Valor de los métodos de seguimiento en el postoperatorio del cáncer de mama / The value of routine follow-up studies in breast cancer

A fin de evaluar la utilidad de los estudios complementarios en el seguimiento de cáncer de mama 108 pacientes con estadio I y II fueron seguidos de acuerdo con un esquema fijo durante los primeros 5 años de postoperatorio. En este período, 14 de ellas tuvieron metástasis a distancia (7 sintomáticas y 7 asintomáticas). Los diferentes exámenes de laboratorio mostraron baja sensibilidad y valor predictivo positivo, y alta especificidad y valor predictivo negativo. El costo de la detección de metástasis en pacientes con ganglios negativos fue de 7 veces mayor que en aquellos con ganglios positivos. No hubo diferencia estadísticamente significativa entre los pacientes con metástasis sintomáticas versus asintomáticas en cuanto al intervalo libre de enfermedad o sobrevida después de la detección dela metástasis. Se concluye que la realización de estudios de laboratorio en el seguimiento del paciente con estadio I y II de cáncer de mama es una forma costosa de detectar unas pocas metástasis asintomáticas, para las cuales no se puede esperar una ventaja terapéutica

Cost-effectiveness in the diagnosis and treatment of carcinoma of unknown primary origin.

Between 2% and 9% of patients with cancer present with metastatic nonsquamous cell carcinoma of unknown primary origin. Traditionally, a series of investigations is undertaken to locate the primary origin of the tumour, although many of these tests are often painful or distressing to patients, unsuccessful in locating the primary site and costly to the health care system. Moreover, even if a tumour is found it usually cannot be treated surgically. However, a small number of cancers of unknown primary origin can be cured, arrested or effectively palliated with systemic treatment. This study compares the costs and outcomes of the current practice of comprehensively searching for the primary tumour with those of an alternative, limited approach that identifies only the primary tumours for which relatively effective systemic therapy exists. Decision trees were constructed for the two diagnostic approaches and their associated therapeutic options. Costs and probabilities were integrated with published data on the survival of patients with each type of cancer. The results indicate that the comprehensive diagnostic strategy may increase 1-year survival rates from 11.0% to 11.5%. On the basis of Ontario cost data it is calculated that the additional costs of a comprehensive search for 1000 patients will range from approximately $2 million to $8 million, depending on the subsequent treatment strategy.