Development and Psychometric Analysis of an Instrument to Measure the Reasons that Oncological Patients give when Participating in a Psychological Intervention

This work presents the psychometric study of a questionnaire on participation in psychological therapy (QPPT). The study is applied to oncological patients and the questionnaire was designed to evaluate the reasons given by chronic patients when participating or not in programmes of psychological treatment. The questionnaire includes six rational areas which resulted from the confirmatory factorial analysis.The internal consistency of the scales was analysed through Cronbach’s Alpha, and their discriminatory capacity between criterion groups of oncological patients was tested by means of t-tests and discriminant analyses. The results support, to a reasonable extent, the reliability and validity of the QPPT as an instrument to evaluate the reasons of participation or refusal of psychological treatment in oncological patients.     

Budget impact analysis of comprehensive genomic profiling in patients with advanced non-small cell lung cancer

Aims: Broad molecular profiling of patients with advanced non-small cell lung cancer (NSCLC) is strongly advised to optimize genomic matching with available targeted treatment options or investigational agents. Unlike conventional molecular diagnostic testing, or smaller hotspot panels, comprehensive genomic profiling (CGP) identifies genomic alterations across hundreds of clinically relevant cancer genes from a single tissue specimen. The present study sought to estimate the budget impact of increased use of CGP using a 324-gene panel (FoundationOne) vs non-CGP (represented by a mix of conventional molecular diagnostic testing and smaller NGS hotspot panels) and the number needed to test with CGP to gain 1 life year.

Materials and methods: A decision analytic model was developed to assess the budget impact of increased CGP in advanced NSCLC from a US private payer perspective. Model inputs were based on published literature (epidemiology and treatment outcomes), real-world data (testing and rates, medical service costs), list prices for CGP and anti-cancer drugs, and assumptions for clinical trial participation.

Results: Among 2 million covered lives, 532 had advanced NSCLC; 266 underwent molecular diagnostic testing. An increase in CGP among those tested, from 2% to 10%, was associated with $0.02 per member per month budget impact, of which $0.013 was attributable to costs of prolonged drug treatment and survival and $0.005 to testing cost. Approximately 12 patients would need to be tested with CGP to add 1 life year.

Limitations: The model incorporated certain assumptions to account for inputs with a limited evidence profile and simplify the possible post-CGP treatments.

Conclusions: An increase in CGP utilization from 2% to 10% among patients with advanced NSCLC undergoing molecular diagnostic testing was associated with a modest budget impact, most of which was attributable to increased use of more effective treatments and prolonged survival.     

The perceived effects of holiday‐taking upon the health and wellbeing of patients treated for cancer

The role that holidays play within health and wellbeing has been addressed infrequently within academic research. Much of the work that does exist has tended to focus upon illnesses or health complaints arising as a consequence of travel. Any beneficial health effects of travel largely have been neglected. This paper reports the empirical findings of a qualitative study conducted to determine the perceived effects of holiday‐taking upon the health and wellbeing of a group of cancer patients, a population ignored by the tourism community. Four perceived effects are identified relating to personal health, social effectiveness, personal identity and regaining independence, and the implications of these findings discussed. Copyright © 2003 John Wiley & Sons, Ltd.     

胃癌根治切除术治疗老年胃癌患者的疗效分析

目的探讨胃癌根治切除术治疗老年胃癌患者的疗效。方法对157例老年胃癌患者采用胃癌根治切除术治疗和围术期处理措施的效果进行回顾分析。结果 157例患者术后发生并发症39例,1年内病死56例。结论手术技术的进步和有力的围术期支持治疗,可以保证老年患者胃癌根治切除术患者取得较好疗效。     

经尿道等离子体前列腺切除联合去势术治疗晚期前列腺癌并膀胱出口梗阻25例报告

目的 探讨经尿道等离子体前列腺切除治疗晚期前列腺癌所致膀胱出口梗阻的效果.方法 选取我院2012年3月至2013年4月收治的25例晚期前列腺癌并膀胱出口梗阻患者,采用电凝功率为80W、电切功率为160W的等离子体双极电切系统,膀胱冲洗液采用生理盐水,灌注时间控制在1～2h.结果 本组患者平均切除（42.6±12.8）g前列腺组织,平均手术时间为65min.膀胱冲洗24～48h,术后置管3～7d,平均（4.5±1.8）d.术后继发1例暂时性尿失禁,3例尿道外口狭窄,1例尿路感染伴血尿.25例患者在拔管之后可自行排尿.结论 TUPKVP具有并发症少、不易引起TUR综合症、止血效果好、安全性高等优点,可以对尿路梗阻进行有效地缓解,是一种姑息性治前列腺癌的措施,能够大幅度提高生活质量和延长患者生命,值得在临床上大量应用.     

Modeling cause-of-death mortality using hierarchical Archimedean copula

Studying changes in cause-specific (or competing risks) mortality rates may provide significant insights for the insurance business as well as the pension systems, as they provide more information than the aggregate mortality data. However, the forecasting of cause-specific mortality rates requires new tools to capture the dependence among the competing causes. This paper introduces a class of hierarchical Archimedean copula (HAC) models for cause-specific mortality data. The approach extends the standard Archimedean copula models by allowing for asymmetric dependence among competing risks, while preserving closed-form expressions for mortality forecasts. Moreover, the HAC model allows for a convenient analysis of the impact of hypothetical reduction, or elimination, of mortality of one or more causes on the life expectancy. Using US cohort mortality data, we analyze the historical mortality patterns of different causes of death, provide an explanation for the ‘failure’ of the War on Cancer, and evaluate the impact on life expectancy of hypothetical scenarios where cancer mortality is reduced or eliminated. We find that accounting for longevity improvement across cohorts can alter the results found in existing studies that are focused on one single cohort.     

Real-world incidence and burden of adverse events among non-metastatic prostate cancer patients treated with secondary hormonal therapies following androgen deprivation therapy

Abstract

Aims: To describe the incidence and identify prognostic factors of central nervous system (CNS) adverse events (AEs) and any AEs (CNS, skin rash, or fracture) and evaluate the healthcare resource utilization (HCRU), direct medical costs, and therapy discontinuation associated with these AEs among non-metastatic prostate cancer (nmPC) patients who received secondary hormone therapies.

Methods and results: nmPC patients who had initiated secondary hormonal therapy with enzalutamide, bicalutamide, or abiraterone ≥1?year after androgen deprivation therapy (ADT) were identified in the MarketScan database. Survival analyses were used to describe the incidence of CNS or any AEs. Annual HCRU and costs were compared across patient groups (CNS AE vs no CNS AE; any AE vs no AE) using propensity score weighted generalized linear models. Multivariate Cox proportional hazards models were used to identify AE predictors and compare risks of discontinuation.

Results: The analysis included 532 patients who initiated secondary hormonal therapies, among whom 201 (38%) and 244 (46%) experienced a CNS AE and any AE, respectively. Median times to CNS AE and any AE from therapy initiation were 17.90 and 11.00?months, respectively. Predictors of any AE were any AE in the baseline period (≤6?months before starting therapy), Charlson Comorbidity Index (CCI) score (1 vs 0), surgical castration, and older age. Predictors of CNS AEs were CNS AE in the baseline period and CCI score (1 vs 0). CNS and any AEs were associated with significantly higher HCRU. CNS AEs were associated with significantly higher incremental total medical costs ($18,522). CNS AEs and any AEs significantly increased therapy discontinuation risk by 48% and 38%, respectively.

Conclusions: AEs increase the economic burden and therapy discontinuation among nmPC patients receiving secondary hormonal therapies subsequent to ADTs. These patients should be carefully evaluated for AEs to reduce therapy discontinuation, HCRU, and direct medical costs.     

替吉奥联合奥沙利铂在晚期结肠癌化疗中的临床效果及不良反应

目的 探讨晚期结肠癌患者应用替吉奥联合奥沙利铂化疗治疗的临床效果及不良反应发生情况.方法 选取2018年1—12月沈阳市肛肠医院收治的70例晚期结肠癌患者作为研究对象,采用随机双盲法分为观察组与对照组,各35例.观察组采用替吉奥联合奥沙利铂行化疗治疗,对照组采用奥沙利铂行化疗治疗,比较两组患者化疗期间不良反应发生率、治...