‘I Was Trapped at Home’: Men's Experiences with Leisure While Giving Care to Partners During a Breast Cancer Experience

Men whose partners are diagnosed with breast cancer experience many changes to daily living, including taking on additional family and household roles and responsibilities, caring for their partner, and often relinquishing leisure activities. Although leisure participation has been found to help individuals cope and to mitigate the negative effect of traumatic life events, men's experience with leisure during their partners’ breast cancer experience has received little attention. The purpose of this study was to explore men's experiences with leisure and the meaning of those experiences during and following their partners’ breast cancer diagnosis and treatment. Semi-structured, face-to-face interviews were conducted with 10 men. The findings illuminate that men's leisure became more home-based, was used to release and regulate emotions, and provided a means to maintain identity. The illness experience also increased men's appreciation of leisure with their partners.     

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.     

miR-652对非小细胞肺癌H460细胞凋亡和迁移的影响

目的 观察miR-652对非小细胞肺癌H460细胞凋亡和迁移的影响.方法 应用细胞计数实验检测miR-652的浓度对肺癌H460细胞的影响;应用细胞划痕实验检测miR-652对肺癌H460细胞迁移的影响;应用蛋白质免疫印迹技术检测肺癌H460细胞凋亡蛋白表达情况.结果 在H460细胞中,miR-652表达显著减少;转染...     

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...     

Using the 21-gene assay to guide adjuvant chemotherapy decision-making in early-stage breast cancer: a cost-effectiveness evaluation in the German setting

Abstract

Objective:

The 21-gene assay (Oncotype DX Breast Cancer Test (Genomic Health Inc., Redwood City, CA)) is a well validated test that predicts the likelihood of adjuvant chemotherapy benefit and the 10-year risk of distant recurrence in patients with ER+, HER2? early-stage breast cancer. The aim of this analysis was to evaluate the cost-effectiveness of using the assay to inform adjuvant chemotherapy decisions in Germany.     

酪氨酸激酶抑制剂治疗非小细胞肺癌的临床应用

吉非替尼为一种选择性的EGFR一蛋白酪氨酸激酶抑制剂,能阻断酪氨酸蛋白激酶信号传导通路,从而促进肿瘤细胞凋亡。它是作为第一个用于肺癌治疗的分子靶向药物,在治疗非小细胞肺癌中拥有其自身的优越性在临床中取得了一定成效,但仍存在很多问题。本文针对吉非替尼靶向治疗非肺癌小细胞肺癌中的优点和所面临的问题进行阐述。     

胃癌的化疗和综合治疗进展

回顾了近年来国内外众多关于治疗胃癌的文献，系统阐述了癌症的治疗反应和评估方法的研究进展，尤其是药物剂量、疗效、适应证、生存率等。化疗或综合治疗可用于晚期病人以及术前和／或术后病人。术前化疗可以提高根治性切除率。用于术后病人可能减少复发、转移。术后于腹腔内注入化疗药，可能预防腹膜播散。总之，化疗及综合治疗可能降低胃癌的复发，并对延长生存期有益。     

Healthcare costs among men with favorable risk prostate cancer managed with observation strategies versus immediate treatment in an integrated healthcare system

Objective: This study explored short-term healthcare costs of men managed with observation strategies (OBS) vs immediate treatment (IMT) for favorable risk prostate cancer (PCa) from the Geisinger Health System, a single integrated health system in Pennsylvania, as evidence from the community setting is limited.

Methods: A retrospective cohort study was conducted using electronic health records from men aged ≥40 years diagnosed with favorable risk PCa (T1 or 2, PSA ≤15?ng/mL, Gleason ≤7 [3?+?4]) between January 2005 and October 2013. Prostate-specific healthcare costs were compared between the OBS and IMT cohorts in men with ≥3 years of follow-up and available linked claims data. Sub-group analyses focused on those men with low-risk PCa (T1-2a, PSA ≤10?ng/mL, Gleason ≤6). Sensitivity analysis stratified the study sample in three cohorts: OBS, switched from OBS to definitive treatment (OBS switch), and IMT.

Results: A total of 352 patients were included (OBS?=?70 and IMT?=?282). Compared with IMT, OBS resulted in significantly lower cumulative PCa-related healthcare costs for the first 3 years ($15,785 vs $23,177; p-value <.001). The main cost drivers were outpatient procedures. The OBS cohort had the lowest incremental PCa-related healthcare costs in the first 3 years (OBS: $5,011 vs OBS switch: $26,040, net cost savings?=?$21,029, p?p?Conclusions: In favorable risk PCa, half of the patients who initially chose OBS eventually underwent treatment after their PCa diagnosis. As expected, OBS was associated with reduced disease management costs compared with IMT.     

Cost-effectiveness of pembrolizumab in combination with chemotherapy in the 1st line treatment of non-squamous NSCLC in the US

Abstract

Aims: To describe cost-effectiveness of pembrolizumab plus platinum and pemetrexed chemotherapy in metastatic, non-squamous, NSCLC patients in the US.

Materials and methods: A model is developed utilizing partitioned survival analysis to estimate the cost-effectiveness of KEYNOTE-189 trial comparators pembrolizumab?+?chemotherapy (carboplatin/cisplatin?+?pemetrexed) vs chemotherapy alone. Clinical efficacy, treatment utilization, health utility, and safety data are derived from the trial and projected over 20 years. For extrapolating survival beyond the trial, a novel SEER population-data approach is applied (primary analysis), with separate estimation via traditional parametric extrapolation methods. Costs for drugs and non-drug disease management are also incorporated. Based on an indirect treatment comparison, cost-effectiveness of pembrolizumab?+?chemotherapy vs pembrolizumab monotherapy is evaluated for patients with programmed death-ligand 1 (PD-L1)?≥?50%.

Results: In the full non-squamous population, pembrolizumab?+?chemotherapy is projected to increase life expectancy by 2.04 years vs chemotherapy (3.96 vs 1.92), for an approximate doubling of life years. Resultant incremental cost-effectiveness ratios (ICERs) are $104,823/QALY and $87,242/life year. In patients with PD-L1?≥?50% and 1–49%, life expectancy is more than doubled (4.53 vs 1.88 years) and (4.87 vs 2.01 years), with a 32% (2.60 vs 1.97 years) increase in PD-L1?<?1% patients. Corresponding incremental costs/quality-adjusted life year (QALY) are $103,402, $66,837, and $183,529 for PD-L1?≥?50%, 1–49%, and <1% groups, respectively. Versus pembrolizumab monotherapy in PD-L1?≥?50% patients, representing current standard of care, pembrolizumab?+?chemotherapy increases life expectancy by 65% (4.53 vs 2.74 years) at an ICER of $147,365/QALY.

Limitations and conclusions: The addition of pembrolizumab to chemotherapy is projected to extend life expectancy to a point not previously seen in previously untreated metastatic non-squamous NSCLC. Although ICERs vary by sub-group and comparator, results suggest pembrolizumab?+?chemotherapy yields ICERs near, or in most cases, well below a 3-times US per capita GDP threshold of $180,000/QALY, and may be a cost-effective first-line treatment for metastatic non-squamous NSCLC patients.