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Research and Reviews for the Practicing Oncologist
Cost-benefit analysis of decision support methods for patients with breast cancer in a rural community
Background Decision support interventions help patients who are facing difficult treatment decisions and improve shared decision making. There is little evidence of the economic impact of these interventions.
Objective To determine the costs of providing a decision support intervention in the form of consultation planning (CP) and consultation planning with recording and summary (CPRS) to women with breast cancer and to compare the cost benefit of CP and CPRS by telephone versus in person.
Methods Sixty-eight women with breast cancer who were being treated at a rural cancer resource center were randomized to CP in person or by telephone. All participants were then provided with an audio-recording of the physician consultation along with a typed summary for the full intervention (CPRS). Surveys completed by the participants and center staff provided data for measuring costs and willingness-to-pay (WTP) benefits. Societal perspective costs and incremental net benefit (INB) across delivery methods was determined.
Results Total CP costs were $208.72 for telephone and $264.00 for in-person delivery. Significantly lower telephone-group costs (P ˂ .001) were a result of lower participant travel expenses. Participants were willing to pay $154.12 for telephone and $144.03 for in-person CP (P = .85). WTP did not exceed costs of either delivery method compared with no intervention. INB of providing CP for telephone versus in person was $65.37, favoring telephone delivery. Sensitivity analysis revealed that with more efficient CP training, WTP became greater than the costs of delivering CP by telephone versus no intervention.
Limitations There may be some income distribution effects in the measurement of WTP.
Conclusions Providing CP by telephone was significantly less costly with no significant difference in benefit. Participants’ WTP only exceeded the full cost of CP with more efficient training or higher participant volume. A positive INB showed telephone delivery is efficient and may increase accessibility to decision support services, particularly in rural communities.
Click on the PDF icon at the top of this introduction to read the full article.
Background Decision support interventions help patients who are facing difficult treatment decisions and improve shared decision making. There is little evidence of the economic impact of these interventions.
Objective To determine the costs of providing a decision support intervention in the form of consultation planning (CP) and consultation planning with recording and summary (CPRS) to women with breast cancer and to compare the cost benefit of CP and CPRS by telephone versus in person.
Methods Sixty-eight women with breast cancer who were being treated at a rural cancer resource center were randomized to CP in person or by telephone. All participants were then provided with an audio-recording of the physician consultation along with a typed summary for the full intervention (CPRS). Surveys completed by the participants and center staff provided data for measuring costs and willingness-to-pay (WTP) benefits. Societal perspective costs and incremental net benefit (INB) across delivery methods was determined.
Results Total CP costs were $208.72 for telephone and $264.00 for in-person delivery. Significantly lower telephone-group costs (P ˂ .001) were a result of lower participant travel expenses. Participants were willing to pay $154.12 for telephone and $144.03 for in-person CP (P = .85). WTP did not exceed costs of either delivery method compared with no intervention. INB of providing CP for telephone versus in person was $65.37, favoring telephone delivery. Sensitivity analysis revealed that with more efficient CP training, WTP became greater than the costs of delivering CP by telephone versus no intervention.
Limitations There may be some income distribution effects in the measurement of WTP.
Conclusions Providing CP by telephone was significantly less costly with no significant difference in benefit. Participants’ WTP only exceeded the full cost of CP with more efficient training or higher participant volume. A positive INB showed telephone delivery is efficient and may increase accessibility to decision support services, particularly in rural communities.
Click on the PDF icon at the top of this introduction to read the full article.
Background Decision support interventions help patients who are facing difficult treatment decisions and improve shared decision making. There is little evidence of the economic impact of these interventions.
Objective To determine the costs of providing a decision support intervention in the form of consultation planning (CP) and consultation planning with recording and summary (CPRS) to women with breast cancer and to compare the cost benefit of CP and CPRS by telephone versus in person.
Methods Sixty-eight women with breast cancer who were being treated at a rural cancer resource center were randomized to CP in person or by telephone. All participants were then provided with an audio-recording of the physician consultation along with a typed summary for the full intervention (CPRS). Surveys completed by the participants and center staff provided data for measuring costs and willingness-to-pay (WTP) benefits. Societal perspective costs and incremental net benefit (INB) across delivery methods was determined.
Results Total CP costs were $208.72 for telephone and $264.00 for in-person delivery. Significantly lower telephone-group costs (P ˂ .001) were a result of lower participant travel expenses. Participants were willing to pay $154.12 for telephone and $144.03 for in-person CP (P = .85). WTP did not exceed costs of either delivery method compared with no intervention. INB of providing CP for telephone versus in person was $65.37, favoring telephone delivery. Sensitivity analysis revealed that with more efficient CP training, WTP became greater than the costs of delivering CP by telephone versus no intervention.
Limitations There may be some income distribution effects in the measurement of WTP.
Conclusions Providing CP by telephone was significantly less costly with no significant difference in benefit. Participants’ WTP only exceeded the full cost of CP with more efficient training or higher participant volume. A positive INB showed telephone delivery is efficient and may increase accessibility to decision support services, particularly in rural communities.
Click on the PDF icon at the top of this introduction to read the full article.
Community Oncology Podcast - Pretreatment PET in eosphageal cancer
In his first podcast for 2013, Dr. David Henry, Editor in Chief of Community Oncology, highlights an article on the impact of pretreatment positron emission tomography on disease control and treatment decisions in advanced esophageal cancer and another on the relationship between patient age, comorbidities, and neutropenic complications in patients receiving myelosuppressive chemotherapy. Other highlights include a Community Translations essay and accompanying Commentary on the recently approved regorafenib for previously treated metastatic colorectal cancer.
In his first podcast for 2013, Dr. David Henry, Editor in Chief of Community Oncology, highlights an article on the impact of pretreatment positron emission tomography on disease control and treatment decisions in advanced esophageal cancer and another on the relationship between patient age, comorbidities, and neutropenic complications in patients receiving myelosuppressive chemotherapy. Other highlights include a Community Translations essay and accompanying Commentary on the recently approved regorafenib for previously treated metastatic colorectal cancer.
In his first podcast for 2013, Dr. David Henry, Editor in Chief of Community Oncology, highlights an article on the impact of pretreatment positron emission tomography on disease control and treatment decisions in advanced esophageal cancer and another on the relationship between patient age, comorbidities, and neutropenic complications in patients receiving myelosuppressive chemotherapy. Other highlights include a Community Translations essay and accompanying Commentary on the recently approved regorafenib for previously treated metastatic colorectal cancer.
Live from ASH: Dr. David Henry shares his 'did you know' picks
Dr. David Henry, the editor-in-chief of the Community Oncology journal, shares some of his "did you know" picks from the annual meeting of the American Society of Hematology. His 5-minute report reviews the new international prognostic scoring system for myelodysplastic syndromes, gene expression profiling for diffuse large b-cell lymphoma, approach to Waldenstrom's macroglobulin anemia, gray zone lymphoma, multiple myeloma updates, and more.
Dr. David Henry, the editor-in-chief of the Community Oncology journal, shares some of his "did you know" picks from the annual meeting of the American Society of Hematology. His 5-minute report reviews the new international prognostic scoring system for myelodysplastic syndromes, gene expression profiling for diffuse large b-cell lymphoma, approach to Waldenstrom's macroglobulin anemia, gray zone lymphoma, multiple myeloma updates, and more.
Dr. David Henry, the editor-in-chief of the Community Oncology journal, shares some of his "did you know" picks from the annual meeting of the American Society of Hematology. His 5-minute report reviews the new international prognostic scoring system for myelodysplastic syndromes, gene expression profiling for diffuse large b-cell lymphoma, approach to Waldenstrom's macroglobulin anemia, gray zone lymphoma, multiple myeloma updates, and more.
Dr. Mike Fisch tracks the trends from ASCO's Quality Care Symposium
We caught up with Dr. Michael Fisch of MD Anderson Cancer Center at the close of American Society of Clinical Oncology's first Quality Care Symposium to review the meeting's highlights.
According to Dr Fisch, palliative care pervaded the entire meeting, and its principles resonated from talk to talk, including assessing and managing symptoms to improve cancer care, the importance of communicating goals of care, and end-of-life planning.
We caught up with Dr. Michael Fisch of MD Anderson Cancer Center at the close of American Society of Clinical Oncology's first Quality Care Symposium to review the meeting's highlights.
According to Dr Fisch, palliative care pervaded the entire meeting, and its principles resonated from talk to talk, including assessing and managing symptoms to improve cancer care, the importance of communicating goals of care, and end-of-life planning.
We caught up with Dr. Michael Fisch of MD Anderson Cancer Center at the close of American Society of Clinical Oncology's first Quality Care Symposium to review the meeting's highlights.
According to Dr Fisch, palliative care pervaded the entire meeting, and its principles resonated from talk to talk, including assessing and managing symptoms to improve cancer care, the importance of communicating goals of care, and end-of-life planning.
LinkedIn + Facebook + HIPPA + friendly and secure = Doximity
Doximity. It’s an obvious mash-up of “doctors” and “proximity,” but it gets the point across. The “private network for physicians” hopes to do for clinicians what LinkedIn does for other professionals and Facebook does for the masses—connect like-minded people. Or in Doximity’s case, connect medical minds, the first step to professional sharing and collaboration and growing referral networks.
*Click on the links to the left of this introduction for a PDF of the full article and related Commentary.
Doximity. It’s an obvious mash-up of “doctors” and “proximity,” but it gets the point across. The “private network for physicians” hopes to do for clinicians what LinkedIn does for other professionals and Facebook does for the masses—connect like-minded people. Or in Doximity’s case, connect medical minds, the first step to professional sharing and collaboration and growing referral networks.
*Click on the links to the left of this introduction for a PDF of the full article and related Commentary.
Doximity. It’s an obvious mash-up of “doctors” and “proximity,” but it gets the point across. The “private network for physicians” hopes to do for clinicians what LinkedIn does for other professionals and Facebook does for the masses—connect like-minded people. Or in Doximity’s case, connect medical minds, the first step to professional sharing and collaboration and growing referral networks.
*Click on the links to the left of this introduction for a PDF of the full article and related Commentary.
Plasmablastic lymphoma presenting as proptosis and impending visual loss
A 40-year-old Hispanic man with an unremarkable medical history presented to the emergency department with sudden onset swelling of and loss of vision in the left eye. His symptoms had initially developed 3 months before his presentation and were considered to have been the result of a possible infection of the orbital muscle and associated inflammation. He had symptomatic improvement after steroid treatment. However, he began to notice increasing left nasal congestion, double vision, and facial numbness after discontinuation of steroids.
*For a PDF of the full article, click on the link to the left of this introduction.
A 40-year-old Hispanic man with an unremarkable medical history presented to the emergency department with sudden onset swelling of and loss of vision in the left eye. His symptoms had initially developed 3 months before his presentation and were considered to have been the result of a possible infection of the orbital muscle and associated inflammation. He had symptomatic improvement after steroid treatment. However, he began to notice increasing left nasal congestion, double vision, and facial numbness after discontinuation of steroids.
*For a PDF of the full article, click on the link to the left of this introduction.
A 40-year-old Hispanic man with an unremarkable medical history presented to the emergency department with sudden onset swelling of and loss of vision in the left eye. His symptoms had initially developed 3 months before his presentation and were considered to have been the result of a possible infection of the orbital muscle and associated inflammation. He had symptomatic improvement after steroid treatment. However, he began to notice increasing left nasal congestion, double vision, and facial numbness after discontinuation of steroids.
*For a PDF of the full article, click on the link to the left of this introduction.
Variation by age in neutropenic complications among patients with cancer receiving chemotherapy
Background Age is among the most important risk factors for neutropenia-related hospitalization, but evidence is limited regarding the relative contributions of age and other risk factors.
Objective To explore the associations among patient age, other risk factors, and neutropenic complications in patients with cancer receiving myelosuppressive chemotherapy.
Methods This retrospective cohort study, which used a US commercial insurance claims database, included patients aged 40 years or older with non-Hodgkin lymphoma (NHL), breast cancer, or lung cancer who initiated chemotherapy between January 1, 2006 and March 31, 2010. The primary endpoint was the risk of neutropenia-related hospitalization during the first chemotherapy course. We used cubic spline modeling to estimate the association between neutropenia-related hospitalization and age, adjusting for patient and treatment characteristics. Logistic regression analyses examined the effects of other risk factors.
Results A total of 15,638 patients were included (NHL, n = 2,506; breast cancer, n = 9,110; lung cancer, n = 4,022), mean age 56-66 years. Neutropenia-related hospitalization occurred in 8.7% of NHL patients, 4.2% of breast cancer patients, and 3.9% of lung cancer patients. The association between age and the risk of neutropenia-related hospitalization was stronger in NHL than in lung or breast cancer. Patient comorbidities and chemotherapy characteristics had considerable effects on risk of neutropenia-related hospitalization.
Limitations Disease stage and other clinical factors could not be identified from the claims data.
Conclusion In addition to age, oncologists should evaluate individual patient risk factors including patient comorbidities and type of chemotherapy regimen.
*To read the full article, click on the PDF icon at the top of this introduction.
Background Age is among the most important risk factors for neutropenia-related hospitalization, but evidence is limited regarding the relative contributions of age and other risk factors.
Objective To explore the associations among patient age, other risk factors, and neutropenic complications in patients with cancer receiving myelosuppressive chemotherapy.
Methods This retrospective cohort study, which used a US commercial insurance claims database, included patients aged 40 years or older with non-Hodgkin lymphoma (NHL), breast cancer, or lung cancer who initiated chemotherapy between January 1, 2006 and March 31, 2010. The primary endpoint was the risk of neutropenia-related hospitalization during the first chemotherapy course. We used cubic spline modeling to estimate the association between neutropenia-related hospitalization and age, adjusting for patient and treatment characteristics. Logistic regression analyses examined the effects of other risk factors.
Results A total of 15,638 patients were included (NHL, n = 2,506; breast cancer, n = 9,110; lung cancer, n = 4,022), mean age 56-66 years. Neutropenia-related hospitalization occurred in 8.7% of NHL patients, 4.2% of breast cancer patients, and 3.9% of lung cancer patients. The association between age and the risk of neutropenia-related hospitalization was stronger in NHL than in lung or breast cancer. Patient comorbidities and chemotherapy characteristics had considerable effects on risk of neutropenia-related hospitalization.
Limitations Disease stage and other clinical factors could not be identified from the claims data.
Conclusion In addition to age, oncologists should evaluate individual patient risk factors including patient comorbidities and type of chemotherapy regimen.
*To read the full article, click on the PDF icon at the top of this introduction.
Background Age is among the most important risk factors for neutropenia-related hospitalization, but evidence is limited regarding the relative contributions of age and other risk factors.
Objective To explore the associations among patient age, other risk factors, and neutropenic complications in patients with cancer receiving myelosuppressive chemotherapy.
Methods This retrospective cohort study, which used a US commercial insurance claims database, included patients aged 40 years or older with non-Hodgkin lymphoma (NHL), breast cancer, or lung cancer who initiated chemotherapy between January 1, 2006 and March 31, 2010. The primary endpoint was the risk of neutropenia-related hospitalization during the first chemotherapy course. We used cubic spline modeling to estimate the association between neutropenia-related hospitalization and age, adjusting for patient and treatment characteristics. Logistic regression analyses examined the effects of other risk factors.
Results A total of 15,638 patients were included (NHL, n = 2,506; breast cancer, n = 9,110; lung cancer, n = 4,022), mean age 56-66 years. Neutropenia-related hospitalization occurred in 8.7% of NHL patients, 4.2% of breast cancer patients, and 3.9% of lung cancer patients. The association between age and the risk of neutropenia-related hospitalization was stronger in NHL than in lung or breast cancer. Patient comorbidities and chemotherapy characteristics had considerable effects on risk of neutropenia-related hospitalization.
Limitations Disease stage and other clinical factors could not be identified from the claims data.
Conclusion In addition to age, oncologists should evaluate individual patient risk factors including patient comorbidities and type of chemotherapy regimen.
*To read the full article, click on the PDF icon at the top of this introduction.
Regorafenib in previously treated metastatic colorectal cancer
The multikinase inhibitor regorafenib was recently approved for the treatment of patients with metastatic colorectal cancer (mCRC) who had been previously treated with fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapy, anti-VEGF therapy, and, for patients with wild-type KRAS tumors, anti-EGFR therapy.1 Regorafenib inhibits numerous membrane-bound and intracellular kinases involved in normal cell function and in oncogenesis, tumor angiogenesis, and maintenance of the tumor microenvironment (including RET, VEGFR1, VEGFR2, VEGFR3, KIT, PDGFR- , PDGFR- , FGFR1, FGFR2, TIE2, DDR2, Trk2A, Eph2A, RAF-1, BRAF, BRAFV600E, SAPK2, PTK5, and Abl kinases). The approval was based on findings in the international, phase 3 CORRECT trial2…
*Click on the links to the left of this introduction for a PDF of the full article and related Commentary.
The multikinase inhibitor regorafenib was recently approved for the treatment of patients with metastatic colorectal cancer (mCRC) who had been previously treated with fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapy, anti-VEGF therapy, and, for patients with wild-type KRAS tumors, anti-EGFR therapy.1 Regorafenib inhibits numerous membrane-bound and intracellular kinases involved in normal cell function and in oncogenesis, tumor angiogenesis, and maintenance of the tumor microenvironment (including RET, VEGFR1, VEGFR2, VEGFR3, KIT, PDGFR- , PDGFR- , FGFR1, FGFR2, TIE2, DDR2, Trk2A, Eph2A, RAF-1, BRAF, BRAFV600E, SAPK2, PTK5, and Abl kinases). The approval was based on findings in the international, phase 3 CORRECT trial2…
*Click on the links to the left of this introduction for a PDF of the full article and related Commentary.
The multikinase inhibitor regorafenib was recently approved for the treatment of patients with metastatic colorectal cancer (mCRC) who had been previously treated with fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapy, anti-VEGF therapy, and, for patients with wild-type KRAS tumors, anti-EGFR therapy.1 Regorafenib inhibits numerous membrane-bound and intracellular kinases involved in normal cell function and in oncogenesis, tumor angiogenesis, and maintenance of the tumor microenvironment (including RET, VEGFR1, VEGFR2, VEGFR3, KIT, PDGFR- , PDGFR- , FGFR1, FGFR2, TIE2, DDR2, Trk2A, Eph2A, RAF-1, BRAF, BRAFV600E, SAPK2, PTK5, and Abl kinases). The approval was based on findings in the international, phase 3 CORRECT trial2…
*Click on the links to the left of this introduction for a PDF of the full article and related Commentary.
Community Oncology Podcast - Everolimus for tuberous sclerosis
Everolimus for tuberous sclerosis-associated tumors, BRCA testing in underserved women, and thoughts on cancer care site of service are the topics for the December 2012 Community Oncology podcast by Editor in Chief Dr. David Henry.
Everolimus for tuberous sclerosis-associated tumors, BRCA testing in underserved women, and thoughts on cancer care site of service are the topics for the December 2012 Community Oncology podcast by Editor in Chief Dr. David Henry.
Everolimus for tuberous sclerosis-associated tumors, BRCA testing in underserved women, and thoughts on cancer care site of service are the topics for the December 2012 Community Oncology podcast by Editor in Chief Dr. David Henry.
Dr. Raul Ruiz goes to Washington
Dr. Raul Ruiz has traded in his white coat for an office on Capitol Hill. An emergency physician from California’s Coachella Valley, Dr. Ruiz is the newest physician, and one of three democrat physicians, serving in Congress. When the 113th Congress begins on Jan. 3, Dr. Ruiz said he will focus on physician payment reform as well as addressing disparities in income, healthcare, and education.
Unlike many congressional physicians – the majority of whom are Republicans – Dr. Ruiz said he wants to keep some Affordable Care Act provisions in place, while ensuring the health care workforce can support them. To find out more about Dr. Ruiz, check out our video.
Dr. Raul Ruiz has traded in his white coat for an office on Capitol Hill. An emergency physician from California’s Coachella Valley, Dr. Ruiz is the newest physician, and one of three democrat physicians, serving in Congress. When the 113th Congress begins on Jan. 3, Dr. Ruiz said he will focus on physician payment reform as well as addressing disparities in income, healthcare, and education.
Unlike many congressional physicians – the majority of whom are Republicans – Dr. Ruiz said he wants to keep some Affordable Care Act provisions in place, while ensuring the health care workforce can support them. To find out more about Dr. Ruiz, check out our video.
Dr. Raul Ruiz has traded in his white coat for an office on Capitol Hill. An emergency physician from California’s Coachella Valley, Dr. Ruiz is the newest physician, and one of three democrat physicians, serving in Congress. When the 113th Congress begins on Jan. 3, Dr. Ruiz said he will focus on physician payment reform as well as addressing disparities in income, healthcare, and education.
Unlike many congressional physicians – the majority of whom are Republicans – Dr. Ruiz said he wants to keep some Affordable Care Act provisions in place, while ensuring the health care workforce can support them. To find out more about Dr. Ruiz, check out our video.