摘要:

In an era of increasing cost containment in health care, it has become extremely important to allocate resources as efficiently as possible. This implies that formal health economic considerations are taken into account. One area of increasing importance is the field of economic appraisal, which allows the monetary value of medical interventions to be quantified. This type of research is extremely useful in the field of supportive care of cancer patients. In addition to economic considerations, social, political, and ethical issues must also be addressed. Finally, the sum of these activities will enable us to make better choices in health care, and ensure that sufficient resources are allocated to supportive cancer treatment.

ISSN:1040-8746    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Febrile neutropenia is a changing syndrome which requires periodic updates as our armamentarium against this condition improves, and the characteristics of the pathogens change. In addition, cost of therapy has become a major issue when designing therapeutic strategies. This article reviews the basis of the current therapeutic approaches to febrile neutropenia, and this information is used to propose an algorithm for the management of this condition taking into consideration, in addition to these medical aspects, cost-effectiveness.

ISSN:1040-8746    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The granulopoiesis-stimulating agents (GSAs) have been effectively utilized in a variety of fashions to treat or prevent febrile neutropenia or to assist patients receiving dose-intensive chemotherapy with or without stem cell support. The high cost of these agents, along with their wide-scale clinical application, has fostered a number of economic analyses. Cost minimization models based on randomized trials and driven by hospitalization costs have provided febrile neutropenia risk thresholds for the use of the GSAs which have been incorporated into clinical practice guidelines. A number of important studies concerning the clinical and economic impact of these agents have been reported over the past year. The clinical role and economic impact of the GSAs in the management of either established febrile neutropenia or afebrile neutropenia remains uncertain. While several studies have confirmed the clinical value of the prophylactic use of these agents in both solid tumors and hematological malignancies, few have addressed their effect on cost or quality of life. The GSAs have demonstrated clinical as well as potential economic benefit in patients receiving high-dose chemotherapy with either bone marrow or peripheral blood stem cell support. Recent studies suggest a clinical and economic advantage for growth factor mobilization and peripheral blood stem cell support compared with bone marrow transplantation in patients receiving high-dose chemotherapy. The rapid evolution of technological and supportive care methods in this area will necessitate further clinical and economic evaluation.

ISSN:1040-8746    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

It has been estimated that 85% to 90% of all cancer patient care occurs in the outpatient setting, and the vast majority of chemotherapy is administered in the outpatient setting either in physician offices or hospital clinics. With the introduction of white blood cell growth factors in the early 1990s, dose-intensive regimens either for curative or palliative therapy became more common. Since that time, major dose-limiting toxicities have become gastrointestinal mucositis and chemotherapy-induced thrombocytopenia. Patient-reported symptoms have also become important as the changing financing and reimbursement for health care shifts the focus to a patient-centered, value-oriented approach in hematology and medical oncology. This paper will examine advances in the management of three common complications of antineoplastic therapy, mucositis, thrombocytopenia, and fatigue, with a particular emphasis on cost-effectiveness as it relates to value in health care.

ISSN:1040-8746    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Palliative care and palliative medicine embrace the philosophy and the body of knowledge regarding the correct treatment of patients with terminal disease. Palliative treatments can be delivered intramurally (eg, in a hospice or palliative care unit) or at home (home care hospice). The optimal delivery pattern consists of the co-utilization of both care settings, to allow patients who need palliative, supportive, and terminal care to benefit from each setting. In obtaining the available resources, health service costs in Western countries have lately become exorbitant. Home care hospice is a system capable of defeating the challenge on two fronts: to meet the patients' needs and to fulfill this task through economically advantageous practices. Home care hospice is undoubtedly more cost-effective than conventional or generic home care, conventional care (hospitalization), and inpatient hospice care. Its advantage is more evident in the last 3 months of life, due to shorter hospitalization and nonutilization of high-technology interventions and high-cost drugs. The development of a range of palliative care programs integrating primary territorial care and specialized palliative services can constitute the ideal synthesis to respond to patients' needs in a threefold manner: firstly, the patient's right to qualified palliative and terminal care; secondly, the requirements of health services, and lastly, cost containment through a correct and tailored use of available resources.

ISSN:1040-8746    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Recently, the availability of 5-hydroxytryptamine-3 antagonists has provided better protection from chemotherapy-induced emesis. These drugs, in combination with dexamethasone, are more expensive but more cost-effective than the alternative antiemetic regimens in the prevention of acute emesis induced by high single dose and low and repeated doses of cisplatin and, probably, of acute emesis induced by moderately emetogenic chemotherapy. In the prevention of emesis induced by oral cyclophosphamide-methotrexate-fluorouracil and in the prevention of delayed emesis induced by cisplatin and moderately emetogenic chemotherapy, the most cost-effective choices are represented, respectively, by a combination of intravenous dexamethasone on day 1 and 8 plus 14-day oral metoclopramide (a combination of oral dexamethasone plus metoclopramide and oral dexamethasone alone). In all cases, the 5-hydroxytryptamine-3 antagonists should be used only in patients in whom the most cost-effective antiemetic regimens either fail or are not tolerated.

ISSN:1040-8746    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Major advances continue virtually weekly in our understanding of the molecular biology of sarcomas. Steven Skapek, Linda Shaffer, and James Barker (pp 318–325) give an excellent review of many of these findings. An increasing number of these tumors are being defined by their characteristic cytogenetic abnormalities, with rapid diagnosis made practical by reverse transcriptase poly-merase chain reaction (RT-PCR), fluorescentin-situhybridization (FISH), comparative genomic hybridization (CGH), and spectral karyotyping (SKY) techniques. Studies of specific genetic pathways (eg, p53andRB) are identifying candidate sites for future therapeutic attempts.

ISSN:1040-8746    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Recently, much research has been directed toward gaining a better understanding of sarcoma biology. To accomplish this goal, researchers have focused on characterizing the cytogenetic abnormalities that are detectable by routine karyotyping. With the use of widely-available molecular biologic tools, new information on the genetic abnormalities of sarcomas is rapidly emerging. In addition, physicians are beginning to successfully apply cytogenetic and molecular biologic findings to clinical settings in the form of molecular diagnostic and prognostic tests. Moreover, detailed study of these genetic abnormalities is leading to a better understanding of the molecular pathology of sarcomas, which may eventually lead to better therapy. In this paper, we will review the important new findings on genetic abnormalities in sarcomas, clinical applications of cytogenetic studies, and insight into the biology of sarcomas.

ISSN:1040-8746    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

In this review, recent advances in the clinical therapy of osteosarcoma, including results from the European Osteosarcoma Intergroup trial demonstrating the efficacy of a short intensive two drug protocol are discussed as well the evolving role of ifosfamide. Biologically, the area of interest on chromosome 3q, which may contain an osteosarcoma tumor suppressor gene, is being narrowed, and several promising new therapeutic approaches including tumor vaccine have been explored. In chondrosarcoma research, abnormalities in hereditary multiple exostoses genes, which encode protein products essential for normal cartilage development, and a potential mechanism for the characteristic chemotherapy resistance of cartilaginous tumors (overexpression of P-glycoprotein) have been described. Surgical advances include testing of total en bloc spondylectomy for vertebral tumors as well as a noninvasively extendable long bone endoprosthesis. Finally, new insights in diagnostic imaging, including the evolving role of201Tl,99mTc-MIBI (methoxyisobutylisonitrile), and newer variations on magnetic resonance imaging are reviewed.

ISSN:1040-8746    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The Ewing family of tumors has been defined by the presence of anEWS-etsgene rearrangement. Using molecular techniques for the visualization of this aberration, several tumors of unusual location and histology were recently identified and added to this group. Increasing experimental data suggest that EWS-ets fusions act as transforming transcription factors. Subtractive screening of transgenic fibroblasts has led to the identification of potential targets. The authentic cellular context for these aberrant gene products is still unknown and may be diverse, however. Clinical heterogeneity has stimulated a search for genetic factors that may relate to treatment response. The effect of theEWS-etsfusion transcript structure on localized disease has been recently confirmed and frequentp16tumor suppressor alterations have been described. The presence of metastases at diagnosis as the major predictor of outcome has been assessed on a submicroscopic level by reverse transcriptase-polymerase chain reaction. Problems arising from these studies are discussed, although the biological basis for variable disease extension remains obscure.

ISSN:1040-8746    

出版商:OVID    

年代:1998

数据来源: OVID