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Gerber DE. Taking It to the States: Adapting Information Blocking Legislation to Oncology. J Clin Oncol 2023; 41:4348-4351. [PMID: 37410962 DOI: 10.1200/jco.23.01108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 05/30/2023] [Indexed: 07/08/2023] Open
Abstract
Oncologists have successfully pushed for new state laws on how we release life-changing test results
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Affiliation(s)
- David E Gerber
- Department of Internal Medicine (Division of Hematology-Oncology) and O'Donnell School of Public Health, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
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2
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Affiliation(s)
- Klaus Rose
- klausrose Consulting, Pediatric Drug Development & More, Aeussere Baselstrasse 308, 4125, Riehen, Switzerland.
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Barry E, Walsh JA, Weinrich SL, Beaupre D, Blasi E, Arenson DR, Jacobs IA. Navigating the Regulatory Landscape to Develop Pediatric Oncology Drugs: Expert Opinion Recommendations. Paediatr Drugs 2021; 23:381-394. [PMID: 34173206 PMCID: PMC8275539 DOI: 10.1007/s40272-021-00455-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2021] [Indexed: 11/30/2022]
Abstract
Regulatory changes have been enacted in the United States (US) and European Union (EU) to encourage the development of new treatments for pediatric cancer. Here, we review some of the factors that have hampered the development of pediatric cancer treatments and provide a comparison of the US and EU regulations implemented to address this clinical need. We then provide some recommendations for each stage of the oncology drug development pathway to help researchers maximize their chance of successful drug development while complying with regulations. A key recommendation is the engagement of key stakeholders such as regulatory authorities, pediatric oncologists, academic researchers, patient advocacy groups, and a Pediatric Expert Group early in the drug development process. During drug target selection, sponsors are encouraged to consult the Food and Drug Administration (FDA), European Medicines Agency (EMA), and the FDA target list, in addition to relevant US and European consortia that have been established to characterize and prioritize oncology drug targets. Sponsors also need to carefully consider the resourcing requirements for preclinical testing, which include ensuring appropriate access to the most relevant databases, clinical samples, and preclinical models (cell lines and animal models). During clinical development, sponsors can account for the pharmacodynamic (PD)/pharmacokinetic (PK) considerations specific to a pediatric population by developing pediatric formulations, selecting suitable PD endpoints, and employing sparse PK sampling or modeling/simulation of drug exposures where appropriate. Additional clinical considerations include the specific design of the clinical trial, the potential inclusion of children in adult trials, and the value of cooperative group trials.
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Affiliation(s)
- Richard L Schilsky
- From the American Society of Clinical Oncology, Alexandria, VA (R.L.S.); the Health and Medicine Division, National Academies of Science, Engineering, and Medicine, Washington, DC (S.N.); the University of Chicago Comprehensive Cancer Center, Chicago (M.M.L.B.); and the Dana-Farber Cancer Institute, Harvard Medical School, Brigham and Women's Hospital, and Boston Children's Hospital - all in Boston (E.J.B.)
| | - Sharyl Nass
- From the American Society of Clinical Oncology, Alexandria, VA (R.L.S.); the Health and Medicine Division, National Academies of Science, Engineering, and Medicine, Washington, DC (S.N.); the University of Chicago Comprehensive Cancer Center, Chicago (M.M.L.B.); and the Dana-Farber Cancer Institute, Harvard Medical School, Brigham and Women's Hospital, and Boston Children's Hospital - all in Boston (E.J.B.)
| | - Michelle M Le Beau
- From the American Society of Clinical Oncology, Alexandria, VA (R.L.S.); the Health and Medicine Division, National Academies of Science, Engineering, and Medicine, Washington, DC (S.N.); the University of Chicago Comprehensive Cancer Center, Chicago (M.M.L.B.); and the Dana-Farber Cancer Institute, Harvard Medical School, Brigham and Women's Hospital, and Boston Children's Hospital - all in Boston (E.J.B.)
| | - Edward J Benz
- From the American Society of Clinical Oncology, Alexandria, VA (R.L.S.); the Health and Medicine Division, National Academies of Science, Engineering, and Medicine, Washington, DC (S.N.); the University of Chicago Comprehensive Cancer Center, Chicago (M.M.L.B.); and the Dana-Farber Cancer Institute, Harvard Medical School, Brigham and Women's Hospital, and Boston Children's Hospital - all in Boston (E.J.B.)
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6
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Bethay SS, Travis MJ, Batt SK, Bochenek SH, Schwieterman PA. The Financial Effect of Medicare Coverage Design and Safety Net Options for Cancer Care. J Manag Care Spec Pharm 2020; 26:76-80. [PMID: 31880225 PMCID: PMC10391109 DOI: 10.18553/jmcp.2020.26.1.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND National spending on specialty medications accounted for approximately $193 billion in 2016. The coverage design for Medicare Parts B and D has shifted medication costs to patients, which may prohibit patients from starting or maintaining therapy due to affordability. As a result, patients have enrolled in safety net financial options, such as patient assistance and foundation programs. Safety net options may provide savings not otherwise realized by Medicare; however, they may have a negative financial effect on health systems and pharmaceutical manufacturers. OBJECTIVES To (a) quantify financial savings to Medicare as a result of patient enrollment in patient assistance programs and (b) quantify the financial effect of safety net options for patients, manufacturers, and the academic medical center that participated in this study. METHODS A single-center, nonrandomized, retrospective pilot study of Medicare beneficiaries was conducted. Patients who were prescribed hematology/oncology specialty medications and enrolled in safety net options between July 2015 and June 2017 were included. Investigators collected data related to fill history, drug cost, and prescription coverage. The primary outcome was the overall cost savings to Medicare as a result of patient enrollment in patient assistance programs. Secondary outcomes included total patient out-of-pocket savings as a result of foundation copayment support, financial effect on manufacturers as a result of patient assistance programs, and health system revenue impact as a result of safety net options. Descriptive statistics were used. RESULTS This study included 114 patients. Medicare saved $5,083,816.83 over 2 years as a result of patient assistance programs. Eight foundations provided $240,350.04 in patient insurance copayments. Nine manufacturers provided 2,243 free drug doses, valued at $3,379,032.34. The participating medical center missed the opportunity for $6,481,543.55 in revenue due to patient assistance programs. CONCLUSIONS The participating medical center's efforts to improve access to oncology care took considerable time and resources. These activities, as well as unreimbursed infusion services, were costs to the medical center that may not be recognized by Medicare. Manufacturers also supported patient access through their sponsored patient assistance programs. The use of these services and safety net options resulted in cost savings to Medicare and their beneficiaries. DISCLOSURES No outside funding supported this study. The authors have nothing to disclose. Findings from this study were part of a podium research presentation at the Great Lakes Pharmacy Residency Conference; April 25, 2018; West Lafayette, IN.
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Affiliation(s)
- Stephanie S. Bethay
- PGY-2 Health-System Pharmacy Administration Resident, UK HealthCare, Lexington, Kentucky
| | | | - Stephen K. Batt
- Specialty Pharmacy Infusion Services, UK HealthCare, Lexington, Kentucky
| | | | - Philip A. Schwieterman
- Markey Cancer Center and Kentucky Children’s Hospital, UK HealthCare, Lexington, Kentucky
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Tang M, Joensuu H, Simes RJ, Price TJ, Yip S, Hague W, Sjoquist KM, Zalcberg J. Challenges of international oncology trial collaboration-a call to action. Br J Cancer 2019; 121:515-521. [PMID: 31378784 PMCID: PMC6889481 DOI: 10.1038/s41416-019-0532-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/30/2019] [Accepted: 07/04/2019] [Indexed: 11/25/2022] Open
Abstract
International collaboration in oncology trials has the potential to enhance clinical trial activity by expediting the recruitment of large patient populations, testing treatments in diverse populations and facilitating the study of rare tumours or specific molecular subtypes. However, a number of challenges continue to hinder the efficient and productive conduct of both commercial and non-commercial international clinical trials. These challenges include complex and burdensome regulatory requirements, the high cost of conducting trials, and logistical challenges associated with ethics review, drug supply and biospecimen collection and management. We propose solutions to promote oncology trial collaboration, such as regulatory reform, harmonisation of trial initiation and management processes and greater recognition and funding of academic (non-commercial) clinical trials. It is only through coordinated effort and leadership from researchers, regulators and those responsible for health systems that the full potential of international trial collaboration can be realised.
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Affiliation(s)
- Monica Tang
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.
| | - Heikki Joensuu
- Department of Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Robert J Simes
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Timothy J Price
- The Queen Elizabeth Hospital and University of Adelaide, Adelaide, SA, Australia
| | - Sonia Yip
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Wendy Hague
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Katrin M Sjoquist
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - John Zalcberg
- Alfred Health and the School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Ben-Aharon O, Magnezi R, Leshno M, Goldstein DA. Median Survival or Mean Survival: Which Measure Is the Most Appropriate for Patients, Physicians, and Policymakers? Oncologist 2019; 24:1469-1478. [PMID: 31320502 DOI: 10.1634/theoncologist.2019-0175] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 05/20/2019] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Understanding the efficacy of treatments is crucial for patients, physicians, and policymakers. Median survival, the most common measure used in the outcome reporting of oncology clinical trials, is easy to understand; however, it describes only a single time point. The interpretation of the hazard ratio is difficult, and its underlying statistical assumptions are not always met. The objective of this study was to evaluate alternative measures based on the mean benefit of novel oncology treatments. MATERIALS AND METHODS We reviewed all U.S. Food and Drug Administration (FDA) approvals for oncology agents between 2013 and 2017. We digitized survival curves as reported in the clinical trials used for the FDA approvals and implemented statistical transformations to calculate for each trial the restricted mean survival time (RMST), as well as the mean survival using Weibull distribution. We compared the mean survival with the median survival benefit in each clinical trial. RESULTS The FDA approved 83 solid tumor indications for oncology agents between 2013 and 2017, of which 27 approvals based on response rates, whereas 49 approvals were based on survival endpoints (progression-free survival and overall survival). The average improvement in median overall survival or progression-free survival was 4.6 months versus 3.6 months improvement in the average RMST and 6.1 months improvement in mean survival using Weibull distribution. CONCLUSION Mean survival may supply valuable information for different stakeholders. Its inclusion should be considered in the reporting of prospective clinical trials. IMPLICATIONS FOR PRACTICE Mean survival may supply valuable information for different stakeholders. Its inclusion should be considered in the reporting of clinical trials.
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Affiliation(s)
- Omer Ben-Aharon
- Department of Management, Health System Management Program, Bar Ilan University, Ramat Gan, Israel
| | - Racheli Magnezi
- Department of Management, Health System Management Program, Bar Ilan University, Ramat Gan, Israel
| | - Moshe Leshno
- Coller School of Management, Tel Aviv University, Tel Aviv, Israel
| | - Daniel A Goldstein
- Davidoff Cancer Center, Rabin Medical Center, Petah Tiqva, Israel
- Department of Oncology, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, North Carolina, USA
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Mauri D, Tsali L, P Polyzos N, Valachis A, Zafeiria G, Kalopita K, Tsiara A, Yerolatsite M, Zarkavelis G, Kampletsas E, Mouzaki I, Ntellas P, Filis P, Pentheroudakis G. Facing internet fake-medicine and web para-pharmacy in the total absence of official recommendations from medical societies. J BUON 2019; 24:1314-1325. [PMID: 31646774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE Internet fake information, parapharmacy and counterfeit drugs are a market of hundreds of billion dollars. Misleading internet data decrease patients' compliance to medical care, promote use of questionable and detrimental practices, and jeopardize patient outcome. This is particularly harmful among cancer patients, especially when pain and nutritional aspects are considered. Provision of Web recommendations for the general audience (patients, relatives, general population) from official medical-providers might be useful to outweigh the detrimental internet information produced by non-medical providers. METHODS 370 oncology and anesthesiology related societies were analyzed. Our objective was to evaluate the magnitude of web-recommendation for cancer cachexia and cancer pain for the general audience provided by official medical organizations' web sites at global level. RESULTS Magnitude of web-recommendations at global level was surprisingly scant both for coverage and consistency. Seven official medical societies provided updated web-recommendation for cancer cachexia to their patients/family members, and 15 for cancer pain. Scantiness was unrelated by continent, developmental index, oncology tradition, economic-geographic area and society type scrutinized. CONCLUSIONS Patients need expert advice when exposed to fake internet information largely dominated by paramedical market profits. In this era of "new media" the patients' net-education represents a new major educational challenge for medical societies.
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Affiliation(s)
- Davide Mauri
- Department of Medical Oncology, University Hospital of Ioannina, Greece
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Frank X. Is Watson for Oncology per se Unreasonably Dangerous?: Making A Case for How to Prove Products Liability Based on a Flawed Artificial Intelligence Design. Am J Law Med 2019; 45:273-294. [PMID: 31722630 DOI: 10.1177/0098858819871109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Artificial intelligence (AI) machines hold the world's curiosity captive. Futuristic television shows like West World are set in desert lands against pink sunsets where sleek, autonomous AI fulfill every human need, desire, and kink. But I, Robot, a movie where robots turn against the humans they serve, reminds us that AI is precarious. Academicians who study how AI interacts with tort law, such as Jessica Allain, David Vladeck, and Sjur Dyrkoltbotn, claim that the current legal regime is incapable of addressing the liability issues AI present. Both Allain and Vladeck focus their research on whether tort law can accommodate claims against fully autonomous AI machines, while Dyrkoltbotn explores how AI can be leveraged to help plaintiffs identify the genesis of their injuries. The solution this article presents is not exclusively tailored to fully autonomous AI and does not identify how technology can be used in tort claims. It instead demonstrates that the current tort law regime can provide relief to plaintiffs who are injured by AI machines. In particular, this article argues that the manner in which Watson for Oncology is designed presents a new context in which courts should adopt a per se rule of liability that favors plaintiffs who bring damage claims against AI machines by expanding the definition of what it means for a device to be unreasonably dangerous.
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Chambers DA, Amir E, Saleh RR, Rodin D, Keating NL, Osterman TJ, Chen JL. The Impact of Big Data Research on Practice, Policy, and Cancer Care. Am Soc Clin Oncol Educ Book 2019; 39:e167-e175. [PMID: 31099675 DOI: 10.1200/edbk_238057] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The concept of "big data" research-the aggregation and analysis of biologic, clinical, administrative, and other data sources to drive new advances in biomedical knowledge-has been embraced by the cancer research enterprise. Although much of the conversation has concentrated on the amalgamation of basic biologic data (e.g., genomics, metabolomics, tumor tissue), new opportunities to extend potential contributions of big data to clinical practice and policy abound. This article examines these opportunities through discussion of three major data sources: aggregated clinical trial data, administrative data (including insurance claims data), and data from electronic health records. We will discuss the benefits of data use to answer key oncology practice and policy research questions, along with limitations inherent in these complex data sources. Finally, the article will discuss overarching themes across data types and offer next steps for the research, practice, and policy communities. The use of multiple sources of big data has the promise of improving knowledge and providing more accurate data for clinicians and policy decision makers. In the future, optimization of machine learning may allow for current limitations of big data analyses to be attenuated, thereby resulting in improved patient care and outcomes.
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Affiliation(s)
- David A Chambers
- 1 Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Eitan Amir
- 2 Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ramy R Saleh
- 2 Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Danielle Rodin
- 3 Radiation Medicine Program, Princess Margaret Cancer Centre and the University of Toronto, Toronto, Ontario, Canada
| | - Nancy L Keating
- 4 Department of Health Care Policy, Harvard Medical School, Boston, MA
| | | | - James L Chen
- 6 Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH
- 7 Department of Biomedical Informatics, The Ohio State University, Columbus, OH
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Yip S, Fleming J, Shepherd HL, Walczak A, Clark J, Butow P. "As Long as You Ask": A Qualitative Study of Biobanking Consent-Oncology Patients' and Health Care Professionals' Attitudes, Motivations, and Experiences-the B-PPAE Study. Oncologist 2018; 24:844-856. [PMID: 30413662 DOI: 10.1634/theoncologist.2018-0233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 08/28/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Consent to biobanking remains controversial, with little empirical data to guide policy and practice. This study aimed to explore the attitudes, motivations, and concerns of both oncology patients and health care professionals (HCPs) regarding biobanking. MATERIALS AND METHODS Qualitative interviews were conducted with oncology patients and HCPs purposively selected from five Australian hospitals. Patients were invited to give biobanking consent as part of a clinical trial and/or for future research were eligible. HCPs were eligible if involved in consenting patients to biobanking or to donate specimens to clinical trials. RESULTS Twenty-two patients participated, with head and neck (36%) and prostate (18%) the most common cancer diagnoses; all had consented to biobanking. Twenty-two HCPs participated, from across eight cancer streams and five disciplines. Themes identified were (a) biobanking is a "no brainer"; (b) altruism or scientific enquiry; (c) trust in clinicians, science, and institutions; (d) no consent-just do it; (e) respecting patient choice ("opt-out"); (f) respectful timing of the request; (g) need for emotional/family support; (h) context of the biobanking request matters; and (i) factors for biobanking success. DISCUSSION These findings reinforced previous findings regarding high public trust in, and support for, biobanking. An initial opt-in consent approach with the option of later opt-out was favored by patients to respect and recognize donor generosity, whereas HCPs preferred an upfront opt-out model. Factors impacting biobanking success included the context of the request for use in a trial or specific research question, pre-existing patient and HCP rapport, a local institution champion, and infrastructure. IMPLICATIONS FOR PRACTICE Patients and health care professionals (HCPs) who experienced cancer biobanking consent were overwhelmingly supportive of biobanking. The motivations and approaches to seeking consent were largely mirrored between the groups. The findings of this study support the opt-in model of biobanking favored by patients; however, HCPs preferred an opt-out model. Both groups recognize the importance of making the request for biobanking at an appropriate time, preferably with emotional or family support, and respecting the timing of the request and privacy of the patient. Biobanking success can be promoted by hospital departments with a research focus by identifying an institutional biobanking champion and ensuring local infrastructure is available.
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Affiliation(s)
- Sonia Yip
- Sydney Catalyst Translational Cancer Research Centre, University of Sydney, Sydney, Australia
| | - Jennifer Fleming
- Sydney Catalyst Translational Cancer Research Centre, University of Sydney, Sydney, Australia
| | - Heather L Shepherd
- Psycho-oncology Co-operative Research Group, School of Psychology, University of Sydney, Sydney, Australia
| | | | - Jonathan Clark
- Central Clinical School, University of Sydney, Sydney, Australia
| | - Phyllis Butow
- Centre for Medical Psychology and Evidence-Based Decision-Making, University of Sydney, Sydney, Australia
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Hallek M, Bokemeyer C, Lüftner D, Weissinger F. Vorwort. Oncol Res Treat 2018; 41 Suppl 3:1. [PMID: 30056448 DOI: 10.1159/000491683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Koczwara B, Stover AM, Davies L, Davis MM, Fleisher L, Ramanadhan S, Schroeck FR, Zullig LL, Chambers DA, Proctor E. Harnessing the Synergy Between Improvement Science and Implementation Science in Cancer: A Call to Action. J Oncol Pract 2018; 14:335-340. [PMID: 29750579 PMCID: PMC6075851 DOI: 10.1200/jop.17.00083] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Bogda Koczwara
- Flinders University, Adelaide, South Australia, Australia; University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, Chapel Hill; Durham Veterans Affairs Health Care System; Duke University Medical Center, Durham, NC; Department of Veterans Affairs Medical Center, White River Junction, VT; Geisel School of Medicine, Hanover; Dartmouth Institute for Health Policy and Clinical Practice; Dartmouth Hitchcock Medical Center, Lebanon, NH; Oregon Health & Science University, Portland, OR; Children’s Hospital of Philadelphia, Philadelphia; Fox Chase Cancer Center, Cheltenham, PA; Dana-Farber Cancer Institute; Harvard T.H. Chan School of Public Health, Boston, MA; National Cancer Institute, Bethesda, MD; and Washington University in St Louis, St Louis, MO
| | - Angela M. Stover
- Flinders University, Adelaide, South Australia, Australia; University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, Chapel Hill; Durham Veterans Affairs Health Care System; Duke University Medical Center, Durham, NC; Department of Veterans Affairs Medical Center, White River Junction, VT; Geisel School of Medicine, Hanover; Dartmouth Institute for Health Policy and Clinical Practice; Dartmouth Hitchcock Medical Center, Lebanon, NH; Oregon Health & Science University, Portland, OR; Children’s Hospital of Philadelphia, Philadelphia; Fox Chase Cancer Center, Cheltenham, PA; Dana-Farber Cancer Institute; Harvard T.H. Chan School of Public Health, Boston, MA; National Cancer Institute, Bethesda, MD; and Washington University in St Louis, St Louis, MO
| | - Louise Davies
- Flinders University, Adelaide, South Australia, Australia; University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, Chapel Hill; Durham Veterans Affairs Health Care System; Duke University Medical Center, Durham, NC; Department of Veterans Affairs Medical Center, White River Junction, VT; Geisel School of Medicine, Hanover; Dartmouth Institute for Health Policy and Clinical Practice; Dartmouth Hitchcock Medical Center, Lebanon, NH; Oregon Health & Science University, Portland, OR; Children’s Hospital of Philadelphia, Philadelphia; Fox Chase Cancer Center, Cheltenham, PA; Dana-Farber Cancer Institute; Harvard T.H. Chan School of Public Health, Boston, MA; National Cancer Institute, Bethesda, MD; and Washington University in St Louis, St Louis, MO
| | - Melinda M. Davis
- Flinders University, Adelaide, South Australia, Australia; University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, Chapel Hill; Durham Veterans Affairs Health Care System; Duke University Medical Center, Durham, NC; Department of Veterans Affairs Medical Center, White River Junction, VT; Geisel School of Medicine, Hanover; Dartmouth Institute for Health Policy and Clinical Practice; Dartmouth Hitchcock Medical Center, Lebanon, NH; Oregon Health & Science University, Portland, OR; Children’s Hospital of Philadelphia, Philadelphia; Fox Chase Cancer Center, Cheltenham, PA; Dana-Farber Cancer Institute; Harvard T.H. Chan School of Public Health, Boston, MA; National Cancer Institute, Bethesda, MD; and Washington University in St Louis, St Louis, MO
| | - Linda Fleisher
- Flinders University, Adelaide, South Australia, Australia; University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, Chapel Hill; Durham Veterans Affairs Health Care System; Duke University Medical Center, Durham, NC; Department of Veterans Affairs Medical Center, White River Junction, VT; Geisel School of Medicine, Hanover; Dartmouth Institute for Health Policy and Clinical Practice; Dartmouth Hitchcock Medical Center, Lebanon, NH; Oregon Health & Science University, Portland, OR; Children’s Hospital of Philadelphia, Philadelphia; Fox Chase Cancer Center, Cheltenham, PA; Dana-Farber Cancer Institute; Harvard T.H. Chan School of Public Health, Boston, MA; National Cancer Institute, Bethesda, MD; and Washington University in St Louis, St Louis, MO
| | - Shoba Ramanadhan
- Flinders University, Adelaide, South Australia, Australia; University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, Chapel Hill; Durham Veterans Affairs Health Care System; Duke University Medical Center, Durham, NC; Department of Veterans Affairs Medical Center, White River Junction, VT; Geisel School of Medicine, Hanover; Dartmouth Institute for Health Policy and Clinical Practice; Dartmouth Hitchcock Medical Center, Lebanon, NH; Oregon Health & Science University, Portland, OR; Children’s Hospital of Philadelphia, Philadelphia; Fox Chase Cancer Center, Cheltenham, PA; Dana-Farber Cancer Institute; Harvard T.H. Chan School of Public Health, Boston, MA; National Cancer Institute, Bethesda, MD; and Washington University in St Louis, St Louis, MO
| | - Florian R. Schroeck
- Flinders University, Adelaide, South Australia, Australia; University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, Chapel Hill; Durham Veterans Affairs Health Care System; Duke University Medical Center, Durham, NC; Department of Veterans Affairs Medical Center, White River Junction, VT; Geisel School of Medicine, Hanover; Dartmouth Institute for Health Policy and Clinical Practice; Dartmouth Hitchcock Medical Center, Lebanon, NH; Oregon Health & Science University, Portland, OR; Children’s Hospital of Philadelphia, Philadelphia; Fox Chase Cancer Center, Cheltenham, PA; Dana-Farber Cancer Institute; Harvard T.H. Chan School of Public Health, Boston, MA; National Cancer Institute, Bethesda, MD; and Washington University in St Louis, St Louis, MO
| | - Leah L. Zullig
- Flinders University, Adelaide, South Australia, Australia; University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, Chapel Hill; Durham Veterans Affairs Health Care System; Duke University Medical Center, Durham, NC; Department of Veterans Affairs Medical Center, White River Junction, VT; Geisel School of Medicine, Hanover; Dartmouth Institute for Health Policy and Clinical Practice; Dartmouth Hitchcock Medical Center, Lebanon, NH; Oregon Health & Science University, Portland, OR; Children’s Hospital of Philadelphia, Philadelphia; Fox Chase Cancer Center, Cheltenham, PA; Dana-Farber Cancer Institute; Harvard T.H. Chan School of Public Health, Boston, MA; National Cancer Institute, Bethesda, MD; and Washington University in St Louis, St Louis, MO
| | - David A. Chambers
- Flinders University, Adelaide, South Australia, Australia; University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, Chapel Hill; Durham Veterans Affairs Health Care System; Duke University Medical Center, Durham, NC; Department of Veterans Affairs Medical Center, White River Junction, VT; Geisel School of Medicine, Hanover; Dartmouth Institute for Health Policy and Clinical Practice; Dartmouth Hitchcock Medical Center, Lebanon, NH; Oregon Health & Science University, Portland, OR; Children’s Hospital of Philadelphia, Philadelphia; Fox Chase Cancer Center, Cheltenham, PA; Dana-Farber Cancer Institute; Harvard T.H. Chan School of Public Health, Boston, MA; National Cancer Institute, Bethesda, MD; and Washington University in St Louis, St Louis, MO
| | - Enola Proctor
- Flinders University, Adelaide, South Australia, Australia; University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, Chapel Hill; Durham Veterans Affairs Health Care System; Duke University Medical Center, Durham, NC; Department of Veterans Affairs Medical Center, White River Junction, VT; Geisel School of Medicine, Hanover; Dartmouth Institute for Health Policy and Clinical Practice; Dartmouth Hitchcock Medical Center, Lebanon, NH; Oregon Health & Science University, Portland, OR; Children’s Hospital of Philadelphia, Philadelphia; Fox Chase Cancer Center, Cheltenham, PA; Dana-Farber Cancer Institute; Harvard T.H. Chan School of Public Health, Boston, MA; National Cancer Institute, Bethesda, MD; and Washington University in St Louis, St Louis, MO
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Pearson AD, Heenen D, Kearns PR, Goeres A, Marshall LV, Blanc P, Vassal G. 10-year report on the European Paediatric Regulation and its impact on new drugs for children's cancers. Lancet Oncol 2018; 19:285-287. [PMID: 29508745 DOI: 10.1016/s1470-2045(18)30105-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 01/08/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Andrew Dj Pearson
- Paediatric and Adolescent Oncology Drug Development, The Royal Marsden NHS Foundation Trust, Sutton, SM2 5PT, UK; Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, Sutton, UK; Innovative Therapy for Children with Cancer, Europe.
| | | | - Pamela R Kearns
- Innovative Therapy for Children with Cancer, Europe; Cancer Research UK Clinical Trials Unit Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; SIOPE Brussels, Belgium
| | - Anne Goeres
- Unite 2 Cure, Europe; Fondatioun Kriibskrank Kanner, Strassen, Luxembourg
| | - Lynley V Marshall
- Paediatric and Adolescent Oncology Drug Development, The Royal Marsden NHS Foundation Trust, Sutton, SM2 5PT, UK; Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, Sutton, UK
| | | | - Gilles Vassal
- Innovative Therapy for Children with Cancer, Europe; SIOPE Brussels, Belgium; Department of Clinical Research, Gustave Roussy, Paris-Saclay University, Villejuif, France
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17
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Abstract
Limitations of screening mammography in patients with dense breasts combined with the significant increased risk for breast cancer have made the issue of dense breasts a matter of great concern in recent years, leading to advocacy for policy change and legislation. Dense breast notification legislation requires direct patient notification of mammographic results indicating the presence of dense breast tissue. The aim of this study was to summarize the state of dense breast notification legislation across the country. The general intent of dense breast notification legislation is to increase awareness of dense breasts and encourage patients to discuss the clinical issues with their physicians. It was first enacted in Connecticut in 2009, and since then, 27 other states have passed, rejected, or considered dense breast notification legislation. At the federal level, a bill was introduced in October 2011, but it was not enacted. There are significant differences in the language of the laws from state to state that complicate implementation. Furthermore, legislated recommendations for possible additional testing are often unaccompanied by legal provisions for insurance coverage, which potentially results in unequal access.
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Affiliation(s)
| | - Ruth C Carlos
- Department of Radiology, University of Michigan School of Medicine, Ann Arbor, Michigan; University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan.
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Vassal G, Kearns P, Blanc P, Scobie N, Heenen D, Pearson A. Orphan Drug Regulation: A missed opportunity for children and adolescents with cancer. Eur J Cancer 2017; 84:149-158. [PMID: 28818704 DOI: 10.1016/j.ejca.2017.07.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 07/14/2017] [Accepted: 07/18/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Oncology represents a major sector in the field of orphan drug development in Europe. The objective was to evaluate whether children and adolescents with cancer benefited from the Orphan Drug Regulation. METHODS Data on orphan drug designations (ODDs) and registered orphan drugs from 8th August 2000 to 10th September 2016 were collected from the Community Register of medicinal products for human use. Assessment history, product information and existence of paediatric investigation plans were searched and retrieved from the European Medicine Agency website. RESULTS Over 16 years, 272 of 657 oncology ODDs (41%) concerned a malignant condition occurring both in adults and children. The five most common were acute myeloid leukaemia, high-grade glioma, acute lymphoblastic leukaemia, graft-versus-host disease and soft-tissue sarcomas. 74% of 31 marketing authorisations (MAs) for an indication both in adults and children (26 medicines) had no information for paediatric use in their Summary of Product Characteristics (SmPC) at the time of the first MA. Furthermore, 68% still have no paediatric information in their most recently updated SmPC, at a median of 7 years after. Only 15 ODDs (2%) pertained to a malignancy occurring specifically in children and only two drugs received an MA: Unituxin for high-risk neuroblastoma and Votubia for sub-ependymal giant-cell astrocytoma. CONCLUSION The Orphan Drug Regulation failed to promote the development of innovative therapies for malignancies occurring in children. Major delays and waivers occurred through the application of the Paediatric Medicines Regulation. The European regulatory environment needs to be improved to accelerate innovation for children and adolescents dying of cancer.
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Affiliation(s)
- Gilles Vassal
- Department of Clinical Research, Gustave Roussy, Paris-Sud University, Paris, France; Innovative Therapy for Children with Cancer, Villejuif, France.
| | - Pam Kearns
- Innovative Therapy for Children with Cancer, Villejuif, France; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Patricia Blanc
- Imagine for Margo, 9 Avenue Eric Tabarly, 78112 Fourqueux, France
| | | | | | - Andy Pearson
- Innovative Therapy for Children with Cancer, Villejuif, France; Paediatric Drug Development, Children and Young People's Unit, The Royal Marsden NHS Foundation Trust, Sutton, SM2 5PT, UK; Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, Sutton, SM2 5NG, UK
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20
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Il'nitskiy AP, Solenova LG. [Topical problems of occupational cancer in Russia.]. Med Tr Prom Ekol 2017:1-5. [PMID: 30351786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The authors present data on occupational oncologic morbidity in Russia by federal districts and regions. Over 2002- 2014, a total of 497 cases of occupational cancer was registered, that is less than 0,3% of minimal expected number of cases. Necessity is to urgent improvement of legislation and methodic basis, informational supply, providing qualitative account of occupational oncologic morbidity. Important role in solving this problem could be played by continued sanitary and hygienic certification of caricnogenically dangerous institutions in RF and creation of Federal register (governmental automated information system) of individuals who had (has) occupational exposure to carcinogenic factors.
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Schleicher SM, Wood NM, Lee S, Feeley TW. How the Affordable Care Act Has Affected Cancer Care in the United States: Has Value for Cancer Patients Improved? Oncology (Williston Park) 2016; 30:468-474. [PMID: 27188679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
MESH Headings
- Cost-Benefit Analysis
- Delivery of Health Care, Integrated/economics
- Delivery of Health Care, Integrated/legislation & jurisprudence
- Early Detection of Cancer/economics
- Health Care Costs/legislation & jurisprudence
- Health Policy/economics
- Health Policy/legislation & jurisprudence
- Health Services Accessibility/economics
- Health Services Accessibility/legislation & jurisprudence
- Humans
- Insurance, Health, Reimbursement/economics
- Insurance, Health, Reimbursement/legislation & jurisprudence
- Medical Oncology/economics
- Medical Oncology/legislation & jurisprudence
- Neoplasms/diagnosis
- Neoplasms/economics
- Neoplasms/therapy
- Patient Protection and Affordable Care Act/economics
- Patient Protection and Affordable Care Act/legislation & jurisprudence
- Policy Making
- Preventive Health Services/economics
- Preventive Health Services/legislation & jurisprudence
- Process Assessment, Health Care/economics
- Process Assessment, Health Care/legislation & jurisprudence
- Quality Improvement/economics
- Quality Improvement/legislation & jurisprudence
- Quality Indicators, Health Care/economics
- Quality Indicators, Health Care/legislation & jurisprudence
- Treatment Outcome
- United States
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Rosen J, Sutton JH. Bariatric surgery, liability, and trauma: Key issues debated in state legislatures. Bull Am Coll Surg 2015; 100:21-27. [PMID: 26749966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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24
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25
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26
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Fredslund SV, Høgdal N, Christensen MB, Wessel I. Dysphagia training after head and neck cancer fails to follow legislation and national recommendations. Dan Med J 2015; 62:A5067. [PMID: 26050828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Dysphagia is a known sequela after head and neck cancer (HNC) and causes malnutrition, aspiration pneumonia and a reduced quality of life. Due to improved survival rates, the number of patients with sequelae is increasing. Evidence on the ideal HNC-specific rehabilitation of dysphagia is lacking, but several studies indicate that early initiation is crucial. The aim of this study was to map the existing dysphagia rehabilitation programmes for HNC patients in Denmark. METHODS Occupational therapists (OTs), oncologists and surgeons from five hospitals participated in a nationwide questionnaire-based survey, along with OTs from 39 municipal health centres. RESULTS HNC patients rarely receive preventive occupational therapy before treatment, and hospital-based OTs mainly attend to HNC patients undergoing surgery. Far from all oncology and surgical departments complete the required rehabilitation plans upon discharge which leaves many patients untreated. There are vast differences between the municipalities' rehabilitation programmes and between the expertise employed in municipalities and hospitals. CONCLUSION Existing HNC rehabilitation does not meet official Danish guidelines. Only a fraction of HNC patients are offered rehabilitation and often long after completing treatment. Municipal rehabilitation services vary considerably in terms of type, duration, intensity and expertise. Dysphagia-related rehabilitation requires an improved monitoration, possibly with an increase in the uptake of centralised dysphagia rehabilitation. FUNDING not relevant. TRIAL REGISTRATION not relevant.
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Affiliation(s)
- Sara Vinther Fredslund
- Klinik for Ergo- og Fysioterapi 8511, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Denmark.
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Steensma DP. Mimicking MacGyver in the oncology clinic: improvisation and creative solutions, only rarely involving duct tape. J Natl Compr Canc Netw 2015; 13:371-3. [PMID: 25736013 DOI: 10.6004/jnccn.2015.0048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Trosman JR, Weldon CB, Kate Kelley R, Phillips KA. Challenges of coverage policy development for next-generation tumor sequencing panels: experts and payers weigh in. J Natl Compr Canc Netw 2015; 13:311-8. [PMID: 25736008 PMCID: PMC4372087 DOI: 10.6004/jnccn.2015.0043] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Next-generation tumor sequencing (NGTS) panels, which include multiple established and novel targets across cancers, are emerging in oncology practice, but lack formal positive coverage by US payers. Lack of coverage may impact access and adoption. This study identified challenges of NGTS coverage by private payers. METHODS We conducted semi-structured interviews with 14 NGTS experts on potential NGTS benefits, and with 10 major payers, representing more than 125,000,000 enrollees, on NGTS coverage considerations. We used the framework approach of qualitative research for study design and thematic analyses and simple frequencies to further describe findings. RESULTS All interviewed payers see potential NGTS benefits, but all noted challenges to formal coverage: 80% state that inherent features of NGTS do not fit the medical necessity definition required for coverage, 70% view NGTS as a bundle of targets versus comprehensive tumor characterization and may evaluate each target individually, and 70% express skepticism regarding new evidence methods proposed for NGTS. Fifty percent of payers expressed sufficient concerns about NGTS adoption and implementation that will preclude their ability to issue positive coverage policies. CONCLUSIONS Payers perceive that NGTS holds significant promise but, in its current form, poses disruptive challenges to coverage policy frameworks. Proactive multidisciplinary efforts to define the direction for NGTS development, evidence generation, and incorporation into coverage policy are necessary to realize its promise and provide patient access. This study contributes to current literature, as possibly the first study to directly interview US payers on NGTS coverage and reimbursement.
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Affiliation(s)
- Julia R. Trosman
- UCSF Center for Translational and Policy Research on Personalized Medicine (TRANSPERS), Department of Clinical Pharmacy, University of California, San Francisco (UCSF), San Francisco, California
- Center for Business Models in Healthcare, Chicago Illinois
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Christine B. Weldon
- UCSF Center for Translational and Policy Research on Personalized Medicine (TRANSPERS), Department of Clinical Pharmacy, University of California, San Francisco (UCSF), San Francisco, California
- Center for Business Models in Healthcare, Chicago Illinois
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - R. Kate Kelley
- UCSF Center for Translational and Policy Research on Personalized Medicine (TRANSPERS), Department of Clinical Pharmacy, University of California, San Francisco (UCSF), San Francisco, California
- Department of Medicine, Division of Hematology/Oncology, UCSF, San Francisco, California
| | - Kathryn A. Phillips
- UCSF Center for Translational and Policy Research on Personalized Medicine (TRANSPERS), Department of Clinical Pharmacy, University of California, San Francisco (UCSF), San Francisco, California
- Helen Diller Family Comprehensive Cancer Center at UCSF, San Francisco, California
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Downs CG, Fowler L, Kolodziej M, Newcomer LH, Ogaily MS, Purcell WT, Winkelmann JC, Goodman C. The Affordable Care Act: where are we now? An NCCN roundtable. J Natl Compr Canc Netw 2015; 12:745-7. [PMID: 24853209 DOI: 10.6004/jnccn.2014.0182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Affordable Care Act (ACA) is a transformational event for health care in the United States, with multiple impacts on health care, the economy, and society. Oncologists and other health care providers are already experiencing many changes-direct and indirect, anticipated and unanticipated. A distinguished and diverse panel assembled at the NCCN 19th Annual Conference to discuss the early phase of implementation of the ACA. The roundtable touched on early successes and stumbling blocks; the impact of the ACA on contemporary oncology practice and the new risk pool facing providers, payers, and patients; and some of the current and future challenges that lie ahead for all.
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Iacobucci G. More than 100 cancer experts attack Saatchi bill as potentially dangerous. BMJ 2014; 349:g6794. [PMID: 25395504 DOI: 10.1136/bmj.g6794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Fujisaka Y, Nakagawa K. [Lung cancer: progress in diagnosis and treatments. Topics: II. Diagnosis and examination; 1. Training plan for oncology professionals]. Nihon Naika Gakkai Zasshi 2014; 103:1267-1272. [PMID: 25151789 DOI: 10.2169/naika.103.1267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Johari V. Professional misconduct or criminal negligence: when does the balance tilt? Indian J Med Ethics 2014; 11:117-120. [PMID: 24727625 DOI: 10.20529/ijme.2014.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Indexed: 06/03/2023]
Affiliation(s)
- Veena Johari
- Courtyard Attorneys, 47/1345, MIG Adarshnagar, Worli, Mumbai 400 030.
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34
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Dyer C. Cancer surgeon who faces litigation and misconduct allegations is found to lack mental capacity. BMJ 2014; 348:g1463. [PMID: 24513778 DOI: 10.1136/bmj.g1463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Dyer C. Cancer researcher convicted of child pornography charges is spared erasure after showing remorse. BMJ 2014; 348:g270. [PMID: 24430464 DOI: 10.1136/bmj.g270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
Patients and payers (government and private) are frustrated with the fee-for-service system (FFS) of payment for outpatient health services. FFS rewards volume and highly valued services, including expensive diagnostics and therapeutics, over lesser valued cognitive services. Proposed payment schemes would incent collaboration and coordination of care among providers and reward quality. In oncology, new payment schemes must address the high costs of all services, particularly drugs, while preserving the robust distribution of sites of service available to patients in the United States. Information technology and personalized cancer care are changing the practice of oncology. Twenty-first century oncology will require increasing cognitive work and shared decision making, both of which are not well regarded in the FFS model. A high proportion of health care dollars are consumed in the final months of life. Effective delivery of palliative and end-of-life care must be addressed by practice and by new models of payment. Value-based reimbursement schemes will require oncology practices to change how they are structured. Lessons drawn from the principles of primary care's Patient Centered Medical Home (PCMH) will help oncology practice to prepare for new schemes. PCMH principles place a premium on proactively addressing toxicities of therapies, coordinating care with other providers, and engaging patients in shared decision making, supporting the ideal of value defined in the triple aim-to measurably improve patient experience and quality of care at less cost. Payment reform will be disruptive to all. Oncology must be engaged in policy discussions and guide rational shifts in priorities defined by new payment models.
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Affiliation(s)
- John V Cox
- From the Texas Oncology Methodist Dallas Cancer Centers, Texas Oncology, PA, Dallas, TX; Swedish Cancer Institute Edmonds, Seattle, WA; Cedar Associates, LLC, and Stanford School of Medicine, Palo Alto, CA; Massachusetts General Hospital Cancer Center, Boston, MA; New Mexico Oncology Hematology Consultants, LTD, Albuquerque, NM
| | - Jeffery C Ward
- From the Texas Oncology Methodist Dallas Cancer Centers, Texas Oncology, PA, Dallas, TX; Swedish Cancer Institute Edmonds, Seattle, WA; Cedar Associates, LLC, and Stanford School of Medicine, Palo Alto, CA; Massachusetts General Hospital Cancer Center, Boston, MA; New Mexico Oncology Hematology Consultants, LTD, Albuquerque, NM
| | - John C Hornberger
- From the Texas Oncology Methodist Dallas Cancer Centers, Texas Oncology, PA, Dallas, TX; Swedish Cancer Institute Edmonds, Seattle, WA; Cedar Associates, LLC, and Stanford School of Medicine, Palo Alto, CA; Massachusetts General Hospital Cancer Center, Boston, MA; New Mexico Oncology Hematology Consultants, LTD, Albuquerque, NM
| | - Jennifer S Temel
- From the Texas Oncology Methodist Dallas Cancer Centers, Texas Oncology, PA, Dallas, TX; Swedish Cancer Institute Edmonds, Seattle, WA; Cedar Associates, LLC, and Stanford School of Medicine, Palo Alto, CA; Massachusetts General Hospital Cancer Center, Boston, MA; New Mexico Oncology Hematology Consultants, LTD, Albuquerque, NM
| | - Barbara L McAneny
- From the Texas Oncology Methodist Dallas Cancer Centers, Texas Oncology, PA, Dallas, TX; Swedish Cancer Institute Edmonds, Seattle, WA; Cedar Associates, LLC, and Stanford School of Medicine, Palo Alto, CA; Massachusetts General Hospital Cancer Center, Boston, MA; New Mexico Oncology Hematology Consultants, LTD, Albuquerque, NM
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DeMartino J. Evolving policy issues in oncology: revisiting biosimilars and molecular testing. J Natl Compr Canc Netw 2013; 11:1174-7. [PMID: 24029129 DOI: 10.6004/jnccn.2013.0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Arie S. Paediatrician wrongly detained in UAE for murder finally returns to South Africa. BMJ 2013; 346:f3314. [PMID: 23693063 DOI: 10.1136/bmj.f3314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Snyder KM, Reaman G, Avant D, Pazdur R. The impact of the written request process on drug development in childhood cancer. Pediatr Blood Cancer 2013; 60:531-7. [PMID: 23335552 DOI: 10.1002/pbc.24346] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 08/30/2012] [Indexed: 12/27/2022]
Abstract
PURPOSE The Food and Drug Administration (FDA) Modernization Act, enacted in 1997, created a pediatric exclusivity incentive allowing sponsors to qualify for an additional 6 months of marketing exclusivity after satisfying the requirements outlined in the Written Request (WR). This review evaluates the impact of the WR mechanism on the development of oncology drugs in children. METHODS A search of the FDA document archiving, reporting, and regulatory tracking system was performed for January 1, 2000 to December 31, 2010. Drugs were identified and pediatric-specific labeling information was obtained from Drugs@fda.gov and FDA Pediatric Labeling Changes Table. RESULTS Fifty WRs have been issued for oncology drugs. Pediatric studies have been submitted for 14 drugs. Thirteen received pediatric exclusivity. As of December 31, 2010, labeling changes have been made for 11 drugs. Three drugs were approved for pediatric use. CONCLUSION WRs have provided a mechanism to promote the study of drugs in pediatric malignancies. Information from studies resulting from the WRs regarding safety, pharmacokinetics, and tolerability of oncology drugs has been incorporated into pediatric labeling for 11/14 of the drugs. Earlier communication and collaboration between the FDA, National Cancer Institute, clinical investigators, and commercial sponsors are envisioned to facilitate the identification and prioritization of emerging new drugs of interest for WR consideration. Since this is the only regulatory mechanism, resulting from specific legislative initiatives relevant to cancer drug development for children, efforts to enhance its impact on increasing drug approval for pediatric cancer indications are warranted.
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Affiliation(s)
- Kristen M Snyder
- Office of Hematology and Oncology Products, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland 20901-0002, USA
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Duska LR, Engelhard CL. The Patient Protection and Affordable Care Act: what every provider of gynecologic oncology care should know. Gynecol Oncol 2013; 129:606-12. [PMID: 23500090 DOI: 10.1016/j.ygyno.2013.02.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 02/26/2013] [Accepted: 02/27/2013] [Indexed: 11/19/2022]
Abstract
The Patient Protection and Affordable Care Act (ACA) was signed into law by President Barack Obama in 2010. While initial implementation of the law began shortly thereafter, the full implementation will take place over the next few years. With respect to cancer care, the act was intended to make care more accessible, affordable, and comprehensive across different parts of the country. For our cancer patients and our practices, the ACA has implications that are both positive and negative. The Medicaid expansion and access to insurance exchanges are intended to increase the number of insured patients and thus improve access to care, but many states have decided to opt out of the Medicaid program and in these states access problems will persist. Screening programs will be put in place for insured patients but may supplant federally funded programs that are currently in place for uninsured patients and may not follow current screening guidelines. Both hospice and home health providers will be asked to provide more services with less funding, and quality measures, including readmission rates, will factor into reimbursement. Insured patients will have access to all phases of clinical trial research. There is a need for us as providers of Gynecologic Oncology care to be active in the implementation of the ACA in order to ensure that our patients and our practices can survive and benefit from the changes in health care reimbursement, with the ultimate goals of improving access to care and quality while reducing unsustainable costs.
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Affiliation(s)
- Linda R Duska
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA.
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Majeed A. Why have the breast surgeons been referred to the GMC? BMJ 2012; 345:e7626. [PMID: 23149486 DOI: 10.1136/bmj.e7626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gendy R, Vidya R. Stafford breast surgeons reply to BMJ news article. BMJ 2012; 345:e7625. [PMID: 23149335 DOI: 10.1136/bmj.e7625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
High-grade gliomas are an infrequent disease diagnosed usually in the fifth or sixth decade. Careful histopathological diagnosis is essential because tumour grade and type condition the treatment. Magnetic resonance with gadolinium is considered the standard radiologic exploration and should be followed by tissue sampling. Treatment of these patients should be decided in a multidisciplinary committee. Surgery, radiotherapy and chemotherapy are the basis of patients' treatment, with the best results obtained when the three of them can be used.
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Affiliation(s)
- Alfonso Berrocal
- Medical Oncology Service, Hospital General Universitario, Valencia, Spain.
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Abstract
Cervical cancer (CC) is the second most common cancer worldwide, with a well known origin, infection by high-risk human papilloma virus. Although screening programmes have led to a relevant reduction in the incidence and mortality due to CC in developed countries, it is still an important cause of mortality in young women in undeveloped countries. Clinical stage is the most relevant prognostic factor in CC and the standard of care is still based on it. In early stages, the primary treatment is surgery or radiotherapy, whereas concomitant chemo-radiotherapy is the conventional approach in locally advanced stage. In the setting of recurrent or metastatic CC the treatment is largely palliative, so it is important to develop new therapeutic strategies.
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Affiliation(s)
- Ana Oaknin
- Medical Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain.
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Cassinello Espinosa J, González Del Alba Baamonde A, Rivera Herrero F, Holgado Martín E. SEOM guidelines for the treatment of bone metastases from solid tumours. Clin Transl Oncol 2012; 14:505-11. [PMID: 22721794 DOI: 10.1007/s12094-012-0832-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Bone metastases are a common and distressing effect of cancer, being a major cause of morbidity in many patients with advanced stage cancer, in particular in breast and prostate cancer. Patients with bone metastases can experience complications known as skeletal-related events (SREs) which may cause significant debilitation and have a negative impact on quality of life and functional independence. The current recommended systemic treatment for the prevention of SREs is based on the use of bisphosphonates: ibandronate, pamidronate and zoledronic acid- the most potent one- are approved in advanced breast cancer with bone metastases, whereas only zoledronic acid is indicated in advanced prostate cancer with bone metastases. The 2011 ASCO guidelines on breast cancer, recommend initiating bisphosphonate treatment only for patients with evidence of bone destruction due to bone metastases. Denosumab, a fully human antibody that specifically targets the RANK-L, has been demonstrated in two phase III studies to be superior to zoledronic acid in preventing or delaying SREs in breast and prostate cancer and non-inferior in other solid tumours and mieloma; it's convenient subcutaneous administration and the fact that does not require dose adjustment in cases of renal impairment, make this agent an attractive new therapeutic option in patients with bone metastases. Finally, in a phase III study against placebo, denosumab significantly increased the median metastasis-free survival in high risk non-metastatic prostate cancer, arising the potential role of these bone-modifying agents in preventing or delaying the development of bone metastases.
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Dyer C. Breast surgeons are referred to GMC for refusing to take part in a review of their unit. BMJ 2012; 345:e6985. [PMID: 23077333 DOI: 10.1136/bmj.e6985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Soltau U, Sterly C. [New legal possibilities for certification]. Onkologie 2012; 35 Suppl 4:7-10. [PMID: 22678068 DOI: 10.1159/000337994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Undine Soltau
- Zentralstelle der Länder für Gesundheitsschutz bei Arzneimitteln und Medizinprodukten, Bonn, Deutschland
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Brodowicz T, Ciuleanu T, Crawford J, Filipits M, Fischer JR, Georgoulias V, Gridelli C, Hirsch FR, Jassem J, Kosmidis P, Krzakowski M, Manegold C, Pujol JL, Stahel R, Thatcher N, Vansteenkiste J, Minichsdorfer C, Zöchbauer-Müller S, Pirker R, Zielinski CC. Third CECOG consensus on the systemic treatment of non-small-cell lung cancer. Ann Oncol 2012; 23:1223-1229. [PMID: 21940784 DOI: 10.1093/annonc/mdr381] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The current third consensus on the systemic treatment of non-small-cell lung cancer (NSCLC) builds upon and updates similar publications on the subject by the Central European Cooperative Oncology Group (CECOG), which has published such consensus statements in the years 2002 and 2005 (Zielinski CC, Beinert T, Crawford J et al. Consensus on medical treatment of non-small-cell lung cancer--update 2004. Lung Cancer 2005; 50: 129-137). The principle of all CECOG consensus is such that evidence-based recommendations for state-of-the-art treatment are given upon which all participants and authors of the manuscript have to agree (Beslija S, Bonneterre J, Burstein HJ et al. Third consensus on medical treatment of metastatic breast cancer. Ann Oncol 2009; 20 (11): 1771-1785). This is of particular importance in diseases in which treatment options depend on very particular clinical and biologic variables (Zielinski CC, Beinert T, Crawford J et al. Consensus on medical treatment of non-small-cell lung cancer--update 2004. Lung Cancer 2005; 50: 129-137; Beslija S, Bonneterre J, Burstein HJ et al. Third consensus on medical treatment of metastatic breast cancer. Ann Oncol 2009; 20 (11): 1771-1785). Since the publication of the last CECOG consensus on the medical treatment of NSCLC, a series of diagnostic tools for the characterization of biomarkers for personalized therapy for NSCLC as well as therapeutic options including adjuvant treatment, targeted therapy, and maintenance treatment have emerged and strongly influenced the field. Thus, the present third consensus was generated that not only readdresses previous disease-related issues but also expands toward recent developments in the management of NSCLC. It is the aim of the present consensus to summarize minimal quality-oriented requirements for individual patients with NSCLC in its various stages based upon levels of evidence in the light of a rapidly expanding array of individual therapeutic options.
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Affiliation(s)
- T Brodowicz
- Clinical Division of Oncology, Comprehensive Cancer Center, Medical University Vienna-General Hospital, Vienna, Austria; Central European Cooperative Oncology Group
| | - T Ciuleanu
- Medical Oncology Department, Institute of Oncology, Cluj-Napoca, Romania
| | - J Crawford
- Department of Medicine, Duke Medical Center, Durham, USA
| | - M Filipits
- Institute of Cancer Research, Department of Medicine I, Comprehensive Cancer Center, Medical University Vienna-General Hospital, Vienna, Austria
| | - J R Fischer
- Department of Medicine II, Onkology, Klinik Löwenstein, Löwenstein, Germany
| | - V Georgoulias
- Department of Medical Oncology, University General Hospital of Heraklion, Heraklion, Crete, Greece
| | - C Gridelli
- Division of Medical Oncology, S.G. Moscati Hospital, Contrada Amoretta, Italy
| | - F R Hirsch
- Department of Pathology, University of Colorado, Aurora, USA
| | - J Jassem
- Central European Cooperative Oncology Group; Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
| | - P Kosmidis
- Department of Medical Oncology, Hygeia Hospital, Athens, Greece
| | - M Krzakowski
- Central European Cooperative Oncology Group; Department of Lung and Thoracic Tumours, Maria Sklodowska Curie Memorial Cancer Center, Warsaw, Poland
| | - Ch Manegold
- Department of Surgery, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - J L Pujol
- Department of Oncology Lung, Hopital Arnaud de Villeneuve, Montpellier, France
| | - R Stahel
- Laboratory for Molecular Oncology, Department of Thoracic Oncology, Clinic and Policlinic for Oncology, University Hospital Zurich, Zurich, Switzerland
| | - N Thatcher
- Department of Medical Oncology, Christie Hospital NHS Trust, Manchester, UK
| | - J Vansteenkiste
- Respiratory Oncology Unit (Pulmonology), University Hospital Gasthuisberg, Leuven, Belgium
| | - C Minichsdorfer
- Clinical Division of Oncology, Comprehensive Cancer Center, Medical University Vienna-General Hospital, Vienna, Austria
| | - S Zöchbauer-Müller
- Clinical Division of Oncology, Comprehensive Cancer Center, Medical University Vienna-General Hospital, Vienna, Austria
| | - R Pirker
- Clinical Division of Oncology, Comprehensive Cancer Center, Medical University Vienna-General Hospital, Vienna, Austria
| | - C C Zielinski
- Clinical Division of Oncology, Comprehensive Cancer Center, Medical University Vienna-General Hospital, Vienna, Austria; Central European Cooperative Oncology Group.
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Ettinger DS, Agulnik M, Cates JMM, Cristea M, Denlinger CS, Eaton KD, Fidias PM, Gierada D, Gockerman JP, Handorf CR, Iyer R, Lenzi R, Phay J, Rashid A, Saltz L, Shulman LN, Smerage JB, Varadhachary GR, Zager JS, Zhen WK. NCCN Clinical Practice Guidelines Occult primary. J Natl Compr Canc Netw 2012; 9:1358-95. [PMID: 22157556 DOI: 10.6004/jnccn.2011.0117] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Occult primary tumors, or cancers of unknown primary (CUPs), are defined as histologically proven metastatic malignant tumors whose primary site cannot be identified during pretreatment evaluation. They have a wide variety of clinical presentations and a poor prognosis in most patients. Patients with occult primary tumors often present with general complaints, such as anorexia and weight loss. Clinical absence of primary tumor, early dissemination, aggressiveness, and unpredictability of metastatic pattern are characteristic of these tumors. Life expectancy is very short, with a median survival of 6 to 9 months. In most patients, occult primary tumors are refractory to systemic treatments, and chemotherapy is only palliative and does not significantly improve long-term survival. However, certain clinical presentations of these tumors are associated with a better prognosis. Special pathologic studies can identify subsets of patients with tumor types that are more responsive to chemotherapy. Treatment options should be individualized for this selected group of patients to achieve improved response and survival rates.
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Benson AB, Arnoletti JP, Bekaii-Saab T, Chan E, Chen YJ, Choti MA, Cooper HS, Dilawari RA, Engstrom PF, Enzinger PC, Fleshman JW, Fuchs CS, Grem JL, Knol JA, Leong LA, Lin E, May KS, Mulcahy MF, Murphy K, Rohren E, Ryan DP, Saltz L, Sharma S, Shibata D, Skibber JM, Small W, Sofocleous CT, Venook AP, Willett C. Colon cancer. J Natl Compr Canc Netw 2012; 9:1238-90. [PMID: 22056656 DOI: 10.6004/jnccn.2011.0104] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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