Nanomedicines for enhanced permeability and retention (EPR)-stratified patients have the potential to improve treatment outcomes

2021 ◽  
Author(s):  
Moataz Dowaidar
Keyword(s):  
Clinical Trials ◽  
Treatment Outcomes ◽  
Cancer Patients ◽  
Survival Rates ◽  
The United States ◽  
Improve Treatment ◽  
Enhanced Permeability And Retention ◽  
Wide Range ◽  
The Cost

Nanomedicines are being tasked with boosting the efficacy of existing immunotherapies. Understanding the pathophysiology of the targeted tumors is critical for devising the optimum strategy. The corticosteroid dexamethasone has recently been discovered to promote tumor perfusion and nanomedicine accumulation. Only a limited percentage of patients, however, respond to immune checkpoint blockage (ICB). In the United States, for example, it is believed that ICB therapy is ineffective for about 87 percent of cancer patients. The care of enhanced permeability and retention (EPR)-stratified patients has the potential to improve treatment outcomes. Treating patients with several metastatic foci with varying amounts of EPR impact could increase nanomedicine impact in cancer patients, but only losartan has yet to reach clinical trials. Other medication repurposing techniques have been proposed for the increased efficacy of small medicines and antibodies, but they are still in clinical trials and need to be tested in human patients. The treatment of these patients could improve the effectiveness of nanomedi-based immunotherapy and reduce the toxicity of chemotherapy and radiation therapy. This could have a positive effect on cancer patients' survival rates and quality of life, as well as on the cost of treatment. The potential of nanomedicines to deliver a wide range of immunomodulating drugs and modulate their action in space

Measuring the Incremental Cost of Clinical Cancer Research

2001 ◽  
Vol 19 (1) ◽  
pp. 105-110 ◽  
Author(s):  
Dana P. Goldman ◽  
Michael L. Schoenbaum ◽  
Arnold L. Potosky ◽  
Jane C. Weeks ◽  
Sandra H. Berry ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Cancer Treatment ◽  
Incremental Cost ◽  
Cancer Patients ◽  
Phase Ii ◽  
The United States ◽  
Phase Iii ◽  
Ongoing Effort ◽  
Cancer Trials ◽  
The Cost

PURPOSE: To summarize evidence on the costs of treating patients in clinical trials and to describe the Cost of Cancer Treatment Study, an ongoing effort to produce generalizable estimates of the incremental costs of government-sponsored cancer trials. METHODS: A retrospective study of costs will be conducted with 1,500 cancer patients recruited from a randomly selected sample of institutions in the United States. Patients accrued to either phase II or phase III National Cancer Institute–sponsored clinical trials during a 15-month period will be asked to participate in a study of their health care utilization (n = 750). Costs will be measured approximately 1 year after their trial enrollment from a combination of billing records, medical records, and an in-person survey questionnaire. Similar data will be collected for a comparable group of cancer patients not in trials (n = 750) to provide an estimate of the incremental cost. RESULTS: Evidence suggests insurers limit access to trials because of cost concerns. Public and private efforts are underway to change these policies, but their permanent status is unclear. Previous studies found that treatment costs in clinical trials are similar to costs of standard therapy. However, it is difficult to generalize from these studies because of the unique practice settings, insufficient sample sizes, and the exclusion of potentially important costs. CONCLUSION: Denials of coverage for treatment in a clinical trial limit patient access to trials and could impede clinical research. Preliminary estimates suggest changes to these policies would not be expensive, but these results are not generalizable. The Cost of Cancer Treatment Study is an ongoing effort to provide generalizable estimates of the incremental treatment cost of phase II and phase III cancer trials. The results should be of great interest to insurers and the research community as they consider permanent ways to finance cancer trials.

Epoetin Alfa Treatment Results in Clinically Significant Improvements in Quality of Life in Anemic Cancer Patients When Referenced to the General Population

2003 ◽  
Vol 21 (2) ◽  
pp. 366-373 ◽  
Author(s):  
David Cella ◽  
Martin J. Zagari ◽  
Christina Vandoros ◽  
Dennis D. Gagnon ◽  
Hans-Jürgen Hurtz ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Clinical Trial ◽  
Clinical Trials ◽  
Cancer Patients ◽  
The United States ◽  
Internet Survey ◽  
Epoetin Alfa ◽  
Clinical Trial Results ◽  
Population Norm

Purpose: Anemia, highly common among cancer patients, is often an underlying cause of cancer-related fatigue and other quality-of-life (QOL) deficits. Although randomized clinical trials have shown that treatment with epoetin alfa increases hemoglobin levels, reduces fatigue, lessens transfusion requirements, and improves overall QOL, cancer-related anemia and fatigue remain undertreated. This is, in part, because scales and measures of QOL are still relatively unfamiliar to most clinicians and because population-based reference ranges are lacking, thus making clinical trial results difficult to interpret. Methods: To aid in the interpretation of QOL results from clinical trials, we administered the Functional Assessment of Cancer Therapy–Anemia (FACT-An) QOL instrument to a nationally representative sample of 1,400 people using an Internet survey panel in the United States. We then compared the FACT-An data from the Internet survey with the QOL data of a 375-patient randomized, double-blind clinical trial evaluating epoetin alfa versus placebo in anemic cancer patients. Results: FACT-An, as administered to the survey population, displayed good psychometric properties and was able to discriminate between respondents with histories of specified illnesses, including anemia and cancer, and those without. Comparison of the population norm and clinical trial data showed that treatment with epoetin alfa resulted in clinically meaningful as well as statistically significant improvements in QOL (P < .01). Conclusion: Reliable population norm data are now available to aid in the interpretation of clinical trial results where the FACT-An questionnaire is administered. In the clinical trial, treatment with epoetin alfa overcame much of the QOL deficit seen in anemic cancer patients compared with the norm population sample.

scholarly journals Evaluating Public Programs with Close Substitutes: The Case of Head Start*

2016 ◽  
Vol 131 (4) ◽  
pp. 1795-1848 ◽  
Author(s):  
Patrick Kline ◽  
Christopher R. Walters
Keyword(s):  
Head Start ◽  
Test Score ◽  
The United States ◽  
Cost Ratio ◽  
Public Programs ◽  
Benefit Cost Ratio ◽  
Wide Range ◽  
Fiscal Impacts ◽  
The Cost ◽  
Benefit Cost

Abstract We use data from the Head Start Impact Study (HSIS) to evaluate the cost-effectiveness of Head Start, the largest early childhood education program in the United States. Head Start draws roughly a third of its participants from competing preschool programs, many of which receive public funds. We show that accounting for the fiscal impacts of such program substitution pushes estimates of Head Start’s benefit-cost ratio well above one under a wide range of assumptions on the structure of the market for preschool services and the dollar value of test score gains. To parse the program’s test score impacts relative to home care and competing preschools, we selection-correct test scores in each care environment using excluded interactions between experimental assignments and household characteristics. We find that Head Start generates larger test score gains for children who would not otherwise attend preschool and for children who are less likely to participate in the program.

scholarly journals The Current Status of Integrative Oncology in Korea

2021 ◽  
Vol 20 ◽  
pp. 153473542110638
Author(s):  
Eun-Bin Kwag ◽  
Soo-Dam Kim ◽  
Ji Hye Park ◽  
So-Jung Park ◽  
Mi-Kyung Jeong ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cancer Patients ◽  
Causes Of Death ◽  
Survival Rates ◽  
Current Status ◽  
Integrative Oncology ◽  
Recurrence Rates ◽  
Current State ◽  
Look Ahead

Cancer is one of the leading causes of death worldwide, and Korea is no exception. Humanity has been fighting cancer for many years, and as a result, we now have effective treatments such as chemotherapy, radiation, and surgery. However, there are other issues that we are only now beginning to address, such as cancer patients’ quality of life. Moreover, numerous studies show that addressing these issues holistically is critical for overall cancer treatment and survival rates. This paper describes how Korea is attempting to reduce cancer incidence and recurrence rates while also managing the quality of life of cancer patients. Integrative Oncology is the field that addresses these broad issues, and understanding the current state of integrative oncology in Korea is critical. The goal of this paper is to provide an overview of the current state of integrative oncology in Korea as well as to look ahead to future developments.

National survey on the effect of oncology drug shortages in clinical practice: A Hematology Oncology Pharmacy Association (HOPA) survey.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e13609-e13609
Author(s):  
Sarah Hudson-Disalle ◽  
David L. DeRemer ◽  
Larry W Buie ◽  
Mark Hamm ◽  
Jeffrey Pilz ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Supportive Care ◽  
Cancer Patients ◽  
Medication Errors ◽  
The United States ◽  
Adverse Outcomes ◽  
Common Disease ◽  
Drug Shortages ◽  
Oncology Drug ◽  
The Impact

e13609 Background: Drug shortages are a clear and growing challenge. Prominent shortages included oncology medications and supportive care products essential for the care of cancer patients. Oncology drug shortages often result in disruptions in the timing of chemotherapy treatments, alterations in the dose or regimen administered, or even missed doses when alternative agents are unavailable. The purpose of this survey was to characterize the impact of oncology drug shortages across the United States, including the experiences of health care organizations, resource implications, and the impact on patient safety, patient care, and clinical trials. Methods: A 34-item online survey was distributed to HOPA membership of the Hematology Oncology Pharmacy Association to gather information on shortages of oncology drugs (i.e., all drugs essential in the care of cancer patients, including supportive care agents. Results: Sixty-eight organizations completed the survey; almost all completed by pharmacists, and analysis completed. Sixty-three percent of institutions reported one or more drugs shortages a month, with a 34.33% increase in 2019 from 2018. Sixty four percent of responded had incurred increased costs from oncology drugs shortages, with 7% noting reimbursement issues when switched to brand name therapies due to shortages. Treatment delays, reduced doses or alternative regimens were reported by 74.63% of respondents. The most common disease states which causes a dose delay of treatment included Acute Lymphocytic Leukemia, Lymphoma and Multiple Myeloma with dose reductions noted in 36.36%, 36.36 and 15.91%. The top five oncology drugs on shortage included epirubicin, flutamide, decitabine, mechlorethamine, dactinomycin with the top 5 supportive care drugs on shortage being noted as hydrocortisone, bivalirudin, promethazine, mycophenolate sodium and scopolamine. Respondents noted medication errors related to oncology drug shortages at 4.48%, with noted errors including incorrect conversion from iv to oral etoposide and incorrect EMR drug builds. Oncology Drug shortages impacted clinical trials in 13.4% of respondents in which 54.55% of respondents noting patients not being enrolled in clinical trials. Conclusions: A survey of US oncology pharmacists and technicians indicated that oncology drug shortages occurred frequently in 2020. Shortages led to delays in chemotherapy and changes in treatment or omission, complicated clinical research and increased the risk of medication errors and adverse outcomes.

The Impact of Mesh Implantation on Vaginal Smooth Muscle Innervation and Contraction

2013 ◽  
Author(s):  
Zegbeh C. Jallah ◽  
Pamela Moalli ◽  
Andrew Feola ◽  
William Barone ◽  
Stacy Palcsey ◽  
...  
Keyword(s):  
Structural Integrity ◽  
Surgical Repair ◽  
The United States ◽  
Pelvic Organ ◽  
Muscle Innervation ◽  
Vaginal Canal ◽  
The Cost ◽  
Vaginal Smooth Muscle ◽  
The Impact

Pelvic organ prolapse (POP) is a multifactorial disorder characterized by the descent of the pelvic organs into the vaginal canal. This disorder is associated with decreased quality of life, and even depression, yet 50% of women over the age of fifty are living with POP. The cost associated with the repair of POP exceeds one billion dollars annually, in the United States alone. This rather exorbitant figure includes the cost of surgery performed for symptom management, but does not include strategies which address the underlying cause of the disorder for which there are none. Because failure rates of native tissue repairs are as high as 30%, vaginal mesh is increasingly used in the surgical repair of POP. The procedure aims to reinforce the fibromuscular layer of the vagina and the paravaginal attachments, thus providing structural integrity to the weakened native tissues. However, the use of mesh is limited by mesh-related complications including exposure, erosion, pain contraction and infection.

The clinical value and the cost-effectiveness of follow-up in endometrial cancer patients

2004 ◽  
Vol 14 (5) ◽  
pp. 931-937 ◽  
Author(s):  
W. A. A. Tjalma ◽  
P. A. Van Dam ◽  
A. P. Makar ◽  
D. J. Cruickshank
Keyword(s):  
Endometrial Cancer ◽  
Cost Effectiveness ◽  
Cancer Patients ◽  
Survival Rates ◽  
Risk Groups ◽  
Evidence Base ◽  
Clinical Value ◽  
The Times ◽  
The Cost

The aim of the present article was to evaluate the cost-effectiveness of follow-up in endometrial cancer patients. A literature review was performed regarding the studies that addressed routine follow-up of endometrial cancer. For each published study, the costs of the follow-up program were calculated according to Belgium standards. A mean total of 13% relapsed. Symptomatology and clinical examination detected over 83% of the recurrences. The follow-up cost in euro after 5 and 10 years ranged between 127.68 and 2028.78 and between 207.48 and 2353.48, respectively. Based on the available data, there is little evidence of routine follow-up improving survival rates. Multiple protocols are used in practice without an evidence base. There is an urgent need for prospective randomized studies to evaluate the value of the current so-called ‘standard medical practice of follow-up.’ It is to be expected that the cost of follow-up could be reduced considerably, for instance, by tailoring to low- and high-risk groups, or by abandoning routine follow-up. Symptomatic patients, however, should be evaluated immediately. A reduction in the number of visits and examinations would mean an enormous reduction in costs. This economic benefit would be warmly welcomed in the times of increased health costs and decreased budgets.

scholarly journals A National Study of Oncology Nurses Discussing Cancer Clinical Trials With Patients

2019 ◽  
Vol 41 (12) ◽  
pp. 1747-1760
Author(s):  
Susan A. Flocke ◽  
Nora L. Nock ◽  
Sarah Fulton ◽  
Seunghee Margevicius ◽  
Sharon Manne ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Cancer Patients ◽  
Behavioral Control ◽  
The United States ◽  
Subjective Norms ◽  
Oncology Nurses ◽  
Equation Modeling ◽  
National Study ◽  
Perceived Behavioral Control ◽  
Oncology Nurse

In the United States less than 10% of cancer patients engage in clinical trials. Although most oncology nurses have multiple opportunities to discuss clinical trials with patients, barriers including attitudes and social norms may impede these discussions. Guided by the Theory of Planned Behavior, we developed and evaluated measures for attitudes, subjective norms, and perceived behavioral control of nurses for discussing clinical trials with cancer patients. Of the 18,000 Oncology Nurse Society members invited, 1,964 completed the survey. Structural equation modeling and internal consistency reliability were used to evaluate items and constructs. We found that overall model fit and reliability was good: Confirmatory Fit Index (CFI) = 0.91, Root Mean Square Error of Approximation (RMSEA) = 0.05; attitudes, 21 items, alpha = 0.84; perceived behavioral control, 10 items, alpha = 0.85; and subjective norms, 9 items, alpha = 0.89. These measures of attitudes, subjective norms, and perceived behavioral control show good reliability and initial evidence of validity.

scholarly journals Assessing U.S. Landscape Architecture Faculty Research Contribution

Land ◽  
2020 ◽  
Vol 9 (3) ◽  
pp. 64
Author(s):  
Robert D. Brown ◽  
Tamanna Tasnum ◽  
YouJoung Kim
Keyword(s):  
Professional Education ◽  
Landscape Architecture ◽  
Social Issues ◽  
The United States ◽  
Scholarly Output ◽  
Wide Range ◽  
The Us ◽  
Available Information ◽  
Contribution Level

Landscape architecture programs in the United States are assessed based on the quality of the professional education received by their students. Research is becoming an increasingly important part of the profession as evidence-based landscape architecture grows, and it is critical that university faculty provide information that can be used in professional practice to resolve important environmental and social issues. In many universities, individual landscape architecture faculty are encouraged to conduct research and their performance is evaluated based largely on the quantity and quality of their scholarly output. This paper used publicly-available information to conduct a citation analysis for individual faculty and professionally accredited landscape architecture programs across the US. There was a wide range in the contribution level with some programs and some individuals who were very productive, while many others contributed very little. This might point to an attempt by programs to maintain a balance between scholarly contributions and the education of professional landscape architects. As research becomes an increasing important part of the profession, the productive programs and individuals identified in this study might provide models for others to emulate.

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