RESUMO
Locoregional and distant metastases account for most cases of morbidity and mortality associated with melanoma. In addition, local recurrences of melanoma might be the onset of disseminated disease. Therefore, precise diagnosis and therapy are warranted to minimize morbidity and increase survival in a subset of patients. However, the correct distribution of the metastatic lesions on the skin is often difficult to estimate. We present the application of noncontrast-enhanced 3-Tesla MRI using surface coil to detect locoregional cutaneous metastases of malignant melanoma on the basis of the topographic assessment of skin lesions. Furthermore, in a systematic review, we summarize the current knowledge about application of MRI in assessment of location, distribution, and depth of cutaneous primary malignant melanoma. MRI might be applied to evaluate the location, distribution, size, and depth of the locoregional cutaneous metastasis of malignant melanoma to identify the optimal cost-effective treatment strategies and monitor their effects.
Assuntos
Melanoma , Neoplasias Cutâneas , Humanos , Imageamento por Ressonância Magnética , Melanoma/patologia , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/secundário , Melanoma Maligno CutâneoRESUMO
As melanoma is one of the leading cancers in average years of life lost per death from disease, screening and early diagnosis are imperative to decrease morbidity and mortality. Socioeconomic status (SES) has been shown to be associated with melanoma incidence. However, it is unclear if this association holds true in universal healthcare systems where screening, diagnostic, and treatment services are available to all patients. The objective of this systematic review was to evaluate the evidence on the association of SES and melanoma incidence in Canada. A comprehensive search of PubMed and EMBASE yielded 7 studies reporting on melanoma incidence or outcomes with respect to SES in Canada. High SES was associated with increased melanoma incidence across all studies, which encompassed all Canadian provinces, and time periods spanning from 1979 to 2012. Studies also reported an increasing incidence of melanoma over time. There were substantial discrepancies in melanoma incidence across Canadian provinces, after controlling for SES and demographic characteristics. Populations of lower SES and living within certain healthcare regions had increased risks of advanced melanoma at diagnosis. This review highlights the potential for inequities in access to care even within a universal healthcare system. Future research is needed to characterize specific risk factors within different patient groups and within the universal health system context in order to implement targeted strategies to lower melanoma incidence, morbidity, and mortality.
Assuntos
Melanoma/epidemiologia , Neoplasias Cutâneas/epidemiologia , Classe Social , População Urbana/estatística & dados numéricos , Canadá/epidemiologia , Acessibilidade aos Serviços de Saúde , Disparidades em Assistência à Saúde , Humanos , Incidência , Melanoma/diagnóstico , Melanoma/patologia , Estadiamento de Neoplasias , População Rural/estatística & dados numéricos , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/secundárioRESUMO
AIM: Real-world data inform the outcome comparisons and help the development of new therapeutic strategies. To this end, we aimed to describe the full characteristics and outcomes in the Epidemiological Strategy and Medical Economics (ESME) cohort, a large national contemporary observational database of patients with metastatic breast cancer (MBC). METHODS: Women aged ≥18 years with newly diagnosed MBC and who initiated MBC treatment between January 2008 and December 2016 in one of the 18 French Comprehensive Cancer Centers (N = 22,109) were included. We assessed the full patients' characteristics, first-line treatments, overall survival (OS) and first-line progression-free survival, as well as updated prognostic factors in the whole cohort and among the 3 major subtypes: hormone receptor positive and HER2-negative (HR+/HER2-, n = 13,656), HER2-positive (HER2+, n = 4017) and triple-negative (n = 2963) tumours. RESULTS: The median OS of the whole cohort was 39.5 months (95% confidence interval [CI], 38.7-40.3). Five-year OS was 33.8%. OS differed significantly between the 3 subtypes (p < 0.0001) with a median OS of 43.3 (95% CI, 42.5-44.5) in HR+/HER2-; 50.1 (95% CI, 47.6-53.1) in HER2+; and 14.8 months (95% CI, 14.1-15.5) in triple-negative subgroups, respectively. Beyond performance status, the following variables had a constant significant negative prognostic impact on OS in the whole cohort and among subtypes: older age at diagnosis of metastases (except for the triple-negative subtype), metastasis-free interval between 6 and 24 months, presence of visceral metastases and number of metastatic sites ≥ 3. CONCLUSIONS: The ESME program represents a unique large-scale real-life cohort on MBC. This study highlights important situations of high medical need within MBC patients. DATABASE REGISTRATION: clinicaltrials.gov Identifier NCT032753.
Assuntos
Neoplasias Abdominais/mortalidade , Neoplasias Ósseas/mortalidade , Neoplasias Encefálicas/mortalidade , Neoplasias da Mama/mortalidade , Metástase Linfática , Neoplasias Cutâneas/mortalidade , Neoplasias Abdominais/prevenção & controle , Neoplasias Abdominais/secundário , Adolescente , Adulto , Fatores Etários , Idoso , Neoplasias Ósseas/prevenção & controle , Neoplasias Ósseas/secundário , Neoplasias Encefálicas/prevenção & controle , Neoplasias Encefálicas/secundário , Mama/patologia , Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Intervalo Livre de Doença , Feminino , França/epidemiologia , Humanos , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , Prognóstico , Intervalo Livre de Progressão , Receptor ErbB-2/análise , Receptor ErbB-2/metabolismo , Receptores de Estrogênio/análise , Receptores de Estrogênio/metabolismo , Receptores de Progesterona/análise , Receptores de Progesterona/metabolismo , Estudos Retrospectivos , Neoplasias Cutâneas/prevenção & controle , Neoplasias Cutâneas/secundário , Adulto JovemRESUMO
BACKGROUND: Post-approval research or monitoring is important to determine real-world safety of new products; however, evidence is scant for vemurafenib in Japanese patients. In Japan, a unique system is officially obligated to investigate post-approval safety. Here we report the first adverse drug reaction (ADR) data from vemurafenib-treated Japanese patients with metastatic melanoma. Data were collected in an early post-marketing phase vigilance (EPPV) study. METHODS: ADRs were events for which a causal relationship with vemurafenib could not be ruled out or was unknown. ADR data were collected for patients treated with vemurafenib (960 mg bid) between 26 February and 25 August 2015. RESULTS: Among 95 patients, 46 patients had 118 ADRs (24 serious ADRs in 13 patients). The most common serious ADRs were hypersensitivity (n = 1; 3 events), arthralgia (n = 2; 2 events), pyrexia (n = 2; 2 events) and drug eruption (n = 2; 2 events). Seven patients had serious skin disorders or hypersensitivity, six of whom had prior anti-programmed cell death-1 (PD-1) antibodies 5-35 days before starting vemurafenib. ADR reports of serious skin disorders appeared to be collected more rapidly than previously reported. Cutaneous squamous cell carcinoma developed in only one patient. CONCLUSIONS: EPPV in Japanese vemurafenib-treated patients identified no new safety signals. The most serious skin and hypersensitivity ADRs occurred in patients with prior anti-PD-1 exposure. Cutaneous squamous cell carcinoma appeared to be rare in Japanese patients. Further research is needed to clarify whether prior treatment with anti-PD-1 agents or racial differences affect the characteristic profile of cutaneous ADRs in Japanese patients.
Assuntos
Indóis/efeitos adversos , Melanoma/tratamento farmacológico , Vigilância de Produtos Comercializados , Neoplasias Cutâneas/tratamento farmacológico , Sulfonamidas/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/efeitos adversos , Aprovação de Drogas , Indústria Farmacêutica , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Feminino , Seguimentos , Humanos , Masculino , Melanoma/patologia , Pessoa de Meia-Idade , Prognóstico , Neoplasias Cutâneas/secundário , Vemurafenib , Adulto JovemAssuntos
Melanoma/secundário , Terapia de Alvo Molecular/métodos , Proteínas Proto-Oncogênicas B-raf/antagonistas & inibidores , Neoplasias Cutâneas/secundário , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados/efeitos adversos , Anticorpos Monoclonais Humanizados/uso terapêutico , Antineoplásicos Imunológicos/efeitos adversos , Antineoplásicos Imunológicos/uso terapêutico , Ensaios Clínicos Fase III como Assunto , Intervalo Livre de Doença , Quimioterapia Combinada , Feminino , Humanos , Imunoterapia/economia , Imunoterapia/métodos , Ipilimumab/uso terapêutico , Melanoma/tratamento farmacológico , Melanoma/patologia , Melanoma/cirurgia , Pessoa de Meia-Idade , Terapia de Alvo Molecular/economia , Nivolumabe , Proteínas Proto-Oncogênicas B-raf/efeitos dos fármacos , Proteínas Proto-Oncogênicas B-raf/genética , Ensaios Clínicos Controlados Aleatórios como Assunto , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/imunologia , Neoplasias Cutâneas/patologiaAssuntos
Alopecia/prevenção & controle , Antineoplásicos/efeitos adversos , Crioterapia , Couro Cabeludo , Alopecia/induzido quimicamente , Alopecia/psicologia , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/psicologia , Carcinoma/tratamento farmacológico , Carcinoma/prevenção & controle , Carcinoma/psicologia , Carcinoma/secundário , Ensaios Clínicos como Assunto , Crioterapia/efeitos adversos , Crioterapia/economia , Crioterapia/instrumentação , Crioterapia/métodos , Feminino , Folículo Piloso/irrigação sanguínea , Folículo Piloso/metabolismo , Humanos , Estudos Observacionais como Assunto , Qualidade de Vida , Neoplasias Cutâneas/etiologia , Neoplasias Cutâneas/prevenção & controle , Neoplasias Cutâneas/secundário , VasoconstriçãoAssuntos
Tomada de Decisões , Árvores de Decisões , Linfonodos/patologia , Melanoma/diagnóstico , Biópsia de Linfonodo Sentinela/métodos , Neoplasias Cutâneas/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Metástase Linfática/diagnóstico , Masculino , Melanoma/secundário , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Cutâneas/secundário , Adulto Jovem , Melanoma Maligno CutâneoRESUMO
BACKGROUND: There is no standard recommendation for metastatic breast cancer treatment (MBC) after two chemotherapy regimens. Eribulin (Halaven®) has shown a significant improvement in overall survival (OS) in this setting. Its use may however be hampered by its cost, which is up to three times the cost of other standard drugs. We report the clinical outcomes and health care costs of a large series of consecutive MBC patients treated with Eribulin. METHODS: A monocentric retrospective study was conducted at Institut Curie over 1 year (August 2012 to August 2013). Data from patient's medical records were extracted to estimate treatment and outcome patterns, and direct medical costs until the end of treatment were measured. Factors affecting cost variability were identified by multiple linear regressions and factors linked to OS by a multivariate Cox model. RESULTS: We included 87 MBC patients. The median OS was 10.7 months (95%CI = 8.0-13.3). By multivariate Cox analysis, independent factors of poor prognosis were an Eastern Cooperative Oncology Group (ECOG) performance status of 3, a number of metastatic sites ≥ 4 and the need for hospitalization. Per-patient costs during whole treatment were 18,694 [CI 95%: 16,028-21,360], and 2581 [CI 95%: 2226-3038] per month. Eribulin administration contributed to 79% of per-patient costs. CONCLUSIONS: Innovative and expensive drugs often appear to be the main cost drivers in cancer treatment, particularly for MBC. There is an urgent need to assess clinical practice benefits.
Assuntos
Antineoplásicos/economia , Neoplasias Ósseas/economia , Neoplasias Encefálicas/economia , Neoplasias da Mama/economia , Custos de Medicamentos , Furanos/economia , Cetonas/economia , Neoplasias Hepáticas/economia , Neoplasias Pulmonares/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/secundário , Neoplasias Encefálicas/tratamento farmacológico , Neoplasias Encefálicas/secundário , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/patologia , Análise Custo-Benefício , Feminino , França , Furanos/uso terapêutico , Humanos , Cetonas/uso terapêutico , Modelos Lineares , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/secundário , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/secundário , Pessoa de Meia-Idade , Análise Multivariada , Metástase Neoplásica , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/economia , Neoplasias Cutâneas/secundário , Taxa de SobrevidaRESUMO
IMPORTANCE: Timely delivery of surgery for cancer affects health care quality and outcomes. However, population-based studies characterizing the delay of surgery for melanoma in the United States have not been performed. OBJECTIVE: To assess the delay of surgery for melanoma by tumor-, patient-, and physician-level characteristics. DESIGN, SETTING, AND PARTICIPANTS: We performed a retrospective cohort study of Medicare beneficiaries diagnosed as having melanoma from January 1, 2000, through December 31, 2009, using the Surveillance, Epidemiology, and End Results-Medicare database. We included all patients undergoing surgical excision of melanoma diagnosed by means of results of skin biopsy. EXPOSURES: Anatomic location and stage of the tumor, patient sociodemographic characteristics, prior melanoma, Elixhauser comorbidities, and the specialties of the physicians who performed the biopsy and surgery. MAIN OUTCOMES AND MEASURES: Surgical delay, measured as the time from the biopsy to surgical excision. We estimated risk-adjusted odds ratios (ORs) and marginal probabilities of delay with 95% CIs for each covariate using mixed-effects logistic regression. RESULTS: Our cohort consisted of 32â¯501 cases of melanoma. Most of the patients were white (95.4%), male (63.1%), married (47.9%), and 75 years or older (60.8%) and did not have a prior melanoma (93.7%). Melanomas were most frequently located on the head and neck (40.5%) and staged as in situ disease (48.2%). More than three-quarters of cases (25 269 [77.7%]) underwent excision within 1.5 months of biopsy. Among those treated after 1.5 months (7232 [22.3%]), 2620 (8.1% of all cases) experienced a delay of longer than 3 months. The incidence of a risk-adjusted surgical delay longer than 1.5 months was significantly increased among patients 85 years or older compared with those younger than 65 years (odds ratio [OR], 1.28 [95% CI, 1.05-1.55]; P = .02), those with a prior melanoma (OR, 1.20 [95% CI, 1.08-1.34]; P = .001), and those with an increased comorbidity burden (OR, 1.18 [95% CI, 1.09-1.27]; P < .001). Melanomas that underwent biopsy and excision by dermatologists had the lowest likelihood of delay (probability, 16% [95% CI, 14%-18%]). The highest likelihood of delay (probability, 31% [95% CI, 24%-37%]) occurred when the biopsy was performed by a nondermatologist and excised by a primary care physician. Similar findings were observed for a delay longer than 3 months. CONCLUSIONS AND RELEVANCE: Approximately 1 in 5 Medicare beneficiaries experience a delay of surgery for melanoma that is longer than 1.5 months. Those patients undergoing biopsy and surgery by dermatologists have the lowest risk for delay, highlighting potential opportunities for improved access to and coordination of dermatologic care.
Assuntos
Neoplasias de Cabeça e Pescoço/cirurgia , Medicare/estatística & dados numéricos , Melanoma/patologia , Melanoma/cirurgia , Recidiva Local de Neoplasia/cirurgia , Segunda Neoplasia Primária/cirurgia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia , Tempo para o Tratamento/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Biópsia/estatística & dados numéricos , Comorbidade , Dermatologia/estatística & dados numéricos , Extremidades , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Masculino , Melanoma/secundário , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Segunda Neoplasia Primária/patologia , Atenção Primária à Saúde/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Programa de SEER , Pele/patologia , Neoplasias Cutâneas/secundário , Cirurgia Plástica/estatística & dados numéricos , Tronco , Estados UnidosRESUMO
Many women diagnosed with breast cancer in low- and middle-income countries (LMICs) present with advanced-stage disease. While cure is not a realistic outcome, site-specific interventions, supportive care, and palliative care can achieve meaningful outcomes and improve quality of life. As part of the 5th Breast Health Global Initiative (BHGI) Global Summit, an expert international panel identified thirteen key resource recommendations for supportive and palliative care for metastatic breast cancer. The recommendations are presented in three resource-stratified tables: health system resource allocations, resource allocations for organ-based metastatic breast cancer, and resource allocations for palliative care. These tables illustrate how health systems can provide supportive and palliative care services for patients at a basic level of available resources, and incrementally add services as more resources become available. The health systems table includes health professional education, patient and family education, palliative care models, and diagnostic testing. The metastatic disease management table provides recommendations for supportive care for bone, brain, liver, lung, and skin metastases as well as bowel obstruction. The third table includes the palliative care recommendations: pain management, and psychosocial and spiritual aspects of care. The panel considered pain management a priority at a basic level of resource allocation and emphasized the need for morphine to be easily available in LMICs. Regular pain assessments and the proper use of pharmacologic and non-pharmacologic interventions are recommended. Basic-level resources for psychosocial and spiritual aspects of care include health professional and patient and family education, as well as patient support, including community-based peer support.
Assuntos
Neoplasias da Mama/terapia , Países em Desenvolvimento , Cuidados Paliativos , Alocação de Recursos , Neoplasias Ósseas/secundário , Neoplasias Ósseas/terapia , Neoplasias Encefálicas/secundário , Neoplasias Encefálicas/terapia , Neoplasias da Mama/economia , Neoplasias da Mama/patologia , Neoplasias da Mama/psicologia , Feminino , Pessoal de Saúde/educação , Humanos , Obstrução Intestinal/terapia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/terapia , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/terapia , Metástase Neoplásica , Manejo da Dor , Educação de Pacientes como Assunto , Neoplasias Cutâneas/secundário , Neoplasias Cutâneas/terapia , Espiritualidade , Assistência Terminal/psicologiaAssuntos
Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/secundário , Linfoma Cutâneo de Células T/diagnóstico , Micose Fungoide/patologia , Tomografia por Emissão de Pósitrons , Neoplasias Cutâneas/secundário , Tomografia Computadorizada por Raios X , Fluordesoxiglucose F18 , Humanos , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Compostos RadiofarmacêuticosAssuntos
Papel do Profissional de Enfermagem/psicologia , Cuidados Paliativos/psicologia , Neoplasias Cutâneas/enfermagem , Úlcera Cutânea/enfermagem , Infecção dos Ferimentos/enfermagem , Bandagens , Imagem Corporal , Cuidadores/psicologia , Efeitos Psicossociais da Doença , Exsudatos e Transudatos/microbiologia , Humanos , Invasividade Neoplásica , Odorantes , Manejo da Dor/enfermagem , Papel do Doente , Pele/patologia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/psicologia , Neoplasias Cutâneas/secundário , Úlcera Cutânea/patologia , Úlcera Cutânea/psicologia , Infecção dos Ferimentos/patologia , Infecção dos Ferimentos/psicologiaAssuntos
Avaliação em Enfermagem/métodos , Higiene da Pele , Neoplasias Cutâneas/enfermagem , Neoplasias Cutâneas/secundário , Dermatite Irritante/etiologia , Exsudatos e Transudatos , Família/psicologia , Hemorragia/etiologia , Humanos , Enfermeiros Clínicos/organização & administração , Enfermeiros Clínicos/psicologia , Papel do Profissional de Enfermagem/psicologia , Odorantes , Dor/etiologia , Higiene da Pele/métodos , Higiene da Pele/enfermagem , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/psicologia , Apoio Social , Assistência Terminal/métodosRESUMO
BACKGROUND: High-frequency sonographic imaging has been used for the preoperative evaluation of primary malignant melanoma. In the present study, to identify the usefulness of 30-MHz sonography for determination of the surgical margin and indication for sentinel lymph node biopsy, the correlation between sonometric and histometric tumor thickness was investigated. METHODS: A total of 74 primary melanomas, in patients seen at the dermatology clinic, Shinshu University Hospital, from 1998 to 2006, were evaluated using high-frequency sonographic equipment with two probes (15 MHz and 30 MHz), and tumor thickness was measured using electronic calipers before surgical treatment. All the primary lesions were surgically excised and Breslow's tumor thickness was measured histologically. RESULTS: In 68 melanomas, excluding 2 lesions of melanoma in situ and 4 lesions with poor sonographic images, sonographic and histologic thickness showed good correlation (r = 0.887). Particularly, in 26 melanomas affecting the soles of the feet, sonographic and histologic thickness showed excellent correlation (r = 0.945). Regarding the T categorization, in which T1-T4 are divided at 1, 2, and 4 mm in thickness, the categories determined with sonometry corresponded very well to those determined with histometry. The correspondence was particularly excellent in thinner primary lesions with thickness around 1 mm. We excised almost all these primary melanomas with surgical margins based on the sonometric thickness. In 22 patients with sonometric thickness more than 1 mm, sentinel lymph node biopsy and/or radical lymphadenectomy was performed. CONCLUSION: High-frequency sonography (30-MHz) is very useful in the preoperative prediction of tumor thickness, particularly in thinner primary lesions, which allows us to determine surgical margins and indication for sentinel lymph node biopsy.
Assuntos
Excisão de Linfonodo , Melanoma/diagnóstico por imagem , Seleção de Pacientes , Biópsia de Linfonodo Sentinela , Neoplasias Cutâneas/diagnóstico por imagem , Humanos , Metástase Linfática , Melanoma/secundário , Melanoma/cirurgia , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Neoplasias Cutâneas/secundário , Neoplasias Cutâneas/cirurgia , UltrassonografiaRESUMO
PURPOSE: The aim of this work was to evaluate the incidence of port-site metastasis in patients undergoing laparoscopy for borderline ovarian carcinoma (BOT). METHODS: Twenty-two patients who underwent laparoscopy from 2004 to 2008 for BOT were evaluated retrospectively. RESULTS: In 15 patients an ultraconservative procedure with enucleation of the annexal neoplasia was carried out, while in five (23%) unilateral salpingo-oophorectomy was performed and in two cases (9%) bilateral salpingo-oophorectomy was done. CONCLUSION: The literature data report few cases of port-site metastasis in BOT patients. Residual cutaneous metastases have been reported to occur within 12 months from the first surgery, generally in association with serous histology. In our analysis, we found 17 out of 22 cases of serous BOT, three mucinous and two endometriod. In no case was cutaneous metastasis revealed after an average of 30 months of follow-up.
Assuntos
Laparoscopia/efeitos adversos , Inoculação de Neoplasia , Neoplasias Ovarianas/cirurgia , Neoplasias Cutâneas/secundário , Parede Abdominal , Adolescente , Adulto , Idoso , Cicatriz/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/patologia , Adulto JovemRESUMO
Malignant wounds, caused by the direct invasion of cancer into the skin, occur in cancer patients with primary skin tumours and as cutaneous metastasis in approximately 10% of patients with metastatic internal malignancies. Malignant wounds have a profound impact on patients, family members and health care providers. The assessment of the patient with malignant wounds can be complex and there is no widely accepted, consistent approach. Valid, descriptive survey research methods were used to develop the Malignant Wound Assessment Tool (MWAT). The authors developed two versions of the MWAT: a brief clinical version (MWAT-C) and a more detailed research version (MWAT-R). Domains include clinical wound features, physical effects and emotional and social impacts of the wound. The two tools underwent content and construct validity testing using a Delphi process. An international panel of professionals with clinical or research expertise related to malignant wounds was formed. Panelists participated in two rounds of review for each tool. Development and face validity testing of the MWAT-C and MWAT-R tools through the Delphi process have resulted in tools ready for clinical application and will support clinical and research activities to improve care for patients with this devastating condition.
Assuntos
Técnica Delphi , Cuidados Paliativos , Projetos de Pesquisa , Neoplasias Cutâneas/patologia , Ferimentos e Lesões/patologia , Humanos , Neoplasias Cutâneas/classificação , Neoplasias Cutâneas/secundário , Inquéritos e Questionários/normas , Ferimentos e Lesões/classificaçãoRESUMO
BACKGROUND: This open controlled prospective study aimed at evaluating the medical and economical impact of first line chemotherapy for metastatic breast cancer (MBC). PATIENTS AND METHODS: Two groups of HER +++ MBC patients were compared: 26 were treated by a combination of trastuzumab and paclitaxel in 4 "prescriber" centers (group A) and 19 patients were treated by any chemotherapy without addition of trastuzumab, in 6 control centers (group B). The cost of chemotherapy and related hospitalizations was taken into account during the first 8 cycles. RESULTS: Forty-five patients, mean age 51 years have been included. The objective response rate was significantly higher in group A (42% vs. 6%, P = 0.036). The median overall survival was 17 months longer in the group A (29 vs. 12 months). The median progression free survival rate was 12.2 months longer in the group A (19 vs. 7 months). The 1-year survival rate was 85% in the group A and 47% in the group B. The mean overall care cost was 33.271 euro per patient in group A versus 11.191 euro per patient in group B. The additional cost per saved year of life expressed as the incremental cost-effectiveness ratio is 15.370 euro 2002. CONCLUSION: The related additional cost seems affordable for an European health care system and justifies the recommendation for its use in the subpopulation overexpressing HER2.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/economia , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/economia , Adulto , Idoso , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais Humanizados , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/economia , Neoplasias Ósseas/secundário , Neoplasias da Mama/patologia , Análise Custo-Benefício , Feminino , Humanos , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/economia , Neoplasias Hepáticas/secundário , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/economia , Neoplasias Pulmonares/secundário , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/economia , Estadiamento de Neoplasias , Paclitaxel/administração & dosagem , Prognóstico , Estudos Prospectivos , Receptor ErbB-2/imunologia , Receptor ErbB-2/metabolismo , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/economia , Neoplasias Cutâneas/secundário , Taxa de Sobrevida , Trastuzumab , Resultado do TratamentoAssuntos
Melanoma/patologia , Biópsia de Linfonodo Sentinela , Neoplasias Cutâneas/secundário , Antígenos de Neoplasias/metabolismo , Humanos , Antígeno MART-1 , Melanoma/metabolismo , Melanoma/cirurgia , Antígenos Específicos de Melanoma , Proteínas de Neoplasias/metabolismo , Estadiamento de Neoplasias , Prognóstico , Medição de Risco , Proteínas S100/metabolismo , Neoplasias Cutâneas/metabolismo , Neoplasias Cutâneas/cirurgiaAssuntos
Neoplasias da Próstata/patologia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/secundário , Idoso , Diagnóstico Diferencial , Virilha , Humanos , Masculino , Avaliação em Enfermagem/métodos , Educação de Pacientes como Assunto , Prognóstico , Higiene da Pele/métodos , Higiene da Pele/enfermagem , Neoplasias Cutâneas/enfermagemRESUMO
Probabilistic Boolean Networks, which form a subclass of Markovian Genetic Regulatory Networks, have been recently introduced as a rule-based paradigm for modeling gene regulatory networks. In an earlier paper, we introduced external control into Markovian Genetic Regulatory networks. More precisely, given a Markovian genetic regulatory network whose state transition probabilities depend on an external (control) variable, a Dynamic Programming-based procedure was developed by which one could choose the sequence of control actions that minimized a given performance index over a finite number of steps. The control algorithm of that paper, however, could be implemented only when one had perfect knowledge of the states of the Markov Chain. This paper presents a control strategy that can be implemented in the imperfect information case, and makes use of the available measurements which are assumed to be probabilistically related to the states of the underlying Markov Chain.