authors performed a literature review on the currently available economic evaluations on CLL treatments. A total of 65 articles were found, of which 11 could be included. These articles were evaluated on the basis of six methodological requirements for economic evaluations, enabling readers to judge the value of the studies. Only a small amount of information was available on the costs of CLL treatments. Future economic evaluations should be performed according to the methodological requirements for these studies, which should also be properly documented.
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MESH Headings
- Algorithms
- Antibodies, Monoclonal/economics
- Antibodies, Monoclonal/therapeutic use
- Antineoplastic Agents/economics
- Antineoplastic Agents/therapeutic use
- Chlorambucil/economics
- Chlorambucil/therapeutic use
- Cost-Benefit Analysis
- Health Care Costs
- Hospital Costs
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/economics
- Leukemia, Lymphocytic, Chronic, B-Cell/radiotherapy
- Lymphoma, Non-Hodgkin/economics
- Lymphoma, Non-Hodgkin/therapy
- Randomized Controlled Trials as Topic
- Stem Cell Transplantation/economics
- Vidarabine/analogs & derivatives
- Vidarabine/economics
- Vidarabine/therapeutic use
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Affiliation(s)
- Kim M Goor
- University Medical Centre Rotterdam, Erasmus MC, Institute for Medical Technology Assessment, PO Box 1738, 3000 DR Rotterdam, The Netherlands.
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Koedoot CG, Oort FJ, de Haan RJ, Bakker PJM, de Graeff A, de Haes JCJM. The content and amount of information given by medical oncologists when telling patients with advanced cancer what their treatment options are. palliative chemotherapy and watchful-waiting. Eur J Cancer 2004; 40:225-35. [PMID: 14728937 DOI: 10.1016/j.ejca.2003.10.008] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This study aimed to determine the content and the amount of information given by medical oncologists when proposing palliative chemotherapy and whether this information given is influenced by patient or physician background characteristics. In a prospective study, 95 patients with incurable cancer were interviewed before they consulted their medical oncologist. Their first consultation was audiotaped, and their eventual decision scored. A coding scheme comprised six categories of information given during the consultation. Medical oncologists mentioned or explained the disease course (53%), symptoms (35%) and prognosis (39%). Most patients were told about the absence of cure (84%). Watchful-waiting was mentioned to only half of the patients, either in one sentence (23%) or explained more extensively (27%). Multilevel analysis revealed that the patients' age, patient's marital status, and consulting in an academic hospital explained 38% of the amount of information given. Most of the physicians' attention is spent on the 'active' treatment option. Older patients, married patients and patients in academic hospitals receive more information.
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Affiliation(s)
- C G Koedoot
- Department of Medical Psychology, Academic Medical Center, PO Box 22700, 1100 DE Amsterdam, The Netherlands.
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Koedoot CG, de Haan RJ, Stiggelbout AM, Stalmeier PFM, de Graeff A, Bakker PJM, de Haes JCJM. Palliative chemotherapy or best supportive care? A prospective study explaining patients' treatment preference and choice. Br J Cancer 2004; 89:2219-26. [PMID: 14676798 PMCID: PMC2395270 DOI: 10.1038/sj.bjc.6601445] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
In palliative cancer treatment, the choice between palliative chemotherapy and best supportive care may be difficult. In the decision-making process, giving information as well as patients' values and preferences become important issues. Patients, however, may have a treatment preference before they even meet their medical oncologist. An insight into the patient's decision-making process can support clinicians having to inform their patients. Patients (n=207) with metastatic cancer, aged 18 years or older, able to speak Dutch, for whom palliative chemotherapy was a treatment option, were eligible for the study. We assessed the following before they consulted their medical oncologist: (1) socio-demographic characteristics, (2) disease-related variables, (3) quality-of-life indices, (4) attitudes and (5) preferences for treatment, information and participation in decision-making. The actual treatment decision, assessed after it had been made, was the main study outcome. Of 207 eligible patients, 140 patients (68%) participated in the study. At baseline, 68% preferred to undergo chemotherapy rather than wait watchfully. Eventually, 78% chose chemotherapy. Treatment preference (odds ratio (OR)=10.3, confidence interval (CI) 2.8-38.0) and a deferring style of decision-making (OR=4.9, CI 1.4-17.2) best predicted the actual treatment choice. Treatment preference (total explained variance=38.2%) was predicted, in turn, by patients' striving for length of life (29.5%), less striving for quality of life (6.1%) and experienced control over the cause of disease (2.6%). Patients' actual treatment choice was most strongly predicted by their preconsultation treatment preference. Since treatment preference is positively explained by striving for length of life, and negatively by striving for quality of life, it is questionable whether the purpose of palliative treatment is made clear. This, paradoxically, emphasises the need for further attention to the process of information giving and shared decision-making.
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Affiliation(s)
- C G Koedoot
- Department of Medical Psychology, Academic Medical Center, PO Box 22700, 1100 DE, Amsterdam, The Netherlands.
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Ringborg U, Bergqvist D, Brorsson B, Cavallin-Ståhl E, Ceberg J, Einhorn N, Frödin JE, Järhult J, Lamnevik G, Lindholm C, Littbrand B, Norlund A, Nylén U, Rosén M, Svensson H, Möller TR. The Swedish Council on Technology Assessment in Health Care (SBU) systematic overview of radiotherapy for cancer including a prospective survey of radiotherapy practice in Sweden 2001--summary and conclusions. Acta Oncol 2003; 42:357-65. [PMID: 14596499 DOI: 10.1080/02841860310010826] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A systematic assessment of radiotherapy for cancer was conducted by The Swedish Council on Technology Assessment in Health Care (SBU) and published in 1996. The assessment reviewed the scientific literature up to 1993 on the use of radiotherapy in the treatment of solid tumours, and estimated the costs associated with radiotherapy. It also described the current practise of radiotherapy in Sweden 1992 and compared practise with scientific knowledge. The SBU has now conducted a follow-up study on radiotherapy for cancer, including a review of the scientific literature from 1994 and a prospective survey of radiotherapy practise in Sweden 2001. The following conclusions were drawn: The role of radiotherapy as an important form of treatment for cancer with both curative and palliative intent has been further confirmed. The use of radiotherapy in Sweden has increased and is now at the internationally recommended level. Radiotherapy in Sweden is mostly given in accordance with the scientific evidence but may still be underutilized in certain situations. The resources for radiotherapy are being utilized more efficiently. The costs of radiotherapy are still 5% of the total cost of cancer care, while the cost of an individual treatment (fraction) has decreased. The need for radiotherapy capacity will increase. In addition, half of the treatment equipment will have to be replaced in the next few years.
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Zackrisson B, Mattsson S, Kjellén E, Glimelius B. Research and development of radiation therapy in clinical routines. Acta Oncol 2003; 42:115-22. [PMID: 12801130 DOI: 10.1080/02841860310004977] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In an investigation conducted by the Swedish Cancer Society, the present status, critical issues and future aspects and potentials were described by an expert group for each of nine major areas of radiation therapy research. In this report, research and development in radiation therapy clinical routines is described. The terms research, development, quality assurance, quality control and clinical routines in radiation therapy are also defined.
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Abstract
Esophageal cancer is a disease with a poor prognosis and high biological aggressiveness. The disease used to be considered a mainly local problem, and palliative care with relief of dysphagia was the goal for most of those concerned with the disease. When surgical techniques were improved and parallel progress was made in intensive care and postoperative care, some patients could be cured of the disease. The development of pre- or postoperative radiotherapy also improved local control. Partly because of the interest that began to be focused on improving survival for this diagnostic group, chemotherapy combined with radiotherapy has been incorporated into the therapeutic arsenal. The aim of this review is to shed light on current treatment principles for esophageal cancer. However, treatment results from studies utilizing combination chemotherapy given concurrently with radiotherapy support the conclusion that well-designed randomized trials with long-term follow-ups should be performed.
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