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Weksler B, Sullivan JL, Schumacher LY. Randomized trial of bupivacaine with epinephrine versus bupivacaine liposome suspension in patients undergoing minimally invasive lung resection. J Thorac Cardiovasc Surg 2021; 161:1652-1661. [DOI: 10.1016/j.jtcvs.2020.01.112] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 01/06/2020] [Accepted: 01/10/2020] [Indexed: 10/24/2022]
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Holst KA, Thiels CA, Ubl DS, Blackmon SH, Cassivi SD, Nichols FC, Shen KR, Wigle DA, Thomas M, Makey IA, Beamer SE, Jaroszewski DE, Allen MS, Habermann EB. Postoperative Opioid Consumption in Thoracic Surgery Patients: How Much Is Actually Used? Ann Thorac Surg 2019; 109:1033-1039. [PMID: 31689406 DOI: 10.1016/j.athoracsur.2019.08.115] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 07/10/2019] [Accepted: 08/08/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND The objective of this initiative was to perform a prospective, multicenter survey of patients after lung resection to assess the amount of opioid medication consumed and the disposition of unused opioids to inform the development of evidence-based prescribing guidelines. METHODS Adults undergoing lung resection with either minimally invasive surgery (MIS; n = 108) or thoracotomy (n = 45) were identified prospectively from 3 academic centers (from March 2017 to January 2018) to complete a 28-question telephone survey 21 to 35 days after discharge. Discharge opioids were converted into morphine milligram equivalents (MME) and were compared across patient and surgical details. RESULTS Of the 153 patients who completed the survey, 89.5% (137) received opioids at discharge with a median prescription of 320 MME (interquartile range [IQR], 225, 450 MME) after MIS and 450 MME (IQR, 300, 600 MME) after thoracotomy (P = .001). Median opioid consumption varied by surgical approach: 90 MME (IQR, 0, 262.5) after MIS and 300 MME (IQR, 50, 382.5 MME) after thoracotomy (P < .001). The majority of patients (73.7%; 101) had residual opioid medication at the time of the survey, and patients after MIS had a relative increase in amount of remaining opioid medication: 58.3% vs 33.3% (P = .05) of the original prescription. Only 5.9% of patients with opioids remaining had properly disposed of them. CONCLUSIONS Although patients undergoing MIS lung resection used significantly less opioid medication over a shorter duration of time than did patients after thoracotomy, they had relatively more excess opioid prescription. Evidence-based, procedure-specific guidelines with tailored pain regimens should be developed and implemented to reduce the amount of postoperative opioid medication remaining in the community.
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Affiliation(s)
- Kimberly A Holst
- Division of Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Daniel S Ubl
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Surgical Outcomes Program, Mayo Clinic, Rochester, Minnesota
| | - Shanda H Blackmon
- Division of Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Stephen D Cassivi
- Division of Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Francis C Nichols
- Division of Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - K Robert Shen
- Division of Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Dennis A Wigle
- Division of Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mathew Thomas
- Division of Cardiothoracic Surgery, Department of Surgery, Mayo Clinic, Jacksonville, Florida
| | - Ian A Makey
- Division of Cardiothoracic Surgery, Department of Surgery, Mayo Clinic, Jacksonville, Florida
| | - Staci E Beamer
- Division of Cardiothoracic Surgery, Department of Surgery, Mayo Clinic, Scottsdale, Arizona
| | - Dawn E Jaroszewski
- Division of Cardiothoracic Surgery, Department of Surgery, Mayo Clinic, Scottsdale, Arizona
| | - Mark S Allen
- Division of Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Elizabeth B Habermann
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Surgical Outcomes Program, Mayo Clinic, Rochester, Minnesota.
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Uemura A, Tanaka R. The importance of antiadhesion treatment for the successful video-assisted thoracic surgery. J Thorac Dis 2019; 11:59-61. [PMID: 30863572 DOI: 10.21037/jtd.2019.01.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Akiko Uemura
- Faculty of Veterinary Medicine, Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo, Japan.,Faculty of Life & Environmental Sciences, Department of Animal Sciences, Teikyo University of Science, Tokyo, Japan
| | - Ryou Tanaka
- Faculty of Veterinary Medicine, Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo, Japan
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Gonzalez-Rivas D, Kuo YC, Wu CY, Delgado M, Mercedes DLT, Fernandez R, Fieira E, Hsieh MJ, Paradela M, Chao YK, Wu CF. Predictive factors of postoperative complications in single-port video-assisted thoracoscopic anatomical resection: Two center experience. Medicine (Baltimore) 2018; 97:e12664. [PMID: 30290649 PMCID: PMC6200447 DOI: 10.1097/md.0000000000012664] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
The purpose of this study was to identify the risk factors for adverse events during single-port video-assisted thoracoscopic (SPVATS) anatomical resections.We retrospectively reviewed patients who had undergone SPVATS anatomic resections between January 2014 and February 2017 in Coruña University Hospital's Minimally Invasive Thoracic Surgery Unit (CHUAC, Spain) and Chang Gung Memorial Hospital (CGMH, Taiwan). Four hundred forty-two patients (male: 306, female: 136) were enrolled in this study. Logistic regression analysis was performed on variables for postoperative complications.Postoperative complications with a 30-day mortality occurred in 94 patients (21.3%) and with a 90-day mortality in 3 patients (0.7%) while the major complication rate was 3.9%. Prolonged air leak (PAL > 5 days) was the most common complication and came by postoperative arrhythmia. Logistic regression indicated that pleural symphysis (odds ratio (OR), 1.91; 95% confidence interval (CI), 1.14-3.18; P = .014), computed tomography (CT) pulmonary emphysema (OR, 2.63; 95% CI, 1.41-4.76; P = .002), well-developed pulmonary CT fissure line (OR, 0.49; 95% CI, 0.29-0.84; P = .009), and tumor size (≥3 cm) (OR, 2.15; 95% CI, 1.30-3.57; P = .003) were predictors of postoperative complications.Our preliminary results revealed that SPVATS anatomic resection achieves acceptable 30- and 90-day surgery related mortality (0.7%) and major complications rate (3.9%). Prolonged Air leak (PAL > 5 days) was the most common postoperative complication. Pleural symphysis, pulmonary emphysema, well-developed pulmonary CT fissure line and tumor size (≥3 cm) were predictors of adverse events during SPVATS anatomic resection.
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Affiliation(s)
- Diego Gonzalez-Rivas
- Coruña University Hospital; Minimally Invasive Thoracic Surgery Unit (UCTMI), Department of Thoracic Surgery, CORUÑA, Spain
| | - Yung Chia Kuo
- Chang Gung University, Division of Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ching Yang Wu
- Chang Gung University, Division of Thoracic and Cardiovascular Surgery, Department of Surgery
| | - Maria Delgado
- Coruña University Hospital; Minimally Invasive Thoracic Surgery Unit (UCTMI), Department of Thoracic Surgery, CORUÑA, Spain
| | - de la Torre Mercedes
- Coruña University Hospital; Minimally Invasive Thoracic Surgery Unit (UCTMI), Department of Thoracic Surgery, CORUÑA, Spain
| | - Ricardo Fernandez
- Coruña University Hospital; Minimally Invasive Thoracic Surgery Unit (UCTMI), Department of Thoracic Surgery, CORUÑA, Spain
| | - Eva Fieira
- Coruña University Hospital; Minimally Invasive Thoracic Surgery Unit (UCTMI), Department of Thoracic Surgery, CORUÑA, Spain
| | - Ming Ju Hsieh
- Coruña University Hospital; Minimally Invasive Thoracic Surgery Unit (UCTMI), Department of Thoracic Surgery, CORUÑA, Spain
| | - Marina Paradela
- Coruña University Hospital; Minimally Invasive Thoracic Surgery Unit (UCTMI), Department of Thoracic Surgery, CORUÑA, Spain
| | - Yin Kai Chao
- Chang Gung University, Division of Thoracic and Cardiovascular Surgery, Department of Surgery
| | - Ching Feng Wu
- Coruña University Hospital; Minimally Invasive Thoracic Surgery Unit (UCTMI), Department of Thoracic Surgery, CORUÑA, Spain
- Chang Gung University, Division of Thoracic and Cardiovascular Surgery, Department of Surgery
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Kelley TM, Bailey DW, Sparks P, Rice R, Caddell E, Currier H, Gallo D. Intercostal Nerve Blockade with Exparel® Results in Lower Opioid Usage during the First 24 Hours after Video-Assisted Thorascopic Surgery. Am Surg 2018. [DOI: 10.1177/000313481808400945] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Liposomal bupivacaine (LipoB) provides prolonged local anesthetic effects and has seen usage in several fields of surgery. We review our experience using LipoB intraoperatively for intercostal nerve blocks after video-assisted throacoscopic surgery (VATS). A retrospective, single-center review was conducted for patients undergoing VATS from August 2012 to December 2014. Patients those who received LipoB as an intercostal nerve block were compared with patients who received blocks with standard bupivacaine. Opiate amounts used within the first six hours and then subsequent 18,48, and 72 hours were converted into morphine equivalents for comparison. Forty-seven patients met inclusion criteria: 21 receiving LipoB intercostal nerve block and 26 controls. Groups were similar for age, diabetes, hypertension, chronic kidney disease, body mass index and American Society of Anesthesiologists scores. The LipoB group had a larger portion of males (P < 0.02). Postoperatively, morphine equivalent usage was significantly less in the LipoB group compared with the standard bupivacaine within the first six hours after surgery (15.62 vs 52.41, P = 0.001) and in the subsequent 18 hours (28.98 vs 65.17, P = 0.01). After the first 24 hours there was not a significant difference in opiate usage between the two groups. There was no difference in length of stay between the two groups. In our study group of VATS patients, an intercostal nerve block with LipoB significantly reduced the usage of postoperative opioids in the first 24 hours only when compared with standard bupivacaine.
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Affiliation(s)
- Thomas M. Kelley
- From the Department of Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia
| | - Daniel W. Bailey
- From the Department of Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia
| | - Preston Sparks
- From the Department of Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia
| | - Robert Rice
- From the Department of Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia
| | - Erin Caddell
- From the Department of Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia
| | - Heather Currier
- From the Department of Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia
| | - Dominic Gallo
- From the Department of Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia
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Neoadjuvant vs definitive concurrent chemoradiotherapy in locally advanced esophageal squamous cell carcinoma patients. World J Surg Oncol 2018; 16:141. [PMID: 30007409 PMCID: PMC6046100 DOI: 10.1186/s12957-018-1444-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 07/05/2018] [Indexed: 12/29/2022] Open
Abstract
Background The optimal treatment for locally advanced esophageal squamous cell carcinoma remains unclear. We compared the clinical outcomes of neoadjuvant concurrent chemoradiotherapy (CCRT) followed by esophagectomy [the surgery group] and CCRT without surgery [the CCRT group] in patients with squamous cell carcinoma from an Asian population. Methods Eligible patients diagnosed from 2008 to 2015 were identified through the Taiwan Cancer Registry. To balance observable potential confounders, we constructed a 1:1 propensity score-matched cohort [surgery vs CCRT]. We compared the hazard ratios between the surgery and CCRT groups for death using a robust variance estimator. We also evaluated the outcomes of patients for freedom from local regional recurrence (FFLRR) and esophageal cancer-specific survival (ECSS). Extensive supplementary analyses were performed to examine the robustness of our findings. Results Our study population included 298 patients balanced with respect to the observed covariables. The hazard ratio of death was 0.56 [95% confidence interval 0.42~0.75] when surgery was compared to CCRT. The results remained significant in the FFLRR and ECSS outcomes. In the supplementary analyses, our results also remained significant when additional covariables were taken into consideration or when the definition of the index date was changed. Conclusions When compared to definitive CCRT, neoadjuvant CCRT followed by esophagectomy was associated with improved overall survival for locally advanced esophageal squamous cell carcinoma. However, given the nonrandomized nature of the study and the sensitivity to potentially unmeasured confounders, our results should be interpreted cautiously.
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Chien CR, Chen WTL, Wang HM, Lin CH, Li CC. Intensity-Modulated Radiotherapy in Neoadjuvant Concurrent Chemoradiotherapy for Locally Advanced Rectal Cancer. Dis Colon Rectum 2016; 59:e401. [PMID: 27145319 DOI: 10.1097/dcr.0000000000000596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Lin CY, Fang HY, Feng CL, Li CC, Chien CR. Cost-effectiveness of neoadjuvant concurrent chemoradiotherapy versus esophagectomy for locally advanced esophageal squamous cell carcinoma: A population-based matched case-control study. Thorac Cancer 2015; 7:288-95. [PMID: 27148413 PMCID: PMC4846616 DOI: 10.1111/1759-7714.12326] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 09/25/2015] [Indexed: 12/25/2022] Open
Abstract
Background Neoadjuvant concurrent chemoradiotherapy (NCCRT) is often considered for locally‐advanced esophageal squamous cell carcinoma (LA‐ESCC) patients; however, no data regarding the cost‐effectiveness of this treatment is available. Our study aimed to evaluate the cost‐effectiveness of NCCRT versus esophagectomy for LA‐ESCC at population level. Methods We identified LA‐ESCC patients diagnosed within 2008–2009 and treated with either NCCRT or esophagectomy through the Taiwan Cancer Registry. We included potential confounding covariables (age, gender, residency, comorbidity, social‐economic status, disease stage, treating hospital level and surgeon's experience, and the use of endoscopic ultrasound before treatment) and used propensity score (PS) to construct a 1:1 population. The duration of interest was three years within the date of diagnosis. Effectiveness was measured as overall survival. We took the payer's perspective and converted the cost to 2014 United States dollars (USD). In sensitivity analysis, we evaluated the potential impact of an unmeasured confounder on the statistical significance of incremental net benefit at suggested willingness‐to‐pay. Results Our study population constituted 150 PS matched subjects. The mean cost (2014 USD) and survival (year) were higher for NCCRT compared with esophagectomy (US$91,460 vs. $75,836 for cost; 2.2 vs. 1.8 for survival) with an estimated incremental cost‐effectiveness ratio of US$39,060/life‐year. Conclusions When compared to esophagectomy, NCCRT is likely to improve survival and is probably more cost‐effective. Cost‐effectiveness results should be interpreted with caution given our results were sensitive to potential unmeasured confounder(s) in sensitivity analysis.
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Affiliation(s)
- Chen-Yuan Lin
- Division of Hematology and Oncology China Medical University Hospital Taichung Taiwan
| | - Hsin-Yuan Fang
- Department of Chest Surgery China Medical University Hospital Taichung Taiwan; School of Medicine College of Medicine China Medical University Taichung Taiwan
| | - Chun-Lung Feng
- Division of Gastroenterology and Hepatology China Medical University Hospital Taichung Taiwan
| | - Chia-Chin Li
- Cancer Center China Medical University Hospital Taichung Taiwan
| | - Chun-Ru Chien
- School of Medicine College of Medicine China Medical University Taichung Taiwan; Department of Radiation Oncology China Medical University Hospital Taichung Taiwan
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Chen WTL, Ke TW, Liao YM, Li CC, Chien CR. Optimal interval of surgery after neoadjuvant radiochemotherapy in T3-4/N0+ rectal cancer: population level evidence in addition to controlled trial. J Gastrointest Oncol 2015; 6:E38-9. [PMID: 26029463 DOI: 10.3978/j.issn.2078-6891.2014.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 11/14/2014] [Indexed: 02/01/2023] Open
Affiliation(s)
- William Tzu-Liang Chen
- 1 Department of Colorectal Surgery, 2 School of Medicine, College of Medicine, 3 Division of Hematology and Oncology, Department of Internal Medicine, 4 Cancer Center, 5 Department of Radiation Oncology, China Medical University Hospital, Taichung 40402, Taiwan
| | - Tao-Wei Ke
- 1 Department of Colorectal Surgery, 2 School of Medicine, College of Medicine, 3 Division of Hematology and Oncology, Department of Internal Medicine, 4 Cancer Center, 5 Department of Radiation Oncology, China Medical University Hospital, Taichung 40402, Taiwan
| | - Yu-Min Liao
- 1 Department of Colorectal Surgery, 2 School of Medicine, College of Medicine, 3 Division of Hematology and Oncology, Department of Internal Medicine, 4 Cancer Center, 5 Department of Radiation Oncology, China Medical University Hospital, Taichung 40402, Taiwan
| | - Chia-Chin Li
- 1 Department of Colorectal Surgery, 2 School of Medicine, College of Medicine, 3 Division of Hematology and Oncology, Department of Internal Medicine, 4 Cancer Center, 5 Department of Radiation Oncology, China Medical University Hospital, Taichung 40402, Taiwan
| | - Chun-Ru Chien
- 1 Department of Colorectal Surgery, 2 School of Medicine, College of Medicine, 3 Division of Hematology and Oncology, Department of Internal Medicine, 4 Cancer Center, 5 Department of Radiation Oncology, China Medical University Hospital, Taichung 40402, Taiwan
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Fang HY, Hsiao FY, Huang HC, Lin YS, Chen CY, Shieh SH, Chen PR, Chen CK, Chien CR. Cost and effectiveness of video-assisted thoracoscopic surgery for clinical stage I non-small cell lung cancer: a population-based analysis. J Thorac Dis 2015; 6:1690-6. [PMID: 25589961 DOI: 10.3978/j.issn.2072-1439.2014.10.27] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 09/25/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND Video-assisted thoracoscopic surgery (VATS) is a minimally invasive alternative to conventional surgery (CS). We aimed to estimate the short-term cost-effectiveness of VATS vs. CS for clinical stage I non-small cell lung cancer (NSCLC-c-stage-I) patients from the payer's perspective (National Health Insurance). METHODS We identified NSCLC-c-stage-I patients diagnosed and received surgery within 2007-2009 through a comprehensive population-based database containing cancer and death registries, and reimbursement data. The duration of interest was 1 year. We included potential confounding covariables through literature searching and our own experience, and used a propensity score to construct a 1:1 population for adjustment. RESULTS Our study population constituted 966 patients. The mean hospital stay [days, standard deviation (SD)] were 14.4 [7] and 16.1 (7.7) for VATS and CS respectively (P=0.002). The mean cost (2013 USD) and survival (year) was $22,316 vs. $21,976 and 0.98 vs. 0.974 for VATS vs. CS. The probability for VATS to be cost-effective (i.e., positive net benefit) was 0.49 & 0.56 at willingness-to-pay (WTP) 50,000 & 100,000 USD/life-year, respectively. CONCLUSIONS We provide the first empirical evidence that when compared to CS, VATS was potentially cost-effective in the short term (1 year) within the common WTP levels in Taiwan.
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Affiliation(s)
- Hsin-Yuan Fang
- 1 Department of Chest Surgery, China Medical University Hospital, Taichung, Taiwan ; 2 School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan ; 3 Graduate Institute of Clinical Pharmacy, College of Medicine, 4 School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan ; 6 Division of Trauma, Emergency Surgery, and Critical Care, China Medical University Hospital, Taichung, Taiwan ; 7 Department of Health Services Administration, College of Health Care, China Medical University, Taichung, Taiwan ; 8 Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Fei-Yuan Hsiao
- 1 Department of Chest Surgery, China Medical University Hospital, Taichung, Taiwan ; 2 School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan ; 3 Graduate Institute of Clinical Pharmacy, College of Medicine, 4 School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan ; 6 Division of Trauma, Emergency Surgery, and Critical Care, China Medical University Hospital, Taichung, Taiwan ; 7 Department of Health Services Administration, College of Health Care, China Medical University, Taichung, Taiwan ; 8 Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Hsu-Chih Huang
- 1 Department of Chest Surgery, China Medical University Hospital, Taichung, Taiwan ; 2 School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan ; 3 Graduate Institute of Clinical Pharmacy, College of Medicine, 4 School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan ; 6 Division of Trauma, Emergency Surgery, and Critical Care, China Medical University Hospital, Taichung, Taiwan ; 7 Department of Health Services Administration, College of Health Care, China Medical University, Taichung, Taiwan ; 8 Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Yu-Sen Lin
- 1 Department of Chest Surgery, China Medical University Hospital, Taichung, Taiwan ; 2 School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan ; 3 Graduate Institute of Clinical Pharmacy, College of Medicine, 4 School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan ; 6 Division of Trauma, Emergency Surgery, and Critical Care, China Medical University Hospital, Taichung, Taiwan ; 7 Department of Health Services Administration, College of Health Care, China Medical University, Taichung, Taiwan ; 8 Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Yi Chen
- 1 Department of Chest Surgery, China Medical University Hospital, Taichung, Taiwan ; 2 School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan ; 3 Graduate Institute of Clinical Pharmacy, College of Medicine, 4 School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan ; 6 Division of Trauma, Emergency Surgery, and Critical Care, China Medical University Hospital, Taichung, Taiwan ; 7 Department of Health Services Administration, College of Health Care, China Medical University, Taichung, Taiwan ; 8 Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Shwn-Huey Shieh
- 1 Department of Chest Surgery, China Medical University Hospital, Taichung, Taiwan ; 2 School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan ; 3 Graduate Institute of Clinical Pharmacy, College of Medicine, 4 School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan ; 6 Division of Trauma, Emergency Surgery, and Critical Care, China Medical University Hospital, Taichung, Taiwan ; 7 Department of Health Services Administration, College of Health Care, China Medical University, Taichung, Taiwan ; 8 Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Pin-Ru Chen
- 1 Department of Chest Surgery, China Medical University Hospital, Taichung, Taiwan ; 2 School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan ; 3 Graduate Institute of Clinical Pharmacy, College of Medicine, 4 School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan ; 6 Division of Trauma, Emergency Surgery, and Critical Care, China Medical University Hospital, Taichung, Taiwan ; 7 Department of Health Services Administration, College of Health Care, China Medical University, Taichung, Taiwan ; 8 Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Chein-Kuang Chen
- 1 Department of Chest Surgery, China Medical University Hospital, Taichung, Taiwan ; 2 School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan ; 3 Graduate Institute of Clinical Pharmacy, College of Medicine, 4 School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan ; 6 Division of Trauma, Emergency Surgery, and Critical Care, China Medical University Hospital, Taichung, Taiwan ; 7 Department of Health Services Administration, College of Health Care, China Medical University, Taichung, Taiwan ; 8 Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Ru Chien
- 1 Department of Chest Surgery, China Medical University Hospital, Taichung, Taiwan ; 2 School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan ; 3 Graduate Institute of Clinical Pharmacy, College of Medicine, 4 School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan ; 6 Division of Trauma, Emergency Surgery, and Critical Care, China Medical University Hospital, Taichung, Taiwan ; 7 Department of Health Services Administration, College of Health Care, China Medical University, Taichung, Taiwan ; 8 Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
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Abstract
This paper is the thirty-sixth consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2013 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior, and the roles of these opioid peptides and receptors in pain and analgesia; stress and social status; tolerance and dependence; learning and memory; eating and drinking; alcohol and drugs of abuse; sexual activity and hormones, pregnancy, development and endocrinology; mental illness and mood; seizures and neurologic disorders; electrical-related activity and neurophysiology; general activity and locomotion; gastrointestinal, renal and hepatic functions; cardiovascular responses; respiration and thermoregulation; and immunological responses.
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY 11367, United States.
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12
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Chien CR, Hsia TC, Chen CY. Cost-effectiveness of chemotherapy combined with thoracic radiotherapy versus chemotherapy alone for limited stage small cell lung cancer: A population-based propensity-score matched analysis. Thorac Cancer 2014; 5:530-6. [PMID: 26767048 DOI: 10.1111/1759-7714.12125] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 04/12/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The addition of thoracic radiotherapy improves the outcome of limited stage small cell lung cancer (LS-SCLC), however, the cost-effectiveness of this process has never been reported. We aimed to estimate the short-term cost-effectiveness of chemotherapy combined with thoracic radiotherapy (C-TRT) versus chemotherapy alone (C/T) for LS-SCLC patients from the payer's perspective (Taiwan National Health Insurance). METHODS We identified LS-SCLC patients diagnosed within 2007-2009 through a comprehensive population-based database containing cancer and death registries, and reimbursement data. The duration of interest was one year within diagnosis. We included potential confounding covariables through literature searching and our own experience, and used a propensity score to construct a 1:1 population for adjustment. We used a net benefit (NB) approach to evaluate the cost-effectiveness at various willingness-to-pay (WTP) levels. Sensitivity analysis regarding potential unmeasured confounder(s) was performed. RESULTS Our study population constituted 74 patients. The mean cost (2013 USD) and survival (year) was higher for C-TRT (42 439 vs. 28 357; 0.94 vs. 0.88). At the common WTP level (50 000 USD/life-year), C-TRT was not cost effective (incremental NB - 11 082) and the probability for C-TRT to be cost effective (i.e. positive net benefit) was 0.005. The result was moderately sensitive to potential unmeasured confounder(s) in sensitivity analysis. CONCLUSIONS We provide evidence that when compared to C/T, C-TRT is effective in improving survival, but is not cost-effective in the short-term at a common WTP level from a payer's perspective. This information should be considered by clinicians when discussing thoracic radiotherapy with their LS-SCLC patients.
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Affiliation(s)
- Chun-Ru Chien
- Department of Radiation Oncology, China Medical University Hospital Taichung, Taiwan; School of Medicine, College of Medicine, College of Health Care, China Medical University Taichung, Taiwan
| | - Te-Chun Hsia
- Internal Medicine, China Medical University Hospital Taichung, Taiwan; Department of Respiratory Therapy, China Medical University Hospital Taichung, Taiwan
| | - Chih-Yi Chen
- Department of Respiratory Therapy, China Medical University Hospital Taichung, Taiwan; Surgery, China Medical University Hospital Taichung, Taiwan; Cancer Center, China Medical University Hospital Taichung, Taiwan
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Ke TW, Liao YM, Chiang HC, Chang SC, Wang PH, Chen YY, Chen WTL, Chien CR. Effectiveness of neoadjuvant concurrent chemoradiotherapy versus up-front proctectomy in clinical stage II-III rectal cancer: A population-based study. Asia Pac J Clin Oncol 2014; 12:e234-40. [PMID: 24571424 DOI: 10.1111/ajco.12172] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2013] [Indexed: 02/02/2023]
Abstract
AIMS Neoadjuvant concurrent chemoradiotherapy (NCCRT) is currently the preferred treatment for rectal cancer of clinical stage II-III based on its efficacy in clinical trials. The population-based effectiveness of NCCRT is rarely reported on in the literature. The purpose of our study is to investigate the nationwide population-based effectiveness of NCCRT as compared with up-front proctectomy. METHODS In this retrospective cohort study, we identified the study population by linking datasets including the cancer registry, death registry and other related files in Taiwan. We identified all patients with rectal adenocarcinoma of American Joint Committee on Cancer clinical stage II or III who were diagnosed in 2007 or 2008 and received either NCCRT or up-front proctectomy. We included patients' age, gender, residence, socioeconomic status and clinical stage as covariables. We used overall survival as the measure of effectiveness. The Cox proportional-hazards regression model was used for statistical analyses. We further conducted sensitivity analyses, one in only those who received optimal postoperative chemotherapy and one in two subgroups matched for propensity score. RESULTS We included 1933 patients (NCCRT: 424; up-front proctectomy: 1509) in the study population. NCCRT was associated with improved survival as compared with up-front proctectomy (adjusted hazard ratio of death 0.656; 95% confidence interval 0.495-0.871). Our results were robust in the sensitivity analyses. CONCLUSION We demonstrated that the use of neoadjuvant concurrent systemic therapy and radiotherapy is associated with better effectiveness in rectal adenocarcinoma of clinical stage II-III as compared with up-front proctectomy. Further studies are needed to elucidate the subgroups most likely to benefit and to clarify NCCRT's cost-effectiveness.
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Affiliation(s)
- Tao-Wei Ke
- Department of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Yu-Min Liao
- Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Hua-Che Chiang
- Department of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Sheng-Chi Chang
- Department of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Pin-Hui Wang
- Department of Cancer Center, China Medical University Hospital, Taichung, Taiwan
| | - Yi-Ya Chen
- Department of Cancer Center, China Medical University Hospital, Taichung, Taiwan
| | - William Tzu-Liang Chen
- Department of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chun-Ru Chien
- Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
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