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Han J, Lai H, Li W, Liao H, Xiao C, Li X, You F, Guo J. Efficacy and safety of traditional plant-based medicines for preventing chronic oxaliplatin-induced peripheral neurotoxicity in patients with colorectal cancer: A systematic review and meta-analysis with core herb contribution. JOURNAL OF ETHNOPHARMACOLOGY 2024; 326:117735. [PMID: 38211824 DOI: 10.1016/j.jep.2024.117735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/05/2023] [Accepted: 01/07/2024] [Indexed: 01/13/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Traditional plant-based medicines (TMs) have been widely used to prevent chronic oxaliplatin-induced peripheral neurotoxicity (OIPN). However, the prevention and safety of TMs for chronic OIPN remain ambiguous. Furthermore, diverse TM prescriptions and complicated components limit in-depth research on the mechanisms of TMs. AIM OF THIS STUDY To determine core TMs and potential pharmacological pathways on the basis of a thorough investigation into the preventive benefits and safety of oral TMs for chronic OIPN in colorectal cancer (CRC). METHODS A search of the PubMed, Cochrane, Embase, CNKI, VIP, and Wanfang databases for RCTs reporting on TMs for chronic OIPN was conducted through December 1, 2022. Subgroup analysis, sensitivity analysis and meta-regression were applied to assess the impacts of influencing variables. The assessment of Risk of Bias was relied on Cochrane Risk of Bias tool. The funnel plot, Egger's test, and the Trim and Fill method were applied to identify potential publication bias. Trial sequential analyses (TSA) were carried out by the TSA tool to increase the robustness. The assessment of the quality of evidence was according to the GRADE system. System pharmacology analysis was employed to screen core herbal combinations to elucidate possible mechanisms for preventing chronic OIPN in CRC. RESULTS The pooled effect estimate with robustness increased by TSA analysis demonstrated that oral TMs appeared to significantly decrease the incidence of chronic OIPN (RR = 0.66, 95% CI (0.56, 0.78); P<0.00001), leukocytopenia (RR = 0.65, 95% CI (0.54,0.79); P<0.00001), and nausea and vomiting (RR = 0.72, 95% CI (0.61,0.84); P<0.0001) as well as improve the Objective Response Rate (ORR) (RR = 1.31, 95% CI (1.09,1.56); P = 0.003). The incidence of severe chronic OIPN was revealed a significant reduction, particularly when chemotherapy was administered for periods of time shorter than six months (RR = 0.33, 95% CI (0.15,0.71); P = 0.005; actuation duration<3 months; RR = 0.33, 95% CI (0.17,0.62); P = 0.0007; actuation duration≥3 months, <6 months). The considerable heterogeneity among studies may be attributable to the severity of dysfunction categorized by grade and accumulated dosage. Using core TMs consisting of Astragalus membranaceus (Fisch.) Bunge, Atractylodes Macrocephala Koidz., Poria cocos (Schw.) Wolf, and Codonopsis pilosula (Franch.) Nannf. To regulate nuclear factor-kappa B against inflammation caused by activation of microglia might be an approach to preventing chronic OIPN. CONCLUSIONS TMs appear to be effective and safe in the prevention of chronic OIPN, especially severe chronic OIPN. Additionally, core TMs consisting of Astragalus membranaceus (Fisch.) Bunge, Atractylodes Macrocephala Koidz., Poria cocos (Schw.) Wolf, and Codonopsis pilosula (Franch.) Nannf were presumably responsible for reducing the incidence of chronic OIPN, and the mechanism may be related to relieving inflammation. However, quality-assured trials with long-term follow-up for exploring inflammatory factors and preliminary research on core TMs and pharmacological pathways are needed.
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Affiliation(s)
- Jierong Han
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shierqiao Road, Jinniu District, Chengdu, Sichuan, 610075, China.
| | - Hengzhou Lai
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shierqiao Road, Jinniu District, Chengdu, Sichuan, 610075, China.
| | - Wenyuan Li
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shierqiao Road, Jinniu District, Chengdu, Sichuan, 610075, China; Evidence-based Traditional Chinese Medicine Center of Sichuan Province, No. 39 Shierqiao Road, Jinniu District, Chengdu, Sichuan, 610075, China.
| | - Huarui Liao
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shierqiao Road, Jinniu District, Chengdu, Sichuan, 610075, China.
| | - Chong Xiao
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shierqiao Road, Jinniu District, Chengdu, Sichuan, 610075, China; Cancer Institute of Chengdu University of Traditional Chinese Medicine, No. 39 Shierqiao Road, Jinniu District, Chengdu, Sichuan, 610075, China.
| | - Xueke Li
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shierqiao Road, Jinniu District, Chengdu, Sichuan, 610075, China; Tumor Teaching and Research Office of Chengdu University of Traditional Chinese Medicine, No. 39 Shierqiao Road, Jinniu District, Chengdu, Sichuan, 610075, China.
| | - Fengming You
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shierqiao Road, Jinniu District, Chengdu, Sichuan, 610075, China; Cancer Institute of Chengdu University of Traditional Chinese Medicine, No. 39 Shierqiao Road, Jinniu District, Chengdu, Sichuan, 610075, China.
| | - Jing Guo
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shierqiao Road, Jinniu District, Chengdu, Sichuan, 610075, China.
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Augustovski F, Tsou F, González L, Martín C, Vigo S, Gabay C, Alcaraz A, Argento F. Impact of Lung Cancer on Health-Related Quality of Life, Financial Toxicity, and Household Economics in Patients From the Public and the Private Healthcare Sector in Argentina. Value Health Reg Issues 2024; 41:94-99. [PMID: 38290167 DOI: 10.1016/j.vhri.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/23/2023] [Accepted: 12/06/2023] [Indexed: 02/01/2024]
Abstract
OBJECTIVES Non-small cell lung cancer (NSCLC) is Argentina's first cause of cancer death. Most patients have an advanced stage at diagnosis, with poor expected survival. This study aimed to characterize the health-related quality of life (HRQOL) and economic impact of patients treated in the private healthcare sector and compare it with that of the public sector. METHODS We undertook an observational cross-sectional study that extended a previous study to a referral private center in Argentina. Outcomes included the EuroQol EQ-5D-3L (to assess HRQOL), Comprehensive Score for Financial Toxicity (financial toxicity instrument), Work Productivity and Activity Impairment - General Health (to assess productivity loss), and out-of-pocket expenses in adults diagnosed of NSCLC. RESULTS We included 30 consecutive patients from a private healthcare center (July 2021 to March 2022), totaling 131 patients (n = 101 from previous public study). The whole sample had low quality of life and relevant economic impact. Patients in the private healthcare sector showed lower disease severity and higher educational level and household income. In addition, private healthcare system patients showed higher utility (0.77 vs 0.73; P < .05) and lower impairment of daily activities (41% vs 59%; P = .01). Private health system patients also showed lower financial toxicity as measured by the Comprehensive Score for Financial Toxicity score (23.9 vs 20.14; P < .05) but showed no differences when financial toxicity was assessed as a dichotomic variable. CONCLUSIONS Although patients with NSCLC treated in a private healthcare center in Argentina showed a relevant HRQOL and economic impact, this impact was smaller than the one observed in publicly funded hospitals.
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Affiliation(s)
- Federico Augustovski
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina; University of Buenos Aires School of Medicine, Buenos Aires, Argentina; Center for Research in Epidemiology and Public Health (CIESP), National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.
| | | | - Lucas González
- Hospital Interzonal General de Agudos Profesor Dr. Rodolfo Rossi, Buenos Aires, Argentina
| | | | - Silvina Vigo
- Hospital Interzonal de Agudos y Crónicos San Juan de Dios de La Plata, Buenos Aires, Argentina; Hospital Interzonal General de Agudos Profesor Dr. Rodolfo Rossi, Buenos Aires, Argentina
| | - Carolina Gabay
- Instituto de Oncología Ángel H. Roffo, Buenos Aires, Argentina
| | - Andrea Alcaraz
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Fernando Argento
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
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Yin Y, Peng Q, Ma L, Dong Y, Sun Y, Xu S, Ding N, Liu X, Zhao M, Tang Y, Mei Z, Shao H, Yan D, Tang W. QALY-type preference and willingness-to-pay among end-of-life patients with cancer treatments: a pilot study using discrete choice experiment. Qual Life Res 2024; 33:753-765. [PMID: 38079024 DOI: 10.1007/s11136-023-03562-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2023] [Indexed: 02/26/2024]
Abstract
PURPOSE Quality-adjusted life-year (QALY) is a dominant measurement of health gain in economic evaluations for pricing drugs. However, end-of-life (EoL) patients' preference for QALY gains in life expectancy (LE) and quality of life (QoL) during different disease stages remains unknown and is seldom involved in decision-making. This study aims to measure preferences and willingness-to-pay (WTP) towards different types of QALY gain among EoL cancer patients. METHODS We attributed QALY gain to four types, gain in LE and QoL, respectively, and during both progression-free survival (PFS) and post-progression survival (PPS). A discrete choice experiment including five attributes (the four QALY attributes and one cost attribute) with three levels each was developed and conducted with 85 Chinese advanced non-small cell lung cancer patients in 2022. All levels were set with QALY gain/cost synthesised from research on anti-lung cancer drugs recently listed by Chinese National Healthcare Security Administration. Each respondent answered six choice tasks in a face-to-face interview. The data were analysed using mixed logit models. RESULTS Patients valued LE-related QALY gain in PFS most, with a relative importance of 81.8% and a WTP of $43,160 [95% CI 26,751 ~ 59,569] per QALY gain. Respondents consistently preferred LE-related to QoL-related QALY gain regardless of disease stage. Patients with higher income or lower education levels tended to pay more for QoL-related QALY gain. CONCLUSION Our findings suggest a prioritised resource allocation to EoL-prolonging health technologies. Given the small sample size and large individual heterogeneity, a full-scale study is needed to provide more robust results.
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Affiliation(s)
- Yue Yin
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, China
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China
| | - Qian Peng
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, China
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China
| | - Longhao Ma
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, China
| | - Yi Dong
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, China
| | - Yinan Sun
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, China
| | - Silu Xu
- Department of Pharmacy, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, China
| | - Nianyang Ding
- Department of Pharmacy, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, China
| | - Xiaolin Liu
- Department of Pharmacy, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, China
| | - Mingye Zhao
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, China
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China
| | - Yaqian Tang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, China
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China
| | - Zhiqing Mei
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, China
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China
| | - Hanqiao Shao
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, China
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China
| | - Dan Yan
- Department of Pharmacy, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, China.
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 211198, China.
| | - Wenxi Tang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, China.
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China.
- Department of Public Management, School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, China.
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Jovanoski N, Bowes K, Brown A, Belleli R, Di Maio D, Chadda S, Abogunrin S. Survival and quality-of-life outcomes in early-stage NSCLC patients: a literature review of real-world evidence. Lung Cancer Manag 2023; 12:LMT60. [PMID: 37693293 PMCID: PMC10485735 DOI: 10.2217/lmt-2023-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/22/2023] [Indexed: 09/12/2023] Open
Abstract
Aim Assess the long-term survival and quality-of-life outcomes in early-stage NSCLC (eNSCLC) patients. Methods Review of long-term survival and quality-of-life after curative treatment in eNSCLC patients in observational studies. Results Disease-free proportion decreased in stage III vs stage I patients. Recurrence-free proportion decreased with age and disease stage. Advanced stage and vascular invasion increased risk of late recurrence. Conditional 5-year relative survival rates did not exceed 87%, indicating higher mortality in eNSCLC survivors. Lower conditional survival rates and relative survival rates were associated with older age and advanced disease. Survivors of eNSCLC had poorer physical quality-of-life. Conclusion Despite curative-intent therapy, survivors of eNSCLC still face significant risks of recurrence, excess mortality, and diminished quality-of-life.
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Affiliation(s)
- Nick Jovanoski
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, Building 002/OG18, CH-4070, Basel, Switzerland
| | - Kathleen Bowes
- Genesis Research, West One, Forth Banks, Newcastle, NE1 3PA, UK
| | - Audrey Brown
- Genesis Research, West One, Forth Banks, Newcastle, NE1 3PA, UK
| | - Rossella Belleli
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, Building 002/OG18, CH-4070, Basel, Switzerland
| | - Danilo Di Maio
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, Building 002/OG18, CH-4070, Basel, Switzerland
| | - Shkun Chadda
- Genesis Research, West One, Forth Banks, Newcastle, NE1 3PA, UK
| | - Seye Abogunrin
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, Building 002/OG18, CH-4070, Basel, Switzerland
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Jovanoski N, Abogunrin S, Di Maio D, Belleli R, Hudson P, Bhadti S, Jones LG. Health State Utility Values in Early-Stage Non-small Cell Lung Cancer: A Systematic Literature Review. PHARMACOECONOMICS - OPEN 2023; 7:723-738. [PMID: 37289325 PMCID: PMC10471534 DOI: 10.1007/s41669-023-00423-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Non-small cell lung cancer (NSCLC) is the predominant histological subtype of lung cancer and is the leading cause of cancer-related deaths globally. Quality of life is an important consideration for patients and current treatments can adversely affect health-related quality of life (HRQoL). OBJECTIVE The objectives of this systematic literature review (SLR) were to identify and provide a comprehensive catalogue of published health state utility values (HSUVs) in patients with early-stage NSCLC and to understand the factors impacting on HSUVs in this indication. METHODS Electronic searches of Embase, MEDLINE and Evidence-Based Medicine Reviews were conducted via the Ovid platform in March 2021 and June 2022 and were supplemented by grey literature searches of conference proceedings, reference lists, health technology assessment bodies, and other relevant sources. Eligibility criteria were based on patients with early-stage (stage I-III) resectable NSCLC receiving treatment in the adjuvant or neoadjuvant setting. No restriction was placed on interventions or comparators, geography, or publication date. English language publications or non-English language publications with an English abstract were of primary interest. A validated checklist was applied to conduct quality assessment of the full publications. RESULTS Twenty-nine publications (27 full publications and two conference abstracts) met all eligibility criteria and reported 217 HSUVs and seven disutilities associated with patients with early NSCLC. The data showed that increasing disease stage is associated with decreasing HRQoL. It was also indicated that utility values vary by treatment approach; however, the choice of treatment may be influenced by the patients' disease stage at presentation. Few studies aligned with the requirements of health technology assessment (HTA) bodies, indicating a need for future studies to conform to these preferences, making them suitable for use in economic evaluations. CONCLUSIONS This SLR found that disease stage and treatment approach were two of several factors that can impact patient-reported HRQoL. Additional studies are warranted to confirm these findings and to investigate emerging therapies for early NSCLC. In collecting a catalogue of HSUV data, this SLR has begun to identify the challenges associated with identifying reliable utility value estimates suitable for use in economic evaluations of early NSCLC.
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Couderc AL, Bouhnik AD, Rey D, Bendiane MK, Greillier L, Nouguerède É, Pille A, Montegut C, Rousseau F, Villani P, Mancini J. Quality of life in older French long-term lung cancer survivors: VICAN5 national survey. Lung Cancer 2023; 180:107197. [PMID: 37116376 DOI: 10.1016/j.lungcan.2023.107197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 04/30/2023]
Abstract
OBJECTIVES This study aimed to describe quality of life (QoL) five years after diagnosis, in a representative sample of lung cancer (LC) survivors, to compare the QoL of survivors aged 70 years or older with that of younger ones, and to identify factors associated with poorer long-term QoL in both age groups. MATERIALS AND METHODS Our study sample consists of all individuals with a LC diagnosed between January 2010 and December 2011, who participated in the French national survey VICAN 5. RESULTS A total of 371 participants had LC. At the time of the survey, 21.3% of the participants were 70 years or older. In this older age group, feeling self-conscious about appearance and suspected neuropathic pain were independently associated with physical QoL impairment and lower Post-Traumatic Growth Inventory score, and suspected neuropathic pain was associated with impaired mental QoL. In younger patients, impaired physical QoL was independently associated with male gender, metastatic cancer, suspected neuropathic pain, report of severe after-effects of LC and difficulty breathing at rest in the past 7 days, and impaired mental QoL was independently associated with male gender, impaired ECOG-PS, and anxiety. CONCLUSION Factors associated with an impaired QoL in LC survivors, varied according to patient age. In both populations, psychological support and adapted physical activity can be offered to improve mental QoL and physical symptomatology. For older survivors with neuropathic pain, analgesic therapies can be discussed to improve long-term QoL.
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Affiliation(s)
- Anne-Laure Couderc
- Internal Medicine, Geriatrics and Therapeutic Unit, AP-HM, Marseille, France; Aix-Marseille Univ, CNRS, EFS, ADES, Marseille, France.
| | - Anne-Déborah Bouhnik
- Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Economics & Social Sciences Applied to Health & Analysis of Medical Information, Marseille, France
| | - Dominique Rey
- Internal Medicine, Geriatrics and Therapeutic Unit, AP-HM, Marseille, France; Aix-Marseille Univ, CNRS, EFS, ADES, Marseille, France
| | - Marc-Karim Bendiane
- Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Economics & Social Sciences Applied to Health & Analysis of Medical Information, Marseille, France
| | - Laurent Greillier
- Multidisciplinary Oncology and Therapeutic Innovations Department, AP-HM, Marseille, France; Aix-Marseille Univ, CNRS, INSERM, CRCM, Marseille, France
| | - Émilie Nouguerède
- Internal Medicine, Geriatrics and Therapeutic Unit, AP-HM, Marseille, France
| | - Ariane Pille
- Internal Medicine, Geriatrics and Therapeutic Unit, AP-HM, Marseille, France
| | - Coline Montegut
- Internal Medicine, Geriatrics and Therapeutic Unit, AP-HM, Marseille, France; Oncology Department, Institut Paoli Calmettes, Marseille, France
| | | | - Patrick Villani
- Internal Medicine, Geriatrics and Therapeutic Unit, AP-HM, Marseille, France; Aix-Marseille Univ, CNRS, EFS, ADES, Marseille, France
| | - Julien Mancini
- Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Economics & Social Sciences Applied to Health & Analysis of Medical Information, Marseille, France; APHM, BIOSTIC, Hop Timone, Marseille, France
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Nagy B, Szilberhorn L, Győrbíró DM, Moizs M, Bajzik G, Kerpel-Fronius A, Vokó Z. Shall We Screen Lung Cancer With Low-Dose Computed Tomography? Cost-Effectiveness in Hungary. Value Health Reg Issues 2023; 34:55-64. [PMID: 36502786 DOI: 10.1016/j.vhri.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/26/2022] [Accepted: 10/30/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Clinical data and cost-effectiveness analyses from several countries support the use of low-dose computed tomography (LDCT) to screen patients with high risk of lung cancer (LC). This study aimed to explore the economic value of screening LC with LDCT in Hungary. METHODS Cohorts of screened and nonscreened subjects were simulated in a decision analytic model over their lifetime. Five steps in the patient trajectory were distinguished: no LC, nondiagnosed LC, screening, diagnosed LC, and post-treatment. Patient pathways were populated based on the Hungarian pilot study of screening, the Nederlands-Leuvens Longkanker Screenings Onderzoek (NELSON) LC screening trial, and local incidence and prevalence data. Healthcare costs were obtained from the National Health Insurance Fund. Utility data were obtained from international sources and adjusted to local tariffs. Scenarios according to screening frequency, age bands (50-74, 55-74 years), and smoking status were analyzed. RESULTS Annual LDCT-based screening compared with no screening for 55- to 74-year-old current smokers showed 0.031 quality-adjusted life-year (QALY) gains for an additional €137, which yields €5707 per QALY. Biennial screening for the same target population showed that purchasing 1 QALY would cost €10 203. The least cost-effective case was biennial screening of the general population aged 50 to 74 years, which yielded €37 931 per QALY. CONCLUSIONS Screening LC with LDCT for a high-risk population could be cost-effective in Hungary. For the introduction of screening with LDCT, targeting the most vulnerable groups while having a long-term approach on costs and benefits is essential.
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Affiliation(s)
- Balázs Nagy
- Syreon Research Institute, Budapest, Hungary; Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary.
| | | | | | | | | | | | - Zoltán Vokó
- Syreon Research Institute, Budapest, Hungary; Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
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Xia Y, Chen Y, Chen J, Gan Y, Su C, Zhang H, Long E, Yan F, Yang Y. Measuring direct non-medical burden among patients with advanced non-small cell lung cancer in China: is there a difference in health status? Front Public Health 2023; 11:1090623. [PMID: 37213608 PMCID: PMC10192575 DOI: 10.3389/fpubh.2023.1090623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 04/06/2023] [Indexed: 05/23/2023] Open
Abstract
Objective This study was conducted to estimate the direct non-medical cost of advanced non-small cell lung cancer (NSCLC) patients and explore whether its associated factors vary by health status. Methods Data were obtained from 13 centers in five provinces for patients with advanced NSCLC in China. The direct non-medical cost of patients since the patients were diagnosed with NSCLC included the cost of transportation, accommodation, meal, hired caregiving, and nutrition. We measured patients' health status by EQ-5D-5L instrument and divided them into good (≥0.75) and poor (<0.75) groups based on the utility score. A generalized linear model (GLM) was used to assess independent associations between statistically significant factors and non-medical financial burden in health status subgroups. Results Data from 607 patients were analyzed. The direct non-medical cost associated with advanced NSCLC since diagnosis was $2,951 per case ($4,060 in the poor health group and $2,505 in the other), with nutrition costing the most. GLM results showed that residence(Urban area vs. Rural area: -1.038, [-2.056, -0.02]), caregivers' occupation type (Farmer vs. Employee: -1.303, [-2.514, -0.093]), hospitalization frequency (0.077, [0.033, 0.12]), average length of hospital stay (0.101, [0.032, 0.17]), and pathological type (Squamous carcinoma vs. Non-squamous carcinoma: -0.852, [-1.607, -0.097]) were independent factors influencing direct non-medical cost in the poor health group. Among participants with good health status, residence (Urban area vs. Rural area: -0.621, [-1.005, -0.236]), marital status (Others vs. Married: 0.762, [0.035, 1.488]), patients' employment status, current caregiving time per day (more than 9 hours per day vs. less than 3 hours per day: 0.471, [0.134, 0.807]), duration of disease (0.015, [0.007, 0.024]), and hospitalization frequency (0.091, [0.068, 0.113]) were statistically associated factors. Conclusion The direct non-medical economic burden of advanced NSCLC patients in China is considerable and differs by health status. Strengthening accessibility for more effective therapies and early nutritional intervention to improve prognosis, and further promoting accessible care forms within relevant healthcare insurance coverage may be potentially feasible approaches to alleviate the direct non-medical economic burden for patients and their families.
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Affiliation(s)
- Yu Xia
- School of Public Health, Fudan University, Shanghai, China
- National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Yingyao Chen
- School of Public Health, Fudan University, Shanghai, China
- National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Jia Chen
- Department of Medical Oncology, The Affiliated Tumor Hospital of Nantong University, Nantong Tumor Hospital, Nantong, China
| | - Yuying Gan
- Department of Respiratory Medicine, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Chunxia Su
- Department of Oncology, Shanghai Pulmonary Hospital, Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Haibo Zhang
- Department of Organization and Personnel, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Enwu Long
- Department of Pharmacy, Sichuan Academy of Medical Sciences/Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Fei Yan
- Department of Oncology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Yi Yang
- School of Public Health, Fudan University, Shanghai, China
- National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
- *Correspondence: Yi Yang
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Lin M, Huang Z, Chen Y, Xiao H, Wang T. Lung cancer patients with chronic obstructive pulmonary disease benefit from anti-PD-1/PD-L1 therapy. Front Immunol 2022; 13:1038715. [PMID: 36532019 PMCID: PMC9751394 DOI: 10.3389/fimmu.2022.1038715] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/17/2022] [Indexed: 12/04/2022] Open
Abstract
Lung cancer (LC) and chronic obstructive pulmonary disease (COPD) are two of the most fatal respiratory diseases, seriously threatening human health and imposing a heavy burden on families and society. Although COPD is a significant independent risk factor for LC, it is still unclear how COPD affects the prognosis of LC patients, especially when LC patients with COPD receive immunotherapy. With the development of immune checkpoint inhibition (ICI) therapy, an increasing number of inhibitors of programmed cell death-1 (PD-1) and PD-1 ligand (PD-L1) have been applied to the treatment of LC. Recent studies suggest that LC patients with COPD may benefit more from immunotherapy. In this review, we systematically summarized the outcomes of LC patients with COPD after anti-PD-1/PD-L1 treatment and discussed the tumor immune microenvironment (TIME) regulated by COPD in LC immunotherapy, which provides novel insights for the clinical treatment of LC patients with COPD.
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Affiliation(s)
- Mao Lin
- Department of Pharmacy, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Zongyao Huang
- Department of Pathology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Yingfu Chen
- Department of Pharmacy, Clinical Medical College and Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Hongtao Xiao
- Department of Pharmacy, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Ting Wang
- Department of Clinical Research, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China,*Correspondence: Ting Wang,
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Leiter A, Kong CY, Gould MK, Kale MS, Veluswamy RR, Smith CB, Mhango G, Huang BZ, Wisnivesky JP, Sigel K. The benefits and harms of adjuvant chemotherapy for non-small cell lung cancer in patients with major comorbidities: A simulation study. PLoS One 2022; 17:e0263911. [PMID: 36378625 PMCID: PMC9665372 DOI: 10.1371/journal.pone.0263911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 09/27/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Randomized controlled trials (RCTs) have demonstrated a survival benefit for adjuvant platinum-based chemotherapy after resection of locoregional non-small cell lung cancer (NSCLC). The relative benefits and harms and optimal approach to treatment for NSCLC patients who have major comorbidities (chronic obstructive pulmonary disease [COPD], coronary artery disease [CAD], and congestive heart failure [CHF]) are unclear, however. METHODS We used a simulation model to run in-silico comparative trials of adjuvant chemotherapy versus observation in locoregional NSCLC in patients with comorbidities. The model estimated quality-adjusted life years (QALYs) gained by each treatment strategy stratified by age, comorbidity, and stage. The model was parameterized using outcomes and quality-of-life data from RCTs and primary analyses from large cancer databases. RESULTS Adjuvant chemotherapy was associated with clinically significant QALY gains for all patient age/stage combinations with COPD except for patients >80 years old with Stage IB and IIA cancers. For patients with CHF and Stage IB and IIA disease, adjuvant chemotherapy was not advantageous; in contrast, it was associated with QALY gains for more advanced stages for younger patients with CHF. For stages IIB and IIIA NSCLC, most patient groups benefited from adjuvant chemotherapy. However, In general, patients with multiple comorbidities benefited less from adjuvant chemotherapy than those with single comorbidities and women with comorbidities in older age categories benefited more from adjuvant chemotherapy than their male counterparts. CONCLUSIONS Older, multimorbid patients may derive QALY gains from adjuvant chemotherapy after NSCLC surgery. These results help extend existing clinical trial data to specific unstudied, high-risk populations and may reduce the uncertainty regarding adjuvant chemotherapy use in these patients.
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Affiliation(s)
- Amanda Leiter
- Division of Endocrinology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Chung Yin Kong
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Michael K. Gould
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, United States of America
| | - Minal S. Kale
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Rajwanth R. Veluswamy
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Cardinale B. Smith
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Grace Mhango
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Brian Z. Huang
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, United States of America
| | - Juan P. Wisnivesky
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Keith Sigel
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
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Lee K. Weight perception and self-rated health: are there differences between cancer survivors and non-cancer survivors? Support Care Cancer 2022; 30:10291-10299. [PMID: 36264360 DOI: 10.1007/s00520-022-07418-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 10/13/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare relationships between self-perceived weight and self-rated health (SRH) between cancer survivors and non-cancer survivors. METHODS A cross-sectional study based on the 2014-2019 Korea National Health and Nutrition Examination Survey was conducted for the associations of self-perceived weight status, measured BMI categories, and combined categories by self-perceived weight and measured BMI with SRH in 1622 cancer survivors and 29,903 non-cancer survivors using complex samples ordinal regression analysis after adjusting for sociodemographic factors, health behaviors, and concurrent diseases. RESULTS Compared to the comparison group (those who were normal weight and self-perceived as average weight in non-cancer survivors), adjusted odds for poorer SRH were higher in cancer survivors and non-cancer survivors who were underweight and self-perceived as underweight (adjusted odds ratios[aORs], 2.69 for non-cancer survivors; 2.62 for cancer survivors), those who were normal weight but self-perceived as underweight or overweight (aORs, 1.69-2.38 for non-cancer survivors; 2.34-3.78 for cancer survivors), and those who were overweight and self-perceived as overweight (aORs, 1.52 for non-cancer survivors; 2.42 for cancer survivors). In cancer survivors, the odds for poorer SRH were greater for those who were normal weight and self-perceived as average weight (aOR = 1.84), whereas the odds were not significant for those who were underweight or overweight and self-perceived as average weight. In non-cancer survivors who self-perceived as average weight, the odds for poorer SRH were significant in those with underweight (aOR = 1.35) or overweight (aOR = 0.84). CONCLUSION According to actual weight status, the association between self-perceived weight and SRH may differ between cancer survivors and non-cancer survivors.
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Affiliation(s)
- Kayoung Lee
- Department of Family Medicine, College of Medicine, Busan Paik Hospital, Inje University, 75, Bokji-ro, Busanjin-gu, Busan, 47392, Republic of Korea.
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12
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Cost-effectiveness of stereotactic body radiotherapy versus conventional radiotherapy for the treatment of surgically ineligible stage I non-small cell lung cancer in the Brazilian public health system. LANCET REGIONAL HEALTH. AMERICAS 2022; 14:100329. [PMID: 36777381 PMCID: PMC9903892 DOI: 10.1016/j.lana.2022.100329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background The Brazilian public health system does not pay for the use of Stereotactic body radiotherapy (SBRT) due to its costs and the absence of cost-effectiveness analysis showing its benefit. The present study aims to evaluate whether the SBRT is a more cost-effective strategy than the conventional fractionated radiotherapy (CFRT) for surgically ineligible stage I non-small cell lung cancer (NSCLC) in the Brazilian public health system. Methods Adopting the perspective of the Brazilian Unified Healthcare System (SUS) as the payer, a Markov model with a lifetime horizon was built to delineate the health states for a cohort of 75-years-old men with medically inoperable NSCLC after treatment with SBRT or CFRT. Transition probabilities and health states utilities were adapted from the literature. Costs were based on the public health system reimbursement values and simulated in the private sector. Findings The SBRT strategy results in more quality-adjusted life-year (QALYs) and costs with an incremental cost-effectiveness ratio (ICER) of R$ 164.86 (U$ 65.16) per QALY and R$ 105 (U$ 41.50) per life-year gained (LYG). This strategy was cost-effective, considering a willingness-to-pay of R$ 25,000 (U$ 9,881.42) per QALY. The net monetary benefit (NMB) was approximately twice higher. The outcomes were confirmed with 92% of accuracy in the probabilistic sensitivity analysis. Interpretation Using a threshold of R$25,000 per QALY, SBRT was more cost-effective than CFRT for NSCLC in a public health system of an upper-middle-income country. SBRT generates higher NMB than CFRT, which could open the opportunity to incorporate new technologies. Funding Varian Medical Systems.
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Zhou X, Du J, Xu G, Chen C, Zheng B, Chen J. Cost-effectiveness of osimertinib versus placebo in resected EGFR-mutated non-small cell lung cancer in China. Cancer Med 2022; 11:4449-4456. [PMID: 35689472 PMCID: PMC9741963 DOI: 10.1002/cam4.4798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/18/2022] [Accepted: 04/21/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE We aim to assess whether osimertinib postoperative adjuvant therapy, compared with placebo, is cost-effective in China. METHODS We set up the Markov model that contains three health states over a 20-year period. Data were collected from the ADAURA trial that included transition probabilities and safety data. Through the analysis of literature and local charges, we explore both the cost and utility values. Sensitivity analyses were employed using TreeAge Pro software to access model stability. FINDINGS Patients in the osimertinib group had 1.46 more Quality-adjusted Life Years (8.45 QALYs vs 6.99 QALYs) than the placebo group at an incremental cost of $14098.51($39962.99 vs $25864.48). Compared with the placebo group, the treatment strategy with osimertinib postoperative adjuvant therapy had an incremental cost-effectiveness ratio of $9661.97/QALY. The probability of the osimertinib-assisted therapy strategy being cost-effective will reach 100% if the threshold of willingness to pay is above $15,000/QALY. IMPLICATIONS From the perspective of the Chinese Healthcare System, the treatment strategy with osimertinib postoperative adjuvant therapy is more cost-effective than the placebo strategy.
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Affiliation(s)
- Xiwen Zhou
- College of FinanceFujian Jiangxia UniversityFuzhouChina
| | - Jianting Du
- Department of Thoracic SurgeryFujian Medical University Union HospitalFuzhouFujianChina,Key Laboratory of Cardio‐Thoracic Surgery (Fujian Medical University)Fujian Province UniversityFuzhouFujianChina
| | - Guobing Xu
- Department of Thoracic SurgeryFujian Medical University Union HospitalFuzhouFujianChina,Key Laboratory of Cardio‐Thoracic Surgery (Fujian Medical University)Fujian Province UniversityFuzhouFujianChina
| | - Chun Chen
- Department of Thoracic SurgeryFujian Medical University Union HospitalFuzhouFujianChina,Key Laboratory of Cardio‐Thoracic Surgery (Fujian Medical University)Fujian Province UniversityFuzhouFujianChina
| | - Bin Zheng
- Department of Thoracic SurgeryFujian Medical University Union HospitalFuzhouFujianChina,Key Laboratory of Cardio‐Thoracic Surgery (Fujian Medical University)Fujian Province UniversityFuzhouFujianChina
| | - Jiahe Chen
- Department of Pharmaceutical and Health Economics, School of PharmacyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
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Assessment of Treatment Strategies for Stage I Non-small Cell Lung Cancer in Patients with Comorbidities. Lung Cancer 2022; 170:34-40. [PMID: 35700630 PMCID: PMC9378574 DOI: 10.1016/j.lungcan.2022.05.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/28/2022] [Accepted: 05/02/2022] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Non-small cell lung cancer (NSCLC) patients frequently have major comorbidities but there is scarce data regarding the impact of these conditions on management strategies. We used simulation modeling to compare different treatments for stage I NSCLC for patients with common major comorbidities. METHODS We used data on NSCLC patinet outcomes and quality of life from: (1) the Surveillance Epidemiology and End Results (SEER) database linked to Medicare claims; (2) Kaiser Permanente Southern California electronic health records; and (3) SEER-Medical Health Outcomes Survey to parameterize a novel simulation model of management and outcomes for stage I NSCLC. Relative efficacy of treatment modalities (lobectomy, segmentectomy, wedge resection and stereotactic body radiotherapy [SBRT]) was collected from existing literature and combined using evidence synthesis methods. We then simulated multiple randomized trials comparing these treatments in a variety of scenarios, estimating quality adjusted life expectancy (QALE) according to age, tumor size, histologic subtype, and comorbidity status. RESULTS Lobectomy and segmentectomy yielded the greatest QALE gains among all simulated age, tumor size and comorbidity groups. Optimal treatment strategies differed by patient sex and age; wedge resection was among the optimal strategies for women aged 80-84 with tumors 0-2 cm in size. SBRT was included in some optimal strategies for patients aged 80-84 with multimorbidity. CONCLUSIONS In simulated comparative trials of four common treatments for stage I NSCLC, aggressive surgical management was typically associated with the greatest projected QALE gains despite the presence of comorbidities, although less aggressive strategies were predicted to be non-inferior in some older comorbid patient groups.
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15
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Optimizing the use of adjuvant chemotherapy in non-small cell lung cancer patients with comorbidities. Curr Probl Cancer 2022; 46:100867. [DOI: 10.1016/j.currproblcancer.2022.100867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 03/23/2022] [Accepted: 04/27/2022] [Indexed: 11/21/2022]
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16
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Ziegelmayer S, Graf M, Makowski M, Gawlitza J, Gassert F. Cost-Effectiveness of Artificial Intelligence Support in Computed Tomography-Based Lung Cancer Screening. Cancers (Basel) 2022; 14:cancers14071729. [PMID: 35406501 PMCID: PMC8997030 DOI: 10.3390/cancers14071729] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/23/2022] [Accepted: 03/23/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Lung cancer screening is already implemented in the USA and strongly recommended by European Radiological and Thoracic societies as well. Upon implementation, the total number of thoracic computed tomographies (CT) is likely to rise significantly. As shown in previous studies, modern artificial intelligence-based algorithms are on-par or even exceed radiologist's performance in lung nodule detection and classification. Therefore, the aim of this study was to evaluate the cost-effectiveness of an AI-based system in the context of baseline lung cancer screening. METHODS In this retrospective study, a decision model based on Markov simulation was developed to estimate the quality-adjusted life-years (QALYs) and lifetime costs of the diagnostic modalities. Literature research was performed to determine model input parameters. Model uncertainty and possible costs of the AI-system were assessed using deterministic and probabilistic sensitivity analysis. RESULTS In the base case scenario CT + AI resulted in a negative incremental cost-effectiveness ratio (ICER) as compared to CT only, showing lower costs and higher effectiveness. Threshold analysis showed that the ICER remained negative up to a threshold of USD 68 for the AI support. The willingness-to-pay of USD 100,000 was crossed at a value of USD 1240. Deterministic and probabilistic sensitivity analysis showed model robustness for varying input parameters. CONCLUSION Based on our results, the use of an AI-based system in the initial low-dose CT scan of lung cancer screening is a feasible diagnostic strategy from a cost-effectiveness perspective.
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Ha DM, Prochazka AV, Bekelman DB, Stevens-Lapsley JE, Studts JL, Keith RL. Modifiable factors associated with health-related quality of life among lung cancer survivors following curative intent therapy. Lung Cancer 2022; 163:42-50. [PMID: 34896804 DOI: 10.1016/j.lungcan.2021.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/27/2021] [Accepted: 11/22/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The number of lung cancer survivors is increasing along with advances in screening, diagnosis, and treatment. Following curative intent therapy, many lung cancer survivors experience significant health-related quality of life (HRQL) impairments. We sought to identify potentially modifiable factors that contribute to the HRQL of these patients. MATERIALS AND METHODS In this cross-sectional observational study of disease-free, stage I-IIIA lung cancer survivors following curative intent therapy, we used a conceptual model to examine factors that included behavioral, objective functional and physiologic, self-rated function and symptom burden, specific comorbidities, and non-modifiable demographic and clinical lung cancer-related characteristics. We assessed HRQL using the valid and prognostic European Organization for Research and Treatment of Cancer Quality of Life (QoL) Core 30 global health/QoL subscale. We used univariable and multivariable linear regression modeling with backward elimination of potentially modifiable and non-modifiable factors, and interpreted clinically and statistically significant, consistent, and independent modifiable factors as meaningful. RESULTS Among 75 participants at a median of 12 months since treatment completion, the mean (standard deviation) C30 global health/QoL score was 62.7 (23.3) points (0-100 scale range). In multivariable analysis, with and without non-modifiable factors, we identified three clinically and statistically significant, consistent, and independent factors (unstandardized β range) associated with global health/QoL: 1) abnormal exercise-induced dyspnea (-9.23 to -10.0 points); 2) impaired self-rated role function (or inability to perform work or daily activities and pursuing leisure-time activities) (-12.6 to -16.4 points); and 3) abnormal insomnia (or trouble sleeping) (-12.6 to -16.4 points). CONCLUSION We identified meaningful modifiable factors associated with the HRQL of disease-free, stage I-IIIA lung cancer survivors following curative intent therapy. Interventions to improve the HRQL of these patients should aim to reduce exercise-induced dyspnea, improve role function - the ability to perform work and other daily including leisure-time activities, and control insomnia.
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Affiliation(s)
- Duc M Ha
- Medical Service, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, United States; Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, United States; Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
| | - Allan V Prochazka
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - David B Bekelman
- Medical Service, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, United States; Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; Denver-Seattle Center of Innovation, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, United States
| | - Jennifer E Stevens-Lapsley
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; Geriatric Research, Education, and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, United States
| | - Jamie L Studts
- Cancer Prevention and Control, University of Colorado Cancer Center, Aurora, CO, United States; Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Robert L Keith
- Medical Service, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, United States; Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Wu D, Li J, Wang Y, Huang H, Huang C. Cost-effectiveness analysis of neoadjuvant versus adjuvant chemotherapy for cT2-4N0-1 non-small cell lung cancer patients during initial treatment phase. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2021; 19:44. [PMID: 34281538 PMCID: PMC8287679 DOI: 10.1186/s12962-021-00280-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 04/28/2021] [Indexed: 12/09/2022] Open
Abstract
Objective The choice between neoadjuvant chemotherapy (NAC) and adjuvant chemotherapy (AC) remains controversial in the treatment of non-small cell lung cancer (NSCLC). There is no significant difference in NAC and AC’s effectiveness. We investigate the cost-effectiveness of NAC versus AC for NSCLC. Method A decision tree model was designed from a payer perspective to compare NAC and AC treatments for NSCLC patients. Parameters included overall survival (OS), surgical complications, chemotherapy adverse events (AEs), treatment initiation probability, treatment time frame, treatment cost, and quality of life (QOL). Sensitivity analyses were performed to characterize model uncertainty in the base cases. Result AC treatment strategy produced a cost saving of ¥3064.90 and incremental quality-adjusted life-years (QALY) of 0.10 years per patient with the same OS. NAC would be cost-effective at a ¥35,446/QALY threshold if the median OS of NAC were 2.3 months more than AC. The model was robust enough to handle variations to all input parameters except OS. In the probability sensitivity analysis, AC remained dominant in 54.4% of simulations. Conclusion The model cost-effectiveness analysis indicates that with operable NSCLC, AC treatment is more cost-effective to NAC. If NAC provides a longer survival advantage, this treatment strategy may be cost-effective. The OS is the main factor that influences cost-effectiveness and should be considered in therapeutic regimes. Supplementary Information The online version contains supplementary material available at 10.1186/s12962-021-00280-w.
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Affiliation(s)
- Dongdong Wu
- Department of Information, Daping Hospital, Army Medical University, Chongqing, China
| | - Juan Li
- Department of Oncology, Daping Hospital, Army Medical University, Chongqing, China
| | - Yubo Wang
- Respiratory Department, Daping Hospital, Army Medical University, Chongqing, China
| | - Hao Huang
- Department of Information, Daping Hospital, Army Medical University, Chongqing, China
| | - Chunji Huang
- Army Medical University, Gaotan Rock, Shapingba District, Chongqing, 400038, China.
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Zhou J, Chao Y, Yao D, Ding N, Li J, Gao L, Zhang Y, Xu X, Zhou J, Halmos B, Tsoukalas N, Kataoka Y, de Mello RA, Song Y, Hu J. Impact of chronic obstructive pulmonary disease on immune checkpoint inhibitor efficacy in advanced lung cancer and the potential prognostic factors. Transl Lung Cancer Res 2021; 10:2148-2162. [PMID: 34164266 PMCID: PMC8182718 DOI: 10.21037/tlcr-21-214] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background The coexistence of chronic obstructive pulmonary disease (COPD) in lung cancer patients often correlates with a poor clinical outcome regardless of tumor stage, mainly due to older age, poor lung function, and complex comorbid disease. Emerging data suggest that the pathogenesis of both diseases involves aberrant immune functioning. We conducted this retrospective study to describe the impact of COPD on the clinical outcomes of lung cancer patients treated with immunotherapy and investigate the potential prognostic factors. Methods In total, 156 patients with advanced-stage lung cancer who received at least one administration of an anti-programmed cell death 1 (PD-1)/anti-programmed cell death-ligand 1 (PD-L1) immune checkpoint inhibitor (ICI) at any treatment line at Zhongshan Hospital Fudan University between May 2018 and December 2019 were enrolled in our study. Overall survival (OS) and progression-free survival (PFS) were analyzed according to the presence of COPD. We also evaluated the prognostic value of circulating cytokine levels for clinical outcome. Results We found that the presence of COPD (both spirometry-based COPD and physician-defined COPD) was significantly associated with longer PFS (316 vs. 186 days, P=0.018). Moderate and severe COPD tended to have a better impact on the survival of these patients. In the present study, we reported that patients with mixed ventilatory defects tended to have a better OS (P=0.043) and PFS (P=0.18) when treated with ICIs compared to the normal lung function group. We also found that low baseline plasma interleukin (IL)-8 and IL-2 receptor (IL-2R) levels were associated with longer PFS in patients with advanced-stage lung cancer who received ICI treatment. Furthermore, patients who had increased IL-2R levels had significantly poorer OS [hazard ratio (HR) =3.63; 95% confidence interval (CI), 0.98–13.44; P=0.040] and PFS (HR =3.241; 95% CI, 1.032–10.18; P=0.035) when treated with ICIs. Nomograms were established based on the independent prognostic factors derived from our final multivariate models. Conclusions COPD was associated with better survival in advanced-stage lung cancer patients treated with ICIs. Plasma IL-8 and IL-2R levels were potential prognostic factors for clinical outcome. The nomograms represent a possibly useful tool for predicting the clinical outcomes of immunotherapy.
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Affiliation(s)
- Jiebai Zhou
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yencheng Chao
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Danwei Yao
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
| | - Ning Ding
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiamin Li
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lei Gao
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yong Zhang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaobo Xu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jian Zhou
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Balazs Halmos
- Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Yuki Kataoka
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Ramon Andrade de Mello
- Faculdade de Medicina Universidade Nove de Julho (UNINOVE), Rua Pedro Oliveira Tavares, Bauru, SP, Brazil
| | - Yuanlin Song
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jie Hu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
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Optimal treatment strategies for stage I non-small cell lung cancer in veterans with pulmonary and cardiac comorbidities. PLoS One 2021; 16:e0248067. [PMID: 33735217 PMCID: PMC7971489 DOI: 10.1371/journal.pone.0248067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/19/2021] [Indexed: 12/25/2022] Open
Abstract
Background Veterans are at increased risk of lung cancer and many have comorbidities such as chronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD). We used simulation modeling to assess projected outcomes associated with different management strategies of Veterans with stage I non-small cell lung cancer (NSCLC) with COPD and/or CAD. Patients and methods Using data from a cohort of 14,029 Veterans (years 2000–2015) with NSCLC we extended a well-validated mathematical model of lung cancer to represent the management and outcomes of Veterans with stage I NSCLC with COPD, with or without comorbid CAD. We simulated multiple randomized trials to compare treatment with lobectomy, limited resection, or stereotactic body radiation therapy (SBRT). Model output estimated expected quality adjusted life years (QALY) of Veterans with stage I NSCLC according to age, tumor size, histologic subtype, COPD severity and CAD diagnosis. Results For Veterans <70 years old lobectomy was associated with greater projected quality-adjusted life expectancy regardless of comorbidity status. For most combinations of tumors and comorbidity profiles there was no dominant treatment for Veterans ≥80 years of age, but less invasive treatments were often superior to lobectomy. Dominant treatment choices differed by CAD status for older patients in a third of scenarios, but not for patients <70 years old. Conclusions The harm/benefit ratio of treatments for stage I NSCLC among Veterans may vary according to COPD severity and the presence of CAD. This information can be used to direct future research study design for Veterans with stage I lung cancer and COPD and/or CAD.
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Blom EF, Haaf KT, de Koning HJ. Systematic Review and Meta-Analysis of Community- and Choice-Based Health State Utility Values for Lung Cancer. PHARMACOECONOMICS 2020; 38:1187-1200. [PMID: 32754857 PMCID: PMC7547043 DOI: 10.1007/s40273-020-00947-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND Using appropriate health state utility values (HSUVs) is critical for economic evaluation of new lung cancer interventions, such as low-dose computed tomography screening and immunotherapy. Therefore, we provide a systematic review and meta-analysis of community- and choice-based HSUVs for lung cancer. METHODS On 6 March 2017, we conducted a systematic search of the following databases: Embase, Ovid MEDLINE, Web of Science, Cochrane CENTRAL, Google Scholar, and the School of Health and Related Research Health Utility Database. The search was updated on 17 April 2019. Studies reporting mean or median lung cancer-specific HSUVs including a measure of variance were included and assessed for relevance and validity. Studies with high relevance (i.e. community- and choice-based) were further analysed. Mean HSUVs were pooled using random-effects models for all stages, stages I-II, and stages III-IV. For studies with a control group, we calculated the disutility due to lung cancer. A sensitivity analysis included only the methodologically most comparable studies (i.e. using the EQ-5D instrument and matching tariff). Subgroup analyses were conducted by time to death, histology, sex, age, treatment modality, treatment line, and progression status. RESULTS We identified and analysed 27 studies of high relevance. The pooled HSUV was 0.68 (95% confidence interval [CI] 0.61-0.75) for all stages, 0.78 (95% CI 0.70-0.86) for stages I-II, and 0.69 (95% CI 0.65-0.73) for stages III-IV (p = 0.02 vs. stage I-II). Heterogeneity was present in each pooled analysis (p < 0.01; I2 = 92-99%). Disutility due to lung cancer ranged from 0.11 (95% CI 0.05-0.17) to 0.27 (95% CI 0.18-0.36). In the sensitivity analysis with the methodologically most comparable studies, stage-specific HSUVs varied by country. Such studies were only identified for Canada, China, Spain, the UK, the USA, Denmark, Germany, and Thailand. In the subgroup analysis by time to death, HSUVs for metastatic non-small-cell lung cancer ranged from 0.83 (95% CI 0.82-0.85) at ≥ 360 days from death to 0.56 (95% CI 0.46-0.66) at < 30 days from death. Among patients with metastatic non-small-cell lung cancer, HSUVs were lower for those receiving third- or fourth-line treatment and for those with progressed disease. Results of subgroup analyses by histology, sex, age, and treatment modality were ambiguous. CONCLUSIONS The presented evidence supports the use of stage- and country-specific HSUVs. However, such HSUVs are unavailable for most countries. Therefore, our pooled HSUVs may provide the best available stage-specific HSUVs for most countries. For metastatic non-small-cell lung cancer, adjusting for the decreased HSUVs in the last year of life may be considered, as may further stratification of HSUVs by treatment line or progression status. If required, HSUVs for other health states may be identified using our comprehensive breakdown of study characteristics.
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Affiliation(s)
- Erik F Blom
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Internal Postal Address Na-2401, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
| | - Kevin Ten Haaf
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Internal Postal Address Na-2401, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Internal Postal Address Na-2401, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
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22
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Cost-effectiveness of lung cancer screening with low-dose computed tomography in heavy smokers: a microsimulation modelling study. Eur J Cancer 2020; 135:121-129. [DOI: 10.1016/j.ejca.2020.05.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/06/2020] [Accepted: 05/12/2020] [Indexed: 12/25/2022]
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Li W, Bai R, Qian L, Chen N, Zhao Y, Han F, Bai L, Li J, Yu Y, Cui J. Cost-effectiveness of icotinib versus whole-brain irradiation with or without chemotherapy in EGFR-mutant NSCLC patients with brain metastases. Asia Pac J Clin Oncol 2020; 17:e40-e47. [PMID: 31957251 DOI: 10.1111/ajco.13291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/26/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE Nonsmall cell lung cancer (NSCLC) patients with brain metastases (BM) have a poor prognosis. Despite the traditional methods including radiotherapy and chemotherapy, epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) might benefit patients on survival and quality of life. We investigated the cost-effectiveness of icotinib compared with whole-brain irradiation (WBI) with or without chemotherapy for NSCLC patients with BM. MATERIALS AND METHODS A Markov model was conducted based on the data of BRAIN trial. We compared the economic benefit between icotinib and the combination of WBI and WBI plus chemotherapy group. We considered disease progression as intracranial progression and overall progression separately. Sensitivity analyses were performed to observe the stability of the model. The willingness-to-pay (WTP) was set as 3× per capita gross domestic product ($25929/quality-adjusted life year [QALY]) from the Chinese healthcare perspective. RESULTS When considering progression as intracranial progression and overall progression, respectively, the incremental cost-effectiveness ratio was $14 882.64/QALY and $13 484.21/QALY between icotinib and WBI/WBI-chemotherapy. Besides, both of the average cost-effective ratio (ACER) and net benefit showed advantage of icotinib (ACER: $34 521.42/QALY for intracranial progression and $36 562.63/QALY for overall progression; net benefit: -$8407.36 for intracranial progression and -$9836.41 for overall progression). One-way sensitivity analyses demonstrated that no thresholds were encountered. The probabilistic sensitivity analyses showed even at a WTP under $18 000/QALY, icotinib could be cost-effective. CONCLUSION Icotinib was cost-effective compared with WBI with or without chemotherapy.
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Affiliation(s)
- Wenqian Li
- The Cancer Center of the First Hospital of Jilin University, Changchun, P. R. China
| | - Rilan Bai
- The Cancer Center of the First Hospital of Jilin University, Changchun, P. R. China
| | - Lei Qian
- The Cancer Center of the First Hospital of Jilin University, Changchun, P. R. China
| | - Naifei Chen
- The Cancer Center of the First Hospital of Jilin University, Changchun, P. R. China
| | - Yuguang Zhao
- The Cancer Center of the First Hospital of Jilin University, Changchun, P. R. China
| | - Fujun Han
- The Cancer Center of the First Hospital of Jilin University, Changchun, P. R. China
| | - Ling Bai
- The Cancer Center of the First Hospital of Jilin University, Changchun, P. R. China
| | - Jiaxuan Li
- The Cancer Center of the First Hospital of Jilin University, Changchun, P. R. China
| | - Yu Yu
- The Cancer Center of the First Hospital of Jilin University, Changchun, P. R. China
| | - Jiuwei Cui
- The Cancer Center of the First Hospital of Jilin University, Changchun, P. R. China
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Yang SC, Kuo CW, Lai WW, Lin CC, Su WC, Chang SM, Wang JD. Dynamic Changes of Health Utility in Lung Cancer Patients Receiving Different Treatments: A 7-Year Follow-up. J Thorac Oncol 2019; 14:1892-1900. [PMID: 31352073 DOI: 10.1016/j.jtho.2019.07.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/10/2019] [Accepted: 07/07/2019] [Indexed: 01/16/2023]
Abstract
INTRODUCTION This study aimed to estimate the utility values of all subtypes of lung cancer. The trajectories after different kinds of treatments and their major determinants were explored on the basis of real-world data and repeated measurements. METHODS From 2011 to 2017, all patients with lung cancer who visited a medical center were invited to fill out the EuroQol Five-Dimension and WHO Quality of Life-Brief questionnaires at each visit. Utility values of quality of life (QoL) after diagnosis and treatments were depicted using a kernel smoothing method. We constructed linear mixed models to predict health utility in each time period and cross-validated them with domain scores of the WHO Quality of Life-Brief. RESULTS A total of 1715 patients were enrolled, with 6762 QoL measurements. Utility values were lower in patients with advanced-stage disease and older patients. Patients receiving second-line targeted therapy showed higher utility values at 0 to 3 months, 3 to 6 months, and 6 months and beyond (0.89, 0.90, and 0.88, respectively) than did those undergoing chemotherapy (0.81, 0.85, and 0.80, respectively). After using mixed models to control confounders, including poor performance status and disease progression, patients receiving second-line chemotherapy showed health utility similar to that at quasi-baseline, whereas utility values related to second-line targeted therapy were higher at 3 to 6 months and 6 months and beyond (β = 0.07, p = 0.010 and β = 0.07, p < 0.001, respectively). There was convergent validity between the utility values and scores of the physical and psychological domains. CONCLUSION Targeted therapy provided treated patients with a higher health utility value than was provided to those treated with chemotherapy. Development of the longitudinal trajectory may help predict changes in QoL and improve the care of lung cancer survivors.
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Affiliation(s)
- Szu-Chun Yang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chin-Wei Kuo
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wu-Wei Lai
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Chung Lin
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wu-Chou Su
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sheng-Mao Chang
- Department of Statistics, College of Management, National Cheng Kung University, Tainan, Taiwan
| | - Jung-Der Wang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Cai H, Zhang L, Li N, Zheng B, Liu M. Cost-effectiveness analysis on binary/triple therapy on the basis of ixazomib or bortezomib for refractory or relapsed multiple myeloma. Leuk Lymphoma 2019; 60:2951-2959. [PMID: 31161831 DOI: 10.1080/10428194.2019.1620947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Hongfu Cai
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China
| | - Longfeng Zhang
- Department of Medical Oncology, Fujian Provincial Cancer Hospital, Fuzhou, China
| | - Na Li
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China
| | - Bin Zheng
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China
| | - Maobai Liu
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China
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Snowsill T, Yang H, Griffin E, Long L, Varley-Campbell J, Coelho H, Robinson S, Hyde C. Low-dose computed tomography for lung cancer screening in high-risk populations: a systematic review and economic evaluation. Health Technol Assess 2019; 22:1-276. [PMID: 30518460 DOI: 10.3310/hta22690] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Diagnosis of lung cancer frequently occurs in its later stages. Low-dose computed tomography (LDCT) could detect lung cancer early. OBJECTIVES To estimate the clinical effectiveness and cost-effectiveness of LDCT lung cancer screening in high-risk populations. DATA SOURCES Bibliographic sources included MEDLINE, EMBASE, Web of Science and The Cochrane Library. METHODS Clinical effectiveness - a systematic review of randomised controlled trials (RCTs) comparing LDCT screening programmes with usual care (no screening) or other imaging screening programmes [such as chest X-ray (CXR)] was conducted. Bibliographic sources included MEDLINE, EMBASE, Web of Science and The Cochrane Library. Meta-analyses, including network meta-analyses, were performed. Cost-effectiveness - an independent economic model employing discrete event simulation and using a natural history model calibrated to results from a large RCT was developed. There were 12 different population eligibility criteria and four intervention frequencies [(1) single screen, (2) triple screen, (3) annual screening and (4) biennial screening] and a no-screening control arm. RESULTS Clinical effectiveness - 12 RCTs were included, four of which currently contribute evidence on mortality. Meta-analysis of these demonstrated that LDCT, with ≤ 9.80 years of follow-up, was associated with a non-statistically significant decrease in lung cancer mortality (pooled relative risk 0.94, 95% confidence interval 0.74 to 1.19). The findings also showed that LDCT screening demonstrated a non-statistically significant increase in all-cause mortality. Given the considerable heterogeneity detected between studies for both outcomes, the results should be treated with caution. Network meta-analysis, including six RCTs, was performed to assess the relative clinical effectiveness of LDCT, CXR and usual care. The results showed that LDCT was ranked as the best screening strategy in terms of lung cancer mortality reduction. CXR had a 99.7% probability of being the worst intervention and usual care was ranked second. Cost-effectiveness - screening programmes are predicted to be more effective than no screening, reduce lung cancer mortality and result in more lung cancer diagnoses. Screening programmes also increase costs. Screening for lung cancer is unlikely to be cost-effective at a threshold of £20,000/quality-adjusted life-year (QALY), but may be cost-effective at a threshold of £30,000/QALY. The incremental cost-effectiveness ratio for a single screen in smokers aged 60-75 years with at least a 3% risk of lung cancer is £28,169 per QALY. Sensitivity and scenario analyses were conducted. Screening was only cost-effective at a threshold of £20,000/QALY in only a minority of analyses. LIMITATIONS Clinical effectiveness - the largest of the included RCTs compared LDCT with CXR screening rather than no screening. Cost-effectiveness - a representative cost to the NHS of lung cancer has not been recently estimated according to key variables such as stage at diagnosis. Certain costs associated with running a screening programme have not been included. CONCLUSIONS LDCT screening may be clinically effective in reducing lung cancer mortality, but there is considerable uncertainty. There is evidence that a single round of screening could be considered cost-effective at conventional thresholds, but there is significant uncertainty about the effect on costs and the magnitude of benefits. FUTURE WORK Clinical effectiveness and cost-effectiveness estimates should be updated with the anticipated results from several ongoing RCTs [particularly the NEderlands Leuvens Longkanker Screenings ONderzoek (NELSON) screening trial]. STUDY REGISTRATION This study is registered as PROSPERO CRD42016048530. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Tristan Snowsill
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Huiqin Yang
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Ed Griffin
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Linda Long
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Jo Varley-Campbell
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Helen Coelho
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Sophie Robinson
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Chris Hyde
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK.,Exeter Test Group, University of Exeter Medical School, Exeter, UK
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Soldera SV, Shakik S, Naik H, Moskovitz M, Chen J, Mittmann N, Xu W, Hope A, Bezjak A, Parajian A, Keshavjee S, Liu G. Favourable health-related quality of life reported in survivors of thymic malignancies. Eur J Cardiothorac Surg 2019; 55:292-299. [PMID: 30084958 DOI: 10.1093/ejcts/ezy259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 06/24/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The management of patients with locally advanced thymic malignancies remains controversial. Differing combinations of surgical resection, chemotherapy and radiation are used in the management of initial and relapsed disease. Treatment-related toxicities and quality of life could inform therapeutic options. This study describes health utility scores (HUS) in survivors with locally advanced thymic malignancies and investigates the impact of multimodality regimens on HUS. METHODS In a cross-sectional study (2014-2017), patients with Masaoka Stage II-IVa thymic malignancies completed various self-reported questionnaires, including EuroQol-5-Dimensions with visual analogue scale (VAS), Eastern Cooperative Oncology Group (ECOG) and Edmonton Symptom Assessment Scale tools. Trimodality versus uni- or bimodality regimens and aggressive versus non-aggressive management of recurrent disease were compared using regression analyses. RESULTS Of the 72 patients, 43 (60%) were male with a median age of 58 years, 65 (90%) had thymoma while 7 (10%) had thymic carcinomas; and median time since diagnosis was 50.5 months (range: 3-266). Median HUS and VAS did not differ between groups (trimodality n = 24 vs uni- or bimodality n = 48: HUS = 0.77 vs 0.80, P = 0.29; VAS = 80 vs 75, P = 0.79, respectively). The distributions of patient-reported ECOG were also similar (P = 0.86). Edmonton Symptom Assessment Scale scores for every assessed symptom were similar for different modalities of therapy. Median scores on these tools were also similar regardless of recurrence status or management of relapsed disease (aggressive versus non-aggressive). CONCLUSION Survivors with Stage II-IVa thymic malignancies report favourable HUS, VAS and self-reported ECOG with minimal symptom burden. These outcomes may be independent of number and type of initial treatment modalities or management of recurrence.
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Affiliation(s)
- Sara Victoria Soldera
- Département d'Hémato-Oncologie, CISSS Montérégie Centre, Hôpital Charles-Lemoyne, Université Sherbrooke, Sherbrooke, QC, Canada.,Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Sharara Shakik
- Epidemiology Department, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Hiten Naik
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Mor Moskovitz
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Judy Chen
- Epidemiology Department, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Nicole Mittmann
- Cancer Care Ontario and Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Wei Xu
- Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Andrew Hope
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Andrea Bezjak
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Armen Parajian
- Department of Thoracic Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Shaf Keshavjee
- Department of Thoracic Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Geoffrey Liu
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
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Cai H, Zhang L, Li N, Chen S, Zheng B, Yang J, Weng L, Liu MB. Cost-effectiveness of Osimertinib as First-line Treatment and Sequential Therapy for EGFR Mutation-positive Non-small Cell Lung Cancer in China. Clin Ther 2019; 41:280-290. [PMID: 30639208 DOI: 10.1016/j.clinthera.2018.12.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 11/21/2018] [Accepted: 12/09/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE This study aimed to evaluate the cost-effectiveness of osimertinib with gefitinib or erlotinib as first-line and sequential therapy for epidermal growth factor receptor (EGFR) mutation-positive non-small cell lung cancer (NSCLC) in China. METHODS The Markov model was used, and the study included 3 health states over a 10-year period. Transition probabilities and safety data were collected from the FLAURA (AZD9291 versus gefitinib or erlotinib in patients with locally advanced or metastatic Non-small Cell Lung Cancer) trial. Cost and utility values were derived from local charges and literature. Sensitivity analyses were performed to observe model stability. FINDINGS The strategy with gefitinib or erlotinib first-line therapy and second-line gene-guided osimertinib therapy (GE-T790M) resulted in a gain of 0.31 quality-adjusted life year (QALY) at a cost of $15,200.95 per patient compared with the gefitinib or erlotinib first-line therapy and second-line chemotherapy (GE-chemotherapy). The incremental QALY and incremental cost values for first-line osimertinib therapy compared with GE-chemotherapy was 0.96 and $69,420.76, respectively. Compared with the GE-T790M strategy (0.96 QALY and $29,223.33), first-line osimertinib was estimated to be more effective (1.61 QALYs) and more costly ($83,443.14). Relative to the GE-chemotherapy strategy, the incremental cost-effectiveness ratios were $47,873.96 and $71,954.08 per QALY gained with GE-T790M and the osimertinib first-line strategy. The incremental cost-effectiveness ratio for first-line osimertinib versus GE-T790M was estimated to be $83,766.61. The results were found to be robust for univariate and multivariable sensitivity analyses. IMPLICATIONS Gefitinib or erlotinib first-line and chemotherapy second-line strategies were the most cost-effective first-line treatments for EGFR mutations in patients with NSCLC. Gefitinib or erlotinib first-line and gene-guided osimertinib second-line strategies were more cost-effective than osimertinib first-line treatment for patients who preferred osimertinib administration in China.
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Affiliation(s)
- Hongfu Cai
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Longfeng Zhang
- Department of Medical Oncology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian Province, China
| | - Na Li
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Shen Chen
- Center for ADR Monitoring of Fuzhou, Fuzhou, Fujian Province, China
| | - Bin Zheng
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Jing Yang
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Lizhu Weng
- School of Pharmacy, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Mao-Bai Liu
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.
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Hechtner M, Eichler M, Wehler B, Buhl R, Sebastian M, Stratmann J, Schmidberger H, Gohrbandt B, Peuser J, Kortsik C, Nestle U, Wiesemann S, Wirtz H, Wehler T, Bals R, Blettner M, Singer S. Quality of Life in NSCLC Survivors - A Multicenter Cross-Sectional Study. J Thorac Oncol 2018; 14:420-435. [PMID: 30508641 DOI: 10.1016/j.jtho.2018.11.019] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 11/18/2018] [Accepted: 11/19/2018] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The objective was to assess quality of life (QoL) in lung cancer survivors, compare it to the general population, and identify factors associated with global QoL, physical functioning, emotional functioning, fatigue, pain, and dyspnea. METHODS Data from NSCLC patients who had survived 1 year or longer after diagnosis were collected cross-sectionally in a multicenter study. QoL was assessed with the European Organisation for the Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30 and the lung cancer module QLQ-LC13 across different clinical subgroups and compared to age- and sex-standardized general population reference values. Multivariable linear regression analyses were performed to test the associations of patient-, tumor-, and treatment-related factors with the six primary QoL scales. RESULTS Six hundred fifty-seven NSCLC patients participated in the study with a median time since diagnosis of 3.7 years (range, 1.0-21.2 years). Compared to the age- and sex-standardized general population, clinically meaningful differences in the QoL detriment were found on almost all domains: lung cancer survivors had clinically relevant poorer global QoL (10 points, p < 0.001). Whereas in 12 months or longer treatment-free patients this detriment was small (8.3), it was higher in patients currently in treatment (16.0). Regarding functioning and symptom scales, respective detriments were largest for dyspnea (41 points), role function (33 points), fatigue (27 points), social function (27 points), physical function (24 points), and insomnia (21 points) observed across all subgroups. The main factor associated with poorer QoL in all primary QoL scales was mental distress (β |19-31|, all p < 0.001). Detriments in QoL across multiple primary QoL scales were also observed with current treatment (β |8-12|, p < 0.01), respiratory comorbidity (β |4-5|, p < 0.01), and living on a disability pension (β |10-11|, p < 0.01). The main factor associated with better QoL in almost all primary QoL scales was higher physical activity (β |10-20|, p < 0.001). Better QoL was also observed in patients with high income (β |10-14|, p < 0.01). CONCLUSIONS Lung cancer survivors experience both functional restrictions and symptoms that persist long term after active treatment ends. This substantiates the importance of providing long-term supportive care.
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Affiliation(s)
- Marlene Hechtner
- University Medical Center, Johannes Gutenberg University, Mainz, Germany; German Cancer Consortium (DKTK), partner site Frankfurt/Mainz, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Martin Eichler
- University Medical Center, Johannes Gutenberg University, Mainz, Germany; German Cancer Consortium (DKTK), partner site Frankfurt/Mainz, Germany; University Hospital Carl Gustav Carus Dresden, Germany
| | - Beatrice Wehler
- University Medical Center, Johannes Gutenberg University, Mainz, Germany; Saarland University Medical Center, Homburg, Germany
| | - Roland Buhl
- University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Martin Sebastian
- University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Jan Stratmann
- University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Heinz Schmidberger
- University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | | | | | | | - Ursula Nestle
- University Medical Center Freiburg, Albert-Ludwig-University, Freiburg Germany; Maria Hilf Hospital Moenchengladbach, Moenchengladbach, Germany
| | - Sebastian Wiesemann
- University Medical Center Freiburg, Albert-Ludwig-University, Freiburg Germany
| | - Hubert Wirtz
- Leipzig University Hospital, Leipzig University, Leipzig, Germany
| | - Thomas Wehler
- Saarland University Medical Center, Homburg, Germany
| | - Robert Bals
- Saarland University Medical Center, Homburg, Germany
| | - Maria Blettner
- University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Susanne Singer
- University Medical Center, Johannes Gutenberg University, Mainz, Germany; University Cancer Center Mainz, Mainz, Germany
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Jeppesen SS, Matzen LE, Brink C, Bliucukiene R, Kasch S, Schytte T, Kristiansen C, Hansen O. Impact of comprehensive geriatric assessment on quality of life, overall survival, and unplanned admission in patients with non-small cell lung cancer treated with stereotactic body radiotherapy. J Geriatr Oncol 2018; 9:575-582. [DOI: 10.1016/j.jgo.2018.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 03/31/2018] [Accepted: 05/15/2018] [Indexed: 10/14/2022]
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Health-related quality of life among cancer survivors in rural China. Qual Life Res 2018; 28:695-702. [DOI: 10.1007/s11136-018-2038-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2018] [Indexed: 10/28/2022]
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Yi YS, Ban WH, Sohng KY. Effect of COPD on symptoms, quality of life and prognosis in patients with advanced non-small cell lung cancer. BMC Cancer 2018; 18:1053. [PMID: 30373585 PMCID: PMC6206922 DOI: 10.1186/s12885-018-4976-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 10/19/2018] [Indexed: 01/15/2023] Open
Abstract
Background Many studies have reported the prevalence of chronic obstructive pulmonary disease (COPD) and its effects and prognosis in patients with lung cancer, but few have considered quality of life and survival of patients with lung cancer according to severity of airway obstruction. This study investigated the presence of COPD and the severity of airway obstruction in patients with non-small cell lung cancer (NSCLC), and analyzed how these factors affected symptoms, quality of life, and prognosis. Methods We retrospectively reviewed the prospective lung cancer database of the Catholic Medical Centers at the Catholic University of Korea from 2014 to 2017. We enrolled patients with advanced NSCLC and evaluated quality of life using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30. We also estimated pulmonary function and analyzed survival data. Results Of the 337 patients with advanced NSCLC, 170 (50.5%) had COPD and 167 (49.5%) did not. Significant differences were observed in symptoms between the two groups. The COPD group complained of more symptoms, such as cough, sputum, and dyspnea, than those in the non-COPD group. The distribution according to the severity of obstruction in the COPD group was as follows: Grade 1 (FEV1 ≥ 80%) 35 patients (20.6%), Grade 2 (50% ≤ FEV1 < 80%) 103 patients (60.6%), Grade 3 (30% ≤ FEV1 < 50%) 24 patients (14.1%), and Grade 4 (FEV1 < 30%) 8 patients (4.7%). The presence of COPD did not affect overall quality of life in patients with NSCLC, but as the airway obstruction increased, physical function decreased, and fatigue and dyspnea were more frequent. The overall median survival of the COPD group was shorter than that of the non-COPD group (median survival, 224 vs. 339 days, p = 0.035). Conclusions In this study, a high prevalence of COPD was found among patients with advanced NSCLC, and COPD patients complained about various symptoms and had diminished quality of life in several sectors. Therefore, it is necessary to actively evaluate quality of life, lung function, and symptoms in patients with lung cancer and reflect them in the treatment and management plans of these patients.
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Affiliation(s)
- Young-Soo Yi
- Doctoral candidate, The Catholic University of Korea, Seoul, South Korea
| | - Woo Ho Ban
- Division of pulmonary, Critical Care and sleep Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kyeong-Yae Sohng
- Department of Nursing, College of Nursing, The Catholic University of Korea, Seoul, South Korea.
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Yip R, Taioli E, Schwartz R, Li K, Becker BJ, Tam K, Htwe YM, Yankelevitz DF, Henschke CI. A Review of Quality of Life Measures used in Surgical Outcomes for Stage I Lung Cancers. Cancer Invest 2018; 36:296-308. [PMID: 30040490 DOI: 10.1080/07357907.2018.1474892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This review summarizes the literature on QoL in early stage lung cancer patients who underwent surgery. PubMed and PsycINFO were searched. Twelve articles from 10 distinct studies were identified for a total of 992 patients. Five QoL measures were used. One study reported only on pre-surgical QoL, six only on post-surgical QoL and three studies reported on both pre- and post-surgical QoL. Timing for the administration of post-surgical QoL surveys varied. The literature on QoL in Stage I non-small-cell lung cancer patients is very sparse. Additional research is needed to explore the impact of different surgical approaches on QoL.
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Affiliation(s)
- Rowena Yip
- a Department of Radiology, Icahn School of Medicine at Mount Sinai , New York , New York, USA
| | - Emanuela Taioli
- b Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai , New York , New York, USA
| | - Rebecca Schwartz
- b Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai , New York , New York, USA.,c Department of Occupational Medicine, Epidemiology and Prevention, Zucker School of Medicine at Hofstra-Northwell , Great Neck , New York, USA
| | - Kunwei Li
- a Department of Radiology, Icahn School of Medicine at Mount Sinai , New York , New York, USA.,d Department of Radiology , Fifth Affiliated Hospital of Sun Yat-sen University , Zhuhai , China
| | - Betsy J Becker
- e Department of Educational Psychology and Learning Systems, College of Education , Florida State University , Tallahassee , Florida, USA
| | - Kathleen Tam
- a Department of Radiology, Icahn School of Medicine at Mount Sinai , New York , New York, USA
| | - Yu Maw Htwe
- f Department of Internal Medicine , Kingsbrook Jewish Medical Center , Brooklyn , New York , USA
| | - David F Yankelevitz
- a Department of Radiology, Icahn School of Medicine at Mount Sinai , New York , New York, USA
| | - Claudia I Henschke
- a Department of Radiology, Icahn School of Medicine at Mount Sinai , New York , New York, USA
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Shen Y, Wu B, Wang X, Zhu J. Health state utilities in patients with advanced non-small-cell lung cancer in China. J Comp Eff Res 2018; 7:443-452. [PMID: 29775084 DOI: 10.2217/cer-2017-0069] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
AIM Non-small-cell lung cancer (NSCLC) is a leading global health threat that impairs patient health outcomes. Health state utilities are fundamental values in economic evaluation and significantly vary across countries. Given the scarce data on the Chinese population, the current study measured utility values in the Chinese patients with NSCLC. METHODS This study was conducted as a cross-sectional survey of patients with advanced NSCLC at the Shanghai Chest Hospital. Utility values were assessed using the EuroQol five-dimension (EQ-5D) instrument and scored based on the Chinese-specific value algorithm. Predictors of utility values were examined using a subgroup analysis and a multiple regression model. RESULTS The mean EQ-5D utility value of recruited patients was 0.814. The regression analysis revealed that tumor stage, treatment regimen and line of therapy were the potential predictors of utility values. CONCLUSION This study provides the Chinese-specific health utility data for advanced NSCLC using the EQ-5D.
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Affiliation(s)
- Yunjie Shen
- Department of Pharmacy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, PR China
| | - Bin Wu
- Department of Pharmacy, Ren Ji Hospital, South Campus, School of Medicine, Shanghai Jiaotong University, Shanghai, PR China
| | - Xiaohui Wang
- Department of Pharmacy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, PR China
| | - Jun Zhu
- Department of Pharmacy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, PR China
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Visser S, de Mol M, Cheung K, van Toor JJ, van Walree NC, Stricker BH, Den Oudsten BL, Aerts JGJV. Treatment Satisfaction of Patients With Advanced Non-Small-cell Lung Cancer Receiving Platinum-based Chemotherapy: Results From a Prospective Cohort Study (PERSONAL). Clin Lung Cancer 2018; 19:e503-e516. [PMID: 29705017 DOI: 10.1016/j.cllc.2018.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 02/05/2018] [Accepted: 03/10/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In patients with advanced non-small-cell lung cancer, the treatment benefits and risks need to be constantly weighed. We explored patient-reported satisfaction with therapy (SWT) and assessed its value in addition to quality of life (QoL) and adverse events (AEs). PATIENTS AND METHODS In a prospective multicenter cohort study, patients with stage IIIB/IV non-small-cell lung cancer received platinum-pemetrexed chemotherapy. They completed the World Health Organization Quality of Life-BREF (WHOQoL-BREF) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) before and during chemotherapy. After the last cycle, patients reported on SWT, expectations of therapy, and feelings about side effects (FSE) using the Cancer Therapy Satisfaction Questionnaire. The explained variance (R2) of QoL after treatment by SWT was calculated. Using multivariable linear regression, we examined the association of SWT with patient- and treatment-related variables, FSE, and AEs. RESULTS Eighty-nine patients finished 4 cycles of chemotherapy, 65 of whom completed the Cancer Therapy Satisfaction Questionnaire. Fifty-six patients (86.2%) would probably or definitely decide to undergo the same treatment again, regardless of deterioration or improvement in QoL or a high or low frequency of AEs during chemotherapy. The explained variance of QoL by SWT was greatest for the EORTC QLQ C-30 global health status/QoL scale (R2 = 0.170). Patient age (β = 0.43; 95% confidence interval [CI], 0.05-0.82), FSE (β = 0.17; 95% CI, 0.06-0.29), and tumor response (β = 7.93; 95% CI (1.64 to 14.22)) were independently associated with SWT. CONCLUSION SWT could provide important supplementary information in addition to QoL assessments and treatment toxicities. Tumor response, older age, and FSE score were associated with better SWT. These insights could affect decision-making during palliative chemotherapy.
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Affiliation(s)
- Sabine Visser
- Department of Pulmonary Medicine, Amphia Hospital Breda, Breda, The Netherlands; Department of Pulmonary Medicine, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus Medical Center University Medical Center, Rotterdam, The Netherlands
| | - Mark de Mol
- Department of Pulmonary Medicine, Amphia Hospital Breda, Breda, The Netherlands; Department of Pulmonary Medicine, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Kiki Cheung
- Department of Epidemiology, Erasmus Medical Center University Medical Center, Rotterdam, The Netherlands; Inspectorate of Health Care, Utrecht, The Netherlands
| | - Jermo J van Toor
- Department of Pulmonary Medicine, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Nico C van Walree
- Department of Pulmonary Medicine, Amphia Hospital Breda, Breda, The Netherlands
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus Medical Center University Medical Center, Rotterdam, The Netherlands; Inspectorate of Health Care, Utrecht, The Netherlands.
| | - Brenda L Den Oudsten
- Department of Medical and Clinical Psychology, Centre of Research on Psychological and Somatic Disorders, Tilburg University, Tilburg, The Netherlands
| | - Joachim G J V Aerts
- Department of Pulmonary Medicine, Amphia Hospital Breda, Breda, The Netherlands; Department of Pulmonary Medicine, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands
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Cost-effectiveness of gefitinib, icotinib, and pemetrexed-based chemotherapy as first-line treatments for advanced non-small cell lung cancer in China. Oncotarget 2018; 8:9996-10006. [PMID: 28036283 PMCID: PMC5354787 DOI: 10.18632/oncotarget.14310] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 12/12/2016] [Indexed: 12/20/2022] Open
Abstract
Tyrosine kinase inhibitors of the epidermal growth factor receptor (EGFR) are becoming the standard treatment option for patients with advanced non-small cell lung cancer (NSCLC) harboring an EGFR mutation, but the economic impact of this practice is unclear, especially in a health resource-limited setting. A decision-analytic model was developed to simulate 21-day patient transitions in a 10-year time horizon. The health and economic outcomes of four first-line strategies (pemetrexed plus cisplatin [PC] alone, PC followed by maintenance with pemetrexed, or initial treatment with gefitinib or icotinib) among patients harboring EGFR mutations were estimated and assessed via indirect comparisons. Costs in the Chinese setting were estimated. The primary outcome was the incremental cost-effectiveness ratio (ICER). Sensitivity analyses were performed. The icotinib strategy resulted in greater health benefits than the other three strategies in NSCLC patients harboring EGFR mutations. Relative to PC alone, PC followed by pemetrexed maintenance, gefitinib and icotinib resulted in ICERs of $104,657, $28,485 and $19,809 per quality-adjusted life-year gained, respectively. The cost of pemetrexed, the EGFR mutation prevalence and the utility of progression-free survival were factors that had a considerable impact on the model outcomes. When the icotinib Patient Assistance Program was available, the economic outcome of icotinib was more favorable. These results indicate that gene-guided therapy with icotinib might be a more cost-effective treatment option than traditional chemotherapy.
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Patel R, Ivanov O, Voigt J. Lifetime cost-effectiveness analysis of intraoperative radiation therapy versus external beam radiation therapy for early stage breast cancer. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2017; 15:22. [PMID: 29151818 PMCID: PMC5679386 DOI: 10.1186/s12962-017-0084-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 11/01/2017] [Indexed: 02/04/2023] Open
Abstract
Background To date no one has examined the quality of life and direct costs of care in treating early stage breast cancer with adjunct intraoperative radiation therapy (IORT) versus external beam radiation therapy (EBRT) over the life of the patient. As well no one has examined the effects of radiation exposure with both therapies on the longer term sequelae. The purpose of this analysis was to examine the cost-effectiveness of IORT vs. EBRT over the life of the patient. Methods A Markov decision-analytic model evaluated these treatment strategies in terms of the direct costs in treating patients over their lifetime (including the downstream costs associated with radiation exposure) and the resultant quality of life of these patients. Medicare reimbursement amounts in treating patients were used for acute, steady state, recurrent cancer(s), and complications associated with radiation exposure. Quality adjusted life years (QALYs) derived from the medical literature were assessed with each of these states. Life expectancies as well were derived from the medical literature. Cost-effectiveness was evaluated for dominance and net monetary benefit [at a willingness to pay (WTP)] of $50,000/QALY. Sensitivity analysis was also performed. Results IORT was the dominant (least costly with greater QALYs) versus EBRT: total costs over the life of the patient = $53,179 (IORT) vs. $63,828 (EBRT) and total QALYs: 17.86 (IORT) vs. 17.06 (EBRT). At a willingness to pay of $50,000 for each additional QALY, the net monetary benefit demonstrated that IORT was the most cost effective option: $839,815 vs. $789,092. The model was most sensitive to the probabilities of recurrent cancer and death for both IORT and EBRT. Conclusion IORT is the more valuable (lower cost with improved QALYs) strategy for use in patients presenting with early stage ER+ breast cancer. It should be used preferentially in these patients.
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Affiliation(s)
- Rakesh Patel
- Radiation Oncology, Good Samaritan Hospital, 425 Samaritan Dr, San Jose, CA 95124 USA
| | - Olga Ivanov
- Breast Health Center, Celebration Health, 2nd Floor, 380 Celebration Pl, Celebration, FL 34747 USA
| | - Jeff Voigt
- Medical Device Consultants of Ridgewood, LLC, 99 Glenwood Rd., Ridgewood, NJ 07450 USA
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Hsu YH, Chai HY, Lin YF, Wang CH, Chen SC. Health-related quality of life and satisfaction with case management in cancer survivors. J Clin Nurs 2017; 26:4597-4604. [PMID: 28295784 DOI: 10.1111/jocn.13805] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2017] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To (i) investigate the characteristics of health-related quality of life and satisfaction with case management and (ii) to identify factors associated with health-related quality of life in cancer survivors. BACKGROUND The level of health-related quality of life can reflect treatment efficacy and satisfaction with cancer care. DESIGN A cross-sectional study design was adopted. METHODS Subjects from the outpatient setting of a cancer centre in northern Taiwan were recruited by consecutive sampling. A set of questionnaires were employed, including a background information form, case management service satisfaction survey (CMSS) and The European Quality of Life Scale (EQ-5D). Descriptive statistics were used to examine levels of health-related quality of life and satisfaction with case management. Pearson's correlation was used to identify relationships between treatment characteristics, satisfaction with case management and health-related quality of life. Multiple stepwise regression was used to identify factors associated with health-related quality of life. RESULTS A total of 252 cancer patients were recruited. The three lowest scores for items of health-related quality of life were mobility, self-care and usual activities. Cancer survivors with higher mobility, less pain and discomfort, and lower anxiety and depression were more likely to have better health-related quality of life. CONCLUSION Mobility, pain and discomfort, and anxiety and depression are important predictive factors of high health-related quality of life in cancer survivors. RELEVANCE TO CLINICAL PRACTICE In clinical care, patients' physical mobility, pain and discomfort, and anxiety and depression are important indicators of health-related quality of life. Case managers should include self-care and symptom management into survivorship care plans to improve health-related quality of life during survival after treatment concludes.
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Affiliation(s)
- Ya-Hui Hsu
- Department of Nursing, Cancer Center, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Graduate Institute of Nursing, College of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Hsiu-Ying Chai
- Department of Nursing, Cancer Center, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Fen Lin
- Department of Nursing, Cancer Center, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chao-Hui Wang
- Department of Nursing, Cancer Center, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Ching Chen
- Department of Nursing, Cancer Center, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Graduate Institute of Nursing, College of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan.,Department of Nursing, College of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan.,Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital, Proton and Radiation Therapy Center, Taoyuan, Taiwan
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Doble B, John T, Thomas D, Fellowes A, Fox S, Lorgelly P. Cost-effectiveness of precision medicine in the fourth-line treatment of metastatic lung adenocarcinoma: An early decision analytic model of multiplex targeted sequencing. Lung Cancer 2017; 107:22-35. [DOI: 10.1016/j.lungcan.2016.05.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 05/12/2016] [Accepted: 05/29/2016] [Indexed: 11/27/2022]
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Brown J, Cook K, Adamski K, Lau J, Bargo D, Breen S, Chawla A. Utility values associated with advanced or metastatic non-small cell lung cancer: data needs for economic modeling. Expert Rev Pharmacoecon Outcomes Res 2017; 17:153-164. [PMID: 28335636 DOI: 10.1080/14737167.2017.1311210] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Cost-effectiveness analyses often inform healthcare reimbursement decisions. The preferred measure of effectiveness is the quality adjusted life year (QALY) gained, where the quality of life adjustment is measured in terms of utility. Areas covered: We assessed the availability and variation of utility values for health states associated with advanced or metastatic non-small cell lung cancer (NSCLC) to identify values appropriate for cost-effectiveness models assessing alternative treatments. Our systematic search of six electronic databases (January 2000 to August 2015) found the current literature to be sparse in terms of utility values associated with NSCLC, identifying 27 studies. Utility values were most frequently reported over time and by treatment type, and less frequently by disease response, stage of disease, adverse events or disease comorbidities. Expert commentary: In response to rising healthcare costs, payers increasingly consider the cost-effectiveness of novel treatments in reimbursement decisions, especially in oncology. As the number of therapies available to treat NSCLC increases, cost-effectiveness analyses will play a key role in reimbursement decisions in this area. Quantifying the relationship between health and quality of life for NSCLC patients via utility values is an important component of assessing the cost effectiveness of novel treatments.
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Affiliation(s)
- Jacqueline Brown
- a Global Patient Outcomes and Real World Evidence , Eli Lilly and Company , Windlesham , UK
| | - Keziah Cook
- b Analysis Group, Inc , Menlo Park , CA , USA
| | | | - Jocelyn Lau
- b Analysis Group, Inc , Menlo Park , CA , USA
| | - Danielle Bargo
- c UK Health Outcomes and HTA team , Eli Lilly and Company Limited , Basingstoke , Hampshire , UK
| | - Sarah Breen
- c UK Health Outcomes and HTA team , Eli Lilly and Company Limited , Basingstoke , Hampshire , UK
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EQ-5D Health Utility Scores: Data from a Comprehensive Canadian Cancer Centre. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2016; 10:105-115. [DOI: 10.1007/s40271-016-0190-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Greenhalgh J, Bagust A, Boland A, Dwan K, Beale S, Hockenhull J, Proudlove C, Dundar Y, Richardson M, Dickson R, Mullard A, Marshall E. Erlotinib and gefitinib for treating non-small cell lung cancer that has progressed following prior chemotherapy (review of NICE technology appraisals 162 and 175): a systematic review and economic evaluation. Health Technol Assess 2016; 19:1-134. [PMID: 26134145 DOI: 10.3310/hta19470] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Lung cancer is the second most diagnosed cancer in the UK. Over 70% of lung cancers are non-small cell lung cancers (NSCLCs). Patients with stage III or IV NSCLC may be offered treatment to improve survival, disease control and quality of life. One-third of these patients receive further treatment following disease progression; these treatments are the focus of this systematic review. OBJECTIVES To appraise the clinical effectiveness and cost-effectiveness of erlotinib [Tarceva(®), Roche (UK) Ltd] and gefitinib (IRESSA(®), AstraZeneca) compared with each other, docetaxel or best supportive care (BSC) for the treatment of NSCLC after disease progression following prior chemotherapy. The effectiveness of treatment with gefitinib was considered only for patients with epidermal growth factor mutation-positive (EGFR M+) disease. DATA SOURCES Four electronic databases (EMBASE, MEDLINE, The Cochrane Library, PubMed) were searched for randomised controlled trials (RCTs) and economic evaluations. Manufacturers' evidence submissions to the National Institute for Health and Care Excellence were also considered. REVIEW METHODS Outcomes for three distinct patient groups based on EGFR mutation status [EGFR M+, epidermal growth factor mutation negative (EGFR M-) and epidermal growth factor mutation status unknown (EGFR unknown)] were considered. Heterogeneity of the data precluded statistical analysis. A de novo economic model was developed to compare treatments (incremental cost per quality-adjusted life-year gained). RESULTS Twelve trials were included in the review. The use of gefitinib was compared with chemotherapy (n = 6) or BSC (n = 1), and the use of erlotinib was compared with chemotherapy (n = 3) or BSC (n = 1). One trial compared the use of gefitinib with the use of erlotinib. No trials included solely EGFR M+ patients; all data were derived from retrospective subgroup analyses from six RCTs [Kim ST, Uhm JE, Lee J, Sun JM, Sohn I, Kim SW, et al. Randomized phase II study of gefitinib versus erlotinib in patients with advanced non-small cell lung cancer who failed previous chemotherapy. Lung Cancer 2012;75:82-8, V-15-32, Tarceva In Treatment of Advanced NSCLC (TITAN), BR.21, IRESSA Survival Evaluation in Lung cancer (ISEL) and IRESSA NSCLC Trial Evaluating REsponse and Survival versus Taxotere (INTEREST)]. These limited data precluded conclusions regarding the clinical effectiveness of any treatment for EGFR M+ patients. For EGFR M- patients, data were derived from the TArceva Italian Lung Optimization tRial (TAILOR) trial and Docetaxel and Erlotinib Lung Cancer Trial (DELTA). Retrospective data were also derived from subgroup analyses of BR.21, Kim et al., TITAN, INTEREST and ISEL. The only statistically significant reported results were for progression-free survival (PFS) for TAILOR and DELTA, and favoured docetaxel over erlotinib [TAILOR hazard ratio (HR) 1.39, 95% confidence interval (CI) 1.06 to 1.82; DELTA HR 1.44, 95% CI 1.08 to 1.92]. In EGFR unknown patients, nine trials (INTEREST, IRESSA as Second-line Therapy in Advanced NSCLC - KoreA, Li, Second-line Indication of Gefitinib in NSCLC, V-15-32, ISEL, DELTA, TITAN and BR.21) reported overall survival data and only one (BR.21) reported a statistically significant result favouring the use of erlotinib over BSC (HR 0.7, 95% CI 0.58 to 0.85). For PFS, BR.21 favoured the use of erlotinib when compared with BSC (HR 0.61, 95% CI 0.51 to 0.74) and the use of gefitinib was favoured when compared with BSC (HR 0.82, 95% CI 0.73 to 0.92) in ISEL. Limitations in the clinical data precluded assessment of cost-effectiveness of treatments for an EGFR M+ population by the Assessment Group (AG). The AG's economic model suggested that for the EGFR M- population, the use of erlotinib was not cost-effective compared with the use of docetaxel and compared with BSC. For EGFR unknown patients, the use of erlotinib was not cost-effective when compared with BSC. CONCLUSIONS/FUTURE WORK The lack of clinical data available for distinct patient populations limited the conclusions of the assessment. Future trials should distinguish between patients with EGFR M+ and EGFR M- disease. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Janette Greenhalgh
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Adrian Bagust
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Angela Boland
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Kerry Dwan
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Sophie Beale
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Juliet Hockenhull
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Christine Proudlove
- North West Medicines Information Centre, Pharmacy Practice Unit, Liverpool, UK
| | - Yenal Dundar
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Marty Richardson
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Rumona Dickson
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Anna Mullard
- The Clatterbridge Centre NHS Foundation Trust, Liverpool, UK
| | - Ernie Marshall
- The Clatterbridge Centre NHS Foundation Trust, Liverpool, UK
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Lathan CS, Cronin A, Tucker-Seeley R, Zafar SY, Ayanian JZ, Schrag D. Association of Financial Strain With Symptom Burden and Quality of Life for Patients With Lung or Colorectal Cancer. J Clin Oncol 2016; 34:1732-40. [PMID: 26926678 DOI: 10.1200/jco.2015.63.2232] [Citation(s) in RCA: 268] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To measure the association between patient financial strain and symptom burden and quality of life (QOL) for patients with new diagnoses of lung or colorectal cancer. PATIENTS AND METHODS Patients participating in the Cancer Care Outcomes Research and Surveillance study were interviewed about their financial reserves, QOL, and symptom burden at 4 months of diagnosis and, for survivors, at 12 months of diagnosis. We assessed the association of patient-reported financial reserves with patient-reported outcomes including the Brief Pain Inventory, symptom burden on the basis of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30, and QOL on the basis of the EuroQoL-5 Dimension scale. Multivariable linear regression models were fit for each outcome and cancer type, adjusting for age, race/ethnicity, sex, income, insurance, stage at diagnosis, and comorbidity. RESULTS Among patients with lung and colorectal cancer, 40% and 33%, respectively, reported limited financial reserves (≤ 2 months). Relative to patients with more than 12 months of financial reserves, those with limited financial reserves reported significantly increased pain (adjusted mean difference, 5.03 [95% CI, 3.29 to 7.22] and 3.45 [95% CI, 1.25 to 5.66], respectively, for lung and colorectal), greater symptom burden (5.25 [95% CI, 3.29 to .22] and 5.31 [95% CI, 3.58 to 7.04]), and poorer QOL (4.70 [95% CI, 2.82 to 6.58] and 5.22 [95% CI, 3.61 to 6.82]). With decreasing financial reserves, a clear dose-response relationship was present across all measures of well-being. These associations were also manifest for survivors reporting outcomes again at 1 year and persisted after adjustment for stage, comorbidity, insurance, and other clinical attributes. CONCLUSION Patients with cancer and limited financial reserves are more likely to have higher symptom burden and decreased QOL. Assessment of financial reserves may help identify patients who need intensive support.
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Affiliation(s)
- Christopher S Lathan
- Christopher S. Lathan, Angel Cronin, Reginald Tucker-Seeley, and Deborah Schrag, Dana-Farber Cancer Institute, Boston, MA; S. Yousuf Zafar, Duke University School of Medicine; John Z. Ayanian, University of Michigan; and Reginald Tucker-Seeley, Harvard T.H. Chan School of Public Health.
| | - Angel Cronin
- Christopher S. Lathan, Angel Cronin, Reginald Tucker-Seeley, and Deborah Schrag, Dana-Farber Cancer Institute, Boston, MA; S. Yousuf Zafar, Duke University School of Medicine; John Z. Ayanian, University of Michigan; and Reginald Tucker-Seeley, Harvard T.H. Chan School of Public Health
| | - Reginald Tucker-Seeley
- Christopher S. Lathan, Angel Cronin, Reginald Tucker-Seeley, and Deborah Schrag, Dana-Farber Cancer Institute, Boston, MA; S. Yousuf Zafar, Duke University School of Medicine; John Z. Ayanian, University of Michigan; and Reginald Tucker-Seeley, Harvard T.H. Chan School of Public Health
| | - S Yousuf Zafar
- Christopher S. Lathan, Angel Cronin, Reginald Tucker-Seeley, and Deborah Schrag, Dana-Farber Cancer Institute, Boston, MA; S. Yousuf Zafar, Duke University School of Medicine; John Z. Ayanian, University of Michigan; and Reginald Tucker-Seeley, Harvard T.H. Chan School of Public Health
| | - John Z Ayanian
- Christopher S. Lathan, Angel Cronin, Reginald Tucker-Seeley, and Deborah Schrag, Dana-Farber Cancer Institute, Boston, MA; S. Yousuf Zafar, Duke University School of Medicine; John Z. Ayanian, University of Michigan; and Reginald Tucker-Seeley, Harvard T.H. Chan School of Public Health
| | - Deborah Schrag
- Christopher S. Lathan, Angel Cronin, Reginald Tucker-Seeley, and Deborah Schrag, Dana-Farber Cancer Institute, Boston, MA; S. Yousuf Zafar, Duke University School of Medicine; John Z. Ayanian, University of Michigan; and Reginald Tucker-Seeley, Harvard T.H. Chan School of Public Health
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Schwenkglenks M, Matter-Walstra K. Is the EQ-5D suitable for use in oncology? An overview of the literature and recent developments. Expert Rev Pharmacoecon Outcomes Res 2016; 16:207-19. [PMID: 26808097 DOI: 10.1586/14737167.2016.1146594] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The European Quality of Life-5 Dimensions (EQ-5D) questionnaire is widely used in oncology to generate quality of life weights (utilities). The typical purpose is to inform health economic evaluation studies. The EQ-5D is generally suitable for this purpose; it has shown a reasonable degree of reliability, content validity, construct validity and responsiveness in the majority of the available studies. In situations of doubt, combination with other quality-of-life instruments may be an option. The authors expect that the five-level version of the EQ-5D will gradually replace the three-level version, due to reduced ceiling effects and more appropriate responsiveness. Further research should address the benefits achievable through additional dimensions or patient-based valuation, and the validity of EQ-5D versions for proxy respondents.
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Affiliation(s)
- Matthias Schwenkglenks
- a Institute of Pharmaceutical Medicine (ECPM) , University of Basel , Basel , Switzerland.,b Epidemiology, Biostatistics and Prevention Institute , University of Zürich , Zürich , Switzerland
| | - Klazien Matter-Walstra
- a Institute of Pharmaceutical Medicine (ECPM) , University of Basel , Basel , Switzerland.,c Network Outcomes Research , Swiss Group for Clinical Cancer Research Coordination Center , Bern , Switzerland
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Govers TM, Schreuder WH, Klop WMC, Grutters JPC, Rovers MM, Merkx MAW, Takes RP. Quality of life after different procedures for regional control in oral cancer patients: cross-sectional survey. Clin Otolaryngol 2016. [PMID: 26198548 DOI: 10.1111/coa.12502] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine health utilities in patients with cT1-2 oral cavity squamous cell carcinoma following different diagnostic and treatment modalities for the neck and to investigate the relation between shoulder morbidity and health utility. DESIGN Cross-sectional survey. SETTING Two Dutch hospitals. PARTICIPANTS Four subgroups of patients with oral cavity cancer who underwent watchful waiting, sentinel lymph node biopsy, elective supraomohyoid neck dissection or therapeutic modified radical neck dissection. MAIN OUTCOME MEASURES Patients received the EuroQol-5D-3L questionnaire and the shoulder disability questionnaire. Mean health utility, visual analogue scale and shoulder disability scores were calculated. RESULTS A total of 181 patients (62%) returned the questionnaires. Mean health utilities, adjusted for age, gender and time since treatment were 0.804, 0.863, 0.834 and 0.794 for the watchful waiting, sentinel lymph node biopsy, supraomohyoid neck dissection and modified radical neck dissection subgroups, respectively. Mean shoulder disability scores (higher score means more shoulder complaints) for these subgroups were 8.64, 10.57, 18.92 and 33.66. Patients with shoulder complaints had a mean utility of 0.78 while patients without shoulder complaints had a mean utility of 0.90. CONCLUSIONS This study shows that more invasive procedures appear to result in lower health utility. The high health utility for patients after sentinel lymph node biopsy supports a role for this procedure in patients with oral cancer.
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Affiliation(s)
- T M Govers
- Department of Operating Rooms, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - W H Schreuder
- Department of Head and Neck Oncology and Surgery, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - W M C Klop
- Department of Head and Neck Oncology and Surgery, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J P C Grutters
- Department of Operating Rooms, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M M Rovers
- Department of Operating Rooms, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M A W Merkx
- Department ofOral and Maxillofacial surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - R P Takes
- Department ofOtorhinolaryngology and Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
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Rauma V, Salo J, Sintonen H, Räsänen J, Ilonen I. Patient features predicting long-term survival and health-related quality of life after radical surgery for non-small cell lung cancer. Thorac Cancer 2016; 7:333-9. [PMID: 27148419 PMCID: PMC4846622 DOI: 10.1111/1759-7714.12333] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 12/14/2015] [Indexed: 12/03/2022] Open
Abstract
Background This study presents a retrospective evaluation of patient, disease, and treatment features predicting long‐term survival and health‐related quality of life (HRQoL) among patients who underwent surgery for non‐small cell lung cancer (NSCLC). Methods Between January 2000 and June 2009, 586 patients underwent surgery at the Helsinki University Hospital. The 276 patients still alive in June 2011 received two validated quality of life questionnaires (QLQ): the generic 15D and the cancer‐specific EORTC QLQ‐C30 + QLQ‐LC13. We used binary and linear regression analysis modeling to identify patient, disease, and treatment characteristics that predicted survival and long‐term HRQoL. Results When taking into account patient, disease, and treatment characteristics, long‐term survival was quite predictable (69.5% correct), but not long‐term HRQoL (R2 between 0.041 and 0.119). Advanced age at the time of surgery, male gender, comorbidity (measured with the Charlson comorbidity index), clinical and pathological stages II‐IV, and postoperative infectious complications predicted a lower survival rate. Features associated with poorer long‐term HRQoL (measured with the 15D) were comorbidity, postoperative complications, and the use of the video‐assisted thoracoscopic surgery (VATS) technique. Conclusions Long‐term HRQoL is only moderately predictable, while prediction of long‐term survival is more reliable. Lower HRQoL is associated with comorbidities, complications, use of the VATS technique, and reduced pulmonary function, while adjuvant therapy is associated with higher HRQoL.
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Affiliation(s)
- Ville Rauma
- Department of General Thoracic and Esophageal Surgery Helsinki University Hospital Heart and Lung Center Helsinki Finland
| | - Jarmo Salo
- Department of General Thoracic and Esophageal Surgery Helsinki University Hospital Heart and Lung Center Helsinki Finland
| | - Harri Sintonen
- Department of Public Health Helsinki University Hospital, Heart and Lung Center Helsinki Finland
| | - Jari Räsänen
- Department of General Thoracic and Esophageal Surgery Helsinki University Hospital Heart and Lung Center Helsinki Finland
| | - Ilkka Ilonen
- Department of General Thoracic and Esophageal Surgery Helsinki University Hospital Heart and Lung Center Helsinki Finland
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Cheung K, de Mol M, Visser S, Den Oudsten BL, Stricker BH, Aerts JGJV. Reliability and validity of the Cancer Therapy Satisfaction Questionnaire in lung cancer. Qual Life Res 2015. [PMID: 26195317 PMCID: PMC4706586 DOI: 10.1007/s11136-015-1062-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE To test the reliability and validity of the Cancer Treatment Satisfaction Questionnaire (CTSQ), to assess its relation with quality of life (QoL), and to assess the interpretability of the domain scores in lung cancer patients receiving intravenous chemotherapy. METHODS Patients with stage IIIB and IV non-squamous non-small cell lung carcinoma treated with pemetrexed were enrolled in our study. They completed the 16-item CTSQ and two other (health-related) QoL questionnaires. Information about sociodemographic characteristics, cancer stage, and the experience of adverse events was collected. Internal consistency, construct validity, and clinical interpretability were calculated. RESULTS Fifty-five patients completed the CTSQ. Correlations of the CTSQ items with its domain were all above 0.40. A high correlation between item 8 and the expectations of therapy and satisfaction with therapy domain was observed (0.50 and 0.48, respectively). The CTSQ domains demonstrated good internal consistency and low to moderate correlations of the CTSQ with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 and World Health Organization Quality of Life-BREF. No significant differences in mean domain scores were observed in relation to the number and severity of different adverse events and chemotherapy-related adverse events. CONCLUSIONS The Dutch version of the CTSQ was found to be a reliable and valid instrument to assess satisfaction and expectations of treatment in lung cancer patients receiving intravenous chemotherapy. Furthermore, the CTSQ proved to be of additional informative value as not all of its domains correlated with the various domains of the existing HRQoL instruments.
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Affiliation(s)
- K Cheung
- Department of Epidemiology, Erasmus MC - University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
- Inspectorate of Health Care, The Hague, The Netherlands.
| | - M de Mol
- Department of Pulmonary Diseases, Amphia Hospital Breda, Breda, The Netherlands
- Department of Pulmonary Diseases, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - S Visser
- Department of Epidemiology, Erasmus MC - University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Pulmonary Diseases, Amphia Hospital Breda, Breda, The Netherlands
- Department of Pulmonary Diseases, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - B L Den Oudsten
- Department of Medical and Clinical Psychology, Centre of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - B H Stricker
- Department of Epidemiology, Erasmus MC - University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
- Inspectorate of Health Care, The Hague, The Netherlands.
| | - J G J V Aerts
- Department of Pulmonary Diseases, Amphia Hospital Breda, Breda, The Netherlands
- Department of Pulmonary Diseases, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Kenzik K, Martin MY, Fouad MN, Pisu M. Health-related quality of life in lung cancer survivors: Latent class and latent transition analysis. Cancer 2015; 121:1520-8. [PMID: 25565326 PMCID: PMC4409523 DOI: 10.1002/cncr.29232] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 11/19/2014] [Accepted: 12/10/2014] [Indexed: 11/12/2022]
Abstract
BACKGROUND Health-related quality of life (HRQOL) heterogeneity among cancer survivors may mask subgroups (classes) with different limitations and long-term outcomes. The authors determined the HRQOL classes that exist among lung cancer survivors, examined transitions among those classes over time, and compared survival outcomes of patients according to the classes present in the initial phase of care. METHODS Lung cancer survivors in the Cancer Care Outcomes Research and Surveillance Consortium completed EuroQol 5-domain quality-of-life questionnaires 4.8 months (initial phase) and >1 year (survivorship phase) after diagnosis (n = 1396). Latent class analysis and latent transition analysis were used to determine HRQOL classes and transitions across time. Correlates of class membership were tested using multinomial logistic regression. Kaplan-Meier and Cox regression analyses were used to compare survival across class membership. RESULTS Latent class analysis identified 4 classes at diagnosis and follow-up: 1) poor HRQOL, 2) pain-dominant impairment, 3) mobility/usual activities impairment, and 4) good HRQOL. Probabilities of remaining in the same class were .87, .85, .82, and .73 for classes 4, 1, 3, and 2, respectively. Younger age, lower income, lower education, comorbidities, and a history of depression/emotional problems were associated with a greater likelihood of being in classes 1, 2, or 3 at follow-up. Patients in classes 1 and 3 had significantly lower median survival estimates than patients in class 4 (4.8 years, 3.8 years, and 5.5 years, respectively; P < .001). CONCLUSIONS Examining the heterogeneity of HRQOL in lung cancer populations allows the identification of classes with different limitations and long-term outcomes and, thus, guides tailored and patient-centered provision of supportive care.
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Affiliation(s)
- Kelly Kenzik
- University of Alabama at Birmingham, School of Medicine
| | | | - Mona N. Fouad
- University of Alabama at Birmingham, School of Medicine
| | - Maria Pisu
- University of Alabama at Birmingham, School of Medicine
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Tramontano AC, Schrag DL, Malin JK, Miller MC, Weeks JC, Swan JS, McMahon PM. Catalog and comparison of societal preferences (utilities) for lung cancer health states: results from the Cancer Care Outcomes Research and Surveillance (CanCORS) study. Med Decis Making 2015; 35:371-87. [PMID: 25670839 DOI: 10.1177/0272989x15570364] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The EQ-5D and SF-6D are 2 health-related quality-of-life indexes that provide preference-weighted measures for use in cost-effectiveness analyses. METHODS The National Cancer Institute's Cancer Care Outcomes Research and Surveillance (CanCORS) Consortium included the EQ-5D and SF-12v2 in their survey of newly diagnosed lung cancer patients. Utilities were calculated from patient-provided scores for each domain of the EQ-5D or the SF-6D. Utilities were calculated for categories of cancer type, stage, and treatment. RESULTS There were 5015 enrolled lung cancer patients with a baseline survey in CanCORS; 2396 (47.8%) completed the EQ-5D, and 2344 (46.7%) also completed the SF-12v2. The mean (standard deviation) utility from the EQ-5D was 0.78 (0.18), and from the SF-6D (derived from SF-12v2) was 0.68 (0.14). The EQ-5D demonstrated a ceiling effect, with 20% of patients reporting perfect scores, translating to a utility of 1.0. No substantial SF-6D floor effects were noted. Utilities increased with age and decreased with stage and comorbidities. Patient-reported (EQ-5D) visual analog scale scores for health status had a moderate (r = 0.48, p < 0.0001) positive correlation with utilities. A subset (n = 1474) completed follow-up EQ-5D questionnaires 11-13 months after diagnosis. Among these patients, there was a nonsignificant decrease in mean utility for stage IV and an increase in mean utility for stages I, II, and III. CONCLUSION This study generated a catalog of community-weighted utilities applicable to societal-perspective cost-effectiveness analyses of lung cancer interventions and compared utilities based on the EQ-5D and SF-6D. Potential users of these scores should be aware of the limitations and think carefully about their use in specific studies.
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Affiliation(s)
- Angela C Tramontano
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA (ACT, MCM, JSS, PMM)
| | - Deborah L Schrag
- Dna-Farber Cancer Institute, Boston, MA (DLS, JCW),Department of Radiology, Harvard Medical School, Boston, MA (DLS, JSS, PMM)
| | | | - Melecia C Miller
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA (ACT, MCM, JSS, PMM)
| | - Jane C Weeks
- Dna-Farber Cancer Institute, Boston, MA (DLS, JCW)
| | - J Shannon Swan
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA (ACT, MCM, JSS, PMM),Department of Radiology, Harvard Medical School, Boston, MA (DLS, JSS, PMM)
| | - Pamela M McMahon
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA (ACT, MCM, JSS, PMM),Department of Radiology, Harvard Medical School, Boston, MA (DLS, JSS, PMM)
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Rauma V, Sintonen H, Räsänen JV, Salo JA, Ilonen IK. Long-Term Lung Cancer Survivors Have Permanently Decreased Quality of Life After Surgery. Clin Lung Cancer 2015; 16:40-5. [DOI: 10.1016/j.cllc.2014.08.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 08/10/2014] [Accepted: 08/26/2014] [Indexed: 11/28/2022]
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