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Weth FR, Hoggarth GB, Weth AF, Paterson E, White MPJ, Tan ST, Peng L, Gray C. Unlocking hidden potential: advancements, approaches, and obstacles in repurposing drugs for cancer therapy. Br J Cancer 2024; 130:703-715. [PMID: 38012383 PMCID: PMC10912636 DOI: 10.1038/s41416-023-02502-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 10/30/2023] [Accepted: 11/13/2023] [Indexed: 11/29/2023] Open
Abstract
High rates of failure, exorbitant costs, and the sluggish pace of new drug discovery and development have led to a growing interest in repurposing "old" drugs to treat both common and rare diseases, particularly cancer. Cancer, a complex and heterogeneous disease, often necessitates a combination of different treatment modalities to achieve optimal outcomes. The intrinsic polygenicity of cancer, intricate biological signalling networks, and feedback loops make the inhibition of a single target frequently insufficient for achieving the desired therapeutic impact. As a result, addressing these complex or "smart" malignancies demands equally sophisticated treatment strategies. Combinatory treatments that target the multifaceted oncogenic signalling network hold immense promise. Repurposed drugs offer a potential solution to this challenge, harnessing known compounds for new indications. By avoiding the prohibitive costs and long development timelines associated with novel cancer drugs, this approach holds the potential to usher in more effective, efficient, and cost-effective cancer treatments. The pursuit of combinatory therapies through drug repurposing may hold the key to achieving superior outcomes for cancer patients. However, drug repurposing faces significant commercial, technological and regulatory challenges that need to be addressed. This review explores the diverse approaches employed in drug repurposing, delves into the challenges faced by the drug repurposing community, and presents innovative solutions to overcome these obstacles. By emphasising the significance of combinatory treatments within the context of drug repurposing, we aim to unlock the full potential of this approach for enhancing cancer therapy. The positive aspects of drug repurposing in oncology are underscored here; encompassing personalized treatment, accelerated development, market opportunities for shelved drugs, cancer prevention, expanded patient reach, improved patient access, multi-partner collaborations, increased likelihood of approval, reduced costs, and enhanced combination therapy.
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Affiliation(s)
- Freya R Weth
- Gillies McIndoe Research Institute, Newtown, Wellington, 6021, New Zealand
- Centre for Biodiscovery and School of Biological Sciences, Victoria University of Wellington, Kelburn, Wellington, 6021, New Zealand
| | - Georgia B Hoggarth
- Gillies McIndoe Research Institute, Newtown, Wellington, 6021, New Zealand
| | - Anya F Weth
- Gillies McIndoe Research Institute, Newtown, Wellington, 6021, New Zealand
| | - Erin Paterson
- Gillies McIndoe Research Institute, Newtown, Wellington, 6021, New Zealand
| | | | - Swee T Tan
- Gillies McIndoe Research Institute, Newtown, Wellington, 6021, New Zealand
- Wellington Regional Plastic, Maxillofacial & Burns Unit, Hutt Hospital, Lower Hutt, 5040, New Zealand
- Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Lifeng Peng
- Centre for Biodiscovery and School of Biological Sciences, Victoria University of Wellington, Kelburn, Wellington, 6021, New Zealand
| | - Clint Gray
- Gillies McIndoe Research Institute, Newtown, Wellington, 6021, New Zealand.
- Centre for Biodiscovery and School of Biological Sciences, Victoria University of Wellington, Kelburn, Wellington, 6021, New Zealand.
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Hopkins JN, Waldman M, Sahai R, Battle J. Evaluating drug stability and sterility in single-dose vials when accessed with a closed system transfer device. SAGE Open Med 2024; 12:20503121241230449. [PMID: 38414830 PMCID: PMC10898290 DOI: 10.1177/20503121241230449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 01/18/2024] [Indexed: 02/29/2024] Open
Abstract
Background Impact of drug wastage is a legitimate and persistent concern. Financial impact of drug waste is borne by the hospital network, patients, and healthcare systems. Measures to reduce drug wastage may have a positive impact throughout healthcare systems. Objective This study investigated the stability and sterility of single-dose vials when repeatedly accessed with a closed system transfer device. By evaluating the sterility and stability, these results may be used to validate the extension of vial usage and lead to potential drug wastage reduction. Methods Sterility testing was performed in accordance with US Pharmacopeia 71. A closed system transfer device was incorporated into simulated compounding tasks, utilizing growth media. Simulated compounding tasks were performed in the clinical environment, followed by incubation to stimulate growth. Stability testing was performed in accordance with US Pharmacopeia monographs at multiple timepoints post access. Test samples were comparatively tested via high-performance liquid chromatography to freshly opened vials at each timepoint. Results No growth was observed in test samples. Control vials displayed growth, where appropriate. The drugs retained stability, when compared to freshly opened vials at 0, 24, 48, and 72 h, post access. Conclusions This study confirms that closed system transfer devices do not contribute to microbial contamination of drug vials, following the repeated access, for up to 7 days and the tested drugs retained equivalent chemical stability for up to 72 h post access. This study may offer a manner by which a facility may assess single-dose vials' sterility and stability, following repeated access by a closed system transfer device.
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A systematic literature review of revealed preferences of decision-makers for recommendations of cancer drugs in health technology assessment. Int J Technol Assess Health Care 2022; 38:e36. [PMID: 35382919 DOI: 10.1017/s0266462322000216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Banh C, Valsvik K, Arredondo A, Notbohm K, Elquza E, Babiker H, Kraft A, Boiles AR, Persky D, Ortega A, McBride A. Transitioning ifosfamide chemotherapy regimens to the ambulatory setting: reviewing cost savings and safety profile. Support Care Cancer 2022; 30:2755-2766. [PMID: 34825982 PMCID: PMC8617555 DOI: 10.1007/s00520-021-06653-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 10/24/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE To characterize and compare both the outcome and cost of treatment of outpatient (OP) and inpatient (IP) ifosfamide therapy. METHODS A single-center retrospective chart review of patients 18 years and older receiving ifosfamide therapy. The primary endpoint compares and evaluates the side effect profiles of ifosfamide-treated patients in the OP/IP settings. The adverse event grading system was characterized using the CTCAE Version 5.0. The highest grade was documented per cycle. The secondary endpoint of this study compares the costs of OP/IP therapy. It was assumed that the cost of medication was equivalent for IP/OP treatments. The cost saved with OP administration was determined by the average cost of hospital stay for IP admission. RESULTS Ifosfamide therapy of 86 patients (57 OP, 29 IP) was reviewed. The predominant OP regimens were doxorobucin-ifosfamide-mesna (AIM) with 43.9% and ifosfamide-etoposide (IE) with 29.8%. Grade 4 anemia, thrombocytopenia, and neutropenia were most frequent in IP vs OP therapies (22.9% IP vs 4.3% OP, 21.6% IP vs 9.2% OP, and 22.8% IP vs 19.6% OP respectively). Neutropenic fever (NF) occurred in 20 OP patients which were predominantly treated with AIM or IE and led to average hospital stay of 6 days. Neurotoxicity, treated with methylene blue (MB) occurred in 4 OP patients. OP therapy saved a total of 783 hospital days, leading to a cost savings of $2,103,921. CONCLUSIONS Transitioning ifosfamide to the OP setting is feasible for academic and community infusion centers with the OP administration being safe, well-tolerated, and associated with decreased total cost of care. The current processes allow for safe transition of chemotherapy of chemotherapy under times of COVID.
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Affiliation(s)
- Cindy Banh
- The University of Arizona Cancer Center, Tucson, AZ, USA
| | | | | | - Kassie Notbohm
- The University of Arizona Cancer Center, Tucson, AZ, USA
| | - Emad Elquza
- The University of Arizona Cancer Center, Tucson, AZ, USA
| | - Hani Babiker
- The University of Arizona Cancer Center, Tucson, AZ, USA
| | - Andrew Kraft
- The University of Arizona Cancer Center, Tucson, AZ, USA
| | | | - Daniel Persky
- The University of Arizona Cancer Center, Tucson, AZ, USA
| | - Alicia Ortega
- The University of Arizona Cancer Center, Tucson, AZ, USA
| | - Ali McBride
- The University of Arizona Cancer Center, Tucson, AZ, USA.
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Collomb B, Dubromel A, Caffin AG, Herledan C, Larbre V, Baudouin A, Cerutti A, Couturier L, Maire M, Karlin L, Maucort-Boulch D, Huot L, Dalle S, Bachy E, Ghesquieres H, Salles G, Couraud S, You B, Freyer G, Trillet-Lenoir V, Ranchon F, Rioufol C. Assessment of Patient Reported Outcomes (PROs) in Outpatients Taking Oral Anticancer Drugs Included in the Real-Life Oncoral Program. Cancers (Basel) 2022; 14:cancers14030660. [PMID: 35158928 PMCID: PMC8833408 DOI: 10.3390/cancers14030660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/25/2022] [Indexed: 12/04/2022] Open
Abstract
Simple Summary Patients receiving oral anticancer agents (OAAs) have a substantial symptom burden. Given the trend toward patient-centered care, the use of patient-reported outcomes (PROs) seems appropriate to secure medication management, and to improve clinical decision-making. The aim of this study was to assess symptoms potentially related to adverse events experienced by cancer outpatients treated by OAAs using PROs. In total, 407 questionnaires were completed by 63 patients, in which 2333 symptoms were reported. Almost three-quarters (74.6%) reported at least one high-level symptom. The symptoms most commonly experienced were fatigue, various psychological disorders and general pain. This initiative is the first step in the implementation of symptom assessment by PROs in patients treated by OAAs. The results highlight the need for close coordination between community and hospital health professionals, and the integration of patient self-reporting systems in oncologic clinical practice. Abstract Background In previous studies, patient-reported outcomes (PROs) have been shown to improve survival in cancer patients. The aim of the present study was to assess symptoms potentially related to adverse events experienced by cancer outpatients treated by oral anticancer agents (OAAs) using PROs. Methods Between September 2018 and May 2019, outpatients starting OAAs were included in a 12-week follow-up to assess 15 symptoms listed in the National Cancer Institute PRO Common Terminology Criteria for Adverse Events, using a 5-point scale of severity or frequency. Patients were requested to alert a referral nurse or pharmacist when they self-assessed high-level (level 3 or 4) symptoms. Results 407 questionnaires were completed by 63 patients in which 2333 symptoms were reported. Almost three-quarters (74.6%) reported at least one high-level symptom. The symptoms that were most commonly experienced were fatigue (>9 in 10 patients; 13.2% of symptoms declared), various psychological disorders (>9 in 10 patients; 28.6% of symptoms declared) and general pain (>8 in 10 patients; 9.4% of symptoms declared). Conclusion PROs are appropriate to detect potential adverse events in cancer outpatients treated by OAAs. This study is the first step for integrating the patient’s perspective in a digital e-health device in routine oncology care.
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Affiliation(s)
- Bastien Collomb
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Amélie Dubromel
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Anne Gaëlle Caffin
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Chloé Herledan
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
- CICLY Centre pour l'Innovation en Cancérologie de Lyon, Université Lyon 1-EA 3738, 69921 Lyon, France
| | - Virginie Larbre
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
- CICLY Centre pour l'Innovation en Cancérologie de Lyon, Université Lyon 1-EA 3738, 69921 Lyon, France
| | - Amandine Baudouin
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Ariane Cerutti
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Laurence Couturier
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Magali Maire
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Lionel Karlin
- Department of Hematology, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Delphine Maucort-Boulch
- Department of Statistics and Bioinformatics, Hospices Civils de Lyon, 69002 Lyon, France
- CNRS UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, 69622 Lyon, France
| | - Laure Huot
- Cellule Innovation, Département de la Recherche Clinique et de L'innovation, Hospices Civils de Lyon, 69002 Lyon, France
| | - Stéphane Dalle
- Dermatology Department, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Emmanuel Bachy
- Department of Hematology, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Hervé Ghesquieres
- Department of Hematology, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Gilles Salles
- Department of Hematology, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Sébastien Couraud
- CICLY Centre pour l'Innovation en Cancérologie de Lyon, Université Lyon 1-EA 3738, 69921 Lyon, France
- Department of Pneumology, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Benoit You
- CICLY Centre pour l'Innovation en Cancérologie de Lyon, Université Lyon 1-EA 3738, 69921 Lyon, France
- Department of Oncology, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Gilles Freyer
- CICLY Centre pour l'Innovation en Cancérologie de Lyon, Université Lyon 1-EA 3738, 69921 Lyon, France
- Department of Oncology, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Véronique Trillet-Lenoir
- CICLY Centre pour l'Innovation en Cancérologie de Lyon, Université Lyon 1-EA 3738, 69921 Lyon, France
- Department of Oncology, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Florence Ranchon
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
- CICLY Centre pour l'Innovation en Cancérologie de Lyon, Université Lyon 1-EA 3738, 69921 Lyon, France
| | - Catherine Rioufol
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
- CICLY Centre pour l'Innovation en Cancérologie de Lyon, Université Lyon 1-EA 3738, 69921 Lyon, France
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Fu M, Naci H, Booth CM, Gyawali B, Cosgrove A, Toh S, Xu Z, Guan X, Ross-Degnan D, Wagner AK. Real-world Use of and Spending on New Oral Targeted Cancer Drugs in the US, 2011-2018. JAMA Intern Med 2021; 181:1596-1604. [PMID: 34661604 PMCID: PMC8524355 DOI: 10.1001/jamainternmed.2021.5983] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/20/2021] [Indexed: 01/23/2023]
Abstract
Importance Launch prices of new cancer drugs in the US have substantially increased in recent years despite growing concerns about the quantity and quality of evidence supporting their approval by the US Food and Drug Administration (FDA). Objective To assess the use of and spending on new oral targeted cancer drugs among US residents with employer-sponsored insurance between 2011 and 2018, stratified by the strength of available evidence of benefit. Design, Setting, and Participants In this cross-sectional study, dispensing claims for oral targeted cancer drugs first approved by the FDA between January 1, 2011, and December 31, 2018, were analyzed. The number of patients with drugs dispensed and the total payment for all claims were aggregated by calendar year, and these outcomes were arrayed according to evidence underlying FDA approvals, including pivotal study design (availability of randomized clinical trials) and overall survival (OS) benefit, as documented in drug labels. This study was conducted from July 17, 2019, to July 23, 2021. Main Outcomes and Measures Annual and cumulative numbers of patients who had dispensing events, and annual and cumulative sums of payment for eligible drugs. Results Of 37 348 patients who had at least 1 of the 44 new oral targeted drugs dispensed between 2011 and 2018, 21 324 were men (57.1%); mean (SD) age was 64.1 (13.1) years. Most individuals (36 246 [97.0%]) received drugs for which evidence from randomized clinical trials existed; however, a growing share of patients received drugs without documented OS benefit during the study period: from 12.7% in 2011 to 58.8% in 2018. Cumulative spending on all sample drugs totaled $3.5 billion by the end of 2018, of which 96.8% was spent on drugs that were approved based on a pivotal randomized clinical trial. Cumulative spending on drugs without documented OS benefit ($1.8 billion [51.6%]) surpassed that on drugs with documented OS benefit ($1.7 billion [48.4%]) by the end of 2018. Conclusions and Relevance The findings of this cross-sectional study suggest that drugs used for treatment of cancer without documented OS benefits are adopted in the health system and account for substantial spending.
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Affiliation(s)
- Mengyuan Fu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Huseyin Naci
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Christopher M. Booth
- Division of Cancer Care and Epidemiology, Departments of Oncology and Public Health Sciences, Queen’s University Cancer Research Institute, Kingston, Canada
| | - Bishal Gyawali
- Division of Cancer Care and Epidemiology, Departments of Oncology and Public Health Sciences, Queen’s University Cancer Research Institute, Kingston, Canada
| | - Austin Cosgrove
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Sengwee Toh
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Ziyue Xu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Dennis Ross-Degnan
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Anita K. Wagner
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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Affiliation(s)
- Carolyn Y Fang
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Zachary A K Frosch
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
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Kennedy C, McCullagh L, Adams R, Trela-Larsen L, Tilson L, Barry M. Estimating the Theoretical Cost Implications of Funding New Drugs Considered Not to Be Cost-Effective. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1402-1406. [PMID: 34593162 DOI: 10.1016/j.jval.2021.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 03/22/2021] [Accepted: 03/31/2021] [Indexed: 06/13/2023]
Abstract
This study aims to estimate the theoretical excess expenditure that would be incurred by the Irish state-payer, should drugs be reimbursed at their original asking ("list") price rather than at a price at which the drug is considered cost-effective. In Ireland, all new drugs are evaluated by the National Centre for Pharmacoeconomics. For this study, drugs that were submitted by pharmaceutical companies from 2012 to 2017 and considered not cost-effective at list price were reviewed. A total of 43 such drugs met our inclusion criteria, and their pharmacoeconomic evaluations were further assessed. The price at which the drug could be considered cost-effective (cost-effective price) at the upper cost-effectiveness threshold used in Ireland (€ 45 000/quality adjusted life-year) was estimated for 18 drugs with an available cost-effectiveness model. Then, for each drug, the list price and cost-effective price (both per unit) were both individually applied to 1 year of national real-world drug utilization data. This allowed the estimation of the expected expenditures under the assumptions of list price paid and cost-effective price paid. The resulting theoretical excess expenditure, the expenditure at list price minus the expenditure at the cost-effective price, was estimated to be €108.2 million. This estimate is theoretical because of the confidentiality of actual drug prices. The estimation is calculated using the list price and likely overestimates the actual excess expenditure, which would reduce to zero if cost-effective prices are agreed. Nevertheless, this estimate illustrates the importance of a process to assess the value of new drugs so that potential excess drug expenditure is identified.
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Affiliation(s)
- Cormac Kennedy
- Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, Trinity College, Dublin 8, Ireland.
| | - Laura McCullagh
- Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, Trinity College, Dublin 8, Ireland; National Centre for Pharmacoeconomics, St James Hospital, Dublin 8, Ireland
| | - Roisin Adams
- Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, Trinity College, Dublin 8, Ireland; National Centre for Pharmacoeconomics, St James Hospital, Dublin 8, Ireland
| | - Lea Trela-Larsen
- National Centre for Pharmacoeconomics, St James Hospital, Dublin 8, Ireland
| | - Lesley Tilson
- Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, Trinity College, Dublin 8, Ireland; National Centre for Pharmacoeconomics, St James Hospital, Dublin 8, Ireland
| | - Michael Barry
- Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, Trinity College, Dublin 8, Ireland; National Centre for Pharmacoeconomics, St James Hospital, Dublin 8, Ireland
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Law CK, Brewer K, Brown C, Wilson K, Bailey L, Hague W, Simes JR, Stevenson A, Solomon M, Morton RL. Return to work following laparoscopic-assisted resection or open resection for rectal cancer: Findings from AlaCaRT-Australasian Laparoscopic Cancer of the Rectum Trial. Cancer Med 2021; 10:552-562. [PMID: 33280266 PMCID: PMC7877361 DOI: 10.1002/cam4.3623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Maintaining employment for adults with cancer is important, however, little is known about the impact of surgery for rectal cancer on an individual's capacity to return to work (RTW). This study aimed to determine the impact of laparoscopic vs. open resection on RTW at 12 months. METHODS Analyses were undertaken among participants randomized in the Australian Laparoscopic Cancer of the Rectum Trial (ALaCaRT), with work status available at baseline (presurgery), and 12 months. Multivariable logistic regression, adjusted for sociodemographic and clinical characteristics estimated the effect of surgery on RTW in any capacity, or return to preoperative work status at 12 months. RESULTS About 228 of 449 (51%) surviving trial participants at 12 months completed work status questionnaires; mean age was 62 years, 66% males, 117 of these received laparoscopic resection (51%). Of 228, 120 were employed at baseline (90 full-time, 30 part-time). Overall RTW in 120 participants in paid work at baseline was 78% (84% laparoscopic, 70% open surgery). Those employed full-time were more likely to RTW at 12 months (OR, 3.55; 95% CI, 1.02-12.31). Those with distant metastases at baseline were less likely to RTW (OR, 0.07; 95% CI, <0.01-0.83). Laparoscopic surgery was associated with a higher rate of RTW but did not reach statistical significance (OR 2.88; 95% CI, 0.95-8.76). CONCLUSIONS Full-time work presurgery and the presence of metastatic disease predicts RTW status at 12 months. A laparoscopic-assisted surgical approach to rectal cancer may facilitate more patients to RTW, however, larger sample sizes are likely needed to confirm this result.
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Affiliation(s)
- Chi Kin Law
- NHMRC Clinical Trials CentreThe University of SydneyCamperdownNSWAustralia
| | - Kate Brewer
- NHMRC Clinical Trials CentreThe University of SydneyCamperdownNSWAustralia
| | - Chris Brown
- NHMRC Clinical Trials CentreThe University of SydneyCamperdownNSWAustralia
| | - Kate Wilson
- NHMRC Clinical Trials CentreThe University of SydneyCamperdownNSWAustralia
| | - Lisa Bailey
- NHMRC Clinical Trials CentreThe University of SydneyCamperdownNSWAustralia
| | - Wendy Hague
- NHMRC Clinical Trials CentreThe University of SydneyCamperdownNSWAustralia
| | - John R. Simes
- NHMRC Clinical Trials CentreThe University of SydneyCamperdownNSWAustralia
| | - Andrew Stevenson
- Faculty of Medicine and Biomedical SciencesUniversity of QueenslandHerstonQldAustralia
| | - Michael Solomon
- Institute of Academic SurgeryRoyal Prince Alfred HospitalUniversity of SydneySydneyNSWAustralia
| | - Rachael L. Morton
- NHMRC Clinical Trials CentreThe University of SydneyCamperdownNSWAustralia
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Meriggi F, Zaniboni A. 'The same old story': thoughts on authorized doses of anticancer drugs. Ther Adv Med Oncol 2020; 12:1758835920905412. [PMID: 32127926 PMCID: PMC7036487 DOI: 10.1177/1758835920905412] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 01/15/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
- Fausto Meriggi
- Oncology Department, Poliambulanza Foundation,
Via Leonida Bissolati 57, Brescia, 25124, Italy
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11
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Link BK. Biosimilars: when a negative study can be positive. Lancet Haematol 2018; 5:e500-e501. [PMID: 30389032 DOI: 10.1016/s2352-3026(18)30172-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 09/26/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Brian K Link
- Department of Internal Medicine, University of Iowa Hospitals, Iowa City, Iowa 52242, USA.
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