The Chinese population in British Columbia has been increasing in recent years due to the migration of the Chinese from Southern China, which has tripled during the last decade. From 1939 to 1980, 296 cases of nasopharyngeal carcinoma (NPC) were seen at the Cancer Control Agency of British Columbia (CCABC). Of these, 167 (56%) were Chinese and 119 (40%) were Caucasians. The incidence of cancer of the nasopharynx in the Chinese born in China was 115 times greater than Caucasians before 1970 and 107 times greater in the 1970s. The incidence of NPC in the Caucasian population remained unchanged as did that of the North American-born Chinese (six times greater than that of the Caucasians) for the last 2 decades. The overall survival for all cases was 39% at 5 years and 28% at 10 years. The survival of cases was better in patients treated after 1970 (48% at 5 years and 36% at 10 years) than in patients treated before 1970 (34% at 5 years and 20% at 10 years). The survival was 50% at 5 years for all N0 cases but it was only 27% in patients with nodal metastasis. The survival of NPC was related essentially to initial staging, type and dose of irradiation, and pre-irradiation biopsy of neck metastasis. The survival was not significantly related to birth place, race, or histological grade.
To compute cost-effectiveness/cost-utility (CE/CU) ratios, from the treatment clinic and societal perspectives, for high-dose palliative radiotherapy treatment (RT) for advanced non-small-cell lung cancer (NSCLC) against best supportive care (BSC) as comparator, and thereby demonstrate a method for computing CE/CU ratios when randomized clinical trial (RCT) data cannot be generated.
Unit cost estimates based on an earlier reported 1989-90 analysis of treatment costs at the Vancouver Island Cancer Centre, Victoria, British Columbia, Canada, are updated to 1997-1998 and then used to compute the incremental cost of an average dose of high-dose palliative RT. The incremental number of life days and quality-adjusted life days (QALDs) attributable to treatment are from earlier reported regression analyses of the survival and quality-of-life data from patients who enrolled prospectively in a lung cancer management cost-effectiveness study at the clinic over a 2-year period from 1990 to 1992.
The baseline CE and CU ratios are $9245 Cdn per life year (LY) and $12,836 per quality-adjusted life year (QALY), respectively, from the clinic perspective; and $12,253/LY and $17,012/QALY, respectively, from the societal perspective. Multivariate sensitivity analysis for the CE ratio produces a range of $5513-28,270/LY from the clinic perspective, and $7307-37,465/LY from the societal perspective. Similar calculations for the CU ratio produce a range of $7205-37, 134/QALY from the clinic perspective, and $9550-49,213/QALY from the societal perspective.
The cost effectiveness and cost utility of high-dose palliative RT for advanced NSCLC compares favorably with the cost effectiveness of other forms of treatment for NSCLC, of treatments of other forms of cancer, and of many other commonly used medical interventions; and lies within the US $50, 000/QALY benchmark often cited for cost-effective care.
A bylaw to regulate the contamination of the environment by tobacco smoke was introduced in the Capital Regional District, Victoria, British Columbia as of January 1st, 1991. This smoking control bylaw rigorously limits smoking in all public premises and restricts size, ventilation and location of designated smoking areas. As of January 1st, 1992 all workplaces in this area have become completely smoke-free. This paper describes the process of developing and implementing a municipal smoking control bylaw. Publicity is essential to raise awareness of the issue and to provide information. Engendering of political and public support and the adoption of an appropriate time line for introduction of the bylaw are also important components of the process. Legislation to control tobacco use has been shown to be an effective component of a comprehensive tobacco reduction strategy. Public health officials are urged to consider the implementation of similar policies to combat the health risks posed by environmental tobacco smoke.
Data collected from lung cancer patients attending the Victoria Clinic of the British Columbia Cancer Agency are used to investigate how resources are rationed in the treatment of non-small-cell lung cancer (NSCLC). An ordered logit model is estimated to analyse empirically the relationship between treatment selection and: tumour stage, size and differentiation; the Feinstein index; Karnofsky performance status (KPS); and the patient's age, gender and marital and smoking status. Implicit rationing is found to occur with respect to all of these factors except the Feinstein index, gender and marital status. With respect to age, KPS and smoker status the main empirical results are: (a) an increase in age from 50 to 85 reduces the expected treatment expenditure by 50-70%, depending on the patient's KPS and smoker status; (b) patients with a KPS less than 80 and of 80, receive 30-46% and 75-85%, respectively, of the expected treatment expenditure for patients with a KPS of 90 or 100, depending on age and smoker status; (c) the expected treatment expenditure for active smokers is about 71-86% of the expenditure for non- or former smokers depending on age and KPS.
Between 1942 and 1978 radiation therapy was given to 362 patients with seminoma of the testis, 40 (11%) of whom had a history of maldescent of either testis. The disease was classified retrospectively according to the extent of the primary tumor, the involvement of the regional lymph nodes and the presence of distant metastases (the TNM system), and the results of treatment were analysed according to the classifications. Among the 275 patients referred for treatment at least 5 years before this analysis the 5-year survival rates were 87% overall, 96% for those with a T1 or T2 (relatively localized) tumour but no evidence of nodal involvement or distant metastases and 62% for the 24 with palpable or distant metastases at the time of clinical presentation. Of the 28 patients in whom the disease recurred 15 were successfully treated. A second primary testicular tumour developed in the contralateral testis of eight patients. The incidence of other cancers was not increased over the expected rate in the general male population of the same age.