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Suh K, Carlson JJ, Xia F, Williamson T, Sullivan SD. Comparative effectiveness of larotrectinib versus entrectinib for the treatment of metastatic NTRK gene fusion cancers. J Comp Eff Res 2022; 11:1011-1019. [PMID: 35993247 DOI: 10.2217/cer-2021-0247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To extrapolate clinical trial results to estimate and compare expected progression-free and overall life years (LYs) and quality-adjusted LYs (QALYs) for larotrectinib and entrectinib in patients with colorectal cancer (CRC), soft tissue sarcoma (STS) and brain metastases prior to treatment with larotrectinib or entrectinib. Methods: A naive direct comparison of larotrectinib versus entrectinib was made using partitioned survival modeling methods from clinical trial data. Results: Larotrectinib resulted in an additional 1.58 LYs (1.17 QALYs), 5.81 LYs (2.02 QALYs) and 1.01 LYs in CRC, STS and baseline brain metastases, respectively, compared with entrectinib. Conclusion: Larotrectinib provided life expectancy and QALY gains compared with entrectinib. Additional studies will be beneficial as more patients are treated and survival data develop to better inform comparative effectiveness results.
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Affiliation(s)
- Kangho Suh
- School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Josh J Carlson
- Comparative Health Outcomes, Policy, and Economics Institute, School of Pharmacy, University of Washington, Seattle, WA 98195, USA
| | - Fang Xia
- Bayer US LLC, Whippany, NJ 07981, USA
| | | | - Sean D Sullivan
- Comparative Health Outcomes, Policy, and Economics Institute, School of Pharmacy, University of Washington, Seattle, WA 98195, USA
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2
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Suh K, Carlson JJ, Xia F, Williamson T, Sullivan SD. The potential long-term comparative effectiveness of larotrectinib vs standard of care for treatment of metastatic TRK fusion thyroid cancer, colorectal cancer, and soft tissue sarcoma. J Manag Care Spec Pharm 2022; 28:622-630. [PMID: 35362337 DOI: 10.18553/jmcp.2022.21373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Larotrectinib is approved for patients with metastatic TRK fusion cancers, including differentiated thyroid (DTC), colorectal cancer (CRC), and soft tissue sarcoma (STS). Given the basket clinical trial design of larotrectinib, direct comparisons against standard of care in each of the mentioned cancers have not been assessed. Also, owing to the limited duration of follow-up in clinical trials, long-term outcomes for treatments are generally not known or estimated. OBJECTIVE: To compare expected life-years (LYs) and quality-adjusted life-years (QALYs) for patients with metastatic DTC, CRC, and STS who are eligible to receive larotrectinib against patients with unknown NTRK gene fusion status receiving standard-of-care therapy. METHODS: We developed a partitioned survival model to estimate the long-term comparative effectiveness of larotrectinib and standard of care for 3 tumor types. Larotrectinib survival data, assessed by independent review committee, were derived from an updated July 2020 analysis of 19, 8, and 23 adult patients (aged ≥ 18 years) with metastatic TRK fusion DTC, CRC, and STS, respectively. The DTC survival data also included 2 patients aged less than 18 years for a total of 21 patients. Survival estimates for standard of care were derived from published clinical trials. Progressionfree and overall survival for all treatments were estimated using survival distributions (Exponential, Weibull, Log-logistic, and Lognormal) fit to the available data. The final exponential form was selected based on goodness-of-fit and clinical plausibility. QALYs were estimated by adjusting the time spent in the preprogression and postprogression health states by utility weights derived from publicly available literature. RESULTS: Patients receiving larotrectinib experienced more LYs and QALYs compared with those receiving standard-of-care treatments across all 3 assessed cancer types. In DTC, patients receiving larotrectinib had 7.15-8.26 additional LYs (5.87-6.12 QALYs); in CRC, patients receiving larotrectinib had 1.26-1.27 additional LYs (1.00 QALYs); and in STS, patients receiving larotrectinib had 5.56 additional LYs (1.99 QALYs). CONCLUSIONS: Compared with standard of care in metastatic TRK wild-type cancers, larotrectinib is estimated to result in improved LY and QALY outcomes based on parametric extrapolations of intrial survival data. Because patient-level data were unavailable for adjusted analyses, a cross-trial comparison was performed. Given the limitations of this analytic approach and the small sample size for larotrectinib in trials, future studies should reassess the comparative effectiveness of larotrectinib vs standard of care as treated patients accrue and long-term survival data mature. DISCLOSURES: K. Suh, J. Carlson, and S. Sullivan report consulting fees from Bayer US LLC. F. Xia and T. Williamson are employees of Bayer US LLC. This study was funded by Bayer US LLC. The sponsor had no role in the design of the study and did not have any role in the execution, analyses, interpretation of the data, or decision to submit results.
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Affiliation(s)
- Kangho Suh
- School of Pharmacy, University of Pittsburgh, PA
| | - Josh J Carlson
- Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle
| | | | | | - Sean D Sullivan
- Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle
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Schuttringer E, Beleche T. The impact of recent power morcellator risk information on inpatient surgery and patient outcomes. J Comp Eff Res 2019; 9:53-65. [PMID: 31840551 DOI: 10.2217/cer-2019-0093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: We examine the impact of the new risk information about a surgical device on surgery and patient outcomes for hysterectomy in the inpatient setting. Methods: We utilize a difference-in-differences approach to assess the impact of new risk information on patient outcomes in the inpatient setting between 2009 and 2014. The inpatient data come from a nationally representative sample of hospitalizations in the USA. We use the likelihood of laparoscopic surgery, measures of resource use and surgical complications as outcome variables. Results: We estimate a three-percentage point decrease in the likelihood of receiving laparoscopic hysterectomy, a one-percentage point increase in the likelihood of experiencing a surgical complication and no impact on resource use, relative to pre-existing means. Conclusion: Our findings show that there was movement away from laparoscopic surgery in the months following the dissemination of new risk information. These changes had limited effect on patient outcomes.
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Affiliation(s)
- Ehren Schuttringer
- Food & Drug Administration Office of the Commissioner, 10903 New Hampshire Ave, Silver Spring, Maryland, MD 20993, USA
| | - Trinidad Beleche
- Food & Drug Administration Office of the Commissioner, 10903 New Hampshire Ave, Silver Spring, Maryland, MD 20993, USA
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4
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van Nooten F, Busschbach J, van Agthoven M, van Exel J, Brouwer W. What should we know about the person behind a TTO? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:1207-1211. [PMID: 29671142 DOI: 10.1007/s10198-018-0975-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Floortje van Nooten
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jan Busschbach
- Section Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands
| | | | - Job van Exel
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Werner Brouwer
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands.
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5
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Royce TJ, Punglia RS, Chen AB, Patel SA, Thornton KA, Raut CP, Baldini EH. Cost-Effectiveness of Surveillance for Distant Recurrence in Extremity Soft Tissue Sarcoma. Ann Surg Oncol 2017; 24:3264-3270. [PMID: 28718037 DOI: 10.1245/s10434-017-5996-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Optimal distant recurrence (DR) surveillance strategies for extremity soft tissue sarcoma (STS) are unknown. We performed a cost-effectiveness analysis of different imaging modalities performed at guideline-specified intervals. METHODS We developed a Markov model simulating lifetime outcomes for 54-year-old patients after definitive treatment for American Joint Committee on Cancer stage II-III extremity STS using four surveillance strategies: watchful waiting (WW), chest X-ray (CXR), chest computed tomography (CCT), and positron emission tomography-computed tomography (PET/CT). Probabilities, utilities, and costs were extracted from the literature and Medicare claims to determine incremental cost-effectiveness ratios (ICER). RESULTS CCT was the most effective and most costly strategy with CXR the most cost-effective strategy at a societal willing-to-pay (WTP) of $100,000/quality-adjusted life year (QALY). The ICER was $12,113/QALY for CXR versus $104,366/QALY for CCT while PET/CT was never cost-effective. Sensitivity analyses demonstrated CCT becomes the preferred imaging modality as the lifetime risk of DR increases beyond 33% or as the WTP increases beyond $120,000/QALY. CONCLUSIONS Optimal DR surveillance imaging for stage II-III extremity STS should be individualized based on patients' risks for DR. These results suggest CXR, or CCT performed at more protracted intervals, may be preferred for lower-risk patients (i.e., DR risk <33%), whereas CCT may be preferred for higher-risk patients (i.e., DR risk >33%). Further study of optimal strategies is needed. In the interim, these findings may help to refine guidelines to reduce resource overutilization during routine surveillance of lower-risk sarcoma patients.
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Affiliation(s)
- Trevor J Royce
- Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA, USA. .,Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA.
| | - Rinaa S Punglia
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA
| | - Aileen B Chen
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA
| | - Sagar A Patel
- Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA, USA.,Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA
| | - Katherine A Thornton
- Center for Bone and Soft Tissue Sarcoma, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA
| | - Chandrajit P Raut
- Center for Bone and Soft Tissue Sarcoma, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA.,Division of Surgical Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA
| | - Elizabeth H Baldini
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA.,Center for Bone and Soft Tissue Sarcoma, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA
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Berry V, Basson L, Bogart E, Mir O, Blay JY, Italiano A, Bertucci F, Chevreau C, Clisant-Delaine S, Liegl-Antzager B, Tresch-Bruneel E, Wallet J, Taieb S, Decoupigny E, Le Cesne A, Brodowicz T, Penel N. REGOSARC: Regorafenib versus placebo in doxorubicin-refractory soft-tissue sarcoma-A quality-adjusted time without symptoms of progression or toxicity analysis. Cancer 2017; 123:2294-2302. [PMID: 28295221 PMCID: PMC5485075 DOI: 10.1002/cncr.30661] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 01/11/2017] [Accepted: 01/13/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND In a placebo‐controlled, randomized phase 2 trial (ClinicalTrials.gov identifier NCT01900743), regorafenib improved progression‐free survival (PFS) for patients with doxorubicin‐pretreated advanced nonadipocytic sarcoma. A quality‐adjusted time without symptoms of progression or toxicity (Q‐TWiST) post hoc exploratory analysis was applied to provide an integrated measure of its clinical benefit. METHODS In the base‐case analysis, each patient's overall survival (OS) was partitioned into 3 mutually exclusive health states: the time with a grade 3 or 4 adverse event (TOX), the time without symptoms of disease or grade 3 or 4 toxicity from treatment, and the time after tumor progression or relapse. The time spent in each state was weighted with a health‐state utility associated with that state and was summed to calculate the Q‐TWiST. The stability of the base‐case analysis was explored with several sensitivity analyses. RESULTS In nonadipocytic sarcoma, the PFS was (4.0 months [2.6‐5.5 months] with regorafenib vs 1.0 month [0.9‐1.8 months] with a placebo; hazard ratio, 0.36 [0.25‐0.53]; P < .0001); the OS was 13.4 months (8.6‐17.3 months) with regorafenib and 9.0 months (6.8‐12.5 months) with a placebo (hazard ratio, 0.67 [0.44‐1.02]). With the classic definition of TOX (including all grade 3 and 4 clinical adverse events), the Q‐TWiSTs were 8.0 months (7.0‐9.0 months) with regorafenib and 5.7 months (4.9‐6.4 months) with a placebo (P < .001). CONCLUSIONS For patients with doxorubicin‐pretreated soft‐tissue sarcoma, regorafenib significantly improved quality‐adjusted survival in comparison with a placebo. Cancer 2017;123:2294–2302. © 2017 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. This is an open access article under the terms of the Creative Commons Attribution NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. In patients with doxorubicin‐pretreated nonadipocytic soft‐tissue sarcoma, regorafenib significantly improves quality‐adjusted survival in comparison with a placebo (8.0 vs 5.7 mo; P < .001). See also pages 2200‐2.
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Affiliation(s)
- Vincent Berry
- Medical Oncology Department, Oscar Lambret Center, Lille, France.,Methodology and Clinical Research Platform, SIRIC OncoLille, Lille, France
| | - Laurent Basson
- Biostatisitics and Methodology Unit, Oscar Lambret Center, Lille, France
| | - Emilie Bogart
- Biostatisitics and Methodology Unit, Oscar Lambret Center, Lille, France
| | - Olivier Mir
- Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - Jean-Yves Blay
- Medical Oncology Department, Léon Bérard Center, Lyon, France
| | - Antoine Italiano
- Medical Oncology Department, Bergonié Institute, Bordeaux, France
| | - François Bertucci
- Medical Oncology Department, Paoli-Calmette Institute, Marseille, France
| | - Christine Chevreau
- Medical Oncology Department, University Cancer Institute of Toulouse-Oncopole, Toulouse, France
| | - Stéphanie Clisant-Delaine
- Methodology and Clinical Research Platform, SIRIC OncoLille, Lille, France.,Clinical Research Unit, Oscar Lambret Center, Lille, France
| | | | | | - Jennifer Wallet
- Biostatisitics and Methodology Unit, Oscar Lambret Center, Lille, France
| | - Sophie Taieb
- Radiology Department, Oscar Lambret Center, Lille, France
| | - Emilie Decoupigny
- Methodology and Clinical Research Platform, SIRIC OncoLille, Lille, France.,Clinical Research Unit, Oscar Lambret Center, Lille, France
| | - Axel Le Cesne
- Medical Oncology Department, Gustave Roussy, Villejuif, France
| | | | - Nicolas Penel
- Medical Oncology Department, Oscar Lambret Center, Lille, France.,Methodology and Clinical Research Platform, SIRIC OncoLille, Lille, France
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7
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Tan G, Zhou K, Tan CH, Matchar DB, Farid M, Quek R, Ngeow J. Cost Effectiveness of Universal Hepatitis B Virus Screening in Patients Beginning Chemotherapy for Sarcomas or GI Stromal Tumors. J Glob Oncol 2016; 2:186-199. [PMID: 28717701 PMCID: PMC5497623 DOI: 10.1200/jgo.2015.001669] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE The value of screening for hepatitis B virus (HBV) infection before chemotherapy for nonhematopoietic solid tumors remains unsettled. We evaluated the cost effectiveness of universal screening before systemic therapy for sarcomas, including GI stromal tumors (GISTs). PATIENTS AND METHODS Drawing from the National Cancer Centre Singapore database of 1,039 patients with sarcomas, we analyzed the clinical records of 485 patients who received systemic therapy. Using a Markov model, we compared the cost effectiveness of a screen-all versus screen-none strategy in this population. RESULTS A total of 237 patients were screened for HBV infection. No patients developed HBV reactivation during chemotherapy. The incremental cost-effectiveness ratio per quality-adjusted life-year (QALY) of offering HBV screening to all patients with sarcomas and patients with GISTs exceeded the cost-effectiveness threshold of SG$100,000 per QALY. This result was robust in one-way sensitivity analysis. Our results show that only changes in mortality rate secondary to HBV reactivation could make the incremental cost-effectiveness ratio cross the cost-effectiveness threshold. CONCLUSION Universal HBV screening in patients with sarcomas or GISTs undergoing chemotherapy is not cost effective at a willingness to pay of SG$100,000 per QALY and may not be required.
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Affiliation(s)
- Glorijoy Tan
- , , , , and , National Cancer Centre Singapore; and , Tan Tock Seng Hospital; and , , , , and , Duke-National University of Singapore Graduate Medical School, Singapore
| | - Ke Zhou
- , , , , and , National Cancer Centre Singapore; and , Tan Tock Seng Hospital; and , , , , and , Duke-National University of Singapore Graduate Medical School, Singapore
| | - Chee Hian Tan
- , , , , and , National Cancer Centre Singapore; and , Tan Tock Seng Hospital; and , , , , and , Duke-National University of Singapore Graduate Medical School, Singapore
| | - David B Matchar
- , , , , and , National Cancer Centre Singapore; and , Tan Tock Seng Hospital; and , , , , and , Duke-National University of Singapore Graduate Medical School, Singapore
| | - Mohamad Farid
- , , , , and , National Cancer Centre Singapore; and , Tan Tock Seng Hospital; and , , , , and , Duke-National University of Singapore Graduate Medical School, Singapore
| | - Richard Quek
- , , , , and , National Cancer Centre Singapore; and , Tan Tock Seng Hospital; and , , , , and , Duke-National University of Singapore Graduate Medical School, Singapore
| | - Joanne Ngeow
- , , , , and , National Cancer Centre Singapore; and , Tan Tock Seng Hospital; and , , , , and , Duke-National University of Singapore Graduate Medical School, Singapore
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8
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Wright JD, Cui RR, Wang A, Chen L, Tergas AI, Burke WM, Ananth CV, Hou JY, Neugut AI, Temkin SM, Wang YC, Hershman DL. Economic and Survival Implications of Use of Electric Power Morcellation for Hysterectomy for Presumed Benign Gynecologic Disease. J Natl Cancer Inst 2015; 107:djv251. [PMID: 26449386 PMCID: PMC4849362 DOI: 10.1093/jnci/djv251] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 03/19/2015] [Accepted: 08/06/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Electric power morcellation during laparoscopic hysterectomy allows some women to undergo minimally invasive surgery but may disrupt underlying occult malignancies and increase the risk of tumor dissemination. METHODS We developed a state transition Markov cohort simulation model of the risks and benefits of hysterectomy (abdominal, laparoscopic, and laparoscopic with electric power morcellation) for women with presumed benign gynecologic disease. The model considered perioperative morbidity, mortality, risk of cancer and dissemination, and outcomes in women with an underlying malignancy. We explored the effectiveness from a societal perspective stratified by age (<40, 40-49, 50-59, and ≥60 years). RESULTS Under all scenarios, modeled laparoscopic hysterectomy without morcellation was the most beneficial strategy. Laparoscopic hysterectomy with morcellation was associated with 80.83 more intraoperative complications, 199.64 fewer perioperative complications, and 241.80 fewer readmissions than abdominal hysterectomy per 10 000 women. Per 10 000 women younger than age 40 years, laparoscopic hysterectomy with morcellation was associated with 1.57 more cases of disseminated cancer and 0.97 fewer deaths than abdominal hysterectomy. The excess cases of disseminated cancer per 10 000 women with morcellation compared with abdominal hysterectomy increased with age to 47.54 per 10 000 in women age 60 years and older. Compared with abdominal hysterectomy, this resulted in 0.30 (age 40-49 years), 5.07 (age 50-59 years), and 18.14 (age 60 years and older) excess deaths per 10 000 women in the respective age groups. CONCLUSION Laparoscopic hysterectomy without morcellation is the most beneficial approach of the three methods of hysterectomy studied. In older women, the risks of electric power morcellation may outweigh the benefits of minimally invasive hysterectomy.
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Affiliation(s)
- Jason D Wright
- : Department of Obstetrics and Gynecology (JDW, RRC, LC, AIT, WMB, CVA, JYH) and Department of Medicine (AIN, DLH), Columbia University College of Physicians and Surgeons; Department of Epidemiology (AIT, CVA, AIN, DLH) and Department of Health Policy and Management (AW, YCW), Mailman School of Public Health, Columbia University; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons (JDW, AIT, WMB, JYH, AIN, DLH); New York Presbyterian Hospital, New York, NY (JDW, AIT, WMB, JYH, AIN, DLH); National Cancer Institute, Bethesda, MD (SMT).
| | - Rosa R Cui
- : Department of Obstetrics and Gynecology (JDW, RRC, LC, AIT, WMB, CVA, JYH) and Department of Medicine (AIN, DLH), Columbia University College of Physicians and Surgeons; Department of Epidemiology (AIT, CVA, AIN, DLH) and Department of Health Policy and Management (AW, YCW), Mailman School of Public Health, Columbia University; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons (JDW, AIT, WMB, JYH, AIN, DLH); New York Presbyterian Hospital, New York, NY (JDW, AIT, WMB, JYH, AIN, DLH); National Cancer Institute, Bethesda, MD (SMT)
| | - Anqi Wang
- : Department of Obstetrics and Gynecology (JDW, RRC, LC, AIT, WMB, CVA, JYH) and Department of Medicine (AIN, DLH), Columbia University College of Physicians and Surgeons; Department of Epidemiology (AIT, CVA, AIN, DLH) and Department of Health Policy and Management (AW, YCW), Mailman School of Public Health, Columbia University; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons (JDW, AIT, WMB, JYH, AIN, DLH); New York Presbyterian Hospital, New York, NY (JDW, AIT, WMB, JYH, AIN, DLH); National Cancer Institute, Bethesda, MD (SMT)
| | - Ling Chen
- : Department of Obstetrics and Gynecology (JDW, RRC, LC, AIT, WMB, CVA, JYH) and Department of Medicine (AIN, DLH), Columbia University College of Physicians and Surgeons; Department of Epidemiology (AIT, CVA, AIN, DLH) and Department of Health Policy and Management (AW, YCW), Mailman School of Public Health, Columbia University; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons (JDW, AIT, WMB, JYH, AIN, DLH); New York Presbyterian Hospital, New York, NY (JDW, AIT, WMB, JYH, AIN, DLH); National Cancer Institute, Bethesda, MD (SMT)
| | - Ana I Tergas
- : Department of Obstetrics and Gynecology (JDW, RRC, LC, AIT, WMB, CVA, JYH) and Department of Medicine (AIN, DLH), Columbia University College of Physicians and Surgeons; Department of Epidemiology (AIT, CVA, AIN, DLH) and Department of Health Policy and Management (AW, YCW), Mailman School of Public Health, Columbia University; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons (JDW, AIT, WMB, JYH, AIN, DLH); New York Presbyterian Hospital, New York, NY (JDW, AIT, WMB, JYH, AIN, DLH); National Cancer Institute, Bethesda, MD (SMT)
| | - William M Burke
- : Department of Obstetrics and Gynecology (JDW, RRC, LC, AIT, WMB, CVA, JYH) and Department of Medicine (AIN, DLH), Columbia University College of Physicians and Surgeons; Department of Epidemiology (AIT, CVA, AIN, DLH) and Department of Health Policy and Management (AW, YCW), Mailman School of Public Health, Columbia University; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons (JDW, AIT, WMB, JYH, AIN, DLH); New York Presbyterian Hospital, New York, NY (JDW, AIT, WMB, JYH, AIN, DLH); National Cancer Institute, Bethesda, MD (SMT)
| | - Cande V Ananth
- : Department of Obstetrics and Gynecology (JDW, RRC, LC, AIT, WMB, CVA, JYH) and Department of Medicine (AIN, DLH), Columbia University College of Physicians and Surgeons; Department of Epidemiology (AIT, CVA, AIN, DLH) and Department of Health Policy and Management (AW, YCW), Mailman School of Public Health, Columbia University; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons (JDW, AIT, WMB, JYH, AIN, DLH); New York Presbyterian Hospital, New York, NY (JDW, AIT, WMB, JYH, AIN, DLH); National Cancer Institute, Bethesda, MD (SMT)
| | - June Y Hou
- : Department of Obstetrics and Gynecology (JDW, RRC, LC, AIT, WMB, CVA, JYH) and Department of Medicine (AIN, DLH), Columbia University College of Physicians and Surgeons; Department of Epidemiology (AIT, CVA, AIN, DLH) and Department of Health Policy and Management (AW, YCW), Mailman School of Public Health, Columbia University; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons (JDW, AIT, WMB, JYH, AIN, DLH); New York Presbyterian Hospital, New York, NY (JDW, AIT, WMB, JYH, AIN, DLH); National Cancer Institute, Bethesda, MD (SMT)
| | - Alfred I Neugut
- : Department of Obstetrics and Gynecology (JDW, RRC, LC, AIT, WMB, CVA, JYH) and Department of Medicine (AIN, DLH), Columbia University College of Physicians and Surgeons; Department of Epidemiology (AIT, CVA, AIN, DLH) and Department of Health Policy and Management (AW, YCW), Mailman School of Public Health, Columbia University; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons (JDW, AIT, WMB, JYH, AIN, DLH); New York Presbyterian Hospital, New York, NY (JDW, AIT, WMB, JYH, AIN, DLH); National Cancer Institute, Bethesda, MD (SMT)
| | - Sarah M Temkin
- : Department of Obstetrics and Gynecology (JDW, RRC, LC, AIT, WMB, CVA, JYH) and Department of Medicine (AIN, DLH), Columbia University College of Physicians and Surgeons; Department of Epidemiology (AIT, CVA, AIN, DLH) and Department of Health Policy and Management (AW, YCW), Mailman School of Public Health, Columbia University; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons (JDW, AIT, WMB, JYH, AIN, DLH); New York Presbyterian Hospital, New York, NY (JDW, AIT, WMB, JYH, AIN, DLH); National Cancer Institute, Bethesda, MD (SMT)
| | - Y Claire Wang
- : Department of Obstetrics and Gynecology (JDW, RRC, LC, AIT, WMB, CVA, JYH) and Department of Medicine (AIN, DLH), Columbia University College of Physicians and Surgeons; Department of Epidemiology (AIT, CVA, AIN, DLH) and Department of Health Policy and Management (AW, YCW), Mailman School of Public Health, Columbia University; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons (JDW, AIT, WMB, JYH, AIN, DLH); New York Presbyterian Hospital, New York, NY (JDW, AIT, WMB, JYH, AIN, DLH); National Cancer Institute, Bethesda, MD (SMT)
| | - Dawn L Hershman
- : Department of Obstetrics and Gynecology (JDW, RRC, LC, AIT, WMB, CVA, JYH) and Department of Medicine (AIN, DLH), Columbia University College of Physicians and Surgeons; Department of Epidemiology (AIT, CVA, AIN, DLH) and Department of Health Policy and Management (AW, YCW), Mailman School of Public Health, Columbia University; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons (JDW, AIT, WMB, JYH, AIN, DLH); New York Presbyterian Hospital, New York, NY (JDW, AIT, WMB, JYH, AIN, DLH); National Cancer Institute, Bethesda, MD (SMT)
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Chan A, Lim E, Ng T, Shih V, Quek R, Cheung YT. Symptom burden and medication use in adult sarcoma patients. Support Care Cancer 2014; 23:1709-17. [PMID: 25430481 DOI: 10.1007/s00520-014-2533-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 11/17/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Limited data are available on how symptom burden affects health-related quality of life (HRQoL) in patients with sarcoma. This study aims to describe the symptom burden, HRQoL, and medication use in adult sarcoma patients. METHODS A single-center, cross-sectional study was conducted, and 79 patients were evaluated using three tools: the Rotterdam Symptom Checklist (RSCL), the Beck Anxiety Inventory (BAI), and the Functional Assessment of Cancer Therapy scale-General (FACT-G). Patients' demographic and clinical information, medication history, and use of concomitant medications were recorded. The proportion of patients with clinically significant RSCL score for a particular symptom was compared with the percentage of patients receiving medication for that symptom. RESULTS The mean age was 57.3 ± 15.2 years, with majority of the patients diagnosed with stromal tumor (46.8 %), leiomyosarcoma (15.2 %), and liposarcoma (10.1 %). The most prevalent physical symptoms experienced were tiredness (2.38 ± 1.00), lack of energy (2.04 ± 1.02), and difficulty sleeping (2.00 ± 1.15). The most common psychological symptoms experienced were irritability (1.92 ± 1.01), worrying (1.86 ± 0.90), and anxiety (1.68 ± 0.74). Few (6.3 %) patients received hypnotics while 33.0 % of patients reported difficulty sleeping. A proportion of patients (27.9 %) reported experiencing lack of appetite with only 1.3 % received appetite stimulants. CONCLUSION Adult sarcoma patients experience significant physiological and psychological symptom burden, which has a strong negative impact on HRQoL, with a number of physiological symptoms undertreated with pharmacotherapy.
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Affiliation(s)
- Alexandre Chan
- Department of Pharmacy, Faculty of Science, National University of Singapore, 18 Science 4, Block S4, Singapore, 117543, Singapore,
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Henrichs MP, Krebs J, Gosheger G, Streitbuerger A, Nottrott M, Sauer T, Hoell S, Singh G, Hardes J. Modular tumor endoprostheses in surgical palliation of long-bone metastases: a reduction in tumor burden and a durable reconstruction. World J Surg Oncol 2014; 12:330. [PMID: 25376274 PMCID: PMC4289050 DOI: 10.1186/1477-7819-12-330] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 10/20/2014] [Indexed: 11/24/2022] Open
Abstract
Background Surgical treatment of bone metastases has become increasingly important as patients live longer with metastatic cancer and one of the main aims is a long-lasting reconstruction which survives the patient. Conventional osteosynthesis may not be able to achieve this objective in the context of modern day cancer care. Methods This study evaluates the oncological outcomes, treatment-related complications, and function after resection of metastases and reconstruction with modular tumor endoprostheses in 80 patients. All patients who underwent surgical treatment with modular tumor prostheses for bone metastases from 1993 to 2008 were traced by our tumor database and clinical information was recorded from patient case. Results Mean age was 63 years. The most common primary tumors were renal cell (47%), breast (21%), and lung (8%). The proximal femur was affected in 45%, proximal humerus in 26%, and the distal femur in 17% of cases. In 22 cases, the tumor prosthesis was implanted during a revision operation. Mean overall survival after surgery was 2.9 years. Overall survival rate was 70% at one year and 20% at five years. Implant survival was 83% after one year and 74% at five years. Overall rate of operative revision was 18%. Conclusions Our data collectively suggest that despite higher costs, implantation of modular tumor endoprostheses may be a suitable treatment for bone metastases with a low complication rate and rapid improvement in function in appropriately selected patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jendrik Hardes
- Department of Orthopaedic Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149 Muenster, Germany.
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Pan computed tomography versus selective computed tomography in stable, young adults after blunt trauma with moderate mechanism. J Trauma Acute Care Surg 2014; 77:527-33; discussion 533. [DOI: 10.1097/ta.0000000000000416] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Guest JF, Nanuwa K, Barden R. Utility values for specific hepatic encephalopathy health states elicited from the general public in the United Kingdom. Health Qual Life Outcomes 2014; 12:89. [PMID: 24917331 PMCID: PMC4070646 DOI: 10.1186/1477-7525-12-89] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 05/21/2014] [Indexed: 02/02/2023] Open
Abstract
Background and aims To elicit utility values for five health states corresponding to increasing severity of hepatic encephalopathy, from members of the general public in the UK. The health states studied were Conn grades 0, 1, 2, 3 and 4. Methods Interviewer-administered time trade-off (TTO) and standard gamble (SG) utilities were elicited for the five health states from a random sample of 200 members of the general public in the UK, using health state descriptions validated by clinicians and members of the general public. Results Respondents’ mean age was 49.5 years and 49% were female. Mean utilities were 0.962 (TTO) and 0.915 (SG) for Conn grade 0; 0.912 (TTO) and 0.837 (SG) for Conn grade 1; 0.828 (TTO) and 0.683 (SG) for Conn grade 2; 0.691 (TTO) and 0.489 (SG) for Conn grade 3; and 0.429 (TTO) and 0.215 (SG) for Conn grade 4. The TTO and SG values between the five Conn grades were significantly different (p < 0.001). Additionally, the TTO value was significantly higher than the SG value for the corresponding state (p <0.0001). Conclusion These findings quantify how different Conn grades and level of response to treatment may impact on the health-related quality of life of patients with hepatic encephalopathy. There were greater preference values for lower levels of disease, with the highest value associated with Conn grade 0. These health state preference values can be used to estimate the outcomes of different interventions for hepatic encephalopathy in terms of quality-adjusted life years.
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Affiliation(s)
- Julian F Guest
- Catalyst Health Economics Consultants, 34b High Street, Northwood, Middlesex HA6 1BN, UK.
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Cost effectiveness of first-line treatment with doxorubicin/ifosfamide compared to trabectedin monotherapy in the management of advanced soft tissue sarcoma in Italy, Spain, and sweden. Sarcoma 2013; 2013:725305. [PMID: 24302852 PMCID: PMC3835776 DOI: 10.1155/2013/725305] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 08/20/2013] [Indexed: 11/23/2022] Open
Abstract
Background. Doxorubicin/ifosfamide is a first-line systemic chemotherapy for the majority of advanced soft tissue sarcoma (ASTS) subtypes. Trabectedin is indicated for the treatment of ASTS after failure of anthracyclines and/or ifosfamide; however it is being increasingly used off-label as a first-line treatment. This study estimated the cost effectiveness of these two treatments in the first-line management of ASTS in Italy, Spain, and Sweden. Methods. A Markov model was constructed to estimate the cost effectiveness of doxorubicin/ifosfamide compared to trabectedin monotherapy, defined as the cost per QALY gained, in each country. Results. First-line treatment with doxorubicin/ifosfamide resulted in lower two-year healthcare costs and more QALYs than first-line treatment with trabectedin monotherapy in all three countries. Probabilistic sensitivity analysis showed that at a cost per QALY threshold of €35,000, >90% of a cohort would be cost effectively treated with doxorubicin/ifosfamide compared to trabectedin monotherapy in all three countries. Conclusion. Within the model's limitations, first-line treatment of patients with ASTS with doxorubicin/ifosfamide instead of trabectedin monotherapy affords a cost-effective use of publicly funded healthcare resources in Italy, Spain, and Sweden and is therefore the preferred treatment in all three countries. These findings support the recommendation that trabectedin should remain a second-line treatment.
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