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Li L, Fu L, Li H, Liu T, Sun J. Emerging trends and patterns in healthcare-seeking behavior: A systematic review. Medicine (Baltimore) 2024; 103:e37272. [PMID: 38394511 DOI: 10.1097/md.0000000000037272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVES The study of healthcare-seeking behavior is essential for optimizing resource allocation and improving healthcare services. Its complexity and diversity have made it a prominent research area. Understanding factors influencing healthcare-seeking decisions allows targeted interventions and policy development to address barriers and ensure equitable access to quality healthcare for diverse populations. Such research plays a vital role in enhancing healthcare outcomes and overall population health. METHODS The study utilized a systematic quantitative literature review approach, employing the Web of Science (WOS) Core Collection and PubMed databases as data sources. Additionally, bibliometric tools such as CiteSpace and VOSviewer were employed for analysis and visualization of the literature. RESULTS A comprehensive statistical analysis and visualization were performed on the annual publication volume, publication countries, journals, keywords, and keyword co-occurrence patterns up until 2023. Through this analysis, a framework was established, identifying the determinants and fundamental elements of healthcare-seeking behavior. These findings contribute to the advancement of research in this field and inform future studies and interventions aimed at improving healthcare-seeking behavior. CONCLUSIONS Based on the aforementioned literature review and framework, several conclusions were drawn. The determinants that facilitate healthcare-seeking behavior include improving health education awareness, enhancing healthcare resources, reducing costs, and ensuring system soundness. Additionally, providing social environment support was found to be crucial. Furthermore, the fundamental elements of healthcare-seeking behavior were identified as healthcare demand, healthcare choices, and the process of diagnosis and treatment. These findings provide valuable insights for developing interventions and policies to promote optimal healthcare-seeking behavior.
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Affiliation(s)
- Limin Li
- School of Health Care Management, Anhui Medical University, Hefei, China
| | - Li Fu
- School of Health Care Management, Anhui Medical University, Hefei, China
| | - Hui Li
- School of Health Care Management, Anhui Medical University, Hefei, China
| | - Tong Liu
- School of Health Care Management, Anhui Medical University, Hefei, China
| | - Jiangjie Sun
- School of Health Care Management, Anhui Medical University, Hefei, China
- School of Management, Hefei University of Technology, Hefei, China
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Kowal M, Douglas F, Jayne D, Meads D. Patient choice in colorectal cancer treatment - A systematic review and narrative synthesis of attribute-based stated preference studies. Colorectal Dis 2022; 24:1295-1307. [PMID: 35776854 PMCID: PMC9796068 DOI: 10.1111/codi.16242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 06/14/2022] [Accepted: 06/27/2022] [Indexed: 12/30/2022]
Abstract
AIM The global burden of colorectal cancer (CRC) is set to increase by 60% by 2030. An aging population and increasing treatment complexity add difficulties for patients and clinicians in CRC management. Patient preferences can be investigated using attribute-based stated preference (AbSP) techniques to explore trade-offs between different treatments. These techniques include discrete-choice experiments (DCEs), conjoint analysis and time-trade off (TTO) methods. This systematic review with a narrative synthesis aimed to determine the use and design of AbSP studies in CRC treatment and to identify patient choice themes. METHODS The searches were performed using MEDLINE, Embase, PsycInfo and Cochrane Library in March 2021. All manuscripts featuring the use of AbSP techniques in CRC treatment were included. Data synthesis was performed using a narrative approach. RESULTS The search strategy returned 271 articles. Eighteen AbSP studies were included featuring 1890 patients and 296 clinicians. AbSP techniques compromised DCE (38.9%, n = 7), TTO (38.9%, n = 7) and conjoint analysis (22.2%, n = 4). Eleven studies (61.1%) involved piloting of tasks and the average task completion rate was 75%. CRC treatments included chemotherapy (33%, n = 6), combined treatments (33%, n = 6), surgery (17%, n = 3), targeted therapy (11%, n = 2) and radiotherapy (6%, n = 1). The most examined domain was physical health, investigated with 49 (59.8%) attributes. CONCLUSIONS Life expectancy was the main attribute in chemotherapy treatment. With surgery, patients were willing to trade life-expectancy to avoid adverse outcomes or a permanent stoma. Communication skills, treatment cost, and clinicians' views were important attributes for patients in cancer services. Further research in the elderly population, and other quality of life domains, are needed to deliver patient-centred CRC care.
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Affiliation(s)
- Mikolaj Kowal
- The John Goligher Colorectal Surgery UnitSt. James's University HospitalLeedsUK,Leeds Institute of Medical Research, Faculty of Medicine and HealthUniversity of LeedsLeedsUK
| | - Francesca Douglas
- The John Goligher Colorectal Surgery UnitSt. James's University HospitalLeedsUK,Leeds Institute of Medical Research, Faculty of Medicine and HealthUniversity of LeedsLeedsUK
| | - David Jayne
- The John Goligher Colorectal Surgery UnitSt. James's University HospitalLeedsUK,Leeds Institute of Medical Research, Faculty of Medicine and HealthUniversity of LeedsLeedsUK
| | - David Meads
- Leeds Institute for Health SciencesUniversity of LeedsLeedsUK
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Yong ASJ, Lim YH, Cheong MWL, Hamzah E, Teoh SL. Willingness-to-pay for cancer treatment and outcome: a systematic review. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:1037-1057. [PMID: 34853930 DOI: 10.1007/s10198-021-01407-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 11/03/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Understanding patient preferences in cancer management is essential for shared decision-making. Patient or societal willingness-to-pay (WTP) for desired outcomes in cancer management represents their preferences and values of these outcomes. OBJECTIVE The aim of this systematic review is to critically evaluate how current literature has addressed WTP in relation to cancer treatment and achievement of outcomes. METHODS Seven databases were searched from inception until 2 March 2021 to include studies with primary data of WTP values for cancer treatments or achievement of outcomes that were elicited using stated preference methods. RESULTS Fifty-four studies were included in this review. All studies were published after year 2000 and more than 90% of the studies were conducted in high-income countries. Sample size of the studies ranged from 35 to 2040, with patient being the most studied population. There was a near even distribution between studies using contingent valuation and discrete choice experiment. Based on the included studies, the highest WTP values were for a quality-adjusted life year (QALY) ($11,498-$589,822), followed by 1-year survival ($3-$198,576), quality of life (QoL) improvement ($5531-$139,499), and pain reduction ($79-$94,662). Current empirical evidence suggested that improvement in QoL and pain reduction had comparable weights to survival in cancer management. CONCLUSION This systematic review provides a summary on stated preference studies that elicited patient preferences via WTP and summarised their respective values. Respondents in this review had comparable WTP for 1-year survival and QoL, suggesting that improvement in QoL should be emphasised together with survival in cancer management.
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Affiliation(s)
- Alene Sze Jing Yong
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia
| | - Yi Heng Lim
- School of Biosciences, Taylor's University, Subang Jaya, Selangor, Malaysia
| | - Mark Wing Loong Cheong
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia
| | | | - Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia.
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Bordonaro R, Piazza D, Sergi C, Cordio S, Tomaselli S, Gebbia V. Out-of-pocket costs in gastrointestinal cancer patients: Lack of a perfectly framed problem contributing to financial toxicity. Crit Rev Oncol Hematol 2021; 167:103501. [PMID: 34673219 DOI: 10.1016/j.critrevonc.2021.103501] [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: 06/01/2020] [Revised: 08/15/2021] [Accepted: 10/10/2021] [Indexed: 12/01/2022] Open
Abstract
Fighting cancer is an economically expensive challenge for both health care payers, and the patients and their families and the median costs for cancer care are rapidly increasing in the last decade. Although both direct and indirect costs of medical assistance have been a frequent source of distress and contention, however analysis of the non-medical expenses incurred directly by cancer patients has not received adequate attention. Developing a deeper understanding of so-called "out-of-pocket" costs may be necessary. Out-of-pocket costs for medical care range from 7 % to 11 % of medical costs for all payers. However, the range of out-of-pocket costs shows considerable variability in different studies. In this review, we reviewed available data concerning direct and indirect medical costs, including psychosocial ones.
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Affiliation(s)
- Roberto Bordonaro
- Medical Oncology Unit, Azienda Ospedaliera di Rilievo Nazionale e Alta Specializzazione (ARNAS), Ospedale Garibaldi, Catania, Italy
| | - Dario Piazza
- GSTU Foundation for Cancer Research, Palermo, Italy
| | - Concetta Sergi
- Medical Oncology Unit, Azienda Ospedaliera di Rilievo Nazionale e Alta Specializzazione (ARNAS), Ospedale Garibaldi, Catania, Italy
| | - Stefano Cordio
- Medical Oncology Unit - Azienda Ospedaliera Provinciale 7, Ragusa, Italy
| | | | - Vittorio Gebbia
- Medical Oncology and Supportive Care Unit, La Maddalena Cancer Center, Palermo, Italy; PROMISE Department - University of Palermo, Palermo, Italy.
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Quantitative Preferences for Lung Cancer Treatment from the Patients' Perspective: A Systematic Review. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 13:521-536. [PMID: 32686052 DOI: 10.1007/s40271-020-00434-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Regulatory agencies as well as private organizations pursue programs that advocate patient centricity and emphasize the importance of dialog with patients. Various methods are applied to elicit the preferences of patients regarding the aspects of treatment they lend more importance to. Decisions on treatment choices are critical to patients with lung cancer because of their poor prognosis and the serious trade-off between safety and efficacy in traditional cytotoxic chemotherapy. METHODS We conducted a systematic literature review of quantitative patient preference studies of patients with lung cancer. Our exhaustive search of MEDLINE, CINAHL, EMBASE, PLOS, and SpringerLink identified 15 relevant studies published from January 2000 to April 2020 that enabled us to assess the relative importance of treatment attributes according to lung cancer patients' perspective. RESULTS The literature review revealed that patients with lung cancer tend to place a higher weight on efficacy and quality of life (QoL) attributes than on other attributes. Overall survival was found to be the most important among the efficacy attributes. The consequences of adverse events seemed less important than the possible efficacy from therapies. The clinical utility of treatment, such as the route of administration, was generally not considered important. It remains inconclusive whether sociodemographic factors and/or medical history affect the relative importance of a patient's preference. CONCLUSION Our systematic review clarified that patients generally prefer a better efficacy profile to a better safety profile, which underscores the importance of improved benefits in anti-lung cancer drug development.
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Aogi K, Takeuchi H, Saeki T, Aiba K, Tamura K, Iino K, Imamura CK, Okita K, Kagami Y, Tanaka R, Nakagawa K, Fujii H, Boku N, Wada M, Akechi T, Iihara H, Ohtani S, Okuyama A, Ozawa K, Kim YI, Sasaki H, Shima Y, Takeda M, Nagasaki E, Nishidate T, Higashi T, Hirata K. Optimizing antiemetic treatment for chemotherapy-induced nausea and vomiting in Japan: Update summary of the 2015 Japan Society of Clinical Oncology Clinical Practice Guidelines for Antiemesis. Int J Clin Oncol 2021; 26:1-17. [PMID: 33161452 PMCID: PMC7788035 DOI: 10.1007/s10147-020-01818-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/16/2020] [Indexed: 01/07/2023]
Abstract
Patients with cancer should appropriately receive antiemetic therapies against chemotherapy-induced nausea and vomiting (CINV). Antiemetic guidelines play an important role in managing CINV. Accordingly, the first Japanese antiemetic guideline published in 2010 by the Japan Society of Clinical Oncology (JSCO) has considerably aided Japanese medical staff in providing antiemetic therapies across chemotherapy clinics. With the yearly advancements in antiemetic therapies, the Japanese antiemetic guidelines require revisions according to published evidence regarding antiemetic management worldwide. A revised version of the first antiemetic guideline that considered several upcoming evidences had been published online in 2014 (version 1.2), in which several updated descriptions were included. The 2015 JSCO clinical practice guideline for antiemesis (version 2.0) (in Japanese) has addressed clinical antiemetic concerns and includes four major revisions regarding (1) changes in emetogenic risk categorization for anti-cancer agents, (2) olanzapine usage as an antiemetic drug, (3) the steroid-sparing method, and (4) adverse drug reactions of antiemetic agents. We herein present an English update summary for the 2015 JSCO clinical practice guideline for antiemesis (version 2.0).
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Affiliation(s)
- Kenjiro Aogi
- Department of Breast Oncology, National Hospital Organization Shikoku Cancer Center, Ehime, Japan
| | - Hideki Takeuchi
- Department of Breast Oncology, Saitama Medical University, Saitama, Japan
- Department of Breast Surgical Oncology, Japan Organization of Occupational Health and Safety Yokohama Rosai Hospital, Yokohama, Japan
- Department of Breast Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Toshiaki Saeki
- Department of Breast Oncology, Saitama Medical University International Medical Center, Saitama, Japan.
| | - Keisuke Aiba
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
- Todachuo General Hospital, Saitama, Japan
| | - Kazuo Tamura
- General Medical Research Center, Fukuoka University Hospital, Fukuoka, Japan
| | - Keiko Iino
- Department of Adult Nursing, National College of Nursing, Tokyo, Japan
| | - Chiyo K Imamura
- Department of Clinical Pharmacokinetics and Pharmacodynamics, Keio University, Tokyo, Japan
- Advanced Cancer Translational Research Institute, Showa University, Tokyo, Japan
| | - Kenji Okita
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University Postgraduate School of Medicine, Sapporo, Hokkaido, Japan
- JR Sapporo Hospital, Sapporo, Hokkaido, Japan
| | - Yoshikazu Kagami
- Division of Radiation Oncology, Department of Radiology, Showa University School of Medicine, Tokyo, Japan
| | - Ryuhei Tanaka
- Department of Pediatric Hematology and Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Kazuhiko Nakagawa
- Department of Medical Oncology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Hirofumi Fujii
- Department of Clinical Oncology, Jichi Medical University, Tochigi, Japan
| | - Narikazu Boku
- Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Makoto Wada
- Department of Psycho-Oncology and Palliative Medicine, Osaka International Cancer Institute, Osaka, Japan
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | | | - Shoichiro Ohtani
- Department of Breast Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Ayako Okuyama
- Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Keiko Ozawa
- Department of Nursing, NTT Medical Center Tokyo, Tokyo, Japan
| | - Yong-Il Kim
- Department of Medical Oncology, Seirei Hamamatsu General Hospital, Sizuoka, Japan
- Department of Medical Oncology, Yodogawa Christian Hospital, Osaka, Japan
| | - Hidenori Sasaki
- Division of Medical Oncology, Hematology and Infectious Disease, Department of Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Ibaraki, Japan
| | - Masayuki Takeda
- Department of Medical Oncology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Eijiro Nagasaki
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
- Todachuo General Hospital, Saitama, Japan
| | - Toshihiko Nishidate
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University Postgraduate School of Medicine, Sapporo, Hokkaido, Japan
- JR Sapporo Hospital, Sapporo, Hokkaido, Japan
| | - Takahiro Higashi
- Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Kouichi Hirata
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University Postgraduate School of Medicine, Sapporo, Hokkaido, Japan
- JR Sapporo Hospital, Sapporo, Hokkaido, Japan
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Health Related Quality of Life of Cancer Patients in Ethiopia. JOURNAL OF ONCOLOGY 2018; 2018:1467595. [PMID: 29849628 PMCID: PMC5925207 DOI: 10.1155/2018/1467595] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 03/08/2018] [Indexed: 12/12/2022]
Abstract
Background Neoplasm, AKA cancer (Ca), is associated with major morbidity and mortality. Aim Measurement of health related quality of life (HRQoL) of Ca patients is uncommon in Ethiopia. The present study determined the HRQoL and its determinants among people living with Ca in north Ethiopia. Methods A prospective hospital based study was conducted from 1 January 2017 to 30 August 2017 on Ca patients attending cancer treatment center of University of Gondar Teaching Hospital. The European Organization for Research and Treatment of Cancer Questionnaire version 3 was utilized to collect the data. The rate of QoL was presented using means with standard deviation (±SD). Binary logistic regression was employed to determine factors associated with HRQoL. Result The present study is based on the findings from 150 subjects. The rate of QoL was 52.7 (20.1) (mean ± SD). The highest functional status was emotional functioning 61 (25.5). Patients with no disease metastasis, 92.1 (5.1), had high QoL as compared to metastasis, 22.1 (18.9) (p = 0.03). Patients with affected physical functioning have a 20% reduction in QoL and Adjusted Odds Ratio (AOR) of 0.794 [0.299-891]. Patients with low satisfaction level with the provided care, 0.82 [0.76-0.93], and those with unmet needs, 0.85 [0.80-0.95], experienced reduced level of HRQoL. Conclusion Health related quality of life of cancer patients was found to be low in Ethiopia. Patients with limited rate of disease metastasis had improved HRQoL. Further, the unmet needs of Ca patients and the level of satisfaction with the overall care were found to influence the extent of HRQoL. Therefore, early detection of neoplasm to arrest metastasis is warranted in order to achieve better QoL. In addition, addressing the unmet needs of these patients and ensuring higher satisfaction rate are recommended to maintain adequate HRQoL.
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Bien DR, Danner M, Vennedey V, Civello D, Evers SM, Hiligsmann M. Patients' Preferences for Outcome, Process and Cost Attributes in Cancer Treatment: A Systematic Review of Discrete Choice Experiments. THE PATIENT 2017; 10:553-565. [PMID: 28364387 PMCID: PMC5605613 DOI: 10.1007/s40271-017-0235-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION As several studies have been conducted to elicit patients' preferences for cancer treatment, it is important to provide an overview and synthesis of these studies. This study aimed to systematically review discrete choice experiments (DCEs) about patients' preferences for cancer treatment and assessed the relative importance of outcome, process and cost attributes. METHODS A systematic literature review was conducted using PubMed and EMBASE to identify all DCEs investigating patients' preferences for cancer treatment between January 2010 and April 2016. Data were extracted using a predefined extraction sheet, and a reporting quality assessment was applied to all studies. Attributes were classified into outcome, process and cost attributes, and their relative importance was assessed. RESULTS A total of 28 DCEs were identified. More than half of the studies (56%) received an aggregate score lower than 4 on the PREFS (Purpose, Respondents, Explanation, Findings, Significance) 5-point scale. Most attributes were related to outcome (70%), followed by process (25%) and cost (5%). Outcome attributes were most often significant (81%), followed by process (73%) and cost (67%). The relative importance of outcome attributes was ranked highest in 82% of the cases where it was included, followed by cost (43%) and process (12%). CONCLUSION This systematic review suggests that attributes related to cancer treatment outcomes are the most important for patients. Process and cost attributes were less often included in studies but were still (but less) important to patients in most studies. Clinicians and decision makers should be aware that attribute importance might be influenced by level selection for that attribute.
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Affiliation(s)
- Daniela R Bien
- Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Marion Danner
- Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Vera Vennedey
- Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Daniele Civello
- Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Silvia M Evers
- Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, PO Box 6161, 6200 MD, Maastricht, The Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, PO Box 6161, 6200 MD, Maastricht, The Netherlands.
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Examining racial variation in antiemetic use and post-chemotherapy health care utilization for nausea and vomiting among breast cancer patients. Support Care Cancer 2016; 24:4839-4847. [PMID: 27465051 DOI: 10.1007/s00520-016-3338-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 07/10/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE Racial minority cancer patients may experience underuse of antiemetic medications to prevent chemotherapy-induced nausea and vomiting (CINV). In addition to its adverse implications for quality of life, antiemetic underuse may contribute to observed disparities in acute illness during chemotherapy. To understand the potential contribution of CINV prophylaxis to breast cancer disparities, we assessed racial variation in potent antiemetic use and post-chemotherapy utilization related to CINV and the relationship between the two. METHODS We used SEER-Medicare data to evaluate the health care utilization in the 14 days following chemotherapy initiation among black and white women receiving highly emetogenic chemotherapy for breast cancer. We used modified Poisson regression to assess the relationship between (1) race and CINV-related utilization and (2) NK1 use and CINV-related utilization, overall and stratified by race. We report adjusted risk ratios (aRR) and 95 % confidence intervals (CI). RESULTS The study included 1130 women. Black women were 11 % less likely than white women to use neurokinin-1 receptor antagonists (NK1s) for CINV prophylaxis (p = 0.02); however, they experienced fewer CINV-related encounters following chemotherapy (unadjusted RR = 0.63, 95 %CI = 0.40-0.99; p = 0.05). After adjustment for clinical covariates, estimates were similar but no longer statistically significant (p = 0.07). Among white women, NK1 use was associated with increased CINV-related utilization (aRR NK1 users vs. non-users: 1.35, 95 % CI = 1.07-1.69, p = 0.01), likely resulting from unmeasured confounders. CONCLUSION Black women were less likely to use NK1s- and CINV-related services. Racial variation in CINV-related services use may be partly explained by differential symptom reporting or access to care.
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Marshall DA, Deal K, Bombard Y, Leighl N, MacDonald KV, Trudeau M. How do women trade-off benefits and risks in chemotherapy treatment decisions based on gene expression profiling for early-stage breast cancer? A discrete choice experiment. BMJ Open 2016; 6:e010981. [PMID: 27256091 PMCID: PMC4893875 DOI: 10.1136/bmjopen-2015-010981] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 03/01/2016] [Accepted: 03/30/2016] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Gene expression profiling (GEP) of tumours informs baseline risk prediction, potentially affecting adjuvant chemotherapy decisions for women with early-stage breast cancer. Since only 15% will experience a recurrence, concerns have been raised about potential harms from overtreatment and high GEP costs in publicly funded healthcare systems. We aimed to estimate preferences and personal utility of GEP testing information and benefit-risk trade-offs in chemotherapy treatment decisions. DESIGN, SETTING AND INTERVENTION Based on literature review and findings from our qualitative research (focus groups, interviews with patients with breast cancer and medical oncologists), we developed a discrete choice experiment (DCE) survey and administered it via an internet panel. The DCE included 12 choice tasks with 5 attributes and 3 alternatives considering orthogonality, D-efficiency and level balance. PARTICIPANTS The DCE survey was administered to 1004 Canadian women from the general population. MAIN OUTCOME MEASURES Preferences were analysed using conditional logit and hierarchical Bayes and evaluated for goodness of fit. We conducted simulation analyses for alternative scenarios. RESULTS GEP test score indicating likely benefit from chemotherapy was the most important attribute. Doctor's clinical estimate of the risk of cancer returning, trust in your cancer doctor and side effects of chemotherapy (temporary and permanent) were relatively less important but showed significant differences among levels. In the scenario analyses, 78% were likely to choose chemotherapy in a high-risk scenario, 55% in a moderate-risk scenario and 33% in a low-risk scenario, with the other attributes held constant. A high GEP score was more important in influencing the choice of chemotherapy for those at intermediate clinical risk. CONCLUSIONS GEP testing information influences chemotherapy treatment decisions in early-stage breast cancer and varies depending on clinical risk. Clinicians should be aware of these differences and tailor the use of GEP testing accordingly.
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Affiliation(s)
- Deborah A Marshall
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Ken Deal
- DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada
| | - Yvonne Bombard
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Natasha Leighl
- Department of Medicine, University of Toronto,Toronto, Ontario, Canada
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Karen V MacDonald
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Maureen Trudeau
- University of Toronto,Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Hohenforst-Schmidt W, Zarogoulidis P, Stopek J, Vogl T, Hübner F, Turner JF, Browning R, Zarogoulidis K, Drevelegas A, Drevelegas K, Darwiche K, Freitag L, Rittger H. DDMC-p53 gene therapy with or without cisplatin and microwave ablation. Onco Targets Ther 2015; 8:1165-73. [PMID: 26056480 PMCID: PMC4446017 DOI: 10.2147/ott.s83794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Lung cancer remains the leading cause of death in cancer patients. Severe treatment side effects and late stage of disease at diagnosis continue to be an issue. We investigated whether local treatment using 2-diethylaminoethyl-dextran methyl methacrylate copolymer with p53 (DDMC-p53) with or without cisplatin and/or microwave ablation enhances disease control in BALBC mice. We used a Lewis lung carcinoma cell line to inoculate 140 BALBC mice, which were divided into the following seven groups; control, cisplatin, microwave ablation, DDMC-p53, DDMC-p53 plus cisplatin, DDMC-p53 plus microwave, and DDMC-p53 plus cisplatin plus microwave. Microwave ablation energy was administered at 20 W for 10 minutes. Cisplatin was administered as 1 mL/mg and the DDMC-p53 complex delivered was 0.5 mL. Increased toxicity was observed in the group receiving DDMC-p53 plus cisplatin plus microwave followed by the group receiving DDMC-p53 plus cisplatin. Infection after repeated treatment administration was a major issue. We conclude that a combination of gene therapy using DDMC-p53 with or without cisplatin and microwave is an alternative method for local disease control. However, more experiments are required in a larger model to identify the appropriate dosage profile.
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Affiliation(s)
| | - Paul Zarogoulidis
- Pulmonary Department-Oncology Unit, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Thomas Vogl
- Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Frankfurt, Germany
| | - Frank Hübner
- II Medical Clinic, Coburg Hospital, University of Wuerzburg, Coburg, Germany
| | - J Francis Turner
- Division of Interventional Pulmonology, Western Regional Medical Center, Goodyear, AZ ; Medical Oncology, Cancer Treatment Centers of America, Western Regional Medical Center, Goodyear, AZ
| | - Robert Browning
- Pulmonary and Critical Care Medicine, Interventional Pulmonology, National Naval Medical Center, Walter Reed Army Medical Center, Bethesda, MD, USA
| | - Konstantinos Zarogoulidis
- Pulmonary Department-Oncology Unit, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonis Drevelegas
- Radiology Department, Interbalkan European Medical Center, Thessaloniki, Greece
| | | | - Kaid Darwiche
- Department of interventional Pneumology, Ruhrlandklinik, University Hospital Essen, University of Essen-Duisburg, Essen, Germany
| | - Lutz Freitag
- Department of interventional Pneumology, Ruhrlandklinik, University Hospital Essen, University of Essen-Duisburg, Essen, Germany
| | - Harald Rittger
- Medical Clinic I, 'Fuerth Hospital, University of Erlangen, Erlangen, Germany
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