1
|
Xavier FD, de Farias DLC, Neto AEH, Ribeiro GN, de Araujo MAS, Carneiro TX, Baiocchi OCCG. Current perspectives on the management of refractory or relapsed classic hodgkin lymphoma in brazil: Balancing efficacy, safety, and tolerability. Oncotarget 2023; 14:977-994. [PMID: 38085126 PMCID: PMC10715043 DOI: 10.18632/oncotarget.28541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 11/06/2023] [Indexed: 12/18/2023] Open
Abstract
Classic Hodgkin lymphoma (CHL), which accounts for 90-95% of all cases of Hodgkin lymphoma, is the most frequent cancer in adolescents and the most frequent lymphoma in adolescents and young adults. Despite progressive improvements over past decades and the general sensitivity of CHL to frontline chemotherapy, approximately 10-15% of patients have refractory disease that either does not respond to such therapy or progresses after an initial partial response. In patients with refractory or relapsed disease, standard treatment until recently consisted mainly of salvage chemotherapy, in many cases followed by high-dose chemotherapy and autologous stem-cell transplantation. However, improved understanding of the pathobiology of CHL, coupled with the introduction of novel agents, has markedly changed the treatment landscape in the past decade. Although refractory or relapsed CHL continues to be challenging, the therapeutic landscape is undergoing profound changes brought about by novel agents, particularly brentuximab vedotin and immunotherapy. In this review, we discuss the most salient treatment options for adult patients with refractory or relapsed CHL, with a special focus on the Brazilian healthcare setting, which is constrained by inherent characteristics of this system. In the attempt to balance efficacy, safety and tolerability, practicing physicians must rely on clinical trials and on results from real-world studies, and use their own point of view and experience, as well as patient characteristics and previous therapy, to make treatment decisions for refractory or relapsed CHL.
Collapse
Affiliation(s)
- Flávia Dias Xavier
- Hospital Universitário de Brasília-Universidade de Brasília/Ebserh, Brasília, DF, Brazil
- Hospital DF Star, Oncologia D’Or, Rede D’Or, Brasília, DF, Brazil
| | | | | | | | | | | | | |
Collapse
|
2
|
Floriano FR, Boeira L, Biella CDA, Pereira VC, Carvalho M, Barreto JOM, Oliveira SMDVLD. Strategies to approach the judicialization of health in Brazil: an evidence brief. CIENCIA & SAUDE COLETIVA 2023. [DOI: 10.1590/1413-81232023281.09132022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Abstract This article seeks to identify and discuss evidence-informed options to address the judicialization of health. The Supporting Policy Relevant Reviews and Trials Tools were used to define the problem and the search strategy, which was carried out in the following databases: PubMed, Health Systems Evidence, Campbell, Cochrane Collaboration, Rx for Change Database, and PDQ-Evidence. Selection and assessment of methodological quality was performed by two independent reviewers. The results were presented in a narrative synthesis. This study selected 19 systematic reviews that pointed out four strategies to address the judicialization of health in Brazil: 1) Rapid response service, 2) Continuous education program, 3) Mediation service between the parties involved, and 4) Adoption of a computer-based, online decision-making support tool and patient-mediated interventions. This study therefore presented and characterized four options that can be considered to address the judicialization of health. The implementation of these options must ensure the participation of different actors, reflecting on different contexts and the impact on the health system. The availability of human and financial resources and the training of teams are critical points for the successful implementation of the options.
Collapse
|
3
|
Floriano FR, Boeira L, Biella CDA, Pereira VC, Carvalho M, Barreto JOM, Oliveira SMDVLD. Strategies to approach the judicialization of health in Brazil: an evidence brief. CIENCIA & SAUDE COLETIVA 2023; 28:181-196. [PMID: 36629563 DOI: 10.1590/1413-81232023281.09132022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/12/2022] [Indexed: 01/11/2023] Open
Abstract
This article seeks to identify and discuss evidence-informed options to address the judicialization of health. The Supporting Policy Relevant Reviews and Trials Tools were used to define the problem and the search strategy, which was carried out in the following databases: PubMed, Health Systems Evidence, Campbell, Cochrane Collaboration, Rx for Change Database, and PDQ-Evidence. Selection and assessment of methodological quality was performed by two independent reviewers. The results were presented in a narrative synthesis. This study selected 19 systematic reviews that pointed out four strategies to address the judicialization of health in Brazil: 1) Rapid response service, 2) Continuous education program, 3) Mediation service between the parties involved, and 4) Adoption of a computer-based, online decision-making support tool and patient-mediated interventions. This study therefore presented and characterized four options that can be considered to address the judicialization of health. The implementation of these options must ensure the participation of different actors, reflecting on different contexts and the impact on the health system. The availability of human and financial resources and the training of teams are critical points for the successful implementation of the options.
Collapse
Affiliation(s)
- Fabiana Raynal Floriano
- Departamento de Gestão e Incorporação de Tecnologias em Saúde, Secretaria de Ciência, Tecnologia, Inovação e Insumos Estratégicos em Saúde, Ministério da Saúde. Zona Cívico-Administrativa. 70058-900 Brasília DF Brasil.
| | | | - Carla de Agostino Biella
- Departamento de Gestão e Incorporação de Tecnologias em Saúde, Secretaria de Ciência, Tecnologia, Inovação e Insumos Estratégicos em Saúde, Ministério da Saúde. Zona Cívico-Administrativa. 70058-900 Brasília DF Brasil.
| | | | | | | | | |
Collapse
|
4
|
Yamauti SM, Barreto JOM, Barberato-Filho S, Machado FLDS, Lopes LC. Public sector implementation strategies to approach the judicialization of health care: a systematic review protocol. Syst Rev 2022; 11:164. [PMID: 35948934 PMCID: PMC9364593 DOI: 10.1186/s13643-022-02043-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 07/28/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The judicialization of health care can be understood as a societal response to pressing healthcare needs, which probably are not being adequately addressed by the current healthcare system. This phenomenon increases the strain on service resources, both in the health sector and in the judiciary system as well, demanding an institutional reorganization to manage judicial actions. It is believed that each institution has developed strategies for coping with the problem in isolation and with little public disclosure. The purpose of this review will be to identify institutional strategies implemented and to investigate their effects in approaching the judicialization of health care. METHODS Electronic searches will be conducted up to December 2021 on 11 databases, supplemented with gray literature and references lists of secondary studies. The descriptor "judicialization of health" will be the basis for conducting the main research. Studies describing any strategy implemented by public institutions to approach the judicialization of health care will be included. Results related to the quality of services provided by the implemented strategy reported in the studies and those that report accessibility, usability, and potential adverse effects or harms caused by the implemented strategy will be investigated. In addition, it will be explored if there have been changes related to the value or characteristics of health litigation. Two reviewers will independently screen all citations, abstract data, and full-text papers. The risk of bias in each study will be appraised using a tool suggested by Cochrane Effective Practice and Care Organization Group (EPOC). Subsequently, the reviewers will also extract the data of interest and classify the findings of these studies according to their performance at the institutional level. The results obtained will be described as a narrative synthesis. DISCUSSION This review may provide evidence on the effects of the strategies implemented to approach the judicialization of health care. It will potentially benefit health care and legal professionals, decision-makers, and researchers by identifying the types and characteristics of strategies that have the potential to improve service delivery in the future. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020160608.
Collapse
Affiliation(s)
- Sueli Miyuki Yamauti
- Graduate Program in Pharmaceutical Science, University of Sorocaba, Rodovia Raposo Tavares, Km 92,5 -, Sorocaba, SP, Brazil
| | | | - Silvio Barberato-Filho
- Graduate Program in Pharmaceutical Science, University of Sorocaba, Rodovia Raposo Tavares, Km 92,5 -, Sorocaba, SP, Brazil
| | | | - Luciane Cruz Lopes
- Graduate Program in Pharmaceutical Science, University of Sorocaba, Rodovia Raposo Tavares, Km 92,5 -, Sorocaba, SP, Brazil.
| |
Collapse
|
5
|
Machado FLDS, Dos Santos DMDSS, Lopes LC. Strategies to Approach Medicines Litigation: An Action Research Study in Brazil. Front Pharmacol 2021; 12:612426. [PMID: 33967753 PMCID: PMC8100662 DOI: 10.3389/fphar.2021.612426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/16/2021] [Indexed: 11/15/2022] Open
Abstract
Background: In the last decades, litigation has been increasingly used to access medicines in Brazil. This phenomenon has led to the development of diverse strategies to reduce its negative impact on the organization of pharmaceutical services. In spite of that, managers still face difficulties dealing with lawsuits. Objective: This study aims to report the planning and implementation of strategies to approach medicines litigation in a municipality located in the southeast region of Brazil. Methods: Mixed methods were employed through an action research cycle. A network coordination team included researchers from university and municipal managers. The scenario analysis comprised the characterization of pharmaceutical services and the profile of medicines lawsuits. Afterward, strategies were planned to deal with the central problem identified. The action plan involved educational outreach visits and distribution of printed materials for health professionals, evaluated through opinion survey. Group conversations were conducted with the users of the public health system, followed by thematic analysis of reports. Results: The characterization of pharmaceutical services in the municipality revealed that treatments supplied were in accordance with the National Medicines Policy. In addition, a sector was implemented to attend demands for non-incorporated medicines. In spite of the services available, the characterization of lawsuits indicated that the main claimants were users of the public health system, requiring non-incorporated medicines, with therapeutic alternatives available. Thus, educational outreach visits were held in 14 health units (23 physicians in total). Everyone who answered the evaluation declared that they were very satisfied with the approach. Group conversations with the users of the health system reached 227 participants in total. In regard to users’ perception about pharmaceutical services, thematic analysis of reports identified three main categories including aspects related to medicines provided, users assisted, and quality of service. Conclusion: The study described the first cycle of an action research project to develop strategies to approach medicines litigation at the municipal level. The application of educational outreach visits for health professionals and group conversations with health system users is a promising approach to improve access to information about pharmaceutical services in Brazil.
Collapse
Affiliation(s)
| | | | - Luciane Cruz Lopes
- Pharmaceutical Sciences Graduate Course, University of Sorocaba, UNISO, Sorocaba, Brazil
| |
Collapse
|
6
|
Freiberg A, Espin J. Towards a taxonomy of judicialisation for access to medicines in Latin America. Glob Public Health 2021; 17:912-925. [PMID: 33650934 DOI: 10.1080/17441692.2021.1892794] [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: 10/22/2022]
Abstract
In Latin America, 'judicialization' for access to healthcare refers to thousands of different claims, conditions, technologies and circumstances. Its impact depends on what is 'judicialized', why, for which benefit, and at what cost to society. Since judges cannot, by themselves, reduce medical uncertainty - or price tags - their health systems are exposed to costly adjudications based solely on interpretations of right to health, or life. The result is a low-governance, inefficient system for deciding coverage. We reviewed lists of judicialised medicines in Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, and Uruguay, dividing them into types A, B and C. We propose a debate by type, and that judges, facing litigation type-C, consider mandating coverage conditional on results, as requisite for reimbursement.
Collapse
Affiliation(s)
| | - Jaime Espin
- Escuela Andaluza de Salud Publica, Granada, Spain
| |
Collapse
|