Many US cancer survivors still lost in transition : The Lancet (U.S. / Canada....)

Many US cancer survivors still lost in transition : The Lancet

Patient-Centered Outcomes Research Institute Amends Draft Research Agenda in Response to Public Comment -- WASHINGTON, April 25, 2012 /PRNewswire-USNewswire/ --

Patient-Centered Outcomes Research Institute Amends Draft Research Agenda in Response to Public Comment -- WASHINGTON, April 25, 2012 /PRNewswire-USNewswire/ --

".....After discussion, the Board voted to make important changes to the Research Agenda. These include clarification of PCORI's focus on patient engagement and transparency; on patients with multiple chronic conditions; on patients with rare diseases; on improving health care systems, including care coordination, access to care, and the role of practice settings and allied health professionals; and on the importance of health literacy.
"The comments we received did not identify major gaps in the National Priorities, and there were no suggestions for additional priorities," said PCORI Executive Director Joe Selby, M.D., MPH. "This indicates that our priorities effectively capture the broad areas where more research is needed. Once the revised National Priorities and Research Agenda are approved, we will issue PCORI's first primary research funding announcements, which will emphasize the inclusion of patients and caregivers at all stages of the research."
PCORI reiterated its commitment to being a learning organization that will continually work with patients and stakeholders to revise its priorities and agenda as needed to address patients' evolving needs....."

No, Virginia, cancer care in Europe doesn't suck, contrary to what a recent paper implies : Respectful Insolence

No, Virginia, cancer care in Europe doesn't suck, contrary to what a recent paper implies : Respectful Insolence

Medscape: Oncologists Are Not Health Economists, Suggests Survey (U.S. & Canadian physician survey)

Oncologists Are Not Health Economists, Suggests Survey
 
 "Interestingly, responses to the clinical scenario did not significantly differ between American and Canadian oncologist."

health media: Cancer Care Costs Higher in U.S. Than Europe, But Survival Longer - MedicineNet

Cancer Care Costs Higher in U.S. Than Europe, But Survival Longer - MedicineNet


MONDAY, April 9 (HealthDay News) -- The United States spends more on health care than any other country, but those high costs may be paying off in cancer survival, a new report suggests.
U.S. cancer patients often live almost two years longer than similar patients in Europe, arguing for the dollar value of care given, researchers say.
However, Dr. Otis Brawley, the chief medical officer and executive vice president at the American Cancer Society, who was not involved in the study, said that "this paper has a huge fatal flaw in it."
"When you look at survival from time of diagnosis to time of death and you have a screened population that has a lot of diagnoses, you're filling that population with people who don't need treatment and because they are over-diagnosed, they have very long survival," he added.
These researchers attribute increased survival to the treatment, when it is really over-diagnosis, Brawley said. "So they are looking at a bunch of wasted, unnecessary treatment and then saying it was money well spent," he said.
"You don't look at survival rates -- this is a classic misuse of survival rates," Brawley said. "You have to look at death rates for each disease and not survival rates. The measurement should not be expense versus survival -- it should be expense versus mortality rate."
On that scale, the United States does well for some cancers and as well as they do in most of Europe for others, he said. "Mortality rates for breast and colon cancer are close to the mortality rates in Europe, but that may include the effect of over-treatment," Brawley said.
The report was published in the April issue of Health Affairs.
For the study, Tomas Philipson, the chair in public policy at the University of Chicago, and colleagues looked at cancer care in the United States and in 10 European countries from 1983 to 1999.
The investigators found that for most cancers, U.S. patients lived longer than Europeans. Americans lived an average of 11.1 years after diagnosis, compared with 9.3 years for Europeans, they said.
When the authors translated survival data to dollars, they found those extra years were worth $598 billion, which is an average of $61,000 per cancer patient.
The value of these survival gains was highest for prostate cancer ($627 billion) and breast cancer ($173 billion), the findings indicated.
To put a monetary value on survival, the researchers used a "statistical-life concept." In many such studies, they said, estimates are based on how much income a person would exchange for a lower risk of mortality.
"Our findings bear on the larger question of whether higher U.S. health care spending is worth it, suggesting -- although not confirming -- that it is," the researchers wrote.
"Further research is required to examine the drivers of spending and their effects on outcomes, including assessing the relative contributions of treatments, screening, the skill of health care personnel and other factors in improving patient outcomes," they concluded.
On the larger issue of the costs of cancer treatment, Brawley said that "we spend money in an irrational way. We harm people by over-treating them and over-treatment costs money."
Many patients are getting treatments that cause harm, but don't really prolong life, Brawley said. It's hard for a doctor to tell a patient there is nothing that can be done.
"That is the kind of thing doctors need to be developing skills in -- it's an emotional hurdle to say 'I can't stop this,'" he said.
Many patients think that giving up is admitting defeat, and want to be treated even if the treatment will do more harm than good, Brawley said.
"We all need to take a step back and take a look at reality and ask whether the patient stands a good chance of benefiting from a particular treatment. If there aren't benefits, then we ought to, perhaps, stop," he said.
"Instead of talking about rationing care, we need to talk about the rational use of care," Brawley added.

US drug shortages could continue for years : The Lancet

US drug shortages could continue for years : The Lancet

discussion (U.S.) : Clinical Pathways for Oncology: More Rigor Needed When Evaluating Models

Clinical Pathways for Oncology: More Rigor Needed When Evaluating Models

DPX-Survivac vaccine - Biotech company raises $2.8 million for R&D | The Chronicle Herald

"Halifax biotechnology company Immunovaccine Inc. has raised $2.8 million in equity funding that will help the company push forward with clinical trials of its anti-cancer vaccine.

“The proceeds will be used to fund research and development and for our other corporate activities,” Immunovaccine chief financial officer Kimberley Stevens said Wednesday.

Foremost among those R&D efforts are the Phase 1 clinical trails on patients with advanced-stage ovarian cancer for DPX-Survivac, Immunovaccine’s therapeutic cancer vaccine. In January, the first patient was vaccinated in the trials, which have been simultaneously approved in Canada and the United States.

The company, through the non-brokered private placement, issued 9,294,005 common shares at 30 cents each to raise the funds.
Under Phase 1 trials, patients in Canada and the United States will be treated with DPX-Survivac after completing debulking surgery — the removal of part of a tumour — and chemotherapy treatments.
If the vaccine is found to be safe for humans, testing will proceed to Phase 2.

Typically, if a vaccine passes Phase 2, the company either licenses it or partners with a big drug company before beginning definitive tests that regulatory agencies use to decide whether to approve a product.
Stevens said the $2.8 million in fresh equity will be enough for Immunovaccine to operate until the first quarter of 2013 before it needs to raise new funds.

Jan 15th: New Symptom Indices Offer No Gain in Ovarian Ca - in Oncology/Hematology, Ovarian Cancer from MedPage Today

Action Points  

---

• Explain that two new ovarian cancer symptom indices offered little advantage over the current Goff Index.



• Point out that for all three indices, sensitivity was lower for data obtained from the general practitioner's notes and highest for those interviewed over the telephone, ant that the specificity was largely unchanged

"The small differences between the three indices indicate that there is little to gain from deriving new symptom indices," the authors concluded.


"This sobering news follows hard on the heels of a large U.S. randomized trial finding no benefit, and indeed some harm, to women who were screened annually with a transvaginal ultrasound exam and a CA-125 blood test compared with a usual care control group," they wrote, referring to the NIH-sponsored Prostate, Lung, Colon, and Ovary (PLCO) screening program (JAMA 2011; 305:2295-2303).

They said one question the ovarian cancer community needs to answer is where it should focus its efforts: On the time between when a tumor is large enough to cause mild symptoms and when it is large enough to cause symptoms that prompt women to call a physician, or on a better understanding of disease etiology, leading to better prevention and therapy.

"These other research directions remain critical as the search continues for better ways to find ovarian cancer early," they said.

Primary source: Journal of the National Cancer Institute Source reference: Lim AWW, et al. "Predictive value of symptoms for ovarian cancer: Comparison of symptoms reported by questionnaire, interview, and general practitioner notes" J Natl Cancer Inst 2012; 104: 1-11. Additional source: Journal of the National Cancer Institute Source reference: Hartge P, Speyer JL. "Finding Ovarian Cancer" J Natl Cancer Inst 2012; DOI: 10.1093/jnci/drj518.

Related Article(s): ESGO: Ultrasound Allows Early Ovarian Cancer Diagnosis ESGO: Anti-CA125 Fails to Slow Ovarian Cancer SGO: Change in Antigen Predicts Ovarian Cancer Outcomes

video/text: Palliative Medicine: Care versus Cure? Dr Diane Meier/ Richard Heffner's Open Mind - dialogue (U.S.)

AIR DATE: 2/26/2011

Prima BioMed Receives Regulatory Scientific Advice on CVac Phase III Trial -- SYDNEY, Feb. 18, 2011 /PRNewswire/ --

"......The trial will be conducted on 750 patients in a double blind placebo controlled study randomized 1:1 of CVac vs. Standard of Care (currently there is no approved maintenance therapy for ovarian cancer), across multiple sites in Europe, the US and Australia....."

Director's Page - National Cancer Institute - Update to the National Cancer Advisory Board (December 2010) 9 minutes

Also: To view the NCAB Meeting discussions in their entirety, visit http://videocast.nih.gov/launch.asp?16326 (5 hrs and 51 minutes)

About INCTR - INCTR – International Network for Cancer Treatment and Research

INCTR is located in Brussels.
It currently has branches in Brazil, Canada, Egypt, France, Nepal and the USA and offices in Cameroon, India, Tanzania and the UK.

Reports:

• A Decade of INCTR: Challenges and Opportunities
• Panel Discussion: Towards A Global Cancer control Program
• Report on Evolution of Pathology Program
• Oncology Nursing Program
• Psychosocial Program
• Development of an INCTR Faculty and Partnerships with Universities
• Open Educational Resources for Cancer (OERC): Two Years of Progress
• Report on Telepathology Meeting, Ile-Ife, Nigeria

2010 newsletter:

"In 2010, cancer overtook ischaemic heart disease as the leading cause of death in the world. While different groupings of diseases (e.g., combining all cardiovascular disease or dividing cancer into many different types) would produce a different rank order, the point should not be missed that cancer can no longer be ignored by global health policy-makers as a major cause of disability or death, as well as economic loss......."

NCI announces plans to reinvigorate clinical trials, December 23, 2010 News Release - National Institutes of Health (NIH)

Note: see second post for list of groups (international) 

 

 "Consolidation of cooperative group program is designed to bring enhanced efficiencies to oncological sciencesThe National Cancer Institute (NCI) has announced major changes to be made in the long-established Clinical Trials Cooperative Group Program ....."

 http://www.cancer.gov/cancertopics/factsheet/NCI/clinical-trials-cooperative-group ...... For more information about cancer, please visit the NCI Web site at http://www.cancer.gov or call NCI's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237)....."

Cancer - NPCR - USCS - View Data Online - cancer stats U.S.

Note: ovarian cancer - 8th in incidence rate; 5th in death rate

eHealthServer.com | European Commission Signs eHealth Agreement with US Department of Health

"...The partnership between the EU and the US, the two world leaders in eHealth, sends a strong signal to all stakeholders that common standards and interoperability bring opportunities for a global approach for the benefit of patients, health systems and the market"

revamped website: (U.S.) Science Serving People - National Cancer Institute

	Cancer Research Progress Information on research advances and a look at the future of cancer prevention, detection, treatment, and survivorship.
	NCI Budget Information National Cancer Institute (NCI) budget requests, data on NCI spending, and an overview of how the institute’s annual budget process works.
	Cancer Research in Your Community Clinical trials and NCI collaborations as well as state-specific cancer information.
	Understanding Cancer Statistics Key facts about the human and economic cost of cancer and resources to help make the data more understandable.
	How Cancer Research Works A look at the process of conducting cancer research — from basic science in the laboratory to treatment in the clinic.
	Policy Highlights Updates on federal cancer news and congressional testimony.

media: U.S. New health care changes are only the beginning - CNN.com

"....Patient advocates say Thursday's changes are only the beginning. "The big resolutions will come in 2014 when you will start to see tens of millions of people getting coverage," says Avram Goldstein, communication director for the Health Care for America Now, a liberal grass roots health advocacy organization. It offers a detailed timeline of what changes consumers can expect over the next few years..." cont'd

Editorial :: Cochrane in the United States of America - The Cochrane Collaboration (background/2010 Keystone, Colorado conference)

 Note: The Gynecologic Cancer Review Group section of the Cochrane is based out of the UK. Consumer reviewers may participate irrespective of geographic location as the Cochrane is primarily internet-based.


"On 18 October 2010, the first joint Colloquium between the Campbell and Cochrane Collaborations opens in Keystone, Colorado, USA. The USA last hosted the Cochrane Collaboration Colloquium and annual meeting in 1998 in Baltimore, Maryland. The Colloquium's return to the USA comes on the heels of President Obama's signing of historic health care reform legislation. As reported, "the reforms, which will cost an estimated USD 940 billion over 10 years, will expand the provision of care to 32 million more people, predominantly the poorest, and will result in the country achieving 95% coverage" (MacAskill 2010). At the same time The American Recovery and Reinvestment Act of 2009 has provided USD 1.1 billion for Comparative Effectiveness Research (CER), and established the Patient-Centered Outcomes Research Institute (PCORI). PCORI will make a major annual investment in CER, through the National Institutes of Health (NIH) and the Agency for Healthcare Research and Quality (AHRQ).

The US contribution to the development of The Cochrane Collaboration has been considerable. US-based researchers represented 7/84 (8.3%) of the pioneers attending the first Cochrane Colloquium in October 1993........."cont'd

U.S. - Shared decision making works: docs - Modern Physician

Note: this website requires registration (free)