Economic Evaluation of Treating Skeletal-Related Events among Prostate Cancer Patients

Objectives

To evaluate the economic burden of treating skeletal-related events (SREs) in prostate cancer (PC) patients with bone metastasis from an insurer perspective.

Comparing Hospital-Based Resource Utilization and Costs for Prostate Cancer Patients With and Without Bone Metastases

Background

Since 2010, several new treatments for prostate cancer (PCa), which have entered the US market, are poised to have an impact on treatment approaches; however, there is a paucity of evidence with respect to treatment patterns and costs. As new treatment patterns emerge, it will be imperative to understand treatment patterns and costs of care prior to the advent of novel treatments.

Objective

As the PCa treatment landscape is evolving, this study sought to compare the hospital-based utilization and costs in two cohorts of patients with PCa: patients with bone metastases (w/BM) and patients without bone metastases (w/oBM). Comparisons were also made for patients with inpatient versus outpatient encounters.

Methods

Patients in the Premier Perspective Database, a US hospital database, between January 2006 and December 2010, treated in an inpatient or outpatient setting for PCa (International Classification of Diseases, 9th Revision [ICD-9] diagnosis codes 185, 233.4) were included. Patients were required to be ≥40 years of age with no additional cancers. Patients were put into cohorts on the basis of the presence of bone metastases (ICD-9 code 198.5 or use of zoledronic acid or pamidronate disodium). Utilization of PCa-related treatments was compared, controlling for age, race, hospital type, payer type, bed size, and admission source and type. Differences in treatments were assessed utilizing logistic regression, while differences in costs were analyzed using gamma-distributed generalized linear models with a log-link function. All costs are reported in US$ 2010.

Results

There were 23,747 hospitalizations for men w/BM (13,716 inpatient; 10,031 outpatient) and 187,708 hospitalizations (74,435 inpatient; 113,258 outpatient) for men w/oBM. The mean length of stay for men w/BM was 4 days compared with 2 days for men w/oBM (P < 0.0001). Overall, the mean cost per encounter was US$9,728 in men with w/BM and US$7,405 in men w/oBM (P = 0.0006). For inpatient stays, the mean cost per encounter was US$14,145 for men w/BM and US$11,944 for men w/oBM. For outpatient visits, the mean cost per encounter was US$3,688 for men w/BM and US$4,422 for men w/oBM. Men w/BM received hormone therapy (44.3 %) and secondary hormone therapy (46.4 %) most often, while men w/oBM received radiation (48.8 %) and surgery (31.9 %) most often.

Conclusion

Costs and utilization of PCa-related treatments vary on the basis of the presence of metastases and treatment setting (inpatient vs. outpatient).     

The Impact of Exercise on Improving Body Composition and PSA in High-Risk Prostate Cancer Patients on Androgen-Deprivation Therapy

This prospective study investigated how exercise impacted chronological changes in anthropometrics, body composition, prostate-specific antigen (PSA) level and prognostic nutrition index (PNI) in high-risk prostate cancer (PCa) patients on androgen deprivation therapy (ADT). The patients were divided into either the usual care or exercise group. All patients received measurements a week before ADT initiation, six- and twelve months after treatment. The exercise group received both aerobic and resistance training. The analysis was conducted using appropriate statistical methods. There were 45 males enrolled (age 67.4 ± 8 years and BMI 25.5 ± 3.6 kg/m²). Profound changes were observed at six months follow-up. The exercise group showed a significant increase in the trunk and leg lean mass, and a lesser loss of total and arm lean mass. A significant decrease in PSA was also observed among the exercise group. PNI and PSA were significantly associated with regional lean mass. Exercise can prevent loss or even increase lean mass in high-risk PCa, especially in the early stage of ADT treatment. Moreover, a strong bond between lean mass and PNI and PSA further underscores the importance of early and continuous exercise interventions.     

Budget Impact of Adaptive Abiraterone Therapy for Castration-Resistant Prostate Cancer

BackgroundThe use of a novel strategy known as adaptive abiraterone therapy based on mathematical modeling of evolutionary dynamics of tumor subpopulations was shown in a clinical trial to extend the time to disease progression in patients with metastatic castration-resistant prostate cancer (CRPC) and reduced the use of abiraterone therapy. Although the clinical impact of adaptive abiraterone treatment is clear, the economic impact of this strategy has not been investigated.ObjectiveTo compare the cost of care with adaptive abiraterone therapy versus standard continuous abiraterone therapy in patients with metastatic CRPC, using patient billing data.MethodsWe performed a retrospective review of billing data for patients with metastatic CRPC who received abiraterone treatment at a large cancer center between June 1, 2012, and August 31, 2018. Patients were divided into 2 groups based on whether they received adaptive abiraterone therapy (N = 15) or continuous abiraterone therapy (N = 21). All patients with refractory, metastatic prostate cancer after castration that was indicated for abiraterone therapy were eligible for this study. Each patient in the adaptive abiraterone therapy cohort received abiraterone plus prednisone treatment until the patient reached a target threshold of 50% or more reduction in prostate-specific antigen (PSA) level compared with his PSA level before abiraterone therapy; treatment was then suspended until the PSA level rose above the 50% of PSA before abiraterone therapy target threshold. The continuous therapy cohort received abiraterone plus prednisone daily until radiographic progression. The primary outcomes were the mean annual cost of care per patient, including and excluding the cost of abiraterone, and the cost of care, by clinical category.ResultsThe median time to disease progression was 25.8 months for patients who received adaptive abiraterone therapy compared with 12.1 months for patients who received continuous abiraterone therapy. Overall, the mean total, including the cost of drug, annual cost per patient who received adaptive abiraterone therapy was $79,093 compared with $146,782 for patients who received continuous abiraterone therapy (P <.0001). The annual cost of care per patient, excluding the cost of abiraterone, was $13,883 for those who received adaptive therapy versus $22,322 for those who received continuous abiraterone therapy (P = .2757), which was not statistically significant.ConclusionPractical precision medicine strategies, such as adaptive abiraterone treatment or pharmacogenomics-targeted dosing, can use known biomarkers, such as PSA, to tailor therapy, generate improved outcomes, and reduce costs without the need for novel drug and diagnostic discovery and development. The results of this study suggest that a large clinical study of adaptive abiraterone therapy is warranted to validate the potential of this strategy to extend the time to disease progression and reduce costs of treatment of metastatic CRPC.     

Soy Isoflavones in Conjunction With Radiation Therapy in Patients With Prostate Cancer

Soy isoflavones sensitize prostate cancer cells to radiation therapy by inhibiting cell survival pathways activated by radiation. At the same time, soy isoflavones have significant antioxidant and anti-inflammatory activity, which may help prevent the side effects of radiation. Therefore, we hypothesized that soy isoflavones could be useful when given in conjunction with curative radiation therapy in patients with localized prostate cancer. In addition to enhancing the efficacy of radiation therapy, soy isoflavones could prevent the adverse effects of radiation. We conducted a pilot study to investigate the effects of soy isoflavone supplementation on acute and subacute toxicity (≤6 mo) of external beam radiation therapy in patients with localized prostate cancer. Forty-two patients with prostate cancer were randomly assigned to receive 200 mg soy isoflavone (Group 1) or placebo (Group 2) daily for 6 mo beginning with the first day of radiation therapy, which was administered in 1.8 to 2.5 Gy fractions for a total of 73.8 to 77.5 Gy. Adverse effects of radiation therapy on bladder, bowel, and sexual function were assessed by a self-administered quality of life questionnaire at 3 and 6 mo. Only 26 and 27 patients returned completed questionnaires at 3 and 6 mo, respectively. At each time point, urinary, bowel, and sexual adverse symptoms induced by radiation therapy were decreased in the soy isoflavone group compared to placebo group. At 3 mo, soy-treated patients had less urinary incontinence, less urgency, and better erectile function as compared to the placebo group. At 6 mo, the symptoms in soy-treated patients were further improved as compared to the placebo group. These patients had less dripping/leakage of urine (7.7% in Group 1 vs. 28.4% in Group 2), less rectal cramping/diarrhea (7.7% vs. 21.4%), and less pain with bowel movements (0% vs. 14.8%) than placebo-treated patients. There was also a higher overall ability to have erections (77% vs. 57.1%). The results suggest that soy isoflavones taken in conjunction with radiation therapy could reduce the urinary, intestinal, and sexual adverse effects in patients with prostate cancer.     

前列腺癌患者的生命质量研究

根据欧洲肿瘤研治组织制定的前列腺癌生活质量量表，对１０２例前列腺癌患者进行了病例－对照研究。应用因子分析将量表分成日常生活起居、家庭社会生活、主观症状、不适和困倦、心理失衡和障碍、性生活等六个方面，结果表明病例和对照各指标之间的差异均有极显著性意义，该量表可以较好地评价前列腺癌患者的生活质量。     

TSH抑制治疗对老年甲状腺癌术后骨代谢相关指标的影响

目的研究TSH抑制治疗对老年甲状腺癌患者术后骨代谢相关指标的影响。方法将医院收治的68例行手术治疗老年甲状腺癌患者纳入研究对象,按照术后治疗差异分为研究组(34例)与对照组(34例),研究组予以TSH抑制治疗,对照组予以TSH常规疗法,另取同期34例健康志愿者作为健康对照组,比较患者术后骨代谢相关指标情况。结果用药前,对照组与研究组FT3、FT4明显低于健康组,且两组TSH明显高于健康组(P<0.05);用药后,研究组FT3、FT4显著高于对照组,且TSH显著低于对照组(P<0.05);用药前后,三组钙、碱性磷酸酶、磷水平、骨密度比较均不具显著性差异(P>0.05)。结论常规剂量TSH能够维持老年甲状腺患者术后正常生理需求,TSH抑制治疗能让甲状腺功能处于亚临床甲亢状态,不会给患者骨代谢以及骨密度带来大的影响。     

晚期前列腺癌的内分泌治疗

近年来由于前列腺癌 (Ｐｃａ)发病率逐年上升以及内分泌治疗的进展 ,人们对晚期Ｐｃａ越来越重视。本院自 1988年至 1998年 4月采用内分泌疗法治疗 14例 ,疗效满意 ,现报告如下。1　临床资料1·1　一般资料　 14例中 ,年龄 5 7～ 76岁 ,平均 6 5 6岁 ,病史 3个月至 4年。所有病例都有不同程度的排尿困难。合并尿频、肉眼血尿、下腹部包块各 4例 ;胸水或腹水 3例 ;进行性消瘦 5例。经Ｂ超及ＣＴ诊断 ,所有病例肿瘤已侵犯到前列腺包膜外。其中累及膀胱、直肠各 2例 ;合并膀胱或淋巴结转移 6例 ;骨盆、肋骨转移各 3例 ;肝、肺、股骨及腰椎转移…     

前列腺癌患者的生命质量研究

美国FDA提出．对肿瘤的治疗必须从存活率的提高和生活质量的改善两方面评价，如何评价癌症患者的生活质量已成为当今临床研究的新课题。本文根据欧洲肿瘤研治组织制定的前列腺癌生活质量量表，对102例前列腺癌患者进行了病例一对照研究。应用因子分析将量表分成日常生活起居、家庭社会生活、主观症状、不适和困倦、心理失衡和障碍、性生活等6个方面，结果表明．病例和对照各指标之间的差异均有非常显著性，该量表可以较好地评价前列腺癌患者的生活质量。     

前列腺癌15例治疗回顾

目的：探讨基层医院前列腺癌的诊断与治疗。方法：分析15例前列腺癌诊疗过程临床资料。结果：13例患者排尿梗阻及尿道刺激症状明显改善,术后PSA降至正常水平,1例失去随访,1例PSA反复波动正接受放射治疗。结论：基层医院要重视前列腺癌的早期诊断。对高危前列腺癌患者,应按照前列腺癌诊断治疗指南,综合应用内分泌治疗、根治性手术、放射治疗、根治性经尿道前列腺切除等治疗方法。     

肝转移介入治疗前后的CT容积测量

目的 比较一维、二维CT和CT容积测量三种方法测量肝转移瘤介入治疗的效果。方法 22例肝转移的患者,在介入治疗前和术后3个月行螺旋CT扫描。在CT工作站分别按一维和二维测量横断层面的全部病灶。用容积测量技术去追踪测量每个病灶,将每个病灶的总和归类分为四组,即全效、部分有效、病变进展和病变稳定。结果 在22例肝转移介入治疗前后肿瘤直径和面积的测量结果是一致的。但容积测量8例与一维测量不符,6例与二维测量不符.4例一维和二维测量结果均为部分有效,而容积测量结果为病变稳定。2例一维和二维测量病变稳定者,容积测量则为部分有效。甚至有2例一维、二维测量为病变进展者,容积测量仍为病变稳定。结论 在肝转移瘤介入治疗前后,肿瘤容积测量结果在大多数病人与一维、二维测量结果不一致.因此,若要证实容积测量的优势,还需要大样本的临床对照研究。     

间歇性内分泌治疗晚期前列腺癌临床效果分析

目的探究间歇性内分泌法治疗晚期前列腺癌的临床效果。方法回顾性分析2013年1月至2014年3月我院收治的56例晚期前列腺癌患者的临床资料,根据治疗方法的不同将患者分为对照组和实验组各28例,对照组患者给予持续性内分泌治疗,实验组患者给予间歇性内分泌治疗。比较两组患者的临床治疗效果、不良反应发生情况和五年生存率。结果两组的治疗总有效率(92.86%vs 85.71%)和5年生存率(78.57%vs 71.43%)相比差异不显著(P>0.05),但实验组的显效率(57.14%)显著高于对照组(25.00%),差异具有统计学意义(P<0.05)。两组骨质疏松和性欲降低等不良反应发生率相比差异不显著(P>0.05),但实验组发热、贫血和食欲下降等不良反应发生率均显著低于对照组,差异具有统计学意义(P<0.05)。结论对于晚期前列腺癌患者,给予其间歇性内分泌治疗的效果好,能够显著提高患者的功能状态、生活质量,同时不良反应少,安全可靠,值得临床推广。     

Physicians’ Preferences for Bone Metastases Drug Therapy in the United States

ObjectiveSeveral characteristics of bone-targeted agents are considered when making treatment decisions. This study evaluated physicians’ therapy preferences for preventing skeletal-related events (SREs) in patients with bone metastases secondary to solid tumors.MethodsA Web-enabled, discrete-choice experiment online survey was conducted among physicians who treated patients with bone metastases and solid tumors in the United States. Respondents chose between pairs of hypothetical medications defined by combinations of six attributes at varying levels for two hypothetical patients. Preference weights for attribute levels were estimated using a random-parameters logit model.ResultsIn total, 200 physicians completed the survey. Their mean age was 52 years, 57% were in practice for more than 15 years, 37% were oncologists, and 65% treated 10 or fewer patients with bone metastases weekly. Out-of-pocket cost to patients was the most important attribute overall. Among clinical outcomes, time to first SRE and risk of renal impairment were the most important attributes. Statistically significant preferences were observed for all attribute levels for time to first SRE, risk of renal impairment, and mode of administration. Predicted choice probability analysis showed that physicians preferred a hypothetical medication with attributes similar to those of denosumab over one with attributes similar to those of zoledronic acid.ConclusionsPhysicians indicated that clinical attributes are important when considering bone-targeting therapy for bone metastases, but consistent with the current health care landscape, patient out-of-pocket cost was the most important. With health care costs being increasingly shifted to patients, physicians require accurate information about co-pays and assistance programs to avoid patients receiving less costly, yet potentially inferior, treatment.     

Nutritional Therapy for Patients with Esophageal Cancer

Malnutrition develops in 79% patients with esophageal cancer. Thus, these patients represent a group of cancer patients, which is the most nutritionally compromised. Dysphagia and more than 10% loss of body weight are already present at the time of diagnosis. Treatments for esophageal cancer contribute significantly to the development of malnutrition. This paper describes the nutritional treatment of patients and nutritional strategies in patients with dysphagia and other nutritional problems that accompany the treatment of patients with esophageal cancer. Here are shown the types and methods of nutritional support, which are suitable for this group of patients. Nutritional support of patients with esophageal cancer is performed as a parallel therapeutic route.     

HoSAGE: Sarcopenia in Older Patients before and after Treatment with Androgen Deprivation Therapy and Radiotherapy for Prostate Cancer

The journal of nutrition, health & aging - Sarcopenia is a muscle disease defined by a loss of muscle strength associated to a decrease in skeletal muscle mass. In addition to aging, many...     

SPECT／CT同机融合显像技术诊断前列腺骨转移的应用价值

目的：探讨带有诊断级多排螺旋CT（MSCT）的SPECT／CT同机融合显像技术在前列腺骨转移诊断中的应用价值。方法：选择43例经病理证实为前列腺癌的患者,静脉注射锝99-亚甲基二膦酸盐（MDP）740-1110MBp,3-6h后行全身骨显像,由两名核医学科医师分析全身骨显像图像,对发现的可疑病灶行同机SPECT／CT扫描,并行图像融合和分析。结果：SPECT／CT同机融合诊断前列腺骨转移的灵敏度为97．02％（35／36）,特异性85．71％（6／7）,准确性95．35（41／43）,阳性预测值97．02％（35／36）,阴性预测值85．71％（6／7）。结论：带有MSCT的SPECT／cT不仅可精确定位,还可以提供局部解剖信息,在明确前列腺癌患者骨转移的诊断中具有良好的临床应用价值。     

Palliative Vitamin C Application in Patients with Radiotherapy-Resistant Bone Metastases: A Retrospective Study

The aim of this study was to observe effects of ascorbic acid application on pain, performance status, and survival time in cancer patients. A retrospective cohort of 39 patients with bone metastases treated with radiotherapy was identified. All patients were radiotherapy-resistant. Fifteen patients who received chemotherapy, and 15 patients who received an infusion of 2.5 g ascorbic acid were included in the study. Nine control patients were treated with neither chemotherapy nor vitamin C. Eastern Cooperative Oncology Group Performance Status Scale and Visual Analog Scale were used to determine performance status and pain assessments. Survival time and rate in patients were defined. Statistical analyses were performed to compare the results of groups. Performance status was increased in 4 patients of vitamin C group and 1 patient of chemotherapy group, whereas performance status in control group was decreased. A median reduction of 50% in pain was observed among the patients in the vitamin C group. Median survival time was 10 mo in patients receiving ascorbic acid, whereas the chemotherapy and control groups had a median survival of 2 mo. Intravenous vitamin C application seems to reduce pain in patients in comparison to other patients who did not receive it. Patient performance status and survival rate were increased using vitamin C.