England: The Cancer Drugs Fund: Guidance to support operation of the Cancer Drugs Fund in 2012-13 : Department of Health - Publications

 Blogger's Note: this is primarily an administrative document, patient/consumer searches for specific drugs are not part of this guidance report

The Cancer Drugs Fund: Guidance to support operation of the Cancer Drugs Fund in 2012-13 : Department of Health - Publications

• Document type:
  Guidance
• Author:
  Department of Health
• Published date:
  23 April 2012
• Primary audience:
  Health and social care professionals
• Publication format:
  A4: electronic format only
• Gateway reference:
  17340
• Pages:
  14
• Supersedes/replaces:
  The Cancer Drugs Fund
• Copyright holder:
  Crown

This document provides guidance to support operation of the Cancer Drugs Fund in 2012-13. It replaces previous guidance for operation of the Cancer Drugs Fund in 2011/12. The Cancer Drugs Fund applies in England only.

• Download The Cancer Drugs Fund: Guidance to support operation of the Cancer Drugs Fund in 2012-13 (PDF, 123K)
• More about publications from the DH

Vitamin D testing – articles of interest : The Lancet

Vitamin D testing (see sidebar)

Other Articles of Interest

Review Vitamin D and multiple sclerosis

Articles Common genetic determinants of vitamin D insufficiency: a genome-wide association study

Research Letters 25-hydroxyvitamin D-1α-hydroxylase in normal and malignant colon tissue

Articles High-dose vitamin D3 during intensive-phase antimicrobial treatment of pulmonary tuberculosis: a double-blind randomised controlled trial

Comment Genetic and environmental determinants of vitamin D status

Vitamin D testing – Authors' reply : The Lancet

Vitamin D testing – Authors' reply : The Lancet

Linked Articles

Correspondence Vitamin D testing :

Correspondence Vitamin D testing

Correspondence Vitamin D testing

Correspondence Vitamin D testing

Patient empowerment—who empowers whom? : The Lancet

Patient empowerment—who empowers whom? : The Lancet

The Lancet

 

"What is patient empowerment? Over 250 participants discussed this question at the first European Conference on Patient Empowerment, recently held in Copenhagen, Denmark, by the European Network on Patient Empowerment (ENOPE 2012). The conference was convened under the auspices of the Danish Presidency of the European Union (EU), and organised by the WHO Regional Office for Europe, Denmark's Ministry of Health, the Danish Committee for Health Education, the Caerum Foundation of Switzerland, and the English Expert Patient's group......

Cochrane: YourHealthNet - navigating effective treatments with systematic reviews

YourHealthNet - navigating effective treatments with systematic reviews

The parts of a Cochrane systematic review and the information they contain - learning to navigate a review

Cochrane systematic reviews

Cochrane systematic reviews are the major output of the international organisation The Cochrane Collaboration, and over 4,000 Cochrane reviews are available online on The Cochrane Library. Because Cochrane review authors carry out their research with scientific rigour and follow detailed guidelines Cochrane reviews are considered a high quality source of research evidence.

David Tovey from The Cochrane Collaboration talks about systematic reviews.   » Read a transcript or » Listen to David's comments » See screen shot... This is how a systematic review looks on The Cochrane Library.

Explore the parts of a Cochrane systematic review

Systematic reviews are a complex mix of process and product - they report on the process review authors undertook, and the conclusions authors came to about what they found. All Cochrane systematic reviews follow the same format and methods; they have the same content in the same sections. This ensures their transparency and rigour.....

Healthnewsreview: The limitations of – and explosion in the number of – observational studies

The limitations of – and explosion in the number of – observational studies:

In the Wall Street Journal, Gautam Naik has a thoughtful piece, “Analytical Trend Troubles Scientists,” hitting on the limitations of – and the explosion in the number of – observational studies.  Excerpts:

“While the gold standard of medical research is the randomly controlled experimental study, scientists have recently rushed to pursue observational studies, which are much easier, cheaper and quicker to do. Costs for a typical controlled trial can stretch high into the millions; observational studies can be performed for tens of thousands of dollars.
In an observational study there is no human intervention. Researchers simply observe what is happening during the course of events, or they analyze previously gathered data and draw conclusions. In an experimental study, such as a drug trial, investigators prompt some sort of change—by giving a drug to half the participants, say—and then make inferences.
But observational studies, researchers say, are especially prone to methodological and statistical biases that can render the results unreliable. Their findings are much less replicable than those drawn from controlled research. Worse, few of the flawed findings are spotted—or corrected—in the published literature.
“You can troll the data, slicing and dicing it any way you want,” says S. Stanley Young of the U.S. National Institute of Statistical Sciences. Consequently, “a great deal of irresponsible reporting of results is going on.”
Despite such concerns among researchers, observational studies have never been more popular.
Nearly 80,000 observational studies were published in the period 1990-2000 across all scientific fields, according to an analysis performed for The Wall Street Journal by Thomson Reuters. In the following period, 2001-2011, the number of studies more than tripled to 263,557, based on a search of Thomson Reuters Web of Science, an index of 11,600 peer-reviewed journals world-wide. The analysis likely doesn’t capture every observational study in the literature, but it does indicate a pattern of growth over time.
A vast array of claims made in medicine, public health and nutrition are based on observational studies, as are those about the environment, climate change and psychology.”

The article addresses the “hot area of medical research” – the search for biomarkers.

“The presence or absence of the biomarkers in a patient’s blood, some theorized, could indicate a higher or lower risk for heart disease—the biggest killer in the Western world.
Yet these biomarkers “are either completely worthless or there are only very small effects” in predicting heart disease, says John Ioannidis of Stanford University, who extensively analyzed two decades’ worth of biomarker research and published his findings in Circulation Research journal in March. Many of the studies, he found, were undermined by statistical biases, and many of the biomarkers showed very little predictive ability of heart disease.
His conclusion is widely upheld by other scientists: Just because two events are statistically associated in a study, it doesn’t mean that one necessarily sets off the other. What is merely suggestive can be mistaken as causal.
That partly explains why observational studies in general can be replicated only 20% of the time, versus 80% for large, well-designed randomly controlled trials, says Dr. Ioannidis. Dr. Young, meanwhile, pegs the replication rate for observational data at an even lower 5% to 10%.
Whatever the figure, it suggests that a lot more of these studies are getting published. Those papers can often trigger pointless follow-on research and affect real-world practices.”

But the story also appropriately points out the contribution obervational studies have made:

“Observational studies do have many valuable uses. They can offer early clues about what might be triggering a disease or health outcome. For example, it was data from observational trials that flagged the increased risk of heart attacks posed by the arthritis drug Vioxx. And it was observational data that helped researchers establish the link between smoking and lung cancer.”

I have written many times about the weakness of news stories that fail to point out the limitations of observational studies and – more specifically – stories that use causal language to describe the findings from observational studies that can “only” point to statistical associations.
News consumers and health care consumers need to better understand the limitations of all studies – including randomized clinical trials.

paywalled: Risk of Colonic Neoplasia After Proctectomy for Rectal Cancer in Hereditary Nonpolyposis Colorectal Cancer (Lynch Syndrome)

abstract

Abstract

Objective: To define the neoplastic risk in the remaining colon after proctectomy for rectal cancer in patients with hereditary nonpolyposis colorectal cancer (HNPCC). (Lynch Syndrome)

Conclusions: Surgeons and patients need to be aware of substantial risk for metachronous neoplasia after proctectomy. Selection of operation should be individualized, but total proctocolectomy and ileoanal pouch should be strongly considered. If patients undergo proctectomy alone, close surveillance is mandatory.

Explaining High Health Care Spending in the United States: An International Comparison of Supply, Utilization, Prices, and Quality - The Commonwealth Fund

Blogger's Note: some interesting comparisons on a variety of comparables including in-hospital 30 day mortality rates, breast/cervical/colorectal cancer survival rates, diagnostic imaging; comparisons of countries:


Explaining High Health Care Spending in the United States: An International Comparison of Supply, Utilization, Prices, and Quality - The Commonwealth Fund

Overview

This analysis uses data from the Organization for Economic Cooperation and Development and other sources to compare health care spending, supply, utilization, prices, and quality in 13 industrialized countries: Australia, Canada, Denmark, France, Germany, Japan, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States......

paywalled: Evaluation of Society of Gynecologic Oncologists (SGO) Ovarian Cancer Quality Surgical Measures

Evaluation of Society of Gynecologic Oncologists (SGO) Ovarian Cancer Quality Surgical Measures: Publication year: 2012

Source: Gynecologic Oncology



Objectives
The Society of Gynecologic Oncologists has developed two measures to assess & improve the surgical care of patients with ovarian cancer (1) description of residual disease following cytoreduction and (2) adequacy of surgical staging. Our aim was to establish baseline surgeon compliance with these two measures.

Methods
A retrospective review of patients with ovarian, fallopian tube or peritoneal cancer undergoing surgery between 7/1/2006 and 7/1/2011 for the purposes of staging and/or cytoreduction was performed at the University of Washington and Geisinger Medical Center. Operative and pathology reports were reviewed to obtain information pertaining to stage, histology, residual disease after surgery and the extent of surgical staging.

Results 
537 cases were identified; 91% with ovarian cancer. 61% of patients had at least stage IIIC disease; 15% had recurrent disease and 16% had neoadjuvant therapy. For patients with stage I-IIIB disease, 74% had full surgical staging, 10% did not have full surgical staging but documented the reason for this in the operative report; 15% did not have full surgical staging, no reason was noted. 25% of all operative reports lacked documentation of residual disease with 40% documenting no gross residual disease, 18% with residual disease<1cm and 18% had suboptimal debulking with>1cm disease remaining. There was a statistically significant increase in appropriate documentation of amount of residual disease over time (p<0.001).

Conclusions
 Our study sets benchmarks for evaluation of documentation in gynecologic oncology centers. Improved documentation and staging will allow for equivalent standards of care across institutions.