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1.
Ann Palliat Med ; 10(10): 10383-10390, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34763484

RESUMO

BACKGROUND: The mortality of malignant tumors in rural areas of China in 2015 was significantly higher than that in city areas (213.6 per 100,000 vs. 191.5 per 100,000), bringing huge economic pressure to individuals and the local community. The comprehensive reform of county-level public hospitals in Yun County has helped patients with critical disease receive appropriate treatment. Therefore, an analysis focused on the epidemiology and disease burden of malignant tumors in Yun County could provide guidance for administrators and health practitioners in other counties. METHODS: This retrospective database study extracted data from the Yun County medical community (including two higher level hospitals: Yun County People's Hospital and Yun County Chinese Medicine Hospital, and 13 township central hospitals) from 1st Jul 2017 to 30th Aug 2020. Patients diagnosed as having a malignant tumor were enrolled and those with abnormal key baseline information were excluded. The epidemiology and disease burden for malignant tumor patients were assessed. RESULTS: A total of 3,792 patients were enrolled, and the most prevalent cancer in 2018 was thyroid (35.4 patients/100,000) and in 2019 this was lung cancer (30.6 patients/100,000). The mean outpatient visits per person for all-cause and tumor-specific visits were 9.99 and 3.94 visits across 2018 and 2019, respectively, and the mean inpatient visits per person in both years were the same at 2.56 visits. Total costs were 14.471 and 20.29 million in 2018 and 2019, respectively, and 71.7% and 73.0% of the total cost were covered by medical insurance over the 2 years. CONCLUSIONS: The medical environment has improved since medical system reform commenced in 2019 in Yun County, and medical insurance has decreased the disease burden for patients and their families significantly.


Assuntos
Efeitos Psicossociais da Doença , Neoplasias , China/epidemiologia , Demografia , Humanos , Neoplasias/epidemiologia , Neoplasias/terapia , Estudos Retrospectivos
2.
Artigo em Inglês | MEDLINE | ID: mdl-34770070

RESUMO

Long-term cancer survivorship care is a crucial component of an efficient healthcare system. For numerous reasons, there has been an increase in the number of cancer survivors; therefore, healthcare decision-makers are tasked with balancing a finite budget with a strong demand for services. Decision-makers require clear and pragmatic interpretation of results to inform resource allocation decisions. For these reasons, the impact and importance of economic evidence are increasing. The aim of the current study was to conduct a systematic review of economic evaluations of long-term cancer survivorship care in Organization for Economic Co-operation and Development (OECD) member countries and to assess the usefulness of economic evidence for decision-makers. A systematic review of electronic databases, including MEDLINE, PubMed, PsycINFO and others, was conducted. The reporting quality of the included studies was appraised using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Each included study's usefulness for decision-makers was assessed using an adapted version of a previously published approach. Overall, 3597 studies were screened, and of the 235 studies assessed for eligibility, 34 satisfied the pre-determined inclusion criteria. We found that the majority of the included studies had limited value for informing healthcare decision-making and conclude that this represents an ongoing issue in the field. We recommend that authors explicitly include a policy statement as part of their presentation of results.


Assuntos
Neoplasias , Organização para a Cooperação e Desenvolvimento Econômico , Análise Custo-Benefício , Tomada de Decisões , Atenção à Saúde , Humanos , Neoplasias/terapia , Sobrevivência
3.
Am J Manag Care ; 27(10): 407-408, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34668668

RESUMO

Patients traveling for cancer treatment often incur financial burdens. The members of the Alliance of Dedicated Cancer Centers should play a role in mitigating housing-associated costs for patients during cancer treatment.


Assuntos
Habitação , Neoplasias , Custos e Análise de Custo , Humanos , Neoplasias/terapia
4.
JCO Glob Oncol ; 7: 1500-1508, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34665667

RESUMO

PURPOSE: Cancer is a growing problem in Africa, and delays in receiving timely cancer care often results in poorer outcomes. The purpose of this study was to identify the patient and health-system factors associated with delayed cancer care in adults living in the Northern Zone of Tanzania. PATIENTS AND METHODS: Between July 2018 and July 2019, we surveyed adult patients presenting to an oncology clinic in Northern Tanzania. Delayed presentation was defined as 12 weeks or longer from initial symptoms to presentation for cancer care. Multivariate logistic regression and adjusted relative risk (aRR) were used to identify factors predicting delayed presentation. RESULTS: Among 244 adult patients with cancer who completed the survey, 78% (n = 191) had delayed presentation. Patient-related factors associated with delayed presentation included lower educational attainment (P = .03), increased travel time (P = .05), lack of cancer knowledge (P < .05), and fear of cancer and cancer treatments (P < .05) on multivariate analysis. On analysis of aRR, patients without private car and those with health insurance had higher risk of delayed presentation (aRR: 1.27; 95% CI, 1.02 to 1.32 and aRR: 1.15; 95% CI, 1.01 to 1.32). There was a strong association with increased number of visits before presentation at the cancer center and delayed presentation (P = .0009). CONCLUSION: Cancer awareness and prevention efforts targeting patients and community-level health care workers are key to reduce delays in cancer care in Northern Tanzania.


Assuntos
Pessoal de Saúde , Neoplasias , Instituições de Assistência Ambulatorial , Humanos , Assistência Médica , Neoplasias/epidemiologia , Neoplasias/terapia , Inquéritos e Questionários , Tanzânia/epidemiologia
5.
J Natl Cancer Inst Monogr ; 2021(57): 3-9, 2021 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-34478510

RESUMO

New models of survivorship care are needed that improve outcomes for the growing number of cancer survivors, address the increasing complexity of their health needs, and deal with the shortage of clinicians and rising costs of this care. Technology can aid the delivery of personalized, stratified survivorship care pathways where the intensity of care, the care setting, and the providers required for that care vary with survivors' needs. Building a cancer data ecosystem of connected data streams that supports and learns from each patient can be used to streamline care, enhance efficiency, reduce costs, and facilitate research. This manuscript describes the input, analytics, and output components of the cancer data ecosystem that must be built and connected and also provides a real-world use case of how such a system could transform care in a large US comprehensive cancer center.


Assuntos
Sobreviventes de Câncer , Neoplasias , Ecossistema , Humanos , Neoplasias/epidemiologia , Neoplasias/terapia , Sobreviventes , Sobrevivência
6.
J Natl Cancer Inst Monogr ; 2021(57): 10-14, 2021 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-34478512

RESUMO

Cancer-related financial hardship is highly prevalent and affects individuals in the setting of cancer care delivery across the survivorship trajectory. Mitigating financial hardship requires multi-level solutions at the policy, payer, health-care system, provider, and individual patient levels. At the highest level, strategies for intervention include enacting policies to improve price transparency and expand insurance coverage. Also needed are implementing systematic screening and financial navigation in cancer care delivery; improving cost communication by provider care teams; developing patient-reported measures that incorporate the multiple, complex dimensions of financial hardship, as reflected in the Economic Strain and Resilience in Cancer tool; and advancing electronic medical record infrastructure to manage data on patient financial hardship. For individual patients, activating their social networks, community resources, and employers provides patient-level support resources to enhance coping. The proposed multi-level approach is needed to overcome financial hardship in the setting of high-quality, high-value cancer care delivery.


Assuntos
Neoplasias , Sobrevivência , Atenção à Saúde , Estresse Financeiro , Humanos , Cobertura do Seguro , Neoplasias/terapia
7.
BMC Cancer ; 21(1): 1036, 2021 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-34530765

RESUMO

BACKGROUND: Optimising the care of individuals with cancer without imposing significant financial burden related to their anticancer treatment is becoming increasingly difficult. The American Society of Clinical Oncology (ASCO) has recommended clinicians discuss costs of cancer care with patients to enhance shared decision-making. We sought information to guide oncologists' discussions with patients about these costs. METHODS: We searched Medline, EMBASE and clinical practice guideline databases from January 2009 to 1 June 2019 for recommendations about discussing the costs of care and financial burden. Guideline quality was assessed with the AGREE-II instrument. RESULTS: Twenty-seven guidelines met our eligibility criteria, including 16 from ASCO (59%). 21 of 27 (78%) guidelines included recommendations about discussion or consideration of treatment costs when prescribing, with information about actual costs in four (15%). Recognition of the risk of financial burden or financial toxicity was described in 81% (22/27) of guidelines. However, only nine guidelines (33%) included information about managing the financial burden. CONCLUSIONS: Current clinical practice guidelines have little information to guide physician-patient discussions about costs of anticancer treatment and management of financial burden. This limits patients' ability to control costs of treatment, and for the healthcare team to reduce the incidence and severity of financial burden. Current guidelines recommend clinician awareness of price variability and high costs of treatment. Clinicians are recommended to explore cost concerns and address financial worries, especially in high risk groups. Future guidelines should include advice on facilitating cost transparency discussions, with provision of cost information and resources.


Assuntos
Comunicação , Efeitos Psicossociais da Doença , Neoplasias/economia , Oncologistas , Relações Médico-Paciente , Guias de Prática Clínica como Assunto/normas , Estresse Financeiro/diagnóstico , Estresse Financeiro/terapia , Custos de Cuidados de Saúde , Humanos , Neoplasias/terapia , Sociedades Médicas
8.
BMC Cancer ; 21(1): 1055, 2021 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-34563142

RESUMO

BACKGROUND: Patient medical out-of-pocket expenses are thought to be rising worldwide yet data describing trends over time is scant. We evaluated trends of out-of-pocket expenses for patients in Australia with one of five major cancers in the first-year after diagnosis. METHODS: Participants from the QSKIN Sun and Health prospective cohort Study with a histologically confirmed breast, colorectal, lung, melanoma, or prostate cancer diagnosed between 2011 and 2015 were included (n = 1965). Medicare claims data on out-of-pocket expenses were analysed using a two-part model adjusted for year of diagnosis, health insurance status, age and education level. Fisher price and quantity indexes were also calculated to assess prices and volumes separately. RESULTS: On average, patients with cancer diagnosed in 2015 spent 70% more out-of-pocket on direct medical expenses than those diagnosed in 2011. Out-of-pocket expenses increased significantly for patients with breast cancer (mean AU$2513 in 2011 to AU$6802 in 2015). Out-of-pocket expenses were higher overall for individuals with private health insurance. For prostate cancer, expenses increased for those without private health insurance over time (mean AU$1586 in 2011 to AU$4748 in 2014) and remained stable for those with private health insurance (AU$4397 in 2011 to AU$5623 in 2015). There were progressive increases in prices and quantities of medical services for patients with melanoma, breast and lung cancer. For all cancers, prices increased for medicines and doctor attendances but fluctuated for other medical services. CONCLUSION: Out-of-pocket expenses for patients with cancer have increased substantially over time. Such increases were more pronounced for women with breast cancer and those without private health insurance. Increased out-of-pocket expenses arose from both higher prices and higher volumes of health services but differ by cancer type. Further efforts to monitor patient out-of-pocket costs and prevent health inequities are required.


Assuntos
Financiamento Pessoal/tendências , Gastos em Saúde/tendências , Neoplasias/economia , Adulto , Fatores Etários , Idoso , Austrália , Neoplasias da Mama/economia , Neoplasias da Mama/terapia , Neoplasias Colorretais/economia , Neoplasias Colorretais/terapia , Custos Diretos de Serviços/tendências , Custos de Medicamentos/tendências , Escolaridade , Honorários Médicos/tendências , Feminino , Financiamento Pessoal/economia , Humanos , Cobertura do Seguro , Seguro Saúde/economia , Seguro Saúde/tendências , Neoplasias Pulmonares/economia , Neoplasias Pulmonares/terapia , Masculino , Melanoma/economia , Melanoma/terapia , Pessoa de Meia-Idade , Neoplasias/terapia , Estudos Prospectivos , Neoplasias da Próstata/economia , Neoplasias da Próstata/terapia , Queensland , Fatores Sexuais , Fatores de Tempo
10.
BMJ Open ; 11(9): e048141, 2021 09 08.
Artigo em Inglês | MEDLINE | ID: mdl-34497081

RESUMO

INTRODUCTION: The combination of biomarkers and drugs is the subject of growing interest both from regulators, physicians and companies. This study protocol of a systematic review is aimed to describe available literature evidences about the cost-effectiveness, cost-utility or net-monetary benefit of the use of biomarkers in solid tumour as tools for customising immunotherapy to identify what further research needs. METHODS AND ANALYSIS: A systematic review of the literature will be carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. PubMed and Embase will be queried from June 2010 to June 2021. The PICOS model will be applied: target population (P) will be patients with solid tumours treated with immune checkpoint inhibitors (ICIs); the interventions (I) will be test of the immune checkpoint predictive biomarkers; the comparator (C) will be any other targeted or non-targeted therapy; outcomes (O) evaluated will be health economic and clinical implications assessed in terms of incremental cost-effectiveness ratio, net health benefit, net monetary benefit, life years gained, quality of life, etc; study (S) considered will be economic evaluations reporting cost-effectiveness analysis, cost-utility analysis, net-monetary benefit. The quality of the evidence will be graded according to Grading of Recommendations Assessment, Development and Evaluation. ETHICS AND DISSEMINATION: This systematic review will assess the cost-effectiveness implications of using biomarkers in the immunotherapy with ICIs, which may help to understand whether this approach is widespread in real clinical practice. This research is exempt from ethics approval because the work is carried out on published documents. We will disseminate this protocol in a related peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42020201549.


Assuntos
Neoplasias , Qualidade de Vida , Biomarcadores , Análise Custo-Benefício , Humanos , Imunoterapia , Neoplasias/terapia , Revisões Sistemáticas como Assunto
11.
JCO Glob Oncol ; 7: 1329-1340, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34473526

RESUMO

PURPOSE: The National Cancer Information System (NCIS) has been operating since 2014, including information reported by health care insurers and providers on people with cancer diagnosed and treated within the Colombian health system. Its main purpose is to identify barriers to an effective access to cancer diagnosis and treatment across the country. We aimed to describe the methodology, scope and results in terms of access to health services with real-world data provided by the NCIS. METHODS: Reporting of all cases of cancer by insurers and providers is mandatory by law. Data gathered include demographic and clinical information about new and old cases of cancer who receive health services. Over the years, the reporting process has been automated and it is currently performed in real time. Data quality is ensured through a standardized data-monitoring process. Access to health services is monitored by quality measures defined by consensus. RESULTS: Since 2015, prevalent cases of invasive cancer have increased from 163,776 to 331,021 in 2020 (increment of 102.12%). Regarding quality measures, the proportion of people staged at diagnosis has increased over the years, especially in breast cancer. Meanwhile, early diagnosis is still concerning for breast and prostate cancer. Time to diagnosis and treatment have not consistently reached the expected goals in breast, cervical, and prostate cancer, whereas they have shown a better level of compliance for stomach and colon and rectum tumors, still not reaching the highest performance. CONCLUSION: The real-world information approach provided by the NCIS may be complementary for cancer control planning in Colombia, emphasizing better management processes of health insurers and providers by identifying barriers for timely access to health care.


Assuntos
Seguro Saúde , Neoplasias , Colômbia , Atenção à Saúde , Serviços de Saúde , Humanos , Sistemas de Informação , Masculino , Neoplasias/diagnóstico , Neoplasias/epidemiologia , Neoplasias/terapia
12.
AIDS Res Hum Retroviruses ; 37(11): 884-892, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34583514

RESUMO

This single-center, retrospective cohort study evaluates whether insurance coverage and Ryan White HIV/AIDS Program assistance are associated with differences in treatment and survival outcomes in Kaposi sarcoma and aggressive non-Hodgkin lymphoma among people with HIV (PWH). Participants were classified as having private, Medicare, Medicaid, or no insurance. Hazard ratios (HRs) for progression and death were estimated using Cox proportional hazards regression models. Propensity score weighting was used to adjust for imbalances in age, ethnicity, and performance status. Among 191 participants, 18% had private insurance, 14% had Medicare, 46% had Medicaid, and 23% were uninsured. Forty-four percent received Ryan White assistance. Participants with Medicare and those without Ryan White assistance were older. Those without Ryan White assistance also had worse performance status. No differences in CD4+ T cell counts, HIV viral loads, highly active antiretroviral therapy adherence, time to treatment, and regimen selection were detected. After adjustment with propensity score weighting, participants without Ryan White assistance had a greater risk of death [adjusted HR 4.06, 95% confidence interval (CI) 1.45-11.41, p = .008] and progression (adjusted HR 3.39, 95% CI 1.43-8.05, p = .006) than those with Ryan White assistance. We conclude that among people with AIDS-defining cancers, those with Medicare and those without Ryan White assistance had higher mortality, possibly due to age and other medical comorbidities. Notably, underinsured PWH who received Ryan White assistance experienced similar outcomes as those with private insurance.


Assuntos
Síndrome de Imunodeficiência Adquirida , Infecções por HIV , Cobertura do Seguro , Neoplasias , Síndrome de Imunodeficiência Adquirida/complicações , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Humanos , Medicare , Neoplasias/complicações , Neoplasias/terapia , Estudos Retrospectivos , Estados Unidos/epidemiologia
13.
Ann Hematol ; 100(11): 2831-2841, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34536088

RESUMO

Since the survival rates of pediatric patients undergoing cancer treatment or hematopoietic stem cell transplantation (HSCT) have increased rapidly in recent decades, the late effects of treatment are now an important focus of patient care. Access to fertility preservation (FP) procedures as well as their financing differs considerably across Europe. However, some countries in Europe have recently changed the legal basis for financing FP procedures; therefore, the implementation of structures is mandatory to give patients access to FP. In this prospective cohort study, we characterized the process for establishing pediatric fertility counseling, including the development of an in-house standard procedure for recommendations regarding FP with potentially gonadotoxic treatment and valuating data from all FP counseling sessions. All data concerning patient characteristics (pubertal status, disease group) and recommendation of FP measures were prospectively collected and adoption of FP measures analyzed. Prior to the establishment of a structured process for FP in our pediatric oncology and stem cell transplantation center, there was no standardized FP counseling. We demonstrate that with the establishment of an inhouse standard procedure, it is possible to give consistent yet individualized FP counseling to approximately 90% of our patients facing gonadotoxic treatment, counseling over 200 patients between 2017 and 2019. This pilot study could potentially be adapted in other pediatric hematology, oncology, and stem cell transplantation centers to allow a more standardized handling of FP counseling for all patients facing gonadotoxic treatment.


Assuntos
Aconselhamento/métodos , Preservação da Fertilidade/métodos , Adolescente , Antineoplásicos/efeitos adversos , Criança , Pré-Escolar , Criopreservação , Feminino , Preservação da Fertilidade/economia , Preservação da Fertilidade/normas , Transplante de Células-Tronco Hematopoéticas , Humanos , Lactente , Infertilidade Feminina/induzido quimicamente , Infertilidade Feminina/etiologia , Infertilidade Feminina/prevenção & controle , Infertilidade Masculina/induzido quimicamente , Infertilidade Masculina/etiologia , Infertilidade Masculina/prevenção & controle , Masculino , Neoplasias/terapia , Recuperação de Oócitos , Ovário/transplante , Estudos Prospectivos , Puberdade , Lesões por Radiação/prevenção & controle , Radioterapia/efeitos adversos , Preservação do Sêmen , Condicionamento Pré-Transplante/efeitos adversos , Adulto Jovem
14.
Curr Oncol ; 28(5): 3649-3658, 2021 09 21.
Artigo em Inglês | MEDLINE | ID: mdl-34590616

RESUMO

Precision medicine in oncology poses unique challenges to the generation of clinical and economic evidence used for cost-effectiveness analyses that can inform health technology assessment. The conduct of randomized controlled trials for biomarker-specific therapies targeted towards small populations has limitations in regard to feasibility, timeliness, and cost. These limitations result in associated challenges for groups involved in the generation of economic evidence to inform treatment-related decision making, including the Committee of Economic Analysis (CEA) at the Canadian Cancer Trials Group (CCTG). We provide a high-level description and vision about the new paradigm of clinical trial design, generation of economic evidence, and novel approaches to economic evaluations necessary in the space of precision medicine in oncology in Canada. The CEA's previous approach to precision medicine, including master protocol designs and single-arm studies, is reviewed. Methods and approaches currently under consideration by the CEA and national collaborators, such as the role of real-world and clinical trial evidence in enabling life-cycle assessment of therapies, are explored. Finally, future initiatives being planned in the space of precision medicine at CCTG, such as the incorporation of correlative studies to identify and test high-performing biomarkers in trials, are discussed.


Assuntos
Neoplasias , Medicina de Precisão , Canadá , Análise Custo-Benefício , Humanos , Neoplasias/terapia , Avaliação da Tecnologia Biomédica
15.
Artigo em Inglês | MEDLINE | ID: mdl-34501835

RESUMO

BACKGROUND: With the increasing burden of cancer worldwide, a need exists to investigate patterns of healthcare utilization and costs. This study aimed to investigate whether the area of residence is associated with the likelihood of a patient receiving treatment at an institution located outside their residing region. This study also analyzed whether medical travel was related to levels of healthcare utilization and costs. METHODS: This study used the 2007 to 2015 National Health Insurance (NHI) claims data. The residing area was categorized into capital area, metropolitan cities, and provincial area. Healthcare utilization was measured based on days of care and costs based on direct, covered medical costs. Chi-square test and analysis of variance (ANOVA) was conducted to investigate the general characteristics of the study population. The relationship between the dependent and independent variables were analyzed using the generalized estimating equation (GEE) model. RESULTS: Of the 64,505 participants included in this study, 19,975 (31.0%) visited medical institutions located outside their residing area. Compared to individuals residing in the capital area, those living in provincial regions (OR 2.202, 95% CI 2.068-2.344) were more likely to visit medical institutions outside their residing area. Healthcare costs were higher in individuals receiving treatment at hospitals located elsewhere (RR 1.054, 95% CI 1.017-1.093). CONCLUSION: Cancer patients residing in provincial areas were likely to visit institutions located outside their residing area for treatment. Medical travel was associated with higher levels of spent healthcare costs. Policies should focus on preventing possible related regional cancer disparity and promoting optimal configuration of cancer services.


Assuntos
Turismo Médico , Neoplasias , Custos de Cuidados de Saúde , Humanos , Programas Nacionais de Saúde , Neoplasias/epidemiologia , Neoplasias/terapia , Aceitação pelo Paciente de Cuidados de Saúde , República da Coreia/epidemiologia
17.
Nat Rev Cancer ; 21(11): 684-685, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34522023
18.
Curr Oncol ; 28(4): 2902-2913, 2021 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-34436020

RESUMO

Over the past decade, there has been a growing development of innovative technologies to treat cancer. Many of these technologies are expensive and not funded by health funds. The present study examined physicians' perceptions of the ethical and clinical aspects of the recommendation and use of unfunded technologies for cancer treatment. This mixed-methods study surveyed 127 oncologists regarding their perceptions toward using unfunded innovative cancer treatment technologies, followed by in-depth interviews with 16 oncologists. Most respondents believed that patients should be offered all treatment alternatives, regardless of their financial situation. However, 59% indicated that they often face dilemmas regarding recommending new unfunded treatments to patients with financial difficulties and without private health insurance. Over a third (38%) stated that they felt uncomfortable discussing the cost of treatment with patients. A predictive model found that physicians facing patients whose medical condition worsened due to an inability to access new treatments, and who expressed the opinion that physicians can assist in locating funding for patients who cannot afford treatments, were more likely to recommend unfunded innovative therapies to patients (F = 5.22, R2 = 0.15, p < 0.001). Subsequent in-depth interviews revealed four key themes: economic considerations in choosing therapy, patient-physician communication, the public healthcare fund, and discussion of treatment costs. Physicians feel a professional commitment to offer patients the best medical care and a moral duty to discuss costs and minimize patients' financial difficulty. There is a need for careful and balanced use of innovative life-prolonging technologies while putting patients at the center of discourse on this complex and controversial issue. It is essential to develop a psychosocial support program for physicians and patients dealing with ethical and psychosocial dilemmas and to set guidelines for oncologists to conduct a comprehensive and collaborative physician-patient discourse regarding all aspects of treatment.


Assuntos
Neoplasias , Oncologistas , Custos de Cuidados de Saúde , Humanos , Neoplasias/terapia , Relações Médico-Paciente , Terapias em Estudo
19.
Int J Mol Sci ; 22(16)2021 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-34445443

RESUMO

Immunotherapy has been a breakthrough in cancer treatment, yet only a subgroup of patients responds to these novel drugs. Parameters such as cytotoxic T-cell infiltration into the tumor have been proposed for the early evaluation and prediction of therapeutic response, demanded for non-invasive, sensitive and longitudinal imaging. We have evaluated the feasibility of X-ray fluorescence imaging (XFI) to track immune cells and thus monitor the immune response. For that, we have performed Monte Carlo simulations using a mouse voxel model. Spherical targets, enriched with gold or palladium fluorescence agents, were positioned within the model and imaged using a monochromatic photon beam of 53 or 85 keV. Based on our simulation results, XFI may detect as few as 730 to 2400 T cells labelled with 195 pg gold each when imaging subcutaneous tumors in mice, with a spatial resolution of 1 mm. However, the detection threshold is influenced by the depth of the tumor as surrounding tissue increases scattering and absorption, especially when utilizing palladium imaging agents with low-energy characteristic fluorescence photons. Further evaluation and conduction of in vivo animal experiments will be required to validate and advance these promising results.


Assuntos
Simulação por Computador , Imunoterapia , Nanopartículas Metálicas , Neoplasias/diagnóstico por imagem , Imagem Óptica/métodos , Tomografia Computadorizada por Raios X/métodos , Animais , Estudos de Viabilidade , Fluorescência , Ouro , Masculino , Camundongos , Camundongos Nus , Método de Monte Carlo , Neoplasias/terapia , Paládio
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