Prognostic utility of differential contrast-enhancement patterns on late gadolinium enhancement cardiac MRI (LGE-CMR) in patients with cancer-associated cardiac masses

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Chan ◽  
W Dinsfriend ◽  
J Kim ◽  
R Steingart ◽  
J.W Weinsaft
Keyword(s):  
Contrast Enhancement ◽  
Cancer Patients ◽  
Cancer Type ◽  
Tissue Properties ◽  
All Cause Mortality ◽  
Prognostic Utility ◽  
Cardiac Masses ◽  
Embolic Risk ◽  
Lge Cmr

Abstract Background LGE-CMR tissue characterization is widely used to identify cardiac masses (CMASS) in cancer patients – including neoplasm (NEO) and thrombus (THR). Prognostic utility of their differential LGE patterns is unknown. Purpose To determine incremental prognostic utility of LGE patterns in CMASS Methods The population comprised of cancer patients with CMASS on LGE-CMR, for which etiology was classified based on presence (NEO) or absence (THR) of enhancement, and controls matched for cancer type/stage. LGE-CMR tissue properties of NEO was classified based on extent of contrast enhancement – diffusely enhancing (DE), mixed (ME), and predominantly avascular (PA). Clinical follow up was performed for embolic events within 6 months of CMR and all-cause mortality. Results 330 cancer patients (55% M; 55±16yo) with an array of cancer diagnoses (19% sarcoma, 17% GI, 13% GU) were studied. Among CMASS+ pts (n=190), 66% had NEO and 34% had THR on LGE. All THR were non-enhancing. Among NEO, LGE pattern was variable (46% DE, 41% ME, 13% PA); ME lesions were larger than other groups (Fig. 1A). Quantitative tissue properties were consistent with qualitative groups, as evidenced by stepwise variation in signal intensity and CNR. Cumulative embolic events were 3-fold higher in CMASS+ than controls (All: 20% vs. 7%, p=0.001; PE: 13% vs. 5%, p=0.02; CVA/systemic embolism: 10% vs. 3%, p=0.01). Median time to event was 1.3 months [IQR 0.1–2.3] from CMR. Aggregate events were similar between NEO and THR, reflecting similar rates of PE and CVA (p=NS). Among CMASS pts with embolic events, 56% were on anticoagulation at time of event (59% NEO, 50% THR, p=0.61). Regarding CMASS morphology, emboli were 3-fold higher among intracavitary (IC) or highly mobile (HM) CMASS (IC: 25% vs 7%, p<0.001; HM: 38% vs 12%, p=0.001). Regarding location, right sided CMASS were associated with a 3–5 fold increase in PE (IC: 19% vs 6%; HM: 35% vs 7%, both p<0.001) and similar CVA events among left sided CMASS (IC: 17% vs. 6%, p=0.02; HM: 33% vs 6%, p=0.05). Embolic events were similar when partitioned based on quantitative LGE patterns between patients with and without embolic events. As for all-cause mortality, NEO on CMR conferred increased mortality than THR (HR 3.06 [CI=1.84–5.1], p<0.001) and matched controls (HR 2.08 [CI=1.42–3.04], p<0.001) during a median follow-up of 9.4 months [IQR 3.6–23.2]. Among NEO subgroups (Fig. 1B), survival was lower in patients with heterogeneous LGE patterns vs matched controls: the lowest survival in ME (p=0.002) suggests increased vascularity and tumor hypoxia/necrosis associated with aggressive tumors and hence larger lesions. Conclusions Among cancer patients, CMR-evidenced CMASS confers high short-term embolic risk, which are equivalently common between NEO and THR. Intra-cavitary location and increased mobility augment embolic risk irrespective of CMASS tissue properties whereas differential LGE patterns on CMR strongly impact prognosis. Funding Acknowledgement Type of funding source: None

scholarly journals Cardiovascular risk factors during cancer treatment: prevalence, incidence and prognostic relevance

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Caro Codon ◽  
T Lopez-Fernandez ◽  
C Alvarez-Ortega ◽  
P Zamora Aunon ◽  
I Rodriguez Rodriguez ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
Cancer Therapy ◽  
Cancer Patients ◽  
Individual Risk ◽  
Funding Source ◽  
Number Of Patients ◽  
All Cause Mortality

Abstract Background The actual usefulness of CV risk factor assessment in the prognostic evaluation of cancer patients treated with cardiotoxic treatment remains largely unknown. Design Prospective multicenter study in patients scheduled to receive anticancer therapy related with moderate/high cardiotoxic risk. Methods A total of 1324 patients underwent follow-up in a dedicated cardio-oncology clinic from April 2012 to October 2017. Special care was given to the identification and control of CV risk factors. Clinical data, blood samples and echocardiographic parameters were prospectively collected according to protocol, at baseline before cancer therapy and then at 3 weeks, 3 months, 6 months, 1 year, 1.5 years and 2 years after initiation of cancer therapy. Results At baseline, 893 patients (67.4%) presented at least 1 risk factor, with a significant number of patients newly diagnosed during follow-up. Individual risk factors were not related with worse prognosis during a 2-year follow-up. However, a higher Systemic Coronary Risk Estimation (SCORE) was significantly associated with higher rates of severe cardiotoxicity and all-cause mortality [HR 1.79 (95% CI 1.16–2.76) for SCORE 5–9 and HR 4.90 (95% CI 2.44–9.82) for SCORE ≥10 when compared with patients with lower SCORE (0–4)]. Conclusions This large cohort of patients treated with a potentially cardiotoxic regimen showed a significant prevalence of CV risk factors at baseline and significant incidence during follow-up. Baseline cardiovascular risk assessment using SCORE predicted severe cardiotoxicity and all-cause mortality. Therefore, its use should be recommended in the evaluation of cancer patients. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): This study was partially funded by the Fondo Investigaciones Sanitarias (Spain), Centro de Investigaciόn Biomédica en Red Cardiovascular CIBER-CV (Spain)

scholarly journals Sexual Health as Part of Gynecologic Cancer Care: What Do Patients Want?

2018 ◽  
Vol 28 (9) ◽  
pp. 1737-1742 ◽  
Author(s):  
Casey M. Hay ◽  
Heidi S. Donovan ◽  
Erin G. Hartnett ◽  
Jeanne Carter ◽  
Mary C. Roberge ◽  
...  
Keyword(s):  
Health Care ◽  
Sexual Health ◽  
Sexual Activity ◽  
Cancer Patients ◽  
Cancer Care ◽  
Gynecologic Cancer ◽  
Relationship Status ◽  
Cancer Type ◽  
Sexual Health Care

ObjectiveSexual health is important to quality of life; however, the sexual health of gynecologic cancer patients is infrequently and inadequately addressed. We sought to understand patient experiences and preferences for sexual health care to help inform strategies for improvement.Methods/MaterialsAn anonymous, cross-sectional survey of outpatient gynecologic cancer patients at a large academic medical center was performed as part of a larger study examining patient and caregiver needs. The survey explored patient-provider discussions about sexuality across 3 domains (experiences, preferences, barriers) and 4 phases of cancer care (diagnosis, treatment, treatment completion, follow-up). Age, relationship status, sexual activity, and cancer type were recorded.ResultsMean age was 63 years. Most patients had ovarian cancer (38%) or endometrial cancer (32%). Thirty-seven percent received treatment within the last month, 55% were in a relationship, and 35% were sexuality active. Thirty-four percent reported sexuality as somewhat or very important, whereas 27% felt that it was somewhat or very important to discuss. Importance of sexuality was associated with age, relationship status, and sexual activity but not cancer type. Fifty-seven percent reported never discussing sexuality. Age was associated with sexuality discussions, whereas relationship status, sexual activity, and cancer type were not. The most common barrier to discussion was patient discomfort. Follow-up was identified as the best time for discussion. Sexuality was most often discussed with a physician or advanced practice provider and usually brought up by the provider.ConclusionsDemographic predictors of importance of sexuality to the patient are age, relationship status, and sexual activity. Providers primarily use age as a proxy for importance of sexuality; however, relationship status and sexual activity may represent additional ways to screen for patients interested in discussing sexual health. Patient discomfort with discussing sexuality is the primary barrier to sexual health discussions, and awareness of this is key to developing effective approaches to providing sexual health care.

scholarly journals SELF-REPORTED WALKING PACE AND ALL-CAUSE MORTALITY AMONG CANCER SURVIVORS IN THE NIH-AARP DIET AND HEALTH STUDY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S387-S388
Author(s):  
Elizabeth Salerno ◽  
Pedro Saint Maurice ◽  
Erik Willis ◽  
Loretta DiPietro ◽  
Charles Matthews
Keyword(s):  
Physical Activity ◽  
Cancer Survivors ◽  
Lower Risk ◽  
Health Study ◽  
Cancer Type ◽  
Study Enrollment ◽  
All Cause Mortality ◽  
After Cancer ◽  
Study Participants

Abstract We examined the association between self-reported walking pace and all-cause mortality among cancer survivors in the NIH-AARP Diet and Health Study. Participants included 30,110 adults (Mage=62.4+/-5.14 years) diagnosed with cancer between study enrollment and follow-up, when they self-reported walking pace. Individuals were followed until death or administrative censoring in 2011. We estimated the hazards ratios (HR) and 95% confidence intervals (CI) for walking pace and all-cause mortality adjusting for age, sex, race, BMI, health status, physical activity and cancer type. Cancer survivors reporting faster walking paces had significantly reduced mortality risk. Relative to those reporting an ‘easy’ walking pace, walking at a ‘normal,’ ‘brisk,’ or ‘very brisk’ pace was associated with significantly lower risk: [HR=0.74 (0.70,0.78)], [HR=0.66 (0.61,0.71)], and [HR=0.73 (0.60,0.89)], respectively. Being ‘unable to walk’ was associated with 30% increased mortality [HR=1.30 (1.15,1.46)]. These findings provide novel support for the association between self-reported walking pace and survival after cancer.

The epidemiology of herpes zoster in patients with invasive cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 9562-9562 ◽  
Author(s):  
L. A. Habel ◽  
G. T. Ray ◽  
M. Horberg ◽  
B. Yawn ◽  
A. Castillo ◽  
...  
Keyword(s):  
Herpes Zoster ◽  
General Population ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Hematologic Malignancy ◽  
Incidence Rates ◽  
Cancer Type ◽  
Adult Health ◽  
Kaiser Permanente

9562 Background: Given the limited available data, the aim of this study was to estimate the incidence of Herpes Zoster (HZ) in cancer patients. Methods: In this retrospective cohort study, we used the Kaiser Permanente Northern California cancer registry to identify adult health plan members diagnosed with an invasive hematologic malignancy (HM) or solid tumor malignancy (STM) during 2001–2005. Potential episodes of HZ were ascertained from time of cancer diagnosis through 2006 from electronic databases using inpatient and outpatient diagnoses, laboratory tests, and prescriptions for antivirals. HZ diagnoses were confirmed by abstraction and clinical review of information from patients' inpatient and outpatient medical records. Incidence rates were calculated as the number of new occurrences of HZ per person-time of follow-up. Age-standardized incidence ratios (SIRs) were computed to compare HZ rates in cancer patients to reported rates in the general population (Yawn et al, 2007). Results: Among the 4,728 STM patients (mean age 66 years, range 18–102), the rate of HZ was 12/1000 person years (py) of follow-up (total 9170 py). Among the 1504 HM patients (mean age 67 years, range 18–97), the rate of HZ was 33/1000 py (total 2355 py). The SIRs and 95% confidence intervals for STM and HM were 1.7 (1.4–2.1) and 4.5 (3.5–5.6), respectively. Among patients with HM, incidence rates were highest in the first year after cancer diagnosis (40/1000 py); rates did not appear to vary markedly over time among patients with STM. For either cancer type, HZ rates were similar for males and females and did not increase consistently with increasing age. Conclusions: Compared to the general population, the incidence of HZ was nearly 2 times higher in patients with STM and over 4 times higher in patients with HM. HZ rates did not differ markedly by age or gender. [Table: see text]

Anticoagulants for the treatment of venous thromboembolism in patients with cancer: An updated pairwise and network meta-analysis of randomized trials.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e14692-e14692
Author(s):  
Shima Sidahmed ◽  
Ahmed Abdalla ◽  
Babikir Kheiri ◽  
Areeg Bala ◽  
Mohammed Salih ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Vitamin K ◽  
Major Bleeding ◽  
Metastatic Cancer ◽  
Meta Analysis ◽  
Number Needed To Treat ◽  
Cancer Type ◽  
Significant Difference ◽  
All Cause Mortality

e14692 Background: Cancer-associated venous thromboembolism (VTE) is common. Although low molecular weight heparin (LMWH) is the standard therapy in this setting, little is known with regard to non-vitamin K antagonist oral anticoagulants (NOACs). Therefore, we thought about evaluating the safety and efficacy of various anticoagulants in this vulnerable population. Methods: Electronic database search was conducted to identify randomized clinical trials (RCTs) that compared LMWH, NOACs, and/or vitamin-K-antagonists (VKA) in cancer patients. We performed frequentist direct and Bayesian network meta-analysis using random-effects model to calculate odds ratios (ORs), 95% confidence intervals (CIs), and 95% credible intervals (CrIs). The primary outcome was VTE (pulmonary embolism and deep-vein thrombosis) recurrence. Secondary outcomes were major bleeding and all-cause mortality. Results: We identified 13 RCTs with 6,595 total patients (mean age 62.4 ± 12.2; 50.4% female; 17.7% hematological malignancies; and 6 months median follow-up). The most common cancer type was colorectal and 48% of the population had metastatic cancer at baseline. NOACs were associated with significantly reduced VTE recurrence compared with VKA (OR = 0.58; 95% CI = 0.40-0.83; P < 0.01; number needed to treat [NNT] = 40) and LMWH (OR = 0.46; 95% CI = 0.25-0.85; P = 0.01; NNT = 20). LMHW was associated with significantly reduced VTE recurrence compared with VKA (OR = 0.52; 95% CI = 0.39-0.71; P < 0.01; NNT = 18). NOACs were associated with significantly reduced major bleeding compared with VKA (OR = 0.56; 95% CI = 0.35-0.91; P = 0.02; NNT = 64). There was no significant difference identified between the anticoagulant groups in regard to all-cause mortality. Conclusions: Among cancer patients with VTE, NOACs were associated with significantly reduced VTE recurrence compared to LMWH and VKA, and significantly reduced major bleeding compared with VKA. LMWH was associated with significantly reduced VTE recurrence compared with VKA.

scholarly journals NQPC-10 (Rare) Cancer patients’ unmet needs (patient-focused healthcare needs) survey

2021 ◽  
Vol 3 (Supplement_6) ◽  
pp. vi22-vi22
Author(s):  
Laureline Gatellier ◽  
Yuko Moue ◽  
Tomohiro Matsuda
Keyword(s):  
Brain Tumor ◽  
Cancer Patient ◽  
Cancer Patients ◽  
Unmet Needs ◽  
Genomic Medicine ◽  
Cancer Type ◽  
Rare Cancer ◽  
Rare Cancers ◽  
Patient Groups

Abstract Background: Rare Cancers Japan (RCJ) consists of members of 20 rare cancer patient groups and individual rare cancer patients, including the Japan Brain Tumor Alliance (JBTA), the Pediatric Brain Tumor Network, and the DIPG Symposium Organizing Committee, and aims to solve the challenges of rare cancers. RCJ, together with the National Cancer Center Japan and the Japan Federation of Cancer Patient Groups is currently conducting a survey to clarify unmet needs of patients, as a follow-up survey to surveys conducted in 2018. Since then, a major paradigm shift happened in Japan, with the advent of genomic medicine and development of new treatments. This study plans to identify the latest unmet needs of cancer patients and to clarify the differences between cancer types to provide data for the improvement of healthcare systems.Purpose: Focusing on unmet needs of cancer patients, we conduct an online questionnaire survey of a total of 1,600 cancer patients (including brain tumor patients) regarding the following endpoints (1) detection and diagnosis, (2) treatment, (3) genomic medicine (access to genetic mutation testing), (4) clinical trials, (5) necessary information, medical care and support systems and (6) quality of life. The collected information will be analyzed to clarify the needs of patients and the nature of patient-centered healthcare. Method: The survey will be administered online, including a mix of open-ended and multiple-choice questions. The total number of questions, including respondent demographics, is 38, and the time required to answer them is expected to be between 15 and 20 minutes. Data analysis will take into account cancer type of cancer, gender, age group and region of residence of the respondent.Expected results: By February 2022, the results of the survey are expected to be available, as basis of discussion to improve brain tumor treatment and follow up, from a multidisciplinary perspective.

Predicting Difference in Mean Survival Time from Reported Hazard Ratios for Cancer Patients

2019 ◽  
Vol 39 (3) ◽  
pp. 228-238 ◽  
Author(s):  
Eeva-Liisa Røssell Johansen ◽  
Mette Lise Lousdal ◽  
Mette Vinther Skriver ◽  
Michael Væth ◽  
Ivar Sønbø Kristiansen ◽  
...  
Keyword(s):  
Survival Time ◽  
Cancer Patients ◽  
Empirical Relationship ◽  
Hazard Ratio ◽  
Cancer Type ◽  
Survival Times ◽  
Mean Survival Time ◽  
Hazard Ratios ◽  
Weibull Models

Background. Gain in mean survival time from new cancer treatments is a core component of cost-effectiveness analyses frequently used by payers for reimbursement decisions. Due to limited follow-up time, clinical trials rarely report this measure, whereas they often report hazard ratios comparing treatment groups. Aim. We aimed to explore the empirical relationship between gain in mean survival time and the hazard ratio for cancer patients. Methods. We included all patients in Norway diagnosed from 1965 through 2004 with late-stage cancer at the point of diagnosis and with one of the following cancers: stomach, colon, rectal, pancreas, lung and trachea, kidney excluding renal pelvis, and metastasized breast and prostate. Patients were followed until emigration, death, or June 30, 2016, whichever came first. Observed mean survival times and hazard ratios were obtained in subcohorts defined by patients’ sex, age, cancer type, and time period of diagnosis, which had nearly complete follow-up. Based on theoretical considerations, we fitted a linear relationship between observed differences in mean survival and logarithmic hazard ratios. For validation, we estimated differences in mean survival from hazard ratios of bootstrap samples with artificially induced censoring and compared with fitting a Weibull distribution. Results. The relationship between differences in mean survival time and corresponding logarithmic hazard ratios was linear for each of the included cancers. The predicted differences in mean survival of the empirical approach generally had smaller bias than the Weibull approach. Conclusion. For cancer diagnoses with poor prognosis, differences in mean survival times could be predicted from corresponding hazard ratios. This hazard ratio–based approach outperforms or is similar to fitting Weibull models to data with incomplete follow-up, while making fewer assumptions.

An assessment of clinical and economic outcomes of U.S. veteran lung cancer patients.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e19122-e19122 ◽  
Author(s):  
Elyse Fritschel ◽  
Li Wang ◽  
Lu Li ◽  
J Zhang ◽  
Onur Baser
Keyword(s):  
Lung Cancer ◽  
Health Care ◽  
Cancer Patients ◽  
Health Care Costs ◽  
The United States ◽  
Economic Outcomes ◽  
Cancer Type ◽  
Lung Cancer Patients ◽  
Care Costs

e19122 Background: More people die from lung cancer in the United States than any other cancer type, and despite improvements in survival for other cancer types, 5-year lung cancer survival has remained low (Centers for Disease Control and Prevention. Lung Cancer. Available at www.cdc.gov/cancer/lung. Accessed February 04 , 2013; Youlden DR, Cramb SM, Baade PD. The international epidemiology of lung cancer: geographical distribution and secular trends. J Thorac Oncol. 2008; 8(3): 819-31.). This study aimed to describe the outcomes of lung cancer patients in the U.S. Department of Veterans Affairs (VA) population. Methods: A retrospective study of patients diagnosed with lung cancer during the study period of October 1, 2005 to September 30, 2010 was conducted using the Veterans Health Administration datasets. Lung cancer patients were identified using International Classification of Disease 9th Revision Clinical Modification (ICD-9-CM) diagnosis code 162.xx. Descriptive statistics were calculated as means ± standard deviation (SD) and percentages. Comorbidities were measured for the 1-year baseline period before the disease identification date. Health care costs and utilization were measured for the 1-year follow-up period after the identification date. Results: In patients identified with lung cancer (n=73,150), common comorbidities included hypertension (n=21,377, 29.22%), chronic airway obstruction (n=14,305, 19.56%), abnormal findings on radiological and other lung field examination (n=12,437, 17.00%), and diabetes (n=11,569, 15.82%). Nearly half of all lung cancer patients had follow-up inpatient visits (46.47%), which translated to an average inpatient cost of $21,420 annually per patient. Nearly every patient studied had at least one follow-up outpatient visit (99.11%), and the average cost per patient totaled $12,986 annually ($12,110 for outpatient office and $411 for outpatient ER service costs). Conclusions: Inpatient and outpatient visits result in considerable health care costs for veteran lung cancer patients. Comorbid conditions are also relatively frequent in this population. Further research could elucidate economic outcomes for lung cancer patients by comorbidity severity.

Anti-Müllerian hormone (AMH) as a marker of ovarian reserve and premature ovarian insufficiency (POI) in children and women with cancer: A systematic review.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24057-e24057
Author(s):  
David A. Cameron ◽  
Richard Anderson ◽  
Florian Clatot ◽  
Isabelle Demeestere ◽  
Matteo Lambertini ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Ovarian Reserve ◽  
Post Treatment ◽  
Cancer Type ◽  
Partial Recovery ◽  
Pediatric Cancer Patients ◽  
Before And After ◽  
Anticancer Treatment ◽  
Pre Treatment

e24057 Background: Female patients undergoing anticancer treatment are at elevated risk of ovarian damage including development of POI. AMH is a key serum biomarker of ovarian reserve. However, its role to identify risk of POI in cancer patients prior to and after treatment is less well understood. Methods: A systematic literature search for AMH in women with cancer was conducted up to 30 August 2020, with formal bias assessment. We aimed at evaluating AMH as a biomarker of ovarian reserve and POI before and after anticancer treatment. Exploratory subgroups were based on age, cancer type and length of follow-up. Results: : Eighty publications (including 7,708 patients) were included in this analysis. All papers reporting AMH before and after treatment reported a large reduction in AMH following treatment, in both adult and paediatric populations. Effect sizes varied depending on the treatment and diagnosis, but ranged from 42% to below the limit of detection, and many reported declines of ≥90%. A majority (25/34, 74%) of studies also reported at least partial recovery of AMH at follow-up. Pre-treatment AMH correlated with post-treatment levels in all studies and younger patient age with higher post-treatment AMH in 21/29 (72%) studies. In 18/32 (58%) publications, oligo/amenorrhea correlated with lower post-treatment AMH. No studies reported correlations between post-treatment AMH and pregnancy, although pregnancy was reported in some patients with low or undetectable AMH. 70% of publications found that within-study variations in treatment (estimated by chemotherapy or radiotherapy type, dosage, duration and/or number of cycles) correlated with AMH reductions and degree of recovery, indicating its potential value as a marker of gonadotoxicity. In women with breast cancer, recovery of AMH was reported in some patients in 10/18 publications; however, AMH levels showed no recovery in many patients receiving alkylating agents or cyclophosphamide-based chemotherapies. In lymphoma, patients receiving ABVD-based regimens had at least partial post-treatment recovery of AMH at follow-up compared with those receiving cyclophosphamide-containing regimens. 16/20 (80%) publications in pediatric cancer patients showed significant reductions in AMH compared with pre-treatment levels or controls. The diagnostic value of post-treatment AMH for POI was supported in 5/5 (100%) studies. AMH levels measured 1–2 years after treatment appeared to be equally reliable at indicating longer-term menstrual outcomes as studies with longer followup. Conclusions: AMH levels were strongly impacted by anticancer treatment, with recovery in some women determined by treatment regimen, age, and pretreatment AMH level. There was evidence for its role in diagnosis of POI, nut further studies are required to clarify its value to assist in patient management.

scholarly journals The cost-effectiveness of follow-up strategies after cancer treatment: a systematic literature review

2018 ◽  
Vol 126 (1) ◽  
pp. 85-100 ◽  
Author(s):  
M Barbieri ◽  
G Richardson ◽  
S Paisley
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Literature Review ◽  
Cancer Patients ◽  
Systematic Literature Review ◽  
Colorectal Disease ◽  
Economic Evaluations ◽  
Cancer Type ◽  
The Cost

Abstract Introduction The cost of treatment and follow-up of cancer patients in the UK is substantial. In a budget-constrained system such as the NHS, it is necessary to consider the cost-effectiveness of the range of management strategies at different points on cancer patients’ care pathways to ensure that they provide adequate value for money. Sources of data We conducted a systematic literature review to explore the cost-effectiveness of follow-up strategies of patients previously treated for cancer with the aim of informing UK policy. All papers that were considered to be economic evaluations in the subject areas described above were extracted. Areas of agreement The existing literature suggests that intensive follow-up of patients with colorectal disease is likely to be cost-effective, but the opposite holds for breast cancer. Areas of controversy Interventions and strategies for follow-up in cancer patients were variable across type of cancer and setting. Drawing general conclusions about the cost-effectiveness of these interventions/strategies is difficult. Growing points The search identified 2036 references but applying inclusion/exclusion criteria a total of 44 articles were included in the analysis. Breast cancer was the most common (n = 11) cancer type followed by colorectal (n = 10) cancer. In general, there were relatively few studies of cost-effectiveness of follow-up that could influence UK guidance. Where there was evidence, in the most part, NICE guidance broadly reflected this evidence. Areas timely to develop research In terms of future research around the timing, frequency and composition of follow-ups, this is dependent on the type of cancer being considered. Nevertheless, across most cancers, the possibility of remote follow-up (or testing) by health professionals other than hospital consultants in other settings appears to warrant further work.

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