紫杉醇脂质体与紫杉醇在乳腺癌新辅助化疗中随机对照研究的Meta分析

目的比较评价新辅助化疗情况下,紫杉醇脂质体与紫杉醇治疗乳腺癌的疗效及毒副作用。方法检索国内外数据库,对符合纳入标准的文献进行质量评价和Meta分析。结果有4项研究纳入分析,共244例患者。紫杉醇脂质体与紫杉醇治疗乳腺癌有效性比较,合并OR值为0.9（0.54,1.50）,经Z检验,P=0.69,差异无统计学意义;紫杉醇脂质体与紫杉醇治疗乳腺癌引起的不良反应中,白细胞减少合并OR值为0.96（0.58,1.60）,经Z检验,P=0.89,差异无统计学意义;脱发合并OR值为0.72（0.42,1.24）,经Z检验,P=0.24,差异无统计学意义;肌肉痛合并OR值为0.45（0.26,0.76）,经Z检验,P=0.003,差异有统计学意义,即紫杉醇脂质体引起的肌肉痛症状更少;皮疹合并OR值为0.19（0.08,0.44）,经Z检验,P=0.0001,差异有统计学意义,即紫杉醇脂质体引起的肌肉痛症状更少。结论紫杉醇脂质体与紫杉醇治疗乳腺癌疗效相当,不良反应中,血液毒性、脱发等发生率相似,但在引起肌肉痛、皮疹方面,紫杉醇脂质体相对于紫杉醇有所缓解。     

西药不良反应临床分析

目的：探讨西药用药过程中发生不良反应的诱发因素。方法回顾性分析2012年4月至2013年12月我院收治的160例西药不良反应患者的临床报告，对不良反应发生的诱发因素、临床表现以及治疗方法和效果等进行总结和分析。结果160例患者均是在使用西药治疗过程中发生不同程度的不良反应，通过采取针对性治疗，治愈151例（94.4%），好转9例（5.6%）。引起不良反应发生的因素与给药方式、抗生素药物类型不同等有关。临床表现以皮肤出现皮疹、红肿及瘙痒为主。结论引起西药不良反应发生因素较多，为有效避免西药用药过程中不良反应的发生，医护人员与患者在用药过程中须严格遵循合理用药准则，尽可能减少不良反应的发生，提高临床用药安全性。     

紫杉醇联合顺铂化疗在晚期非小细胞肺癌患者中的应用效果

目的 探讨紫杉醇+顺铂化疗在晚期非小细胞肺癌（NSCLC）患者中的应用效果。方法 选取2020年7月至2021年1月于阳江市人民医院住院治疗的50例晚期NSCLC患者作为研究对象,根据治疗方法不同分为观察组与对照组,各25例。对照组患者予以放疗治疗,观察组患者在对照组基础上采用紫杉醇+顺铂化疗,比较两组临床疗效、血清肿瘤标志物水平、不良反应发生率、肺癌患者生存质量测定量表（FACT-L）评分。结果 观察组治疗有效率（80.00%）高于对照组（54.00%）,观察组治疗后血清糖类抗原242(CA242)、糖类抗原19-9(CA19-9)、癌胚抗原（CEA）水平低于对照组,观察组治疗后FACT-L评分高于对照组,差异有统计学意义（P<0.05）。观察组不良反应发生率（16.00%）与对照组（20.00%）比较,差异无统计学意义（P>0.05）。结论 紫杉醇+顺铂化疗可有效抑制晚期NSCLC患者疾病进展,降低血清肿瘤标志物水平,改善生命质量,且不良反应较少。     

和胃解毒汤治疗食道癌患者的疗效和安全性

目的探讨和胃解毒汤治疗食道癌患者的疗效以及安全性,为临床治疗食道癌提供新思路。方法选取2019年1月至2020年5月梅州市人民医院收治的食道癌患者62例作为研究对象,按照不同的治疗方案分为对照组(30例)和试验组(32例)。对照组给予调强适形放射治疗加紫杉醇(TXL)联合洛铂(LBP)化疗,即TP化疗方案;试验组在对照组基础上加用和胃解毒汤。比较分析两组患者的治疗效果,并评价两组患者的胃肠道不良反应发生情况。结果试验组治疗有效率及疾病控制率分别为78.13%和87.50%,显著高于对照组的53.33%和66.67%,差异有统计学意义(P<0.05);主要不良反应为胃肠道反应,以恶心呕吐、食欲下降为主,可耐受,其中试验组胃肠道不良反应发生率9.38%,显著低于对照组的30.00%(P<0.05)。结论和胃解毒汤在食道癌患者综合治疗中具有良好的疗效,减轻了不良反应,对治疗食道癌有积极的意义。     

卡介苗治疗中高危非肌层浸润性膀胱癌复发时间与不良反应的关系

目的 探讨中高危非肌层浸润性膀胱癌（NMIBC）患者行卡介苗（BCG）膀胱灌注治疗的复发时间与不良反应之间的关系。方法 选取2018年6月至2021年6月重庆医科大学附属第二医院泌尿外科收治的接受BCG膀胱灌注的550例中高危NMIBC患者作为研究对象,分析BCG膀胱灌注的复发时间与不良反应之间的关系。结果 550例BCG膀胱灌注治疗患者中,86例未出现不良反应,随访12个月,发现1年无复发生存率为82.18%(452/550),累计复发率为17.82%(98/550)。局部不良反应患者与全身不良反应患者复发时间比较差异无统计学意义（t=0.359,P=0.360）。发生2级不良反应患者复发时间短于发生1级不良反应患者,差异有统计学意义（t=7.501,P<0.05）。发生1种及以下不良反应患者复发时间与发生两种不良反应患者复发时间比较差异无统计学意义（P>0.05）,但发生3种及以上不良反应患者复发时间明显短于以上两组,差异有统计学意义（P<0.05）。结论 BCG膀胱灌注治疗的复发时间与患者不良反应分级、数量有着一定的联系,随着不良反应分级与数量的上升,NMIBC...     

贝伐珠单抗联合紫杉醇对转移性乳腺癌患者免疫功能的影响

目的 探讨贝伐珠单抗联合紫杉醇对转移性乳腺癌患者免疫功能的影响。方法 选取2018年1月至2022年4月南昌市第三医院收治的100例转移性乳腺癌患者作为研究对象,按随机数字表法分为对照组与观察组,各50例。对照组接受紫杉醇治疗,观察组接受贝伐珠单抗联合紫杉醇治疗。于治疗4个周期后评估疗效,比较两组治疗前后血清肿瘤标志物、免疫功能指标,记录不良反应。结果 观察组疾病控制率(DCR)为66.00%,高于对照组的46.00%(P<0.05)。治疗后观察组癌胚抗原(CEA)、糖类抗原125(CA125)、细胞角蛋白19片段(CYFRA21-1)水平低于对照组,差异有统计学意义(P<0.05)。治疗后观察组CD3+、CD4+高于对照组,CD8+、骨髓源性抑制细胞(MDSCs)、调节性T细胞(Tregs)低于对照组,差异有统计学意义(P<0.05)。两组不良反应发生率(20.00%vs.16.00%)比较,差异无统计学意义(P>0.05)。结论 贝伐珠单抗联合紫杉醇治疗转移性乳腺癌疗效确切,可降低肿瘤标志物的表达,提高免疫功能,且未增加不良反应。     

化疗后肺结核患者的胃肠道不良反应护理分析

目的探讨肺结核患者化疗后出现胃肠道不良反应的临床护理方法,提高肺结核化疗的疗效,同时减少术后胃肠道不良反应的发生。方法分析我院收治的38例肺结核化疗后出现胃肠道反应的患者,给予一般护理、饮食护理及心理护理。结果 38例患者护理治疗后,胃肠道症状均消失,其中9例伴有肝功能损害的患者,均在保肝的基础上,消除胃肠道不良反应。结论积极有效的护理,即可对胃肠道反应起到减轻效果的作用,减轻患者的心理负担,使患者更积极有效地配合治疗,使肺结核的治疗达到预期效果。     

他汀类药物治疗高脂血症不良反应临床探析

目的探究他汀类药物治疗高脂血症所引发的不良反应特点,并为其临床合理用药积累经验。方法选取我院收治的128例服用他汀类药物治疗的高脂血症患者,记录患者用药过程中所出现的不良反应,并给予对应的干预措施。结果 128例高脂血症患者服用他汀类药物后,出现药物不良反应18例,发生率为14.06%,主要包括胃肠道反应、肝功能异常、横纹肌溶解、周围神经感觉障碍及抑郁症等。18例患者经过对症处理及干预后,所有患者均未出现严重后果及不良反应。结论他汀类药物导致高脂血症患者出现药物不良反应,患者需严格遵医嘱用药,并定期检测肝肾功能。     

耐多药肺结核治疗中不良反应情况分析

目的：探讨耐多药肺结核治疗中不良反应的发生情况。方法选取2013年2月至2014年2月收治的耐多药肺结核患者45例作为研究对象,对耐多药肺结核治疗中出现的不良反应情况进行分析。结果45例耐多药肺结核患者中,有4例患者未发生不良反应,41例患者发生不良反应,其中肝功能异常8例,肠胃道反应14例,低血钾7例,尿蛋白异常4例,尿酸升高、药物疹各3例,视听下降、血清促甲状腺激素异常各1例。结论耐多药肺结核治疗中不良反应最为严重的是肠胃道反应,及时发现并制订有效的治疗方案可提高治疗效果。     

三氧化二砷治疗肝癌的疗效分析

目的探讨三氧化二砷治疗肝癌的临床效果及安全性。方法收集我院自2010年12月～2012年12月收治的44例肝癌患者,其中26例采用三氧化二砷静脉滴注治疗,其余18例姑息手术治疗后采用三氧化二砷微量化疗,观察患者临床缓解率、生化指标、影像学、生活质量改善及不良反应发生情况。结果 44例患者经4～6个疗程治疗后,完全缓解8例,部分缓解22例,稳定8例,进展6例,治疗总有效率为68.2%;有81.8%患者生活质量改善或稳定;其中6例患者在接受2周治疗后肿块明显缩小,15例患者治疗1周后AFP明显下降,治疗前后指标均有明显差异,P<0.05;患者治疗中3例出现呕吐、恶心,7例出现乏力,4例出现骨髓抑制,不良反应发生率为31.8%。结论三氧化二砷治疗肝癌效果显著,促进患者生活质量的提高,值得推广使用。     

比较护理个案管理与常规护理对癌症患者的影响

目的评估护理个案管理对癌症患者护理质量的有效性。方法实验组采用个案护理方式，对照组采用常规护理方式。比较两组患者护理的效果，包括患者持续治疗率、非持续治疗率、长期住院率、非计划再入院率和计划入院进行积极治疗率。专家评估效用达到0.9。结果护理个案管理能更好地为患者提供治疗的及时性和连续性。护理个案管理明显降低了感染引起的非计划性再入院率。患者持续治率疗显著增加。计划入院进行积极治疗率在14天和15～30天内也增加明显。结论癌症个案管理能提高癌症护理服务的效果，这种护理模式将在进一步应用和改善癌症护理上得到完善。     

IMPORTATION AND INNOVATION

Importation of drugs into the US may soon become legal. Since prices of drugs are lower in most other countries than they are in the US, importation would result in a decline in US drug prices. The purpose of this paper is to assess the consequences of importation for new drug development. First, the author presents a simple theoretical model of drug development which suggests that the elasticity of innovation with respect to the expected price of drugs should be at least as great as the elasticity of innovation with respect to expected market size (disease incidence). Then, the cross-sectional relationship between pharmaceutical innovation and market size among a set of diseases (different types of cancer) exhibiting substantial exogenous variation in expected market size is examined. Two different measures of pharmaceutical innovation are analysed: the number of distinct chemotherapy regimens for treating a cancer site and the number of articles published in scientific journals pertaining to drug therapy for that cancer site. Both analyses indicate that the amount of pharmaceutical innovation increases with disease incidence. The elasticity of the number of chemotherapy regimens with respect to the number of cases is 0.53. The elasticity of MEDLINE drug cites with respect to cancer incidence throughout the world is 0.60. In the long run, a 10% decline in drug prices would therefore be likely to cause at least a 5–6% decline in pharmaceutical innovation. Evidence suggests that pharmaceutical industry employment would also decline (by at least 3.5–4%) in response to an exogenous 10% decline in drug prices.     

Annual patient and caregiver burden of oncology clinic visits for granulocyte-colony stimulating factor therapy in the US

Objective:

Prophylactic treatment with granulocyte-colony stimulating factors (G-CSFs) is indicated for chemotherapy patients with a significant risk of febrile neutropenia. This study estimates the annual economic burden on patients and caregivers of clinic visits for prophylactic G-CSF injections in the US.

Methods:

Annual clinic visits for prophylactic G-CSF injections (all cancers) were estimated from national cancer incidence, chemotherapy treatment and G-CSF utilization data, and G-CSF sales and pricing information. Patient travel times, plus time spent in the clinic, were estimated from patient survey responses collected during a large prospective cohort study (the Prospective Study of the Relationship between Chemotherapy Dose Intensity and Mortality in Early-Stage (I–III) Breast Cancer Patients). Economic models were created to estimate travel costs, patient co-pays and the economic value of time spent by patients and caregivers in G-CSF clinic visits.

Results:

Estimated total clinic visits for prophylactic G-CSF injections in the US were 1.713 million for 2015. Mean (SD) travel time per visit was 62 (50) min; mean (SD) time in the clinic was 41 (68) min. Total annual time for travel to and from the clinic, plus time at the clinic, is estimated at 4.9 million hours, with patient and caregiver time valued at $91.8 million ($228 per patient). The estimated cumulative annual travel distance for G-CSF visits is 60.2 million miles, with a total transportation cost of $28.9 million ($72 per patient). Estimated patient co-pays were $61.1 million, ～$36 per visit, $152 per patient. The total yearly economic impact on patients and caregivers is $182 million, ～$450 per patient.

Limitations:

Data to support model parameters were limited. Study estimates are sensitive to the assumptions used.

Conclusions:

The burden of clinic visits for G-CSF therapy is a significant addition to the total economic burden borne by cancer patients and their families.     

Cost analysis: treatment of chemotherapy-induced anemia with erythropoiesis-stimulating agents in five European countries

Abstract

Objective:

Cost-analysis comparing darbepoetin-alfa (DARB), epoetin-alfa (EPO-A), and epoetin-beta (EPO-B) for treatment of chemotherapy-induced anemia in Belgium concluded that costs for DARB-treated patients were significantly lower than costs for EPO-A- or EPO-B-treated patients. The objective of the present study was to extend the Belgian analysis to Austria, France, Italy, Portugal, and Spain, estimating differences in costs between erythropoiesis-stimulating agents (ESAs) in each country.

Methods:

Differences in epidemiology and treatment patterns between countries were adjusted using data from Eurostat, national cancer registries, IMS sales data, and reimbursement and treatment guidelines. Belgian unit costs were replaced with country-specific costs. Costs were analyzed using a mixed-effects model stratifying for propensity score quintiles.

Results:

All populations were comparable to the Belgian population in terms of age, gender, ESA, and blood transfusions use. After adjusting for country-specific chemotherapy use and cancer incidence, total management costs per patient (Euro, 2010) were 19–26% (France, Spain) lower with DARB compared with EPO-A (p?<?0.0001) and 20–36% (Portugal, Austria) compared with EPO-B (p?<?0.01). Anemia-related costs with DARB were between 12% (Portugal; p?=?0.0235) and 38% (Italy; p?<?0.0001) lower compared with EPO-A (p?<?0.01; all remaining countries), and between 13% (Austria; p?=?0.064) and 19% (Portugal; p?=?0.0028) lower compared with EPO-B (p?<?0.05; all remaining countries except Italy; p?=?0.0935).

Limitations:

Not all differences could be accounted for by a lack of country-specific data; however, the potential under- and over-estimation of costs should be similar for all three ESAs.

Conclusions:

These findings are in line with the Belgian analysis. In all countries, total and anemia-related costs were lowest in patients receiving DARB vs EPO-A or EPO-B. This study demonstrates the feasibility of adapting real-life country-specific data to other settings, adjusting for differences in patients’ characteristics and treatment strategies. These findings should be valuable in healthcare decision-making in oncology patients treated in each of the countries studied.     

Health state utility values associated with advanced gastric,oesophageal, or gastro-oesophageal junction adenocarcinoma: a systematic review

Abstract

Objectives:

To systematically identify utility values associated with advanced gastric cancer (GC), oesophageal cancer (OC), or gastro-oesophageal junction (GEJ) cancer. Utility values relating to health states are an essential component for cost-utility analysis (CUA).     

What is the future of cancer care? A technology foresight assessment of experts’ expectations

ABSTRACT

The aim of this paper is to generate qualified information on technologies that are expected to be relevant to cancer care over the next thirty years (2017–2037). Drawing on the concepts of technology foresight, a methodology was developed for future technology research. Future technologies were identified by consulting editorials of journals specializing in oncology. Nine technologies were selected with the potential to impact cancer care in the future. Additionally, a method was developed for consulting a large number of experts from articles indexed in Thomson Reuters Web of Science. In this survey, more than 83,000 cancer specialists were invited to answer a web survey in which they expressed their expectations about the future of cancer care. The questionnaire was answered by 2408 specialists, 56% of whom stated they were highly knowledgeable experts. Our results show that antibody-related therapies, molecular imaging, and tumor delivery systems are the technologies most likely to be used in cancer care in the next thirty years. The main reasons pointed out for the choice of these technologies were improvements in the prognosis of the disease and improved diagnostic reliability. Meanwhile, knowledge and scientific barriers were highlighted as the main obstacles to the development of the technologies deemed to have more limited chances of success.     

姜黄素对前列腺癌PC-3细胞热休克蛋白27表达的影响

目的：探讨姜黄素对前列腺癌PC-3细胞热休克蛋白27（HSP27）表达的影响。方法体外培养人前列腺癌PC-3细胞,随机将其分为4组,空白对照组不给药;大剂量组给予50μmol/L姜黄素2μl;小剂量组给予25μmol/L姜黄素2μl;阴性对照组给予等体积二甲基亚砜（DMSO）。采用免疫荧光染色检测PC-3细胞HSP27的表达情况,采用RT-PCR检测PC-3细胞HSP27 mRNA的表达情况。结果免疫荧光染色结果显示,姜黄素治疗组PC-3细胞HSP27染色强度明显低于空白对照组和阴性对照组,并且大剂量组 HSP27染色强度降低更加明显,与空白对照组比较,差异有统计学意义（P＜0.05）。RT-PCR分析结果显示,姜黄素治疗组PC-3细胞HSP27 mRNA的表达明显降低（50%和60%）,且呈剂量依赖性,与空白对照组比较（128%）,差异有统计学意义（P＜0.05）。结论姜黄素可抑制PC-3细胞HSP27的表达,可能是其抗前列腺癌的机制之一。     

A comparison of healthcare resource use for rotavirus and RSV between vulnerable children with co-morbidities and healthy children: a case control study

Abstract

Objective:

To quantify the differences in hospital length of stay (LOS) and cost between healthy and vulnerable children with cystic fibrosis (CF), insulin-dependent diabetes mellitus (IDDM), cancer, and epilepsy who contract rotavirus (RVGE) or respiratory syncytial virus (RSV).

Methods:

Hospital Episode Statistics (HES) data were collected for England, for children <5 years old, admitted between April 2001 and March 2008, using ICD-10 codes for RVGE and RSV. Cases were identified as having RVGE and/or RSV plus CF, IDDM, cancer, or epilepsy. Healthy controls had RVGE and/or RSV only, additional controls had eczema only. Cost, hospital LOS, and demographics were collected.

Results:

Four hundred and eighty-six (0.5%) cases and 101,784 (99.5%) healthy controls were admitted with RVGE or RSV, with 17,420 eczema controls. RVGE was present in 153 (31.5%) cases and 7532 (7.4%) healthy controls, and RSV in 333 (68.5%) cases and 94,252 (92.6%) healthy controls. Cases were older (1.1 years, SD?=?1.3 years), had greater LOS (9.9 days, SD?=?19.9), and cost more (£3477, SD?=?£7765) than healthy controls (age?=?0.2, SD?=?0.5, p?<?0.001; LOS?=?1.9 days, SD?=?3.1, p?<?0.001; cost?=?£595, SD?=?£727, p?<?0.001). Cost for cases was 6-times greater than healthy controls (p?<?0.001). Controls had a 0.3 day greater LOS (p?<?0.001) with RSV, but a £17 (p?=?0.085) lower mean cost than RVGE.

Conclusion:

RVGE and RSV are more serious diseases in vulnerable children, requiring more intense resource use. The importance of preventing infection in vulnerable children is underlined by hygiene and appropriate isolation and vaccination strategies. When universal vaccination is under consideration, as for rotavirus vaccines, evaluation of a vaccination programme should consider the potentially positive impact on vulnerable children.

Limitations:

Limitations of the study include a dependency on accurate coding, an expectation that patients are identified through laboratory testing, and the possibility of unidentified underlying conditions affecting the burden.     

Cost-effectiveness of 3-year vs 1-year adjuvant therapy with imatinib in patients with high risk of gastrointestinal stromal tumour recurrence in the Netherlands; a modelling study alongside the SSGXVIII/AIO trial

Abstract

Background:

Surgical resection of gastrointestinal stromal tumour (GIST) is rarely curative in patients at high risk of tumour recurrence and therefore 1 year of post-surgery adjuvant imatinib therapy has been recommended in this sub-group. Recently, adjuvant imatinib therapy administered for 3 years has been demonstrated to further increase recurrence-free survival and overall survival. The goal of this study was to assess the economic value of extending the duration of adjuvant imatinib therapy in high-risk patients in the Netherlands.

Methods:

A multistate Markov model was developed to simulate how patients’ clinical status after GIST excision evolves over time until death. The model structure encompassed four primary health states: free of recurrence, first GIST recurrence, second GIST recurrence, and death. Transition probabilities between the health states, data on medical care costs, and quality-of-life were obtained from published sources and from expert opinion.

Results:

The expected number of life years (or quality-adjusted life years, QALYs) was higher in the 3-year group than in the 1-year group, 8.91 (6.55) and 7.04 (5.18) years, respectively. In the 3-year and 1-year group, the expected total costs amounted to €120,195 and €79,361, of which, €74,631 (62%) and €27,619 (35%) were adjuvant therapy drug costs, respectively. The difference in health benefits, that is 1.87 life years or 1.37 QALYs, and costs, €40,835, resulted in incremental cost-effectiveness ratios (ICER) of €21,865 per life year gained, and €29,872 per QALY gained.

Limitations:

A limitation of the study was inherently related to the uncertainty around the predictions of RFS. Scenario analyses were conducted to test the sensitivity of different RFS predictions on the results.

Conclusions:

Delayed recurrence due to treatment with longer-term adjuvant imatinib therapy represents a cost-effective treatment option with an ICER below the generally accepted threshold in the Netherlands.     

The impact of economic factors on treatment results for tumor inpatients in the under-developed Western region of China

Objective:

To discuss the influences of economic factors on the treatment outcomes of cancer patients and the relaxation effects of medical insurance policies on the influences of economic factors.

Method:

The concentration index (CI) and horizontal inequality (HI) of treatment outcomes of cancer patients were calculated and the role of the economy, disease, and other factors to HI was analyzed by describing the influence of treatment expense on the treatment outcomes of different cancer patients.

Results:

The study showed that the equity of the death rate and the effective rate of six types of cancer patients was good. The HI of the cure rate was 0.225, indicating a strong, pro-rich inequity of the cancer inpatient cure rate, while the contribution of the economic factors to HI was 0.158. The uncured rate in the low-cost group represented the rate of patients who discontinued the treatment; the HI was ?0.324, indicating a strong, pro-poor inequity. The relaxation effect on the HI of the cured rate by medical insurance was 14.9%, while the effect on the HI of the uncured rate was 18.7%.

Conclusion:

At present, medical insurance has demonstrated relaxation effects on the fairness of treatment outcomes to some extent. The main reason for this inequity comes from the payment of the items at present. To relieve such inequity to a greater extent, the payment system should be changed and diagnosis-related groups should be implemented.