Cost-Effectiveness Analysis of 12-Versus 4-Weekly Administration of Bone-Targeted Agents in Patients with Bone Metastases from Breast and Castration-Resistant Prostate Cancer

A cost–utility analysis was performed based on the Rethinking Clinical Trials (REaCT) bone-targeted agents (BTA) clinical trial that compared 12-weekly (once every 12 weeks) (n = 130) versus 4-weekly (once every 4 weeks) (n = 133) BTA dosing for metastatic breast and castration-resistant prostate (CRPC) cancer. Using a decision tree model, we calculated treatment and symptomatic skeletal event (SSE) costs as well as quality-adjusted life-years (QALYs) for each treatment option. Deterministic and probabilistic sensitivity analyses were performed to assess the robustness of the study findings. The total cost of BTA treatment in Canadian dollars (C$) and estimated QALYs was C$8965.03 and 0.605 QALY in the 4-weekly group versus C$5669.95 and 0.612 QALY in the 12-weekly group, respectively. De-escalation from 4-weekly to 12-weekly BTA reduces cost (C$3293.75) and improves QALYs by 0.008 unit, suggesting that 12-weekly BTA dominates 4-weekly BTA in breast and CRPC patients with bone metastases. Sensitivity analysis suggests high levels of uncertainty in the cost-effectiveness findings. De-escalation of bone-targeted agents is cost-effective from the Canadian public payer’s perspective.     

Lost in Transition? Thoughts on Retirement,Part 2. “Should I Stay or Should I Go Now?”

Although it is accepted that oncologists should plan for a future beyond full-time oncology, there is little practical guidance for a successful transition into retirement. Previously, we provided strategies for various aspects of retirement planning. However, this became significantly more complicated as we face newer issues such as the COVID-19 pandemic, the move to virtual patient care, greater awareness of burnout, and the increasing burden of regulatory issues such as the electronic medical record. It is evident that more prospective information is needed to guide oncologists in planning their retirement.     

Developing patient-centred strategies to optimize the management of vasomotor symptoms in breast cancer patients: a survey of health care providers

Purpose

Vasomotor symptoms (VMS) such as hot flashes and night sweats are common in breast cancer patients and can affect both quality of life and treatment adherence. However, there is limited practical data to guide clinicians in the optimal selection of therapeutic strategies. A survey of health care providers was performed to better understand perspectives and prescribing practices for managing this problem.

Methods

Canadian health care providers who treat patients with early stage breast cancer (EBC) participated in an anonymous electronic survey. Participants provided their perspectives on the prevalence and severity of VMS among patients with EBC, outlined their management strategies, and provided feedback on the perceived efficacy of interventions for VMS.

Results

Responses were received from 65 providers including breast oncologists (36/65, 55%) and nurses with oncology expertise (29/65, 45%). Seventy-seven percent of participants reported regularly asking patients about VMS, and most indicated that bothersome VMS occurred in the majority of patients. Health care providers cited hot flash severity and sleep disruption as the most important issues for patients. The most common first- and second-line interventions recommended were lifestyle modifications (n?=?32/65, 49.2%) and pharmacologic strategies (n?=?27/65, 41.5%), respectively. Most respondents felt that interventions, including pharmacologic, over-the-counter, and complementary therapies, were only “somewhat effective”. Overall, half of respondents (n?=?35/65, 54%) reported being “confident” in managing VMS.

Conclusion

Given the variability of treatment recommendations, and health care provider uncertainty around the benefits of therapies for VMS, more ‘real-world’ trials are needed to optimize patient care.

     

社会支持和应对方式对肾移植患者生存质量的影响

目的:调查社会支持和医学应对方式对肾移植患者生存质量的影响。方法:于2005-01/02选择在首都医科大学附属北京友谊医院门诊随访的成功接受肾移植手术患者60例,移植肾功能正常,均自愿参加问卷调查。应用以下3个量表:①世界卫生组织生存质量测定量表简表:包括生理领域、心理领域、社会关系领域和环境领域4个因子及自评总分,各个领域得分越高,代表该领域的生存质量越好。②领悟社会支持量表:包括家庭支持、朋友支持和其他人支持3个因子,同时以领悟社会支持总分反映个体感受的社会支持总程度,得分越高,表明个体感受到的支持程度越高。③医学应对问卷:包含面对,回避和屈服3个分量表,分量表得分越高,表明个体越倾向于采用这种应对方式。计算肾移植患者各量表得分,并与常模进行比较。分析肾移植患者领悟社会支持得分、所采用的医学应对方式得分与患者生存质量各领域得分的相关性。结果:60例患者全部进入结果分析,无脱落。①肾移植患者生存质量在生理领域、心理领域,社会关系领域及环境领域的得分均低于常模,其中在生理领域的差异有显著性意义(13.2±2.2,15.1±2.3,P<0.05)。②除生存质量的自评总分与家庭支持有关外(r=0.302,P<0.05),其余4个因子均与家庭支持无相关性(P>0.05)。生存质量各因子及自评总分均与朋友支持、其他人支持和领悟社会支持总分相关(P<0.01)。③肾移植患者回避的应对方式与生存质量中的社会关系领域呈正相关(r=0.311,P=0.016)。结论:肾移植患者生理领域的生存质量较低,生存质量受患者领悟社会支持程度及采取医学应对方式的影响。     

银杏内酯和神经生长因子影响原代人胚肝细胞的增殖及分泌

目的:如何培养足够的肝细胞以及应用一些物质、因子从而使其增加分裂、减少凋亡?观察银杏内酯和神经生长因子对体外原代培养的人胚肝细胞增殖、凋亡及相关分泌功能的影响具有临床实用性意义。方法:实验于2005-07/2006-10在南通大学神经生物学研究所完成。①细胞来源:孕14～16周流产胎儿,由南通市妇幼保健院妇产科提供,产妇及其家属均知情同意,实验经医学伦理委员会批准。银杏内酯由中国药科大学提供,神经生长因子为Roche公司产品。②实验方法:用非灌流法从人胚肝中分离肝细胞,以DMEM作为培养基,接种于4块24孔培养板中,每两块培养板各接种36孔,12孔/组,细胞3×105/孔。银杏内酯组各孔加入含37.5g/L银杏内酯和体积分数为0.1小牛血清的DMEM培养液2mL,神经生长因子组各孔加入含100mg/L神经生长因子和体积分数为0.1小牛血清的DMEM培养液2mL,空白对照组各孔加入仅含体积分数为0.1小牛血清的DMEM培养液2mL。③实验评估:人胚肝细胞原代培养至9d,倒置显微镜下计数每视野的肝细胞数,同时行MTT试验,并用流式细胞仪检测肝细胞凋亡情况。分别于培养3,6,9d时收集肝细胞培养液进行白蛋白含量检测。结果:①原代肝细胞生长情况及肝细胞计数:接种12h后各组肝细胞均已贴壁,3d后可见由3～5个细胞组成的细胞集落,至9d时银杏内酯组和神经生长因子组肝细胞已基本铺满孔底,且呈立体生长倾向,空白对照组肝细胞较少,胞间有空隙存在。至培养9d,银杏内酯组、神经生长因子组、空白对照组每视野内肝细胞计数差异有显著性意义(F=12.97,P=0.00)。②MTT试验结果:原代肝细胞培养至9d时,银杏内酯组、神经生长因子组、空白对照组吸光度值差异有显著性意义(F=71.90,P=0.00)。③肝细胞培养液白蛋白含量:培养3d时各组细胞培养液的白蛋白含量方差分析无明显差异(F=0.23,P=0.79)。培养6,9d同一时间点组间比较差异有显著性意义(F=11.69,P=0.00;F=9.35,P=0.00)。④细胞凋亡情况:银杏内酯组、神经生长因子组、空白对照组凋亡肝细胞百分率分别为11.53%,9.29%,15.27%。结论:银杏内酯和神经生长因子对原代人胚肝细胞的增殖和分泌白蛋白功能均具有促进作用,并抑制细胞凋亡。     

Investigation of the dosimetric effect of respiratory motion using four-dimensional weighted radiotherapy

We have developed a four-dimensional weighted radiotherapy (4DW-RT) technique. This method involves designing the motion of the linear accelerator beam to coincide with the tumour motion determined from 4D-CT imaging while including a weighting factor to account for irregular motion and limitations of the delivery system. Experiments were conducted with a moving phantom to assess limitations of the delivery system when applying this method. Although the multi-leaf collimator motion remains within the tolerance of the linear accelerator, the extent of motion was less than 1 mm larger than the designed one, and there was a net system latency of approximately 0.2 s. The dose distributions were measured and simulated using different weighting factors and motion scenarios. The breathing characteristics (period, extent of motion, drift and standard deviations) of 32 patients were evaluated using the Varian RPM system. Breathing variability was assessed by plotting the average breathing motion as a function of the breathing phase. Simulations were carried out to determine the optimal weighting factor based on typical patient breathing characteristics. These results establish that the 4DW-RT method demonstrates potential for dose escalation without increasing exposure to healthy tissue.     

Patient-related blood drives

Ten patient-related blood drives were evaluated and compared to five other blood drives. The patient-related blood drives were easier to organize, more fruitful, and more satisfying for the donors and workers. The authors suggest a role for patient-related blood drives in the present recruitment system and discuss how hospitals and blood centers can coordinate their efforts to have this type of blood drive. Finally, it is suggested that patient-related blood drives can increase recruitment, especially in large metropolitan areas that suffer from chronic blood shortages.     

Lost in Transition? Thoughts on Retirement,Part 2. “Should I Stay or Should I Go Now?”

Although it is accepted that oncologists should plan for a future beyond full‐time oncology, there is little practical guidance for a successful transition into retirement. Previously, we provided strategies for various aspects of retirement planning. However, this became significantly more complicated as we face newer issues such as the COVID‐19 pandemic, the move to virtual patient care, greater awareness of burnout, and the increasing burden of regulatory issues such as the electronic medical record. It is evident that more prospective information is needed to guide oncologists in planning their retirement.