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[14th Congress European Association of Urology, Stockholm, Sweden. Therapy of advanced cancer of the bladder]

https://arctichealth.org/en/permalink/ahliterature20778
Source
Urologe A. 1999 Sep;38(5 Suppl):1-8
Publication Type
Conference/Meeting Material
Date
Sep-1999

[Adenocarcinoma of the appendix in Iceland 1990-2009. A population based study].

https://arctichealth.org/en/permalink/ahliterature146374
Source
Laeknabladid. 2011 Oct;97(10):537-42
Publication Type
Article
Date
Oct-2011
Author
Halla Vidarsdottir
Jón Gunnlaugur Jónasson
Pall Helgi Möller
Source
Laeknabladid. 2011 Oct;97(10):537-42
Date
Oct-2011
Language
Icelandic
Geographic Location
Iceland
Publication Type
Article
Keywords
Adenocarcinoma - epidemiology - mortality - secondary - therapy
Adult
Aged
Aged, 80 and over
Appendectomy
Appendiceal Neoplasms - epidemiology - mortality - pathology - therapy
Biopsy
Chemotherapy, Adjuvant
Colectomy
Female
Humans
Iceland - epidemiology
Incidence
Male
Middle Aged
Neoplasm Staging
Retrospective Studies
Survival Analysis
Survival Rate
Time Factors
Treatment Outcome
Abstract
Adenocarcinoma of the appendix is less than 0.5% of all gastrointestinal cancers. The aim of this study was to analyse the incidence, symptoms, pathology and treatment of appendiceal adenocarcinoma in a well defined cohort as well as the prognosis of the patients.
This is a retrospective study on all patients diagnosed with adenocarcinoma of the appendix in Iceland from 1990-2009. Information on epidemiological factors, survival and treatment was collected. All histological material was reviewed. Overall survival was estimated with median follow up of 15 months (range, 0-158).
A total of 22 patients were diagnosed with appendiceal adenocarinoma in the study period (median age 63 yrs, range: 30-88, 50% males). Age-standardized incidence was 0.4/100,000/year. The most common symptom was abdominal pain (n=10). Eight patients had clinical signs of appendicitis. Most patients were diagnosed at operation or at pathological examination but one patient was diagnosed at autopsy. Five patients had an appendectomy and 11 a right hemicolectomy. One patient was not operated on and in three patients only a biopsy was taken. Twelve patients had chemotherapy and seven of them for metastatic disease. Eight patients had adenocarcinoma, seven mucinous adenocarcinoma, three signet ring adenocarcinoma, one mixed goblet cell carcinoid and mucinous adenocarcinoma,one mixed adenocarcinoma and signet ring adenocarcinoma and two a mucinous tumour of unknown malignant potential. In eight cases the tumor originated in adenoma. Most of the patients had a stage IV disease (n=13), three stage III, three stage II and three stage I. Operative mortality was 4.8% (n=1). Disease specific five year survival was 54% but overall five year survival was 44% respectively.
Adenocarcinoma of the appendix is a rare disease. No patients were diagnosed pre-operatively. Over half of the patients presented with stage IV disease.
PubMed ID
21998147 View in PubMed
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Adherence and discontinuation of adjuvant hormonal therapy in breast cancer patients: a population-based study.

https://arctichealth.org/en/permalink/ahliterature127527
Source
Breast Cancer Res Treat. 2012 May;133(1):367-73
Publication Type
Article
Date
May-2012
Author
Annette Wigertz
Johan Ahlgren
Marit Holmqvist
Tommy Fornander
Jan Adolfsson
Henrik Lindman
Leif Bergkvist
Mats Lambe
Author Affiliation
Regional Cancer Centre, Uppsala University Hospital, 751 85 Uppsala, Sweden. Annette.Wigertz@akademiska.se
Source
Breast Cancer Res Treat. 2012 May;133(1):367-73
Date
May-2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Antineoplastic Agents, Hormonal - therapeutic use
Aromatase Inhibitors - therapeutic use
Breast Neoplasms - prevention & control
Chemotherapy, Adjuvant
Female
Humans
Logistic Models
Maintenance Chemotherapy
Medication Adherence - statistics & numerical data
Middle Aged
Multivariate Analysis
Neoplasm Recurrence, Local - prevention & control
Neoplasms, Hormone-Dependent - prevention & control
Sweden
Tamoxifen - therapeutic use
Abstract
Adherence to long-term pharmacological treatment for chronic conditions is often less than optimal. Till date, a limited number of population-based studies have assessed adherence to adjuvant hormonal therapy in breast cancer, a therapy with proven benefits in terms of reductions of recurrence and mortality. We aimed to examine rates of adherence and early discontinuation in Sweden where prescribed medications are subsidized for all residents and made available at reduced out-of-pocket costs. Individual-level data were obtained from Regional Clinical Quality Breast Cancer Registers, the Swedish Prescribed Drug Register, and several other population-based registers. Multivariate logistic regression was used to analyze factors associated with adherence to prescribed medication for a period of 3 years. Between January 1 and December 31, 2005, 1,741 patients in central Sweden were identified with estrogen receptor positive breast cancer, and at least one prescription dispensation of either tamoxifen or an aromatase inhibitor. Of these women, 1,193 (69%) were fully adherent to therapy for 3 years (medication possession ratio of 80% or higher and a maximum of 180 days between refills). During the 3-year follow-up, 215 women (12%) had prematurely discontinued therapy. Adherence was positively associated with younger age, large tumor size, being married, and being born in the Nordic countries, while no clear association was observed with education or income. During the 3 years of follow-up, 31% of women were non-adherent to therapy. Further efforts must be undertaken to promote adherence over the entire recommended treatment period.
PubMed ID
22286315 View in PubMed
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Adherence and persistence with oral adjuvant chemotherapy in older women with early-stage breast cancer in CALGB 49907: adherence companion study 60104.

https://arctichealth.org/en/permalink/ahliterature144428
Source
J Clin Oncol. 2010 May 10;28(14):2418-22
Publication Type
Article
Date
May-10-2010
Author
Ann H Partridge
Laura Archer
Alice B Kornblith
Julie Gralow
Debjani Grenier
Edith Perez
Antonio C Wolff
Xiaofei Wang
Helen Kastrissios
Donald Berry
Clifford Hudis
Eric Winer
Hyman Muss
Author Affiliation
Dana-Farber Cancer Institute, 44 Binney St, Boston, MA 02115, USA. ahpartridge@partners.org
Source
J Clin Oncol. 2010 May 10;28(14):2418-22
Date
May-10-2010
Language
English
Publication Type
Article
Keywords
Administration, Oral
Age Factors
Aged
Aged, 80 and over
Antimetabolites, Antineoplastic - administration & dosage - adverse effects
Breast Neoplasms - drug therapy - mortality - pathology - surgery
Canada
Chemotherapy, Adjuvant
Deoxycytidine - administration & dosage - adverse effects - analogs & derivatives
Drug Administration Schedule
Drug Monitoring - instrumentation
Female
Fluorouracil - administration & dosage - adverse effects - analogs & derivatives
Humans
Kaplan-Meier Estimate
Linear Models
Logistic Models
Mastectomy
Medication Adherence
Micro-Electrical-Mechanical Systems - instrumentation
Neoplasm Staging
Risk assessment
Risk factors
Time Factors
Treatment Outcome
United States
Abstract
Patient adherence is critical in evaluating the effectiveness of an oral therapy. We sought to measure adherence among women randomly assigned to capecitabine in a preplanned substudy of a multicenter clinical trial.
Cancer and Leukemia Group B study CALGB 49907 was a randomly assigned trial comparing standard chemotherapy versus oral chemotherapy with capecitabine in patients age 65 years or older with early-stage breast cancer. We used microelectronic monitoring system (MEMS) caps on participants' capecitabine bottles to record pill bottle openings. Capecitabine was given in two divided daily doses for 14 consecutive days of a 21-day cycle for six cycles. Adherence was calculated as the number of doses taken divided by doses expected, taking into account toxicity-related dosing changes. A participant was defined as adherent if 80% or more of expected doses were recorded by MEMS.
Overall, 161 patients were enrolled. Median age was 71 years (range, 65 to 89 years); 124 patients (83%) persisted with capecitabine to completion of planned protocol therapy. Adherence was 78% across all cycles, and adherence did not vary by cycle (P = .32). Twenty-five percent of participants took fewer than 80% of expected doses and were nonadherent. In a logistic regression model, participants with node-negative disease (P = .01) and mastectomy (P = .01) were more likely to be nonadherent. Adherence was not related to age, tumor stage, or hormone receptor status. Adherence was not significantly associated with relapse-free survival or grade 3 or 4 toxicity.
Most older women with early-stage breast cancer were adherent to short-term oral chemotherapy in a randomized clinical trial. Age was not associated with adherence.
Notes
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PubMed ID
20368559 View in PubMed
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Adherence to clinical practice guidelines for adjuvant chemotherapy for colorectal cancer in a Canadian province: a population-based analysis.

https://arctichealth.org/en/permalink/ahliterature118676
Source
J Oncol Pract. 2012 Jul;8(4):253-9
Publication Type
Article
Date
Jul-2012
Author
Daniel Rayson
Robin Urquhart
Martha Cox
Eva Grunfeld
Geoff Porter
Author Affiliation
Dalhousie University, Halifax, Nova Scotia, Canada. Daniel.rayson@cdha.nshealth.ca
Source
J Oncol Pract. 2012 Jul;8(4):253-9
Date
Jul-2012
Language
English
Publication Type
Article
Keywords
Aged
Chemoradiotherapy, Adjuvant
Chemotherapy, Adjuvant
Colorectal Neoplasms - drug therapy - radiotherapy
Combined Modality Therapy
Delivery of Health Care
Female
Guideline Adherence
Guidelines as Topic
Humans
Male
Middle Aged
Nova Scotia
Abstract
Clinical practice guidelines (CPGs) recommend adjuvant chemotherapy after curative-intent surgery for colorectal cancer (CRC). Studies have shown variable rates of adherence to adjuvant therapy CPGs. This study sought to determine the proportion of patients in Nova Scotia receiving CPG-concordant adjuvant chemotherapy within 12 weeks of surgery for CRC in 2001 to 2005, and to identify factors associated with chemotherapy receipt beyond 12 weeks from surgery or chemotherapy nonreceipt.
Patients with stages IIB or III colon or stages II or III rectal cancer who underwent curative-intent surgery in Nova Scotia were identified through the provincial cancer registry and anonymously linked to 14 administrative health databases. Chart review was conducted to obtain chemotherapy data and reasons for chemotherapy nonreceipt. Logistic regression was used to identify factors independently associated with receipt of chemotherapy and meeting the 12-week benchmark (P
Notes
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PubMed ID
23180992 View in PubMed
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Adherence to treatment guidelines in stage II/III rectal cancer in Alberta, Canada.

https://arctichealth.org/en/permalink/ahliterature132600
Source
Clin Oncol (R Coll Radiol). 2012 Feb;24(1):e9-17
Publication Type
Article
Date
Feb-2012
Author
N Sharaf Eldin
Y. Yasui
A. Scarfe
M. Winget
Author Affiliation
School of Public Health, University of Alberta, Alberta, Canada. marcy.winget@albertahealthservices.ca
Source
Clin Oncol (R Coll Radiol). 2012 Feb;24(1):e9-17
Date
Feb-2012
Language
English
Publication Type
Article
Keywords
Adenocarcinoma - pathology - therapy
Aged
Alberta
Antineoplastic Agents - therapeutic use
Chemotherapy, Adjuvant
Digestive System Surgical Procedures
Female
Guideline Adherence - statistics & numerical data
Humans
Male
Medical Oncology - standards - statistics & numerical data
Middle Aged
Neoadjuvant Therapy
Neoplasm Grading
Neoplasm Staging
Practice Guidelines as Topic - standards
Radiotherapy
Radiotherapy, Adjuvant
Rectal Neoplasms - pathology - therapy
Referral and Consultation
Socioeconomic Factors
Abstract
Evidence suggests that pre- and/or postoperative treatment benefits patients with stage II/III rectal cancer. This study aimed to quantify treatment patterns and adherence to treatment guidelines, and to identify barriers to having a consultation with an oncologist and barriers to receiving treatment in stage II/III rectal cancer, in a publicly funded medical care system.
Patients with surgically treated stage II/III rectal adenocarcinoma, diagnosed from 2002 to 2005 in Alberta, a Canadian province with a population of 3 million, were included. Demographic and treatment information from the Alberta Cancer Registry were linked to data from electronic medical records, hospital discharge data and the 2001 Canadian Census. The study outcomes were 'not having an oncologist consultation' and 'not receiving guideline-based treatment'. The relative risks of the two outcomes in association with patient characteristics were estimated using multivariable log-binomial regression.
Of a total of 910 surgically treated stage II/III rectal adenocarcinoma patients, 748 (82%) had a consultation with an oncologist and 414 (45.5%) received treatment. Pre-/post-surgical treatment modalities and timing varied; 96 (10.5%) received neoadjuvant treatment only, 389 (42.7%) received adjuvant treatment only, 119 (13.1%) received both, and 306 (33.6%) had surgery alone. Factors related to not having a consultation with an oncologist included older age, co-morbidities, cancer stage II and region of residence. Older age was the most significantly associated factor with not receiving treatment (relative risk=2.23; 95% confidence interval: 1.89, 2.64).
Disparities exist in the receipt of treatment in stage II/III rectal cancer. Factors such as age, region of residence and stage should not be barriers to consulting an oncologist to discuss or receive treatment. The reasons for these disparities need to be identified and addressed.
PubMed ID
21802914 View in PubMed
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Adjuvant and neoadjuvant therapy for renal cell carcinoma: a survey of the Society of Urologic Oncology.

https://arctichealth.org/en/permalink/ahliterature127792
Source
Urol Oncol. 2013 Oct;31(7):1316-20
Publication Type
Article
Date
Oct-2013
Author
Conrad M Tobert
Robert G Uzzo
Christopher G Wood
Brian R Lane
Author Affiliation
Spectrum Health Hospital System, Grand Rapids, MI 49546, USA; Michigan State University College of Human Medicine, Grand Rapids, MI 49546, USA.
Source
Urol Oncol. 2013 Oct;31(7):1316-20
Date
Oct-2013
Language
English
Publication Type
Article
Keywords
Canada
Carcinoma, Renal Cell - drug therapy - pathology - surgery
Chemotherapy, Adjuvant
Clinical Trials as Topic - methods
Combined Modality Therapy
Humans
Kidney Neoplasms - drug therapy - pathology - surgery
Medical Oncology - methods - organization & administration
Neoadjuvant Therapy
Nephrectomy
Physician's Practice Patterns - statistics & numerical data
Questionnaires
Societies, Medical
United States
Urology - methods - organization & administration
Abstract
Several systemic agents have been approved for patients with advanced renal cell carcinoma (RCC) and others are in various stages of development. We surveyed members of the Society of Urologic Oncology (SUO) regarding the importance of adjuvant and neoadjuvant systemic therapy for RCC and their participation in such trials.
A survey was sent in October 2010 to 564 U.S. and Canadian members of the SUO and the SUO-Clinical Trials Committee with a valid e-mail address. A total of 136 urologic cancer specialists from a mixture of practice patterns responded to the questionnaire (24% participation rate).
At the time of the study, 75% participated in adjuvant or neoadjuvant treatment protocols, including 75% with adjuvant and 16% with neoadjuvant protocols. There was universal support for continued investigation of agents for adjuvant use in RCC with locoregional metastasis (100%) and nearly universal support for investigation of agents in patients with "high risk" (99%) and "intermediate risk" (91%) localized RCC after nephrectomy. The vast majority of respondents also supported investigation of neoadjuvant therapies in patients with advanced RCC (98%) or locally-advanced RCC (98%), with 70% also supporting neoadjuvant trials in patients with localized RCC. Importantly, 98% of respondents indicated interest in participating in future adjuvant and neoadjuvant trials.
Urologic cancer specialists surveyed in late 2010 demonstrated nearly universal support for trials to investigate the role of neoadjuvant and adjuvant therapies for RCC of all stages. With appropriate patient selection and outcome assessment, this widespread support indicates great potential for future clinical trials which will require the participation of urologic surgeons.
PubMed ID
22264501 View in PubMed
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Adjuvant capecitabine, docetaxel, cyclophosphamide, and epirubicin for early breast cancer: final analysis of the randomized FinXX trial.

https://arctichealth.org/en/permalink/ahliterature129460
Source
J Clin Oncol. 2012 Jan 1;30(1):11-8
Publication Type
Article
Date
Jan-1-2012
Author
Heikki Joensuu
Pirkko-Liisa Kellokumpu-Lehtinen
Riikka Huovinen
Arja Jukkola-Vuorinen
Minna Tanner
Riitta Kokko
Johan Ahlgren
Päivi Auvinen
Outi Paija
Leena Helle
Kenneth Villman
Paul Nyandoto
Greger Nilsson
Marjo Pajunen
Raija Asola
Paula Poikonen
Mika Leinonen
Vesa Kataja
Petri Bono
Henrik Lindman
Author Affiliation
Department of Oncology, Helsinki University Central Hospital, Haartmaninkatu 4, PO Box 180, FIN-00029 Helsinki, Finland. heikki.joensuu@hus.fi
Source
J Clin Oncol. 2012 Jan 1;30(1):11-8
Date
Jan-1-2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antimetabolites, Antineoplastic - administration & dosage
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Breast Neoplasms - chemistry - drug therapy - mortality - pathology - surgery
Carcinoma, Ductal, Breast - drug therapy - pathology
Carcinoma, Lobular - drug therapy - pathology
Chemotherapy, Adjuvant
Cyclophosphamide - administration & dosage
Deoxycytidine - administration & dosage - analogs & derivatives
Disease-Free Survival
Drug Administration Schedule
Epirubicin - administration & dosage
Female
Finland
Fluorouracil - administration & dosage - analogs & derivatives
Follow-Up Studies
Humans
Lymphatic Metastasis
Mastectomy - methods
Middle Aged
Neoplasm Grading
Neoplasm Staging
Prospective Studies
Survival Analysis
Taxoids - administration & dosage
Treatment Outcome
Tumor Markers, Biological - analysis
Abstract
Capecitabine is an active agent in the treatment of breast cancer. It is not known whether integration of capecitabine into an adjuvant regimen that contains a taxane, an anthracycline, and cyclophosphamide improves outcome in early breast cancer.
Women with axillary node-positive or high-risk node-negative breast cancer were randomly assigned to receive either three cycles of docetaxel and capecitabine (TX) followed by three cycles of cyclophosphamide, epirubicin, and capecitabine (CEX; n = 753) or three cycles of docetaxel (T) followed by three cycles of cyclophosphamide, epirubicin, and fluorouracil (CEF; n = 747). The primary end point was recurrence-free survival (RFS).
During a median follow-up time of 59 months, 214 RFS events occurred (local or distant recurrences or deaths; TX/CEX, n = 96; T/CEF, n = 118). RFS was not significantly different between the groups (hazard ratio [HR], 0.79; 95% CI, 0.60 to 1.04; P = .087; 5-year RFS, 86.6% for TX/CEX v 84.1% for T/CEF). Fifty-six patients assigned to TX/CEX died during the follow-up compared with 75 of patients assigned to T/CEF (HR, 0.73; 95% CI, 0.52 to 1.04; P = .080). In exploratory analyses, TX/CEX improved breast cancer-specific survival (HR, 0.64; 95% CI, 0.44 to 0.95; P = .027) and RFS in women with triple-negative disease and in women who had more than three metastatic axillary lymph nodes at the time of diagnosis. We detected little severe late toxicity.
Integration of capecitabine into a regimen that contains docetaxel, epirubicin, and cyclophosphamide did not improve RFS significantly compared with a similar regimen without capecitabine.
Notes
Comment In: J Clin Oncol. 2012 Jan 1;30(1):1-222105825
PubMed ID
22105826 View in PubMed
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Adjuvant Capecitabine in Combination With Docetaxel, Epirubicin, and Cyclophosphamide for Early Breast Cancer: The Randomized Clinical FinXX Trial.

https://arctichealth.org/en/permalink/ahliterature285225
Source
JAMA Oncol. 2017 Jun 01;3(6):793-800
Publication Type
Article
Date
Jun-01-2017
Author
Heikki Joensuu
Pirkko-Liisa Kellokumpu-Lehtinen
Riikka Huovinen
Arja Jukkola-Vuorinen
Minna Tanner
Riitta Kokko
Johan Ahlgren
Päivi Auvinen
Outi Lahdenperä
Sanna Kosonen
Kenneth Villman
Paul Nyandoto
Greger Nilsson
Paula Poikonen-Saksela
Vesa Kataja
Jouni Junnila
Petri Bono
Henrik Lindman
Source
JAMA Oncol. 2017 Jun 01;3(6):793-800
Date
Jun-01-2017
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Capecitabine - administration & dosage
Chemotherapy, Adjuvant - methods - mortality
Cyclophosphamide - administration & dosage
Epirubicin - administration & dosage
Female
Finland - epidemiology
Fluorouracil - administration & dosage
Humans
Middle Aged
Receptors, Estrogen - metabolism
Receptors, Progesterone - metabolism
Sweden - epidemiology
Taxoids - administration & dosage
Treatment Outcome
Triple Negative Breast Neoplasms - drug therapy - mortality
Young Adult
Abstract
Capecitabine is not considered a standard agent in the adjuvant treatment of early breast cancer. The results of this study suggest that addition of adjuvant capecitabine to a regimen that contains docetaxel, epirubicin, and cyclophosphamide improves survival outcomes of patients with triple-negative breast cancer (TNBC).
To investigate the effect of capecitabine on long-term survival outcomes of patients with early breast cancer, particularly in subgroups defined by cancer estrogen receptor (ER) and progesterone receptor (PR) content, and HER2 content (human epidermal growth factor receptor 2).
This is an exploratory analysis of the multicenter FinXX randomized clinical trial that accrued 1500 women in Finland and Sweden between January 27, 2004, and May 29, 2007. About half received 3 cycles of docetaxel followed by 3 cycles of cyclophosphamide, epirubicin, and fluorouracil (T+CEF), while the other half received 3 cycles of docetaxel plus capecitabine followed by 3 cycles of cyclophosphamide, epirubicin, and capecitabine (TX+CEX). Data analysis took place between January 27, 2004, and December 31, 2015.
Recurrence-free survival (RFS).
Following random allocation, 747 women received T+CEF, and 753 women received TX+CEX. Five patients were excluded from the intention-to-treat population (3 had overt distant metastases at the time of randomization; 2 withdrew consent). The median age of the remaining 1495 patients was 53 years at the time of study entry; 157 (11%) had axillary node-negative disease; 1142 (76%) had ER-positive cancer; and 282 (19%) had HER2-positive cancer. The median follow-up time after random allocation was 10.3 years. There was no significant difference in RFS or overall survival between the groups (hazard ratio [HR], 0.88; 95% CI, 0.71-1.08; P?=?.23; and HR, 0.84, 95% CI, 0.66-1.07; P?=?.15; respectively). Breast cancer-specific survival tended to favor the capecitabine group (HR, 0.79; 95% CI, 0.60-1.04; P?=?.10). When RFS and survival of the patients were compared within the subgroups defined by cancer steroid hormone receptor status (ER and/or PR positive vs ER and PR negative) and HER2 status (positive vs negative), TX+CEX was more effective than T+CEF in the subset of patients with TNBC (HR, 0.53; 95% CI, 0.31-0.92; P?=?.02; and HR, 0.55, 95% CI, 0.31-0.96; P?=?.03; respectively).
Capecitabine administration with docetaxel, epirubicin, and cyclophosphamide did not prolong RFS or survival compared with a regimen that contained only standard agents. Patients with TNBC had favorable survival outcomes when treated with the capecitabine-containing regimen in an exploratory subgroup analysis.
clinicaltrials.gov Identifier: NCT00114816.
PubMed ID
28253390 View in PubMed
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Adjuvant chemotherapy (5-fluorouracil and levamisole) in Dukes' B and C colorectal carcinoma. A cost-effectiveness analysis.

https://arctichealth.org/en/permalink/ahliterature22339
Source
Ann Oncol. 1997 Jan;8(1):65-70
Publication Type
Article
Date
Jan-1997
Author
J. Norum
B. Vonen
J A Olsen
A. Revhaug
Author Affiliation
Department of Oncology, University of Tromsø, Norway.
Source
Ann Oncol. 1997 Jan;8(1):65-70
Date
Jan-1997
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antineoplastic Combined Chemotherapy Protocols - economics - therapeutic use
Chemotherapy, Adjuvant - economics
Colorectal Neoplasms - drug therapy - economics - mortality - pathology - surgery
Colostomy
Cost-Benefit Analysis
Female
Fluorouracil - administration & dosage - economics
Follow-Up Studies
Health Care Costs
Humans
Length of Stay - economics
Levamisole - administration & dosage - economics
Male
Middle Aged
Norway - epidemiology
Quality of Life
Research Support, Non-U.S. Gov't
Survival Analysis
Survival Rate
Travel - economics
Abstract
BACKGROUND: Adjuvant chemotherapy (5-fluorouracil, levamisole) is now standard practice in the treatment of Dukes' B and C coloretal carcinoma (CRC), and this has increased the financial burden on health care systems world-wide. PATIENTS AND METHODS: Between 1993 and 1996, 95 patients in northern Norway were included in a national randomised CRC study, and assigned to surgery plus adjuvant chemotherapy or surgery alone. In April 1996, 94 of the patients were evaluable and 82 were still alive. The total treatment costs (hospital stay, surgery, chemotherapy, administrative and travelling costs) were calculated. A questionnaire was mailed to all survivors for assessment of the quality of their lives (QoL) (EuroQol questionnaire, a simple QoL-scale, global QoL-measure of the EORTC QLQ-C30), and 62 of them (76%) responded. RESULTS: Adjuvant chemotherapy in Dukes' B and C CRC raised the total treatment costs by 3,369 pounds. The median QoL was 0.83 (0-1 scale) in both arms. Employing a 5% discount rate and an improved survival of adjuvant therapy ranging from 5% to 15%, we calculated the cost of one gained quality-adjusted life-year (QALY) to be between 4,800 pounds and 16,800 pounds. CONCLUSION: Using a cut-off point level of 20,000 pounds per QALY, adjuvant chemotherapy in CRC appears to be cost-effective only when the improvement in 5-year survival is > or = 5%. Adjuvant chemotherapy does not affect short-term QoL.
PubMed ID
9093709 View in PubMed
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