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Garvey G, Cunningham J, Mayer C, Letendre A, Shaw J, Anderson K, Kelly B. Psychosocial Aspects of Delivering Cancer Care to Indigenous People: An Overview. JCO Glob Oncol 2021; 6:148-154. [PMID: 32031444 PMCID: PMC6998016 DOI: 10.1200/jgo.19.00130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Globally, a growing body of evidence has reported significant disparities in cancer outcomes between indigenous and nonindigenous people. Although some effort is being made to address these disparities, relatively little attention has been directed toward identifying and focusing on the psychosocial aspects of cancer care for indigenous patients, which are critical components in improving cancer care and outcomes. The purpose of this article is to describe the results of a scoping review of the psychosocial aspects of cancer care for indigenous people. We highlight considerations in undertaking research in this field with indigenous people and the implications for clinical practice.
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Affiliation(s)
- Gail Garvey
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Joan Cunningham
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Carole Mayer
- Health Sciences North Research Institute, Sudbury, Ontario, Canada.,Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Angeline Letendre
- Alberta Cancer Prevention Legacy Fund, Alberta Health Services, Edmonton, Alberta, Canada
| | - Joanne Shaw
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Kate Anderson
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Brian Kelly
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
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Gijsbertsen B, Kremer JAM. We all want to die in peace - So why don't we? BMJ Support Palliat Care 2020; 11:318-321. [PMID: 32169836 DOI: 10.1136/bmjspcare-2019-002060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 02/10/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Approximately 70% of Americans would prefer to die at home and avoid hospitalization or intensive care during the terminal phase of illness. Given the wish to die at home, it should follow the majority of Americans achieves their wish. However, recent data indicate ~60% of people dies away from home or hospice care. This article sets out to understand what makes it so difficult to attain what we aspire for in death and provide a starting point for change. METHOD The authors reviewed and analysed literature on elements which drive patients to continue treatment even though prospects are grim. RESULTS Six elements which combine into a system driving non-peaceful death were identified (western culture, healthcare system, pharmaceutical industry, professionals, family and loves ones, patients themselves) and complemented with three additional factors entrenched in us as humans which make the system particularly difficult to overcome ((rational) decision making, option framing, inability to change). CONCLUSION Dying in peace is easier said than done because the cards are stacked against us and we seem to remain unaware of the breadth and depth at which continuing treatment is ingrained in our system.
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Affiliation(s)
| | - Jan A M Kremer
- Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
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Abstract
Measures of the severity of cognitive impairment or parkinsonism are the usual endpoints in clinical trials for Alzheimer’s disease (AD) and Parkinson’s disease (PD), but are critically hampered by their lack of disease sensitivity and specificity. Due to the high failure rate of clinical trials, the rate of regulatory approval for efficacious new drugs has stagnated in the past few decades, with the gap between basic science discovery and clinical application metaphorically termed the “Valley of Death”. While the causes for this are probably multiple and complex, the usage of biomarkers as surrogate endpoints, particularly when they are molecularly-specific for the disease, has achieved some success in cancer trials, and it is likely that neurodegenerative disease trials would benefit from the same approach. As dementia and parkinsonism are not disease-specific clinical syndromes, both AD and PD trials have been flawed by reliance on clinical diagnosis and clinical endpoints. Clinical improvement has been a requirement for regulatory approval, but molecularly-specific biomarkers should improve both diagnostic accuracy and tracking of disease progression, allowing quicker screening of drug candidates. However, even when a molecularly-specific biomarker is found, such as amyloid imaging for AD, it may not reflect the entire extant molecular disease repertoire and may not serve equally well in the different roles of preclinical detection, diagnostic confirmation and surrogate endpoint, necessitating the usage of two, three or more biomarkers, deployed in series or in parallel.
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Tong A, Winkelmayer WC, Wheeler DC, van Biesen W, Tugwell P, Manns B, Hemmelgarn B, Harris T, Crowe S, Ju A, O’Lone E, Evangelidis N, Craig JC. Nephrologists' Perspectives on Defining and Applying Patient-Centered Outcomes in Hemodialysis. Clin J Am Soc Nephrol 2017; 12:454-466. [PMID: 28223290 PMCID: PMC5338715 DOI: 10.2215/cjn.08370816] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 11/02/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND OBJECTIVES Patient centeredness is widely advocated as a cornerstone of health care, but it is yet to be fully realized, including in nephrology. Our study aims to describe nephrologists' perspectives on defining and implementing patient-centered outcomes in hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Face-to-face, semistructured interviews were conducted with 58 nephrologists from 27 dialysis units across nine countries, including the United States, the United Kingdom, Australia, Austria, Belgium, Canada, Germany, Singapore, and New Zealand. Transcripts were thematically analyzed. RESULTS We identified five themes on defining and implementing patient-centered outcomes in hemodialysis: explicitly prioritized by patients (articulated preferences and goals, ascertaining treatment burden, defining hemodialysis success, distinguishing a physician-patient dichotomy, and supporting shared decision making), optimizing wellbeing (respecting patient choice, focusing on symptomology, perceptible and tangible, and judging relevance and consequence), comprehending extensive heterogeneity of clinical and quality of life outcomes (distilling diverse priorities, highly individualized, attempting to specify outcomes, and broadening context), clinically hamstrung (professional deficiency, uncertainty and complexity in measurement, beyond medical purview, specificity of care, mechanistic mindset [focused on biochemical targets and comorbidities], avoiding alarm, and paradoxical dilemma), and undermined by system pressures (adhering to overarching policies, misalignment with mandates, and resource constraints). CONCLUSIONS Improving patient-centered outcomes is regarded by nephrologists to encompass strategies that address patient goals and improve wellbeing and treatment burden in patients on hemodialysis. However, efforts are hampered by ambiguities about how to prioritize, measure, and manage the plethora of critical comorbidities and broader quality of life outcomes in a care setting that is technically demanding and driven by biochemical targets. Identifying critical patient-important outcomes and mechanisms for integrating them into practice may help to deliver patient-centered care in hemodialysis and other chronic disease settings.
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Affiliation(s)
- Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Wolfgang C. Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Baylor College of Medicine, Houston, Texas
| | - David C. Wheeler
- Centre for Nephrology, University College London, London, United Kingdom
| | - Wim van Biesen
- Renal Division, Ghent University Hospital, Ghent, Belgium
| | - Peter Tugwell
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Braden Manns
- Departments of Medicine and
- Community Health Sciences, Libin Cardiovascular Institute and O’Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Brenda Hemmelgarn
- Departments of Medicine and
- Community Health Sciences, Libin Cardiovascular Institute and O’Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Tess Harris
- Polycystic Kidney Disease International, London, United Kingdom; and
| | - Sally Crowe
- Crowe Associates Ltd, Oxford, United Kingdom
| | - Angela Ju
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Emma O’Lone
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Nicole Evangelidis
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Jonathan C. Craig
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
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5
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Tagliaferri L, Kovács G, Autorino R, Budrukkar A, Guinot JL, Hildebrand G, Johansson B, Monge RM, Meyer JE, Niehoff P, Rovirosa A, Takàcsi-Nagy Z, Dinapoli N, Lanzotti V, Damiani A, Soror T, Valentini V. ENT COBRA (Consortium for Brachytherapy Data Analysis): interdisciplinary standardized data collection system for head and neck patients treated with interventional radiotherapy (brachytherapy). J Contemp Brachytherapy 2016; 8:336-43. [PMID: 27648088 PMCID: PMC5018530 DOI: 10.5114/jcb.2016.61958] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 07/28/2016] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Aim of the COBRA (Consortium for Brachytherapy Data Analysis) project is to create a multicenter group (consortium) and a web-based system for standardized data collection. MATERIAL AND METHODS GEC-ESTRO (Groupe Européen de Curiethérapie - European Society for Radiotherapy & Oncology) Head and Neck (H&N) Working Group participated in the project and in the implementation of the consortium agreement, the ontology (data-set) and the necessary COBRA software services as well as the peer reviewing of the general anatomic site-specific COBRA protocol. The ontology was defined by a multicenter task-group. RESULTS Eleven centers from 6 countries signed an agreement and the consortium approved the ontology. We identified 3 tiers for the data set: Registry (epidemiology analysis), Procedures (prediction models and DSS), and Research (radiomics). The COBRA-Storage System (C-SS) is not time-consuming as, thanks to the use of "brokers", data can be extracted directly from the single center's storage systems through a connection with "structured query language database" (SQL-DB), Microsoft Access(®), FileMaker Pro(®), or Microsoft Excel(®). The system is also structured to perform automatic archiving directly from the treatment planning system or afterloading machine. The architecture is based on the concept of "on-purpose data projection". The C-SS architecture is privacy protecting because it will never make visible data that could identify an individual patient. This C-SS can also benefit from the so called "distributed learning" approaches, in which data never leave the collecting institution, while learning algorithms and proposed predictive models are commonly shared. CONCLUSIONS Setting up a consortium is a feasible and practicable tool in the creation of an international and multi-system data sharing system. COBRA C-SS seems to be well accepted by all involved parties, primarily because it does not influence the center's own data storing technologies, procedures, and habits. Furthermore, the method preserves the privacy of all patients.
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Affiliation(s)
- Luca Tagliaferri
- Department of Radiation Oncology – Gemelli-ART, Catholic University, Italy
| | - György Kovács
- Interdisciplinary Brachytherapy Unit, University of Lübeck – University Hospital S-H, Campus Lübeck, Germany
| | - Rosa Autorino
- Department of Radiation Oncology – Gemelli-ART, Catholic University, Italy
| | | | - Jose Luis Guinot
- Department of Radiation Oncology, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - Guido Hildebrand
- University Hospital Radiotherapy Department, University of Rostock, Germany
| | - Bengt Johansson
- Department of Oncology, Orebro University Hospital and Orebro University, Sweden
| | | | - Jens E. Meyer
- Head & Neck Surgery Department, AK St. George Hospital, Hamburg, Germany
| | | | | | | | - Nicola Dinapoli
- Department of Radiation Oncology – Gemelli-ART, Catholic University, Italy
| | - Vito Lanzotti
- Software programmer manager; KBO-Labs – Gemelli-ART, Catholic University, Italy
| | - Andrea Damiani
- Mathematics; KBO-Labs – Gemelli-ART, Catholic University, Italy
| | - Tamer Soror
- Interdisciplinary Brachytherapy Unit, University of Lübeck – University Hospital S-H, Campus Lübeck, Germany
| | - Vincenzo Valentini
- Department of Radiation Oncology – Gemelli-ART, Catholic University, Italy
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6
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Garvey G, Cunningham J, He VY, Janda M, Baade P, Sabesan S, Martin JH, Fay M, Adams J, Kondalsamy-Chennakesavan S, Valery PC. Health-related quality of life among Indigenous Australians diagnosed with cancer. Qual Life Res 2016; 25:1999-2008. [PMID: 26831052 DOI: 10.1007/s11136-016-1233-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE Health-related quality of life (HRQoL) and associated factors were assessed among 155 Indigenous Australian adult cancer patients 6 months post-diagnosis. METHODS The Assessment of Quality of Life-4D Questionnaire was used to assess HRQoL. Differences in the median utility score among subgroups of interest were examined using nonparametric tests. Factors associated with excellent HRQoL were assessed through logistic regression. RESULTS Participants' mean age was 52 years (range 20-78), and the majority were female (60 %), unemployed (72 %), and recruited from outpatients clinics (64 %). Breast cancer (27 %) was the most common diagnosis. The median HRQoL score was 0.62; 14 % of participants reported excellent HRQoL (>0.90). After adjusting for age, admission status, and treatment, excellent HRQoL was more likely among participants of Torres Strait Islander origin [adjusted odds ratio (AOR) 3.68; 95 % CI 1.23-11.01], those living in regional areas (AOR 5.59; 95 % CI 1.42-22.06), and those whose main language spoken at home was not English (AOR 3.60; 95 % CI 1.08-11.99) and less likely among those reporting less contact with Indigenous people (AOR 0.23; 95 % CI 0.68-0.81). CONCLUSION Assessing HRQoL is important to identifying and improving the length and quality of cancer survivorship, especially in groups that have significantly poorer cancer outcomes, such as Indigenous Australians. Acknowledging the study's observational nature, we found HRQoL was lower than reported for other Australians, and we identified some socio-demographic factors that were associated with excellent HRQoL. Such assessments are an important component of identifying and evaluating appropriate interventions to improve the health and well-being of Indigenous cancer patients.
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Affiliation(s)
- G Garvey
- Menzies School of Health Research, Charles Darwin University, Brisbane, Australia.
| | - J Cunningham
- Menzies School of Health Research, Charles Darwin University, Brisbane, Australia
| | - V Yf He
- Menzies School of Health Research, Charles Darwin University, Brisbane, Australia
| | - M Janda
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - P Baade
- Cancer Council Queensland, Brisbane, Australia
| | - S Sabesan
- College of Medicine and Dentistry, James Cook University and Townsville Hospital, Townsville, Australia
| | - J H Martin
- University of Newcastle School of Medicine and Public Health, Newcastle, Australia
| | - M Fay
- University of Newcastle School of Medicine and Public Health, Newcastle, Australia
| | - J Adams
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | | | - P C Valery
- Menzies School of Health Research, Charles Darwin University, Brisbane, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
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Abstract
There is evidence from some countries of a trend towards increasingly aggressive pharmacological treatment of patients with advanced, incurable cancer. To what extent should this be understood as a progressive development in which technological innovations address previously unmet needs, or is a significant amount of this expansion explained by futile or even harmful treatment? In this article it is argued that while some of this growth may be consistent with a progressive account of medicines consumption, part of the expansion is constituted by the inappropriate and overly aggressive use of drugs. Such use is often explained in terms of individual patient consumerism and/or factors to do with physician behaviour. Whilst acknowledging the role of physicians and patients' expectations, this paper, drawing on empirical research conducted in the US, the EU and the UK, examines the extent to which upstream factors shape expectations and drive pharmaceuticalisation, and explores the value of this concept as an analytical tool.
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Affiliation(s)
- Courtney Davis
- Department of Social Science, Health and Medicine, School of Social Science and Public Policy, King's College London, Strand, London WC2R 2LS, UK.
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Altwairgi AK, Alfakeeh AH, Hopman WM, Parulekar WR. Quality of reporting of chemotherapy compliance in randomized controlled trials of breast cancer treatment. Jpn J Clin Oncol 2015; 45:520-6. [DOI: 10.1093/jjco/hyv043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 03/08/2015] [Indexed: 11/14/2022] Open
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Meldolesi E, van Soest J, Alitto AR, Autorino R, Dinapoli N, Dekker A, Gambacorta MA, Gatta R, Tagliaferri L, Damiani A, Valentini V. VATE: VAlidation of high TEchnology based on large database analysis by learning machine. COLORECTAL CANCER 2014. [DOI: 10.2217/crc.14.34] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
SUMMARY The interaction between implementation of new technologies and different outcomes can allow a broad range of researches to be expanded. The purpose of this paper is to introduce the VAlidation of high TEchnology based on large database analysis by learning machine (VATE) project that aims to combine new technologies with outcomes related to rectal cancer in terms of tumor control and normal tissue sparing. Using automated computer bots and the knowledge for screening data it is possible to identify the factors that can mostly influence those outcomes. Population-based observational studies resulting from the linkage of different datasets will be conducted in order to develop predictive models that allow physicians to share decision with patients into a wider concept of tailored treatment.
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Affiliation(s)
- Elisa Meldolesi
- Department of Radiation Oncology, Sacred Heart University, Rome, Italy
| | - Johan van Soest
- Department of Radiation Oncology (MAASTRO) GROW School for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Anna Rita Alitto
- Department of Radiation Oncology, Sacred Heart University, Rome, Italy
| | - Rosa Autorino
- Department of Radiation Oncology, Sacred Heart University, Rome, Italy
| | - Nicola Dinapoli
- Department of Radiation Oncology, Sacred Heart University, Rome, Italy
| | - Andre Dekker
- Department of Radiation Oncology (MAASTRO) GROW School for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Roberto Gatta
- Department of Radiation Oncology, Sacred Heart University, Rome, Italy
| | - Luca Tagliaferri
- Department of Radiation Oncology, Sacred Heart University, Rome, Italy
| | - Andrea Damiani
- Department of Radiation Oncology, Sacred Heart University, Rome, Italy
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Bekelman JE, Schultheiss T, Berrington De Gonzalez A. Subsequent malignancies after photon versus proton radiation therapy. Int J Radiat Oncol Biol Phys 2013; 87:10-2. [PMID: 23810521 DOI: 10.1016/j.ijrobp.2013.05.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 05/09/2013] [Indexed: 12/01/2022]
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11
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North CS, Hong BA, Adewuyi SA, Pollio DE, Jain MK, Devereaux R, Quartey NA, Ashitey S, Lee WM, Lisker-Melman M. Hepatitis C treatment and SVR: the gap between clinical trials and real-world treatment aspirations. Gen Hosp Psychiatry 2013; 35:122-8. [PMID: 23219917 DOI: 10.1016/j.genhosppsych.2012.11.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 11/05/2012] [Accepted: 11/06/2012] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Despite the remarkable improvements in pharmacologic treatment efficacy for hepatitis C (HCV) reported in published clinical trials, published research suggests that, in "real-world" patient care, these medical outcomes may be difficult to achieve. This review was undertaken to summarize recent experience in the treatment of HCV in clinical settings, examining the course of patients through the stages of treatment and barriers to treatment encountered. METHOD A comprehensive and representative review of the relevant literature was undertaken to examine HCV treatment experience outside of clinical trials in the last decade. This review found 25 unique studies with data on course of treatment and/or barriers to treatment in samples of patients with HCV not preselected for inclusion in clinical trials. RESULTS Results were examined separately for samples selected for HCV infection versus HCV/HIV coinfection. Only 19% of HCV-selected and 16% of HCV/HIV-coinfection selected patients were considered treatment eligible and advanced to treatment; even fewer completed treatment (13% and 11%, respectively) or achieved sustained virologic response (3% and 6%, respectively). Psychiatric and medical ineligibilities were the primary treatment barriers. CONCLUSION Only by systematically observing and addressing potentially solvable medical and psychosocial barriers to treatment will more patients be enrolled in and complete HCV therapy.
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Affiliation(s)
- Carol S North
- The VA North Texas Health Care System, Dallas, TX, USA.
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12
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Galmarini D, Galmarini CM, Galmarini FC. Cancer chemotherapy: a critical analysis of its 60 years of history. Crit Rev Oncol Hematol 2012; 84:181-99. [PMID: 22542531 DOI: 10.1016/j.critrevonc.2012.03.002] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 02/10/2012] [Accepted: 03/07/2012] [Indexed: 02/07/2023] Open
Abstract
Chemotherapy has already proven widely effective in the treatment of cancer, occupying a prominent place in the current therapeutic arsenal. However, in recent years, there has been a plateau in the evolution of the clinical results obtained with this modality treatment. In some cases, the limitations of chemotherapy observed during the early days still apply. These facts forced us to do a thorough analysis of what happened in the past 60years. We have observed that each major advance obtained in this field was based on empirical clinical observations. We thus believe that the current results of old or new agents can only be improved by understanding the natural history of each specific cancer subtype at the clinical level and by overcoming the physiological barriers involved in chemotherapy failure. This strategy will surely allow us to enlarge the list of curable cancers by chemotherapy.
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Affiliation(s)
- Darío Galmarini
- Fundación Marcel Dargent - Escuela Sudamericana de Oncología, Buenos Aires, Argentina
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13
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Gan HK, You B, Pond GR, Chen EX. Assumptions of Expected Benefits in Randomized Phase III Trials Evaluating Systemic Treatments for Cancer. J Natl Cancer Inst 2012; 104:590-8. [DOI: 10.1093/jnci/djs141] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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14
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Miksad RA. When a decision must be made: role of computer modeling in clinical cancer research. J Clin Oncol 2011; 29:4602-4. [PMID: 22067392 DOI: 10.1200/jco.2011.37.8604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Abstract
Health care expenses in the United States are increasing inexorably. At the current rate of growth, it is anticipated that 20% of the gross national product will consist of health-related expenditures within the next decade. Cancer is the second leading cause of death in the United States, and it is increasing in prevalence because of the aging of the population and the limited number of successful prevention strategies. As the biological characteristics of cancer come into sharper focus, targeted therapies are being developed that offer the promise of increased clinical benefit with fewer toxicities than are associated with conventional treatment. Although spectacular successes are infrequent with this approach, to date, the majority of targeted therapies are modestly effective at best, and extremely costly. This observation suggests that a broadly acceptable definition of value in a cancer therapeutic agent is not at hand, but is sorely needed from the vantage points of the patient and society. A corollary issue of enormous import is how to equitably distribute the health care dollar in the service of achieving the greatest good for the greatest number. Although cancer is responsible for only 5% of the health care budget, its cost is increasing and it can be viewed as paradigmatic when contemplating the problem of equity in health care. Here, a number of concepts are discussed that focus on this goal and its implications for the cancer patient and society at large.
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Affiliation(s)
- Lowell E Schnipper
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
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16
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LoRusso PM, Anderson AB, Boerner SA, Averbuch SD. Making the investigational oncology pipeline more efficient and effective: are we headed in the right direction? Clin Cancer Res 2011; 16:5956-62. [PMID: 21169248 DOI: 10.1158/1078-0432.ccr-10-1279] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Advances in our knowledge of the molecular mechanisms involved in cancer biology have contributed to an increase in novel target-specific oncology therapeutics. Unfortunately, clinical development of new drugs is an expensive and slow process, and the patient and financial resources needed to study the vast number of potential therapies are limited, requiring novel approaches to clinical trial design and patient recruitment. In addition, traditional efficacy endpoints may not be adequate to fully determine the therapeutic worth of the new classes of targeted agents. In this new era of drug development, it has become increasingly clear that new clinical trial design paradigms that examine nontraditional endpoints have become necessary to assist in prioritizing the development of the most promising agents. It is also vital that individual patient management be considered, and the subpopulations of patients most likely to derive benefit or experience harm from a new therapy be identified as early as possible. Phase I and II clinical trials allow investigators doing clinical research the opportunity to define these critical endpoints and subpopulations early on, before conducting large-scale randomized phase III clinical trials, which require an abundance of financial and patient resources.
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Affiliation(s)
- Patricia M LoRusso
- Karmanos Cancer Institute, Wayne State University, Detroit, Michigan 48201, USA.
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17
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Fojo T, Parkinson DR. Biologically targeted cancer therapy and marginal benefits: are we making too much of too little or are we achieving too little by giving too much? Clin Cancer Res 2011; 16:5972-80. [PMID: 21169250 DOI: 10.1158/1078-0432.ccr-10-1277] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
We describe the development and approval of biologically targeted agents in the clinic through examples chosen from the experience with inhibitors of the epidermal growth factor (EGF) and VEGF pathways. Despite extensive biological rationale for the use of these classes of molecules, marginal clinical benefits have been observed in broad patient populations, and the agents have entered into general clinical practice. We discuss why this situation is unsatisfactory because marginal general benefit may often be at the expense of toxicity to nonbenefiting or even harmed patients. Finally, we point out that emerging technologies bring the promise of allowing the identification of patients who might potentially benefit from a therapy. However, development of this technology will not move forward without broader recognition of its need by the range of stakeholders, including patients, advocates, academic and private oncologists, drug sponsors, and those who develop drugs and diagnostic tests.
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Affiliation(s)
- Tito Fojo
- Medical Oncology Branch, Center for Cancer Research, Bethesda, Maryland, USA.
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18
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LoRusso PM, Schnipper LE, Stewart DJ, Boerner SA, Averbuch SD, Wolf W. Translating Clinical Trials into Meaningful Outcomes. Clin Cancer Res 2010; 16:5951-5. [DOI: 10.1158/1078-0432.ccr-10-2632] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Dalton WS, Sullivan DM, Yeatman TJ, Fenstermacher DA. The 2010 Health Care Reform Act: A Potential Opportunity to Advance Cancer Research by Taking Cancer Personally. Clin Cancer Res 2010; 16:5987-96. [DOI: 10.1158/1078-0432.ccr-10-1216] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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