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Rezapour A, Gholampour H, Barzegar M, Irandoust K, Afshari S, Arabloo J, Mahmoodi R, Sarabi Asiabar A, Atefimanesh P, Ghafoori MH. Economic evaluation of stereotactic radiotherapy and stereotactic radiosurgery technologies in the treatment of cancers: a systematic review. Expert Rev Pharmacoecon Outcomes Res 2024:1-24. [PMID: 38738558 DOI: 10.1080/14737167.2024.2353727] [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: 10/05/2023] [Accepted: 05/07/2024] [Indexed: 05/14/2024]
Abstract
INTRODUCTION This systematic review study investigated the cost-effectiveness of stereotactic radiotherapy (SRT) and stereotactic radiosurgery (SRS) for treatment of various types of cancers. METHODS PubMed, Scopus, and Web of Science were searched from 30 December 1990 to 1 January 2023. The entered studies were screened in accordance with the inclusion criteria. The inclusion criteria encompassed all types of economic evaluation studies that investigated SRT/SRS technologies in the treatment of various cancers. RESULTS A total of 47 articles were included in the review. The findings suggest that the use of Linear accelerator technology for the treatment of lung cancer (8 out of 12 studies) and prostate cancer (4 out of 5 studies) was a cost-effective strategy. Linear accelerator was found to be cost-effective in the treatment of liver metastases and liver cancer (2 out of 5 studies). All of the included studies that used Gamma Knife technology in brain metastases reported Gamma-Knife was a cost-effective treatment. Furthermore, in the treatment of prostate and liver cancer, proton therapy was identified as a cost-effective option than other treatments. CONCLUSIONS This study confirms that SRT/SRS is a cost-effective procedure for the treatment of various types of cancers. Therefore, it is recommended to use SRT/SRS technology for optimal use of resources.
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Affiliation(s)
- Aziz Rezapour
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Hanie Gholampour
- Department of Health Economics, School of Health Management and information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Barzegar
- Department of English Language Teaching, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Kamran Irandoust
- Department of Health Economics, School of Health Management and information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Somayeh Afshari
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Jalal Arabloo
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Razieh Mahmoodi
- Department of Health Economics School of Management and Medical Informatics, Tabriz University of Medical Science, Tabriz, Iran
| | - Ali Sarabi Asiabar
- Minimally Invasive Surgery Research center, Iran University of Medical Sciences, Tehran, Iran
| | - Pezhman Atefimanesh
- Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Ghafoori
- Department of Health Economics, School of Health Management and information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Jovanoski N, Abogunrin S, Di Maio D, Belleli R, Hudson P, Bhadti S, Jones LG. Systematic Literature Review to Identify Cost and Resource Use Data in Patients with Early-Stage Non-small Cell Lung Cancer (NSCLC). PHARMACOECONOMICS 2023; 41:1437-1452. [PMID: 37389802 PMCID: PMC10570243 DOI: 10.1007/s40273-023-01295-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/11/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Approximately 2 million new cases and 1.76 million deaths occur annually due to lung cancer, with the main histological subtype being non-small cell lung cancer (NSCLC). The costs and resource use associated with NSCLC are important considerations to understand the economic impact imposed by the disease on patients, caregivers and healthcare services. OBJECTIVE The objective of this systematic literature review (SLR) is to provide a comprehensive overview of the available direct medical costs, direct non-medical costs, indirect costs, cost drivers and resource use data available for patients with early-stage NSCLC. METHODS Electronic searches were conducted via the Ovid platform in March 2021 and June 2022 and were supplemented by grey literature searches. Eligible patients had early-stage (stage I-III) resectable NSCLC and received treatment in the neoadjuvant or adjuvant setting. There was no restriction on intervention or comparators. Publication date was restricted to 2011 onwards, and English language publications or non-English language publications with an English abstract were of primary interest. Due to the anticipation of many studies meeting the inclusion criteria, analyses were restricted to full publications from countries of primary interest (Australia, Brazil, Canada, China, France, Germany, Italy, Japan, South Korea, Spain, UK and the US) and those with > 200 patients. The Molinier checklist was applied to conduct quality assessment. RESULTS Forty-two full publications met the eligibility criteria and were included in this SLR. Early-stage NSCLC was associated with significant direct medical costs and healthcare utilisation, and the economic burden of the disease increased with its progression. Surgery was the primary cost driver in stage I patients, but as patients progressed to stage II and III, treatments such as chemotherapy and radiotherapy, and inpatient care became the main cost drivers. There was no significant difference in resource use between patients with early-stage disease. However, these data were heavily US-centric and there was a paucity of data relating to direct non-medical and indirect costs associated with early-stage NSCLC. CONCLUSIONS Preventing disease progression for patients with NSCLC could reduce the economic burden of NSCLC on patients, caregivers and healthcare systems. This review provides a comprehensive overview of the available cost and resource use data in this indication, which is important in guiding the decisions of policy makers regarding the allocation of resources. However, it also indicates a need for more studies comparing the economic impact of NSCLC in markets in addition to the US.
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Sun H, Wang H, Wei Y, Wang H, Jin C, Chen Y. Cost-effectiveness of stereotactic body radiotherapy versus conventional fractionated radiotherapy for medically inoperable, early-stage non-small cell lung cancer. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2023; 21:46. [PMID: 37507748 PMCID: PMC10375662 DOI: 10.1186/s12962-023-00452-w] [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: 02/22/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Stereotactic body radiotherapy (SBRT) is a novel radio-therapeutic technique that has recently emerged as standard-of-care treatment for medically inoperable, early-stage non-small cell lung cancer (NSCLC). In this study, we compared the cost-effectiveness of SBRT with that of conventional fractionated radiotherapy (CFRT) in patients with medically inoperable, early-stage NSCLC from the perspective of the Chinese health system. METHODS A Markov model was developed to describe health states of patients after treatment with SBRT and CFRT. The recurrence risks, treatment toxicities, and utilities inputs were obtained from the literature. The costs were based on listed prices and real-world evidence. A simulation was conducted to determine the post-treatment lifetime years. For each treatment, the total costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) per QALY were calculated. Deterministic and probabilistic sensitivity analyses were performed to assess the uncertainty of the model parameters. RESULTS In the base case analysis, SBRT was associated with a mean cost of USD16,933 and 2.05 QALYs, whereas CFRT was associated with a mean cost of USD17,726 and 1.61 QALYs. SBRT is a more cost-effective strategy compared with CFRT for medically inoperable, early-stage NSCLC, with USD 1802 is saved for every incremental QALY. This result was validated by DSA and PSA, in which SBRT remained the most cost-effective option. CONCLUSIONS The findings suggested that, compared to CFRT, SBRT may be considered a more cost-effective strategy for medically inoperable, early-stage NSCLC.
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Affiliation(s)
- Hui Sun
- School of Public Health, Fudan University, Shanghai, China
- Key Lab of Health Technology Assessment, School of Public Health, National Health Commission, Fudan University, Shanghai, China
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, China
| | - Huishan Wang
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai, China
- Evidence-Based Medicine Center, Fudan University, Shanghai, China
| | - Yan Wei
- School of Public Health, Fudan University, Shanghai, China
- Key Lab of Health Technology Assessment, School of Public Health, National Health Commission, Fudan University, Shanghai, China
| | - Haiyin Wang
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, China
| | - Chunlin Jin
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, China
| | - Yingyao Chen
- School of Public Health, Fudan University, Shanghai, China.
- Key Lab of Health Technology Assessment, School of Public Health, National Health Commission, Fudan University, Shanghai, China.
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Mutsaers A, Zhang TW, Louie A, Rodrigues G, Palma D, Qu M. Stereotactic or Conventional Radiation for Early-Stage Non-small Cell Lung Cancer: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e38198. [PMID: 37252503 PMCID: PMC10224746 DOI: 10.7759/cureus.38198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2023] [Indexed: 05/31/2023] Open
Abstract
Stereotactic ablative radiotherapy (SABR) has been increasingly used for the treatment of inoperable early-stage non-small cell lung cancer (NSCLC). It has been shown to provide promising local control (LC) and toxicity in prospective trials. However, randomized trials have shown conflicting results in terms of whether SABR confers an overall survival (OS) advantage compared to conventionally fractionated radiotherapy (CFRT). A systematic review of Medline and Embase (inception to December 2020) was performed on early-stage NSCLC patients randomized to SABR versus CFRT. Two independent reviewers screened titles, abstracts, and manuscripts. A random-effects model was used to estimate treatment effects. Toxicity outcomes were compared by the Cochran-Mantel-Haenszel test. Individual patient data were digitally approximated and pooled as secondary analysis. The literature search identified 1494 studies, and 16 studies were included for full-text review. Two randomized trials were identified, including a total of 203 patients, of which 115 (57%) received SABR, and 88 (43%) received CFRT. The weighted mean age was 74 years and 48% of patients were male. Most patients had T1 cancers (67%). Stereotactic ablative radiotherapy was not associated with a significant improvement in OS (hazard ratio: 0.84; 95% confidence interval (CI) 0.34-2.08, p=0.71). There was no significant difference in LC between SABR and CFRT (relative risk: 0.59; CI 0.28-1.23, p=0.16). Of the commonly reported adverse events, one grade 4 toxicity of dyspnea was reported for SABR, while all others i.e., grade 3 or higher toxicities were similar. Stereotactic ablative radiotherapy demonstrated less esophagitis, dyspnea, and skin reaction of any grade. Despite widespread adoption and extensive single-arm prospective and retrospective studies suggesting its benefit, this systematic review and meta-analysis of randomized trials fail to confirm improvements in LC, OS, and toxicity profile of SABR over CFRT in early NSCLC. This small study is likely underpowered to detect clinically significant differences.
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Affiliation(s)
- Adam Mutsaers
- Radiation Oncology, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, CAN
| | | | - Alexander Louie
- Radiation Oncology, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, CAN
| | - George Rodrigues
- Radiation Oncology, Victoria Hospital, London Health Sciences Centre, London, CAN
- Medicine & Dentistry, Western University, London, CAN
| | - David Palma
- Radiation Oncology, Victoria Hospital, London Health Sciences Centre, London, CAN
| | - Melody Qu
- Radiation Oncology, Victoria Hospital, London Health Sciences Centre, London, CAN
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Maia FHDA, Rozman LM, Carvalho HDA, de Soárez PC. Systematic review of economic evaluations on stereotactic ablative radiotherapy (SABR) compared to other radiotherapy techniques or surgical procedures for early-stage non-small cell lung cancer. Cost Eff Resour Alloc 2023; 21:4. [PMID: 36647118 PMCID: PMC9841623 DOI: 10.1186/s12962-023-00415-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 01/03/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Stereotactic ablative radiotherapy (SABR) is recommended as first-choice treatment to inoperable early-stage non-small cell lung cancer (NSCLC). However, it is not widely adopted in developing countries, and its cost-effectiveness is unclear. We aimed to perform a systematic review of full economic evaluations (EE) that compared SABR with other radiotherapy or surgical procedures to assess the results and methodological approach. METHODS The protocol was registered on PROSPERO (CRD42021241640). We included full EE studies with early-stage NSCLC in which one group was submitted to SABR. Studies that were partial EE, included advanced NSCLC or other neoplasm were excluded. We performed the last search on June 2021 in Medline, EMBASE and other databases. The reporting quality were assessed by CHEERS checklist. The main characteristics of each study were tabulated, and the results were presented by a narrative synthesis. RESULTS We included nine studies. Three compared radiotherapy techniques, in which SABR was found to be dominant or cost-effective. Six compared SABR with surgery, and in this group, there was not a unanimous decision. All included only direct healthcare costs but varied about categories included. The parameters used in the model-based studies were highly heterogeneous using mixed data from various sources. The items properly reported varied from 29 to 67%. CONCLUSIONS The studies were all from developed countries and lacked in reporting quality. We recommend that developing countries produce their own studies. More strict alignment to reporting guidelines and use of robust evidence as model parameters are also advised.
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Affiliation(s)
- Fernando Henrique de Albuquerque Maia
- grid.11899.380000 0004 1937 0722Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Av Dr Arnaldo 455, Sao Paulo, SP CEP: 01246903 Brazil ,grid.450640.30000 0001 2189 2026National Institute of Science and Technology for Health Technology Assessment (IATS), CNPq/Brazil, Brasília, Brazil
| | - Luciana Martins Rozman
- grid.11899.380000 0004 1937 0722Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Av Dr Arnaldo 455, Sao Paulo, SP CEP: 01246903 Brazil ,grid.450640.30000 0001 2189 2026National Institute of Science and Technology for Health Technology Assessment (IATS), CNPq/Brazil, Brasília, Brazil
| | - Heloisa de Andrade Carvalho
- grid.11899.380000 0004 1937 0722Departamento de Radiologia E Oncologia, Divisao de Radioterapia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP Brazil
| | - Patrícia Coelho de Soárez
- grid.11899.380000 0004 1937 0722Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Av Dr Arnaldo 455, Sao Paulo, SP CEP: 01246903 Brazil ,grid.450640.30000 0001 2189 2026National Institute of Science and Technology for Health Technology Assessment (IATS), CNPq/Brazil, Brasília, Brazil
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6
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Mutsaers A, Louie AV, Ynoe Moraes F. The case for SABR as the global standard for non-operable early-stage non-small cell lung cancer. LANCET REGIONAL HEALTH. AMERICAS 2022; 14:100361. [PMID: 36777385 PMCID: PMC9903782 DOI: 10.1016/j.lana.2022.100361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Adam Mutsaers
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario M4N 3M5, Canada
| | - Alexander V. Louie
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario M4N 3M5, Canada
| | - Fabio Ynoe Moraes
- Division of Radiation Oncology, Department of Oncology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada,Corresponding author at: Division of Radiation Oncology, Department of Oncology, Kingston General Hospital, Queen's University, 25 King Street West, Burr Wing, Kingston, Ontario, K7L 5P9, Canada.
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Sun H, Jin C, Wang H, Hu S, Chen Y, Wang H. Cost-effectiveness of stereotactic body radiotherapy in the treatment of non-small-cell lung cancer (NSCLC): a systematic review. Expert Rev Pharmacoecon Outcomes Res 2022; 22:723-734. [PMID: 35249432 DOI: 10.1080/14737167.2022.2050217] [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: 11/04/2022]
Abstract
OBJECTIVES This study aims to systematically review the studies on the cost-effectiveness of stereotactic body radiotherapy (SBRT) in the treatment of non-small-cell lung cancer (NSCLC). METHODS A systematic literature search was performed in databases from 2000 through April 2021. The search terms included 'economics,' 'cost,' 'cost effectiveness,' 'SBRT,' and all names for NSCLC. Two reviewers independently screened the titles, abstracts and full texts to determine the studies for the final sample. The quality of the included studies was assessed using the Quality of Health Economic Studies checklist. RESULTS Eleven studies were identified and included in our final review. SBRT was reported to be a cost-effective (5 of 5) option compared to conventional radiotherapy, radiofrequency ablation, and best supportive care for medically inoperable, early-stage NSCLC. However, the identified studies revealed that no single treatment was found to be more cost-effective than others between SBRT and surgical interventions. The key drivers of this cost-effectiveness were the cost of the treatment, utility value, and the rate of surgical mortality. CONCLUSIONS SBRT may be considered a more cost-effective strategy for medically inoperable, early-stage NSCLC. Considering the limited studies available, more related research should be conducted to further validate these results.
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Affiliation(s)
- Hui Sun
- School of Public Health, Fudan University, Shanghai, China.,National Health Commission Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, China Shanghai, China.,Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, China
| | - Chunlin Jin
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, China
| | - Huishan Wang
- Department of Gastroenterology, Shanghai Songjiang District Central Hospital, Shanghai, China
| | - Shanlian Hu
- School of Public Health, Fudan University, Shanghai, China
| | - Yingyao Chen
- School of Public Health, Fudan University, Shanghai, China.,National Health Commission Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, China Shanghai, China
| | - Haiyin Wang
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, China
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Romsa J, Imhoff RJ, Palli SR, Inculet R, Mehta S. SPECT/CT versus planar imaging to determine treatment strategy for non-small-cell lung cancer: a cost-effectiveness analysis. J Comp Eff Res 2022; 11:229-241. [PMID: 35006007 DOI: 10.2217/cer-2021-0139] [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: SPECT/CT has been found to improve predicted postoperative forced expiratory volume in one second (ppoFEV1) assessments in patients with non-small-cell lung cancer (NSCLC). Methods: An economic simulation was developed comparing the cost-effectiveness of SPECT/CT versus planar scintigraphy for a US payer. Clinical outcomes and cost data were obtained through review of the published literature. Results: SPECT/CT increased the accuracy ppoFEV1 assessment, changing the therapeutic decision for 1.3% of nonsurgical patients to a surgical option, while 3.3% of surgical patients shifted to more aggressive procedures. SPECT/CT led to an expected cost of $4694 per life year gained, well below typical thresholds. Conclusion: SPECT/CT resulted in substantially improved health outcomes and was found to be highly cost-effective.
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Affiliation(s)
- Jonathan Romsa
- Department of Medical Imaging, Division of Nuclear Medicine, University of Western Ontario, 800 Commissioners Rd E, London, ON N6A 5W9, Canada
| | - Ryan J Imhoff
- CTI Clinical Trial & Consulting Services, 100 E. RiverCenter Blvd, Covington, KY 41011, USA
| | - Swetha R Palli
- CTI Clinical Trial & Consulting Services, 100 E. RiverCenter Blvd, Covington, KY 41011, USA
| | - Richard Inculet
- Department of Surgery, Division of Thoracic Surgery, University of Western Ontario, 268 Grosvenor Street, St. Joseph's Hospital Rm. E3-117, London, ON N6A 4V2, Canada
| | - Sanjay Mehta
- Department of Medicine, Respirology Division, London Health Sciences Centre, University of Western Ontario, 800 Commissioners Rd E, London, ON N6A 5W9, Canada
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Stanford-Edwards C, Edwards M, Selby A, Lewis R, Powell C, Nicholas O. Creating a Sustainable Future of Radiotherapy Following COP26: A Case for Lung Stereotactic Ablative Radiotherapy Over Surgery? Clin Oncol (R Coll Radiol) 2021; 34:e105-e106. [PMID: 34895991 DOI: 10.1016/j.clon.2021.11.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 11/26/2021] [Indexed: 11/03/2022]
Affiliation(s)
- C Stanford-Edwards
- Swansea Bay University Health Board, South West Wales Cancer Centre, Swansea, UK; The University of Manchester, Manchester, UK.
| | - M Edwards
- Swansea Bay University Health Board, South West Wales Cancer Centre, Swansea, UK
| | - A Selby
- Swansea Bay University Health Board, South West Wales Cancer Centre, Swansea, UK
| | - R Lewis
- Swansea Bay University Health Board, South West Wales Cancer Centre, Swansea, UK
| | - C Powell
- Swansea Bay University Health Board, South West Wales Cancer Centre, Swansea, UK
| | - O Nicholas
- Swansea Bay University Health Board, South West Wales Cancer Centre, Swansea, UK; Swansea University Medical School, Swansea, UK
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Okazaki S, Shibuya K, Takura T, Miyasaka Y, Kawamura H, Ohno T. Cost-effectiveness of carbon-ion radiotherapy versus stereotactic body radiotherapy for non-small-cell lung cancer. Cancer Sci 2021; 113:674-683. [PMID: 34820994 PMCID: PMC8819294 DOI: 10.1111/cas.15216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/07/2021] [Accepted: 11/22/2021] [Indexed: 12/25/2022] Open
Abstract
Carbon-ion radiotherapy (CIRT) for clinical stage I non-small-cell lung cancer (NSCLC) is used as an advanced medical treatment regimen in Japan. Carbon-ion radiotherapy reportedly aids in achieving excellent treatment outcomes, despite its high medical cost. We aimed to compare CIRT with stereotactic body radiotherapy (SBRT) in terms of cost-effectiveness for treating clinical stage I NSCLC. Data of patients with clinical stage I NSCLC treated with CIRT or SBRT at Gunma University between 2010 and 2015 were analyzed. The CIRT and SBRT groups included 62 and 27 patients, respectively. After propensity-score matching, both groups comprised 15 patients. Life year (LY) was used as an indicator of outcome. The CIRT technical fee was 3 140 000 JPY. There was no technical fee for the second CIRT carried out on the same organ within 2 years. The incremental cost-effectiveness ratio (ICER) was calculated by dividing the incremental cost by the incremental LY for 5 years after treatment. Sensitivity analysis was applied to evaluate the impact of LY or costs of each group on ICER. The ICERs were 7 491 017 JPY/LY and 3 708 330 JPY/LY for all patients and matched patients, respectively. Hospitalization and examination costs were significantly higher in the CIRT group, and the impact of the CIRT technical costs was smaller than other costs and LY. Carbon-ion radiotherapy is a cost-effective treatment approach. However, our findings suggest that reducing excessive costs by considering the validity and necessity of examinations and hospitalizations would make CIRT a more cost-effective approach.
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Affiliation(s)
- Shohei Okazaki
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Japan.,Gunma University Heavy Ion Medical Center, Gunma University, Maebashi, Japan
| | - Kei Shibuya
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tomoyuki Takura
- Department of Healthcare Economics and Health Policy, University of Tokyo, Tokyo, Japan
| | - Yuhei Miyasaka
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hidemasa Kawamura
- Gunma University Heavy Ion Medical Center, Gunma University, Maebashi, Japan
| | - Tatsuya Ohno
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Japan.,Gunma University Heavy Ion Medical Center, Gunma University, Maebashi, Japan
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11
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Raymakers AJN, Cameron D, Tyldesley S, Regier DA. Cost-Effectiveness Analysis of Stereotactic Ablative Body Radiotherapy for the Treatment of Oligometastatic Tumors versus Standard of Care. Curr Oncol 2021; 28:1857-1866. [PMID: 34068400 PMCID: PMC8161824 DOI: 10.3390/curroncol28030172] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/13/2021] [Accepted: 04/28/2021] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Recent clinical trial results reported that stereotactic radiotherapy (SABR) may improve survival for patients with oligometastatic (OM) cancer. Given that these results come from a phase II trial, there remains considerable uncertainty about this finding, and about the cost-effectiveness of SABR for patients with OM cancer. In this analysis, we estimate the cost-effectiveness of SABR for oligometastatic cancer patients. METHODS A probabilistic time-dependent Markov model was constructed to simulate treatment of oligometastatic cancer patients over five- and ten-year time horizons. The primary data source was the phase II, Stereotactic Ablative Radiotherapy for the Comprehensive Treatment of Oligometastases (SABR-COMET )trial and supplemented with data from the literature. We estimated the effect of SABR and the standard of care (SoC) using quality-adjusted life-years (QALYs). Costs were measured from a provincial payer perspective (2018 Canadian dollars). RESULTS In the reference case analysis (five-year time horizon), SABR was associated with additional incremental costs of CAD 38,487 and an incremental QALY gain of 0.84. This resulted in an incremental cost-effectiveness ratio (ICER) of CAD 45,726 per QALY gained. Over a ten-year time horizon, the increased uncertainty in the long-term effectiveness of SABR resulted in an ICER of CAD 291,544 per QALY gained. Estimates from the probabilistic analysis indicated that at a willingness-to-pay (WTP) threshold of CAD 50,000 and CAD 100,000 per QALY gained, there is 54% and 78% probability (respectively) that SABR would be cost-effective using the five-year time horizon. CONCLUSIONS The adoption of SABR therapy requires a considerable upfront capital investment. Our results suggest that the cost-effectiveness of SABR is contingent on the uncertainty in the evidence base. Further clinical trials to confirm the effectiveness of SABR and research into the real-world costs associated with this treatment could reduce the uncertainty around implementation of the technology.
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Affiliation(s)
- Adam J. N. Raymakers
- Cancer Control Research, BC Cancer, Vancouver, BC V5Z 1L3, Canada; (A.J.N.R.); (D.C.)
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - David Cameron
- Cancer Control Research, BC Cancer, Vancouver, BC V5Z 1L3, Canada; (A.J.N.R.); (D.C.)
| | - Scott Tyldesley
- Radiation Therapy Program, BC Cancer, Vancouver, BC V5Z 4E6, Canada;
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Dean A. Regier
- Cancer Control Research, BC Cancer, Vancouver, BC V5Z 1L3, Canada; (A.J.N.R.); (D.C.)
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
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Yang D, Cui J, Zhao J, You J, Yu R, Yu H, Jiang L, Li D, Xu B, Shi A. Stereotactic ablative radiotherapy of 60 Gy in eight fractions is safe for ultracentral non-small cell lung cancer. Thorac Cancer 2020; 11:754-761. [PMID: 32012484 PMCID: PMC7049487 DOI: 10.1111/1759-7714.13335] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/08/2020] [Accepted: 01/08/2020] [Indexed: 12/25/2022] Open
Abstract
Background There is no consensus on the definition or recommended radiotherapy treatment of ultracentral non‐small cell lung cancer (NSCLC). Here, we report our institution's experience in treating ultracentral lung cancer patients with stereotactic ablative radiotherapy (SABR) of 60 Gy in eight fractions. Methods We retrospectively reviewed the outcomes of 21 ultracentral NSCLC patients treated with 60 Gy SABR in eight fractions. We defined ultracentral lung cancer as the planning target volume (PTV) directly abutting or overlapping central structures, including the proximal bronchial tree, heart, and great vessels but not the esophagus. The Kaplan‐Meier method was used to estimate overall survival (OS), progression‐free survival (PFS) and local control (LC). Toxicity was scored per the CTCAE v4.03. Results The median follow‐up time was 15 months, and the median OS was 15 months. The one‐ and two‐year OS rates were 87.5% and 76.6%, respectively. The one‐ and two‐year PFS rates were 71.1% and 64.0%, respectively. The one‐ and two‐year LC rates were 92.9% and 92.9%, respectively. The rate of grade 2 treatment‐related toxicities was 19.1%. There was no grade ≥ 3 treatment‐related toxicity. Conclusion SABR of 60 Gy in eight fractions is feasible for ultracentral NSCLC.
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Affiliation(s)
- Dan Yang
- Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Jianing Cui
- Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China.,Department of Radiation Oncology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Beijing, China
| | - Jun Zhao
- Department of Thoracic Oncology I, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Jing You
- Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Rong Yu
- Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Huiming Yu
- Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Leilei Jiang
- Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Dongming Li
- Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Bo Xu
- Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Anhui Shi
- Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
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Abstract
PURPOSE OF REVIEW Significant advances have been made in the field of stereotactic ablative radiotherapy (SABR) for the treatment of pulmonary neoplasms in recent years. This review aims to summarize recent salient evidence on SABR for early-stage nonsmall cell lung cancer (ES-NSCLC). RECENT FINDINGS In medically inoperable patients, SABR remains the standard of care. The optimal SABR dosing regimen is being studied. Comparisons with non-SABR radiotherapy regimens with lower doses per fraction revealed benefit of SABR. In operable patients, no prospective clinical trial comparing SABR and surgery has been completed, although multiple trials are currently underway to address this question. SABR is generally cost-effective and safe in most patients, with preserved patient-reported quality of life. However, increased toxicity with SABR is noted in patients with disease close to, or invading the proximal tracheobronchial tree. Significant SABR-related toxicity and mortality is also reported in patients with coexisting interstitial lung disease. Considerations on pathologic confirmation, surveillance and multiple primaries are also addressed. SUMMARY SABR is an effective and safe treatment for inoperable ES-NSCLC. Ongoing trials and comparative effectiveness research will help to clarify SABR's role in various lung cancer indications going forward.
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Berman AT, Jabbour SK, Vachani A, Robinson C, Choi JI, Mohindra P, Rengan R, Bradley J, Simone CB. Empiric Radiotherapy for Lung Cancer Collaborative Group multi-institutional evidence-based guidelines for the use of empiric stereotactic body radiation therapy for non-small cell lung cancer without pathologic confirmation. Transl Lung Cancer Res 2019; 8:5-14. [PMID: 30788230 PMCID: PMC6351405 DOI: 10.21037/tlcr.2018.12.12] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 12/20/2018] [Indexed: 12/15/2022]
Abstract
The standard of care for managing early stage non-small cell lung cancer (NSCLC) is definitive surgical resection. Stereotactic body radiation therapy (SBRT) has become the standard treatment for patient who are medically inoperable, and it is increasingly being considered as an option in operable patients. With the growing use of screening thoracic CT scans for patients with a history of heavy smoking, as well as improved imaging capabilities, the discovery of small lung nodes has become a common dilemma. As a result, clinicians are increasingly faced with managing lung nodules in patients in whom diagnostic biopsy is not safe or feasible. Herein, we describe the scope of the problem, tools available for predicting the probability that a lung nodule is a malignancy, staging procedures, benefits of pathology-proven and empiric SBRT, considerations of safety based on location of the lesion of concern, and overall efficacy of SBRT.
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Affiliation(s)
- Abigail T. Berman
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Salma K. Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA
| | - Anil Vachani
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Cliff Robinson
- Department of Radiation Oncology, Washington University, St. Louis, MO, USA
| | - J. Isabelle Choi
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Pranshu Mohindra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ramesh Rengan
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - Jeffrey Bradley
- Department of Radiation Oncology, Washington University, St. Louis, MO, USA
| | - Charles B. Simone
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
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Cost-effectiveness analysis of stereotactic body radiotherapy and surgery for medically operable early stage non small cell lung cancer. Radiother Oncol 2018; 128:534-540. [PMID: 29706462 DOI: 10.1016/j.radonc.2018.04.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 03/28/2018] [Accepted: 04/10/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Projections estimate an increase of 50% of the incidence of lung cancer by 2030. Early-stage non-small cell lung cancer represented 19% of NSCLC cases diagnosed in the US between 2005 and 2011. There is rising evidence in favour of lung cancer screening, which will reduce the occurrence of later-stage lung cancers while raising the incidence of early-stage NSCLC. Current guidelines state that for early-stage NSCLC, surgical resection should be performed, and stereotactic body radiotherapy (SBRT) is an option for patients who are non-medically operable. In this study, we compared the cost-effectiveness of SBRT with lobectomy in medically operable patients. METHODS We developed a Markov model based on the survival results of two randomized studies comparing SBRT and video assisted thoracoscopic surgery (VATS) lobectomy in early-stage NSCLC, to describe survival and treatment related complications of patients treated for early-stage NSCLC. This analysis was conducted from the French payer perspective on a lifetime perspective. Utility values, recurrence risks, and costs were adapted from the literature. Deterministic (DSA) and probabilistic (PSA) sensitivity analyses were performed to assess the influence of the assumptions made. RESULTS The Markov model developed was consistent with survival data reported in the pool analysis of the randomized studies. SBRT and lobectomy total costs were 9,234.15€ and 10,726.98€, respectively, and the quality-adjusted life expectancies were 16.35 and 15.80 QALYs, respectively. The DSA, run on every assumption made, revealed that the incremental cost-effectiveness ratio was mainly sensitive to the decrement of utility caused by treatment related complications and initial cost of both surgery and SBRT. The PSA showed that SBRT had the highest probability of cost-effectiveness compared to lobectomy. CONCLUSIONS This is the first medico-economic study evaluating SBRT and lobectomy in stage I NSCLC based on randomized studies, and our analyses suggest that SBRT is dominant over lobectomy in operable early-stage NSCLC treatment. Deterministic and probabilistic sensitivity analyses confirmed that this result was robust and that it was not modified by the assumptions made in the Markov model building.
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16
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Weder W, Moghanaki D, Stiles B, Siva S, Rocco G. The great debate flashes: surgery versus stereotactic body radiotherapy as the primary treatment of early-stage lung cancer. Eur J Cardiothorac Surg 2017; 53:295-305. [DOI: 10.1093/ejcts/ezx410] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/23/2017] [Accepted: 10/28/2017] [Indexed: 12/25/2022] Open
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17
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Gauvreau CL, Fitzgerald NR, Memon S, Flanagan WM, Nadeau C, Asakawa K, Garner R, Miller AB, Evans WK, Popadiuk CM, Wolfson M, Coldman AJ. The OncoSim model: development and use for better decision-making in Canadian cancer control. ACTA ACUST UNITED AC 2017; 24:401-406. [PMID: 29270052 DOI: 10.3747/co.24.3850] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The Canadian Partnership Against Cancer was created in 2007 by the federal government to accelerate cancer control across Canada. Its OncoSim microsimulation model platform, which consists of a suite of specific cancer models, was conceived as a tool to augment conventional resources for population-level policy- and decision-making. The Canadian Partnership Against Cancer manages the OncoSim program, with funding from Health Canada and model development by Statistics Canada. Microsimulation modelling allows for the detailed capture of population heterogeneity and health and demographic history over time. Extensive data from multiple Canadian sources were used as inputs or to validate the model. OncoSim has been validated through expert consultation; assessments of face validity, internal validity, and external validity; and model fit against observed data. The platform comprises three in-depth cancer models (lung, colorectal, cervical), with another in-depth model (breast) and a generalized model (25 cancers) being in development. Unique among models of its class, OncoSim is available online for public sector use free of charge. Users can customize input values and output display, and extensive user support is provided. OncoSim has been used to support decision-making at the national and jurisdictional levels. Although simulation studies are generally not included in hierarchies of evidence, they are integral to informing cancer control policy when clinical studies are not feasible. OncoSim can evaluate complex intervention scenarios for multiple cancers. Canadian decision-makers thus have a powerful tool to assess the costs, benefits, cost-effectiveness, and budgetary effects of cancer control interventions when faced with difficult choices for improvements in population health and resource allocation.
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Affiliation(s)
- C L Gauvreau
- Health Economics, Canadian Partnership Against Cancer, Toronto, ON
| | - N R Fitzgerald
- Health Economics, Canadian Partnership Against Cancer, Toronto, ON
| | - S Memon
- Health Economics, Canadian Partnership Against Cancer, Toronto, ON
| | | | - C Nadeau
- Health Analysis, Statistics Canada, Ottawa, ON
| | - K Asakawa
- Health Analysis, Statistics Canada, Ottawa, ON
| | - R Garner
- Health Analysis, Statistics Canada, Ottawa, ON
| | - A B Miller
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - W K Evans
- Department of Oncology, McMaster University, Hamilton, ON
| | - C M Popadiuk
- Faculty of Medicine, Memorial University, St. John's, NL
| | - M Wolfson
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON
| | - A J Coldman
- Cancer Control Research, BC Cancer Research Centre, Vancouver, BC
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Treatment-Related Toxicity in Patients With Early-Stage Non-Small Cell Lung Cancer and Coexisting Interstitial Lung Disease: A Systematic Review. Int J Radiat Oncol Biol Phys 2017; 98:622-631. [DOI: 10.1016/j.ijrobp.2017.03.010] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/20/2017] [Accepted: 03/07/2017] [Indexed: 01/20/2023]
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19
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Bahig H, Chen H, Louie AV. Surgery versus SABR for early stage non-small cell lung cancer: the moving target of equipoise. J Thorac Dis 2017; 9:953-956. [PMID: 28523146 DOI: 10.21037/jtd.2017.03.80] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Hanbo Chen
- Department of Radiation Oncology, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada
| | - Alexander V Louie
- Department of Radiation Oncology, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada
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20
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Hopmans W, Damman OC, Porsius JT, Zwaan L, Senan S, Timmermans DRM. Treatment recommendations by clinicians in stage I non-small cell lung cancer: A study of factors that influence the likelihood of accounting for the patient's preference. PATIENT EDUCATION AND COUNSELING 2016; 99:1808-1813. [PMID: 27372523 DOI: 10.1016/j.pec.2016.05.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 05/25/2016] [Accepted: 05/28/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Surgery and stereotactic ablative radiotherapy (SABR) are both curative treatment options for patients with stage I non-small cell lung cancer (NSCLC). Shared decision making (SDM) has been advocated in this patient group. This study explored clinician decision making in relation to the stated treatment preferences of patients. METHODS In a previous study, we conducted a binary choice experiment with hypothetical cases among 126 clinicians. Secondary data analysis was performed using multilevel logistic regression models, in which random differences between clinicians' decisions were taken into account. We analyzed the influence of patient- and clinician-related characteristics, and uncertainty as experienced by clinicians about their recommendation on the clinician's decision (either in line with the patient's preference or not). RESULTS Significant interactions were observed between patient- and clinician-related characteristics, indicating that patient preferences were selectively taken into account, depending on clinicians' specialty, their views about the comparability of cancer-related outcomes following surgery and SABR, and the degree of uncertainty about the treatment recommendation. CONCLUSIONS Our findings suggest that SDM for stage I NSCLC care is largely influenced by how clinicians weigh available scientific evidence. PRACTICE IMPLICATIONS Clinicians should involve lung cancer patients more and ask for their preferences in making treatment recommendations.
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Affiliation(s)
- Wendy Hopmans
- Department of Public and Occupational Health, EMGO+ Institute for Health and care research, VU University medical center, Amsterdam, The Netherlands; Department of Radiation Oncology, VU University medical center, Amsterdam, The Netherlands
| | - Olga C Damman
- Department of Public and Occupational Health, EMGO+ Institute for Health and care research, VU University medical center, Amsterdam, The Netherlands
| | - Jarry T Porsius
- Department of Public and Occupational Health, EMGO+ Institute for Health and care research, VU University medical center, Amsterdam, The Netherlands
| | - Laura Zwaan
- Institute of Medical Education Research Rotterdam, Erasmus MC, The Netherlands, The Netherlands
| | - Suresh Senan
- Department of Radiation Oncology, VU University medical center, Amsterdam, The Netherlands
| | - Danielle R M Timmermans
- Department of Public and Occupational Health, EMGO+ Institute for Health and care research, VU University medical center, Amsterdam, The Netherlands.
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SABR vs. Limited Resection for Non-small Cell Lung Cancer: Are We Closer to an Answer? Curr Treat Options Oncol 2016; 17:27. [DOI: 10.1007/s11864-016-0407-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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22
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Siva S, Ball D. Curing Operable Stage I Non-Small Cell Lung Cancer With Stereotactic Ablative Body Radiotherapy: The Force Awakens. Oncologist 2016; 21:393-8. [PMID: 26984447 PMCID: PMC4828125 DOI: 10.1634/theoncologist.2015-0477] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 02/02/2016] [Indexed: 12/25/2022] Open
Abstract
In 2016, surgery is the standard of care for peripheral stage I non-small cell lung cancer. However, recent thought-provoking randomized evidence suggests stereotactic ablative body radiotherapy (SABR) has survival outcomes similar to those of surgery. Albeit limited, patient-reported outcomes and quality of life suggest that SABR compares favorably to surgery because it is noninvasive and associated with relatively few treatment-related complications. This article explores the current scientific landscape of surgery and SABR in this patient cohort.
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Affiliation(s)
- Shankar Siva
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - David Ball
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
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23
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A comparison between accelerated hypofractionation and stereotactic ablative radiotherapy (SABR) for early-stage non-small cell lung cancer (NSCLC): Results of a propensity score-matched analysis. Radiother Oncol 2016; 118:478-84. [DOI: 10.1016/j.radonc.2015.12.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 12/19/2015] [Accepted: 12/25/2015] [Indexed: 12/25/2022]
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Chehade S, Palma DA. Stereotactic radiotherapy for early lung cancer: Evidence-based approach and future directions. Rep Pract Oncol Radiother 2015; 20:403-10. [PMID: 26696779 PMCID: PMC4661348 DOI: 10.1016/j.rpor.2014.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 10/29/2014] [Accepted: 11/17/2014] [Indexed: 12/25/2022] Open
Abstract
AIM To review key studies evaluating stereotactic radiotherapy in the setting of early-stage non-small cell lung cancer (NSCLC) for inoperable or high-risk patients, and discuss areas of ongoing research and clinical trials. BACKGROUND The use of stereotactic radiotherapy for the treatment of early stage non-small cell lung cancer (NSCLC) has increased rapidly over the past decade. Numerous studies have reported outcomes for patients treated with SBRT who are unfit for surgical resection, or at high risk of surgical complications. MATERIALS AND METHODS A narrative review. RESULTS The preponderance of evidence suggests that SBRT is associated with excellent local control (∼90% at 3 years) and a favorable toxicity profile. In patients with higher operative risks, such as the elderly and patients with severe COPD, SBRT may provide a less-toxic treatment than surgery with similar oncologic outcomes. Ongoing studies are evaluating the use of SBRT for locally advanced or oligometastatic NSCLC. CONCLUSIONS A large body of evidence now exists to support the use of SBRT for early-stage NSCLC. Decisions regarding the optimal choice of treatment should be individualized, and made in the context of a multidisciplinary team.
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Affiliation(s)
- Samer Chehade
- Faculty of Medicine, University of Western Ontario, London, ON, Canada
| | - David A. Palma
- Faculty of Medicine, University of Western Ontario, London, ON, Canada
- Department of Radiation Oncology, London Health Sciences Centre, London, ON, Canada
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Louie AV, van Werkhoven E, Chen H, Smit EF, Paul MA, Widder J, Groen HJ, van den Borne BE, De Jaeger K, Slotman BJ, Senan S. Patient reported outcomes following stereotactic ablative radiotherapy or surgery for stage IA non-small-cell lung cancer: Results from the ROSEL multicenter randomized trial. Radiother Oncol 2015; 117:44-8. [DOI: 10.1016/j.radonc.2015.08.011] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 08/11/2015] [Accepted: 08/11/2015] [Indexed: 12/31/2022]
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Liu HW, Gabos Z, Ghosh S, Roberts B, Lau H, Kerba M. Outcomes in stage I non-small cell lung cancer following the introduction of stereotactic body radiotherapy in Alberta - A population-based study. Radiother Oncol 2015; 117:71-6. [PMID: 26349589 DOI: 10.1016/j.radonc.2015.08.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 08/17/2015] [Accepted: 08/22/2015] [Indexed: 12/25/2022]
Abstract
PURPOSE To review outcomes of patients with stage I non-small cell lung cancer (NSCLC) following the introduction of stereotactic body radiation therapy (SBRT). METHODS SBRT cases were linked to the cancer registry database along with clinical, treatment and health service parameters for n=2146 cases of stage I NSCLC diagnosed between 2005 and 2011. The pre-diagnosis Aggregated Clinical Risk Grouping score (ACRG3) was used as a proxy for pre-treatment patient comorbidity. A Cox regression model and the concordance statistic (C-statistic) were used to examine variables predicted for overall survival (OS). RESULTS The SBRT utilization rate increased annually with superior OS to conventional RT (median survival [MS] of 39.4 VS. 23.5months, P<0.001) despite higher ACRG3 scores. Surgical patients were younger, had lower ACRG3, achieving MS of 69.6months. Regression analysis indicated both Surgery (hazard ratio [HR]=0.23, 95% CI: 0.18-0.28) and SBRT (HR=0.33, 95% CI: 0.21-0.51) remained most strongly associated with OS. ACRG3 (HR=0.79, P<0.001) and age (HR=0.83, P=0.03) were independently associated with OS. The OS model was associated with the C-statistic at 0.86, 95% CI: 0.81-0.90. CONCLUSION In stage I NSCLC patients treated with surgery have the best survival. SBRT demonstrates improved OS compared to conventional RT. C-statistic result demonstrates discrimination of treatment selection factors on OS.
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Affiliation(s)
- Hong-Wei Liu
- Central Alberta Cancer Centre, Red Deer, Canada; Department of Oncology, University of Alberta, Canada; Department of Oncology, University of Calgary, Canada.
| | - Zsolt Gabos
- Cross Cancer Institute, Edmonton, Canada; Department of Oncology, University of Alberta, Canada
| | - Sunita Ghosh
- Cross Cancer Institute, Edmonton, Canada; Department of Oncology, University of Alberta, Canada
| | - Barbara Roberts
- Data Integration, Measurement & Reporting, Alberta Health Services, Canada
| | - Harold Lau
- Tom Baker Cancer Centre, Calgary, Canada; Department of Oncology, University of Calgary, Canada
| | - Marc Kerba
- Tom Baker Cancer Centre, Calgary, Canada; Department of Oncology, University of Calgary, Canada
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Walters S, Benitez-Majano S, Muller P, Coleman MP, Allemani C, Butler J, Peake M, Guren MG, Glimelius B, Bergström S, Påhlman L, Rachet B. Is England closing the international gap in cancer survival? Br J Cancer 2015; 113:848-60. [PMID: 26241817 PMCID: PMC4559829 DOI: 10.1038/bjc.2015.265] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 06/19/2015] [Accepted: 06/24/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND We provide an up-to-date international comparison of cancer survival, assessing whether England is 'closing the gap' compared with other high-income countries. METHODS Net survival was estimated using national, population-based, cancer registrations for 1.9 million patients diagnosed with a cancer of the stomach, colon, rectum, lung, breast (women) or ovary in England during 1995-2012. Trends during 1995-2009 were compared with estimates for Australia, Canada, Denmark, Norway and Sweden. Clinicians were interviewed to help interpret trends. RESULTS Survival from all cancers remained lower in England than in Australia, Canada, Norway and Sweden by 2005-2009. For some cancers, survival improved more in England than in other countries between 1995-1999 and 2005-2009; for example, 1-year survival from stomach, rectal, lung, breast and ovarian cancers improved more than in Australia and Canada. There has been acceleration in lung cancer survival improvement in England recently, with average annual improvement in 1-year survival rising to 2% during 2010-2012. Survival improved more in Denmark than in England for rectal and lung cancers between 1995-1999 and 2005-2009. CONCLUSIONS Survival has increased in England since the mid-1990s in the context of strategic reform in cancer control, however, survival remains lower than in comparable developed countries and continued investment is needed to close the international survival gap.
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Affiliation(s)
- Sarah Walters
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Sara Benitez-Majano
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Patrick Muller
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Michel P Coleman
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Claudia Allemani
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - John Butler
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
- Department of Gynaecological Oncology, Royal Marsden Hospital, London SW3 6JJ, UK
| | - Mick Peake
- Glenfield Hospital, University Hospitals of Leicester, Groby Road, Leicester LE3 9QP, UK
| | - Marianne Grønlie Guren
- Department of Oncology, Oslo University Hospital, Ullevaal, PO Box 4956, Nydalen, NO-0424 Oslo, Norway
- K. G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, PO Box 4953, Nydalen, NO-0424 Oslo, Norway
| | - Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Akademiska sjukhuset, SE-751 85 Uppsala, Sweden
| | | | - Lars Påhlman
- Department of Surgical Sciences, Uppsala University, Akademiska sjukhuset, SE-751 85 Uppsala, Sweden
| | - Bernard Rachet
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Simone CB, Dorsey JF. Additional data in the debate on stage I non-small cell lung cancer: surgery versus stereotactic ablative radiotherapy. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:172. [PMID: 26366389 PMCID: PMC4543325 DOI: 10.3978/j.issn.2305-5839.2015.07.26] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 07/23/2015] [Indexed: 12/25/2022]
Abstract
Lobectomy has been the standard of care for patients with early stage non-small cell lung cancer (NSCLC), resulting in nearly universal local control and excellent overall survival. However, up to one-quarter of early stage patients are unable to undergo or refuse definitive resection. With the increasing adoption of stereotactic ablative radiotherapy (SABR) over conventionally fractionated radiotherapy among medical inoperable patients, tumor control and overall survival rates in this population have significantly improved. Trials demonstrating excellent outcomes among both medically inoperable and medical operable patients with stage I NSCLC have spurred interest in comparisons between surgery and SABR. The recent publication of the randomized STARS and ROSEL trials demonstrated fewer toxicities and an improvement in overall survival among patients treated with SABR compared with surgery. Based on these trials and retrospective comparisons between the modalities, definitive SABR now more firmly appears to be a viable first-line option for treating patients with operable stage I NSCLC.
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Affiliation(s)
- Charles B Simone
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Jay F Dorsey
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, USA
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Chaudhuri AA, Tang C, Binkley MS, Jin M, Wynne JF, von Eyben R, Hara WY, Trakul N, Loo BW, Diehn M. Stereotactic ablative radiotherapy (SABR) for treatment of central and ultra-central lung tumors. Lung Cancer 2015; 89:50-6. [PMID: 25997421 DOI: 10.1016/j.lungcan.2015.04.014] [Citation(s) in RCA: 134] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 04/26/2015] [Accepted: 04/27/2015] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Treatment of central and ultra-central lung tumors with stereotactic ablative radiotherapy (SABR) remains controversial due to risks of treatment-related toxicities compared with peripheral tumors. Here we report our institution's experience in treating central and ultra-central lung tumor patients with SABR. MATERIALS AND METHODS We retrospectively reviewed outcomes in 68 patients with single lung tumors, 34 central and 34 peripheral, all treated with SABR consisting of 50 Gy in 4-5 fractions. Tumor centrality was defined per the RTOG 0813 protocol. We defined "ultra-central" tumors as those with GTV directly abutting the central airway. RESULTS Median follow-up time was 18.4 months and median overall survival was 38.1 months. Two-year overall survival was similar between ultra-central, central, and peripheral NSCLC (80.0% vs. 63.2% vs. 86.6%, P=0.62), as was 2-year local failure (0% vs. 10.0% vs. 16.3%, P=0.64). Toxicity rates were low and comparable between the three groups, with only two cases of grade 3 toxicity (chest wall pain), and one case of grade 4 toxicity (pneumonitis) observed. Patients with ultra-central tumors experienced no symptomatic toxicities over a median follow-up time of 23.6 months. Dosimetric analysis revealed that RTOG 0813 central airway dose constraints were frequently not achieved in central tumor treatment plans, but this did not correlate with increased toxicity rate. CONCLUSION Patients with central and ultra-central lung tumors treated with SABR (50 Gy in 4-5 fractions) experienced few toxicities and good outcomes, similar to patients with peripheral lung tumors.
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Affiliation(s)
- Aadel A Chaudhuri
- Department of Radiation Oncology, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA 94305, USA
| | - Chad Tang
- Department of Radiation Oncology, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA 94305, USA
| | - Michael S Binkley
- Department of Radiation Oncology, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA 94305, USA
| | - Michelle Jin
- Department of Radiation Oncology, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA 94305, USA
| | - Jacob F Wynne
- Department of Radiation Oncology, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA 94305, USA
| | - Rie von Eyben
- Department of Radiation Oncology, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA 94305, USA
| | - Wendy Y Hara
- Department of Radiation Oncology, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA 94305, USA; Stanford Cancer Institute, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA 94305, USA
| | - Nicholas Trakul
- Department of Radiation Oncology, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA 94305, USA
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA 94305, USA; Stanford Cancer Institute, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA 94305, USA.
| | - Maximilian Diehn
- Department of Radiation Oncology, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA 94305, USA; Stanford Cancer Institute, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA 94305, USA; Institute for Stem Cell Biology & Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA.
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Stereotactic Body Radiotherapy. Clin Oncol (R Coll Radiol) 2015; 27:249-50. [PMID: 25724265 DOI: 10.1016/j.clon.2015.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 01/05/2015] [Indexed: 12/31/2022]
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Louie AV, Palma DA, Dahele M, Rodrigues GB, Senan S. Management of early-stage non-small cell lung cancer using stereotactic ablative radiotherapy: Controversies, insights, and changing horizons. Radiother Oncol 2015; 114:138-47. [DOI: 10.1016/j.radonc.2014.11.036] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 11/18/2014] [Accepted: 11/20/2014] [Indexed: 12/17/2022]
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