A Decade of Research on the Quality of Systemic Cancer Therapy in Routine Care: What Aspects of Quality Are We Measuring?

2015 ◽  
Vol 11 (1) ◽  
pp. 55-61 ◽  
Author(s):  
Shixin Shen ◽  
Monika K. Krzyzanowska
Keyword(s):  
Cancer Therapy ◽  
Early Stage ◽  
Routine Care ◽  
Cytotoxic Chemotherapy ◽  
Clinical Settings ◽  
Early Stage Disease ◽  
Stage Disease

Most studies evaluating quality of systemic cancer therapy have focused on access to cytotoxic chemotherapy in early-stage disease. Studies on other aspects of quality and in different clinical settings are needed.

Quality of systemic cancer therapy in routine care: What are we measuring?

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 249-249
Author(s):  
Shixin (Cindy) Shen ◽  
Monika K. Krzyzanowska
Keyword(s):  
Clinical Trials ◽  
Cancer Therapy ◽  
The United States ◽  
Cytotoxic Chemotherapy ◽  
System Level ◽  
Patient Specific ◽  
Routine Practice ◽  
Treatment Delivery ◽  
Early Stage Disease

249 Background: While clinical trials provide efficacy and early safety information regarding systemic cancer therapy (ST), most cancer patients who receive ST are treated outside clinical trials. We performed a systematic review of studies that have evaluated the quality of ST in routine practice to summarize the literature and define knowledge gaps across five quality domains – access, treatment delivery, toxicity, safety and outcome. Methods: We searched MEDLINE using a combination of terms pertaining to ST, such as “chemotherapy” with keywords related to healthcare quality for articles published in English from January 1, 2000 to December 31, 2010. Articles were included if they were based on original studies that examined quality of ST among adult patients from a population perspective (defined as multiple institutions). Study information was abstracted using a standardized form. Summary statistics were used to describe the results. Results: Our search identified 179 articles. The number of studies published each year increased over time from nine studies in 2000 to 30 in 2010. Most studies were conducted in the United States (58%) in either colorectal (31%) or breast cancers (27%) and focused on adjuvant intent cytotoxic chemotherapy (81%). Majority of the studies retrospectively (92%) identified patients from cancer registries (83%) and used either billing data (64%) or information in the registry itself (27%) for treatment identification. 66% of the studies evaluated a single quality domain, whereas the remaining articles assessed two or more domains. No study was found that examined safety from a population perspective. Access was the most frequently evaluated domain (77%) whereas treatment delivery was the least examined (12%). Treatment toxicity and outcome were evaluated in 21% and 31% of studies, respectively. Among studies that assessed outcome of ST, most evaluated patient specific outcomes such as survival (93%) although a few (13%) examined system level outcomes such as cost. Conclusions: Majority of studies evaluating quality of ST have focused on access to cytotoxic chemotherapy in early stage disease. Further studies focusing on other aspects of quality and in different clinical settings are needed.

Quality of Life in Glaucoma Patients

2013 ◽  
Vol 06 (01) ◽  
pp. 6 ◽  
Author(s):  
Simon Skalicky ◽  
Ivan Goldberg ◽  
◽  
◽  
◽  
...  
Keyword(s):  
Quality Of Life ◽  
Visual Function ◽  
Early Stage ◽  
Life Assessment ◽  
Social Constraints ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Therapeutic Decisions ◽  
Health Related

Glaucoma affects the quality of life (QoL) of millions of people. Patients with glaucoma have a reduced QoL in early stage disease, which worsens as the disease progresses. Reduced visual function is the main determinant of poor QoL in glaucoma, however ocular surface discomfort, psychological factors, and social constraints contribute to the burden of disease. The assessment of QoL in glaucoma is important in clinical practice to assessing a patient’s wellbeing, visual function and level of satisfaction with their care. It can be used to make important therapeutic decisions and allow clinician and patient to share common, realistic goals leading to better treatment outcomes. Quality of life assessment is increasingly important in clinical research. Various tools have been used to assess QoL in glaucoma, including general health-related questionnaires, vision-specific questionnaires, glaucoma-specific questionnaires, utility value assessments and objective visual function assessment. These tools are summarized and critically appraised in this article.

Epithelial ovarian cancer: Therapy of early-stage disease

2001 ◽  
Vol 34 (11) ◽  
pp. 1041-1049 ◽  
Author(s):  
H. G. Meerpohl ◽  
W. Schröder ◽  
S. Olbricht
Keyword(s):  
Ovarian Cancer ◽  
Cancer Therapy ◽  
Epithelial Ovarian Cancer ◽  
Early Stage ◽  
Early Stage Disease ◽  
Stage Disease

scholarly journals Nonsurgical Management of Cervical Cancer: Locally Advanced, Recurrent, and Metastatic Disease, Survivorship, and Beyond

2015 ◽  
pp. e299-e309 ◽  
Author(s):  
Helen J. Mackay ◽  
Lari Wenzel ◽  
Linda Mileshkin
Keyword(s):  
Cervical Cancer ◽  
Early Stage ◽  
Locally Advanced ◽  
Therapeutic Interventions ◽  
Early Stage Disease ◽  
Screening Programs ◽  
Nonsurgical Management ◽  
Stage Disease

Despite the declining incidence of cervical cancer as a result of the introduction of screening programs, globally it remains a leading cause of cancer-related death in women. Outcomes for patients who are diagnosed with anything but early-stage disease remain poor. Here we examine emerging strategies to improve the treatment of locally advanced disease. We discuss emerging biologic data, which are informing our investigation of new therapeutic interventions in persistent, recurrent, and metastatic cervical cancer. We recognize the importance of interventions to improve quality of life and to prevent long-term sequelae in women undergoing treatment. Finally, and perhaps most importantly, we recognize the need for global collaboration and advocacy to improve the outcome for all women at risk of and diagnosed with this disease.

Novel approaches to improve prostate cancer diagnosis and management in early-stage disease

2012 ◽  
Vol 109 ◽  
pp. 1-7 ◽  
Author(s):  
Michael Marberger ◽  
Jelle Barentsz ◽  
Mark Emberton ◽  
Jonas Hugosson ◽  
Stacy Loeb ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Diagnosis ◽  
Early Stage ◽  
Early Stage Disease ◽  
Prostate Cancer Diagnosis ◽  
Diagnosis And Management ◽  
Stage Disease ◽  
Novel Approaches ◽  
Improve Prostate Cancer

scholarly journals Surgery in Small-Cell Lung Cancer

Cancers ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 390
Author(s):  
Nicola Martucci ◽  
Alessandro Morabito ◽  
Antonello La Rocca ◽  
Giuseppe De Luca ◽  
Rossella De Cecio ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Early Stage ◽  
Small Cell ◽  
Stage I ◽  
Phase Iii ◽  
Small Cell Lung ◽  
Early Stage Disease ◽  
Stage Disease

Small-cell lung cancer (SCLC) is one of the most aggressive tumors, with a rapid growth and early metastases. Approximately 5% of SCLC patients present with early-stage disease (T1,2 N0M0): these patients have a better prognosis, with a 5-year survival up to 50%. Two randomized phase III studies conducted in the 1960s and the 1980s reported negative results with surgery in SCLC patients with early-stage disease and, thereafter, surgery has been largely discouraged. Instead, several subsequent prospective studies have demonstrated the feasibility of a multimodality approach including surgery before or after chemotherapy and followed in most studies by thoracic radiotherapy, with a 5-year survival probability of 36–63% for patients with completely resected stage I SCLC. These results were substantially confirmed by retrospective studies and by large, population-based studies, conducted in the last 40 years, showing the benefit of surgery, particularly lobectomy, in selected patients with early-stage SCLC. On these bases, the International Guidelines recommend a surgical approach in selected stage I SCLC patients, after adequate staging: in these cases, lobectomy with mediastinal lymphadenectomy is considered the standard approach. In all cases, surgery can be offered only as part of a multimodal treatment, which includes chemotherapy with or without radiotherapy and after a proper multidisciplinary evaluation.

scholarly journals Female Breast Cancer in Suriname: Pathways to Treatment—A Patient’s Perception

2020 ◽  
Vol 6 (Supplement_1) ◽  
pp. 49-49
Author(s):  
Euridice R. Irving ◽  
Dennis R. A. Mans ◽  
Els Th. M. Dams ◽  
Maureen Y. Lichtveld
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Access To Health Care ◽  
Early Stage ◽  
Diagnosis And Treatment ◽  
Related Factors ◽  
Entire Interval ◽  
Early Stage Disease ◽  
Resource Setting ◽  
Stage Disease

PURPOSE Delays across the entire cancer care continuum are not uncommon. This cross-sectional study explored the health care trajectories of Surinamese women with breast cancer and identified predictors of timely diagnosis and treatment initiation. METHODS One hundred women age 30 years or older who were newly diagnosed with breast cancer in 2017 to 2018 were recruited from all 4 hospitals in Paramaribo. Data on their demographics, lifestyle, reproductive and medical history, health status, and family history of breast cancer and other malignancies were collected using a validated semistructured questionnaire. Using Anderson’s Model of Pathways to Treatment, we defined a patient interval (from detection to first consultation), diagnostic interval (from consultation to histopathologic diagnosis), and treatment interval (from diagnosis to first treatment). Log-transformed data were analyzed using linear regression, and variables with P ≤ .05 were considered statistically significant predictors of intervals. RESULTS All participants had health insurance and access to health care. Eighty-five percent of patients presented with early-stage disease. Ninety percent of patients had self-detected their disease, with 70% finding a lump. Average age was 55.6 years (± 11.8 years). Median durations of patient, diagnostic, and treatment intervals were 13 days (interquartile, range, 4-63 days), 40 days (IQR, 21-57 days), and 18 days (IQR, 8-38 days), respectively. Median duration of the entire interval was 95 days (IQR, 59-272 days). Patient-related factors associated with the intervals were religion (β = −530; P = .003), being employed (β = 149.4; P = .007), and age 50 years and older (β = −195.8; P = .037). Disease-related factors were lump as first symptom (β = −175.6; P = .038) and late-stage disease at diagnosis (β = 213.5; P = .004). CONCLUSION Given the limited-resource setting, delays in Suriname’s health care can be minimized by programs aimed at increasing breast cancer awareness and education; however, delays may have been underestimated as a result of the over-representation of early-stage disease and recall bias regarding the first symptom detected.

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