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1.
J Natl Compr Canc Netw ; 14(7): 837-47, 2016 07.
Artículo en Inglés | MEDLINE | ID: mdl-27407124

RESUMEN

Key challenges facing the oncology community today include access to appropriate, high quality, patient-centered cancer care; defining and delivering high-value care; and rising costs. The National Comprehensive Cancer Network convened a Work Group composed of NCCN Member Institution cancer center directors and their delegates to examine the challenges of access, high costs, and defining and demonstrating value at the academic cancer centers. The group identified key challenges and possible solutions to addressing these issues. The findings and recommendations of the Work Group were then presented at the Value, Access, and Cost of Cancer Care Policy Summit in September 2015 and multi-stakeholder roundtable panel discussions explored these findings and recommendations along with additional items.


Asunto(s)
Atención a la Salud/métodos , Oncología Médica/normas , Neoplasias/economía , Humanos
2.
J Natl Cancer Inst Monogr ; 2014(48): 76-86, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-25174028

RESUMEN

BACKGROUND: The etiology of mantle cell lymphoma (MCL), a distinctive subtype accounting for 2%-10% of all non-Hodgkin lymphoma, is not known. METHODS: We investigated associations with self-reported medical history, lifestyle, family history, and occupational risk factors in a pooled analysis of 557 patients with MCL and 13766 controls from 13 case-control studies in Europe, North America, and Australia. Odds ratios (ORs) and 95% confidence intervals (CIs) associated with each exposure were examined using multivariate logistic regression models. RESULTS: The median age of the MCL patients was 62 years and 76% were men. Risk of MCL was inversely associated with history of hay fever (OR = 0.63, 95% CI = 0.48 to 0.82), and the association was independent of other atopic diseases and allergies. A hematological malignancy among first-degree relatives was associated with a twofold increased risk of MCL (OR = 1.99, 95% CI = 1.39 to 2.84), which was stronger in men (OR = 2.21, 95% CI = 1.44 to 3.38) than women (OR = 1.61, 95% CI = 0.82 to 3.19). A modestly increased risk of MCL was also observed in association with ever having lived on a farm (OR = 1.40, 95% CI = 1.03 to 1.90). Unlike some other non-Hodgkin lymphoma subtypes, MCL risk was not statistically significantly associated with autoimmune disorders, tobacco smoking, alcohol intake, body mass index, or ultraviolet radiation. CONCLUSIONS: The novel observations of a possible role for atopy and allergy and farm life in risk of MCL, together with confirmatory evidence of a familial link, suggest a multifactorial etiology of immune-related environmental exposures and genetic susceptibility. These findings provide guidance for future research in MCL etiology.


Asunto(s)
Estilo de Vida , Linfoma de Células del Manto/epidemiología , Linfoma de Células del Manto/etiología , Exposición Profesional , Adulto , Anciano , Anciano de 80 o más Años , Australia/epidemiología , Australia/etnología , Estudios de Casos y Controles , Comorbilidad , Europa (Continente)/epidemiología , Europa (Continente)/etnología , Femenino , Historia Antigua , Humanos , Linfoma de Células del Manto/diagnóstico , Persona de Mediana Edad , Estadificación de Neoplasias , América del Norte/epidemiología , América del Norte/etnología , Factores de Riesgo , Adulto Joven
3.
Biol Blood Marrow Transplant ; 19(1): 123-8, 2013 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-22940055

RESUMEN

The purpose of this study was to evaluate the standard outpatient dose of 131-Iodine tositumomab (75 cGy) combined with high-dose carmustine, etoposide, cytarabine, and melphalan (BEAM) followed by autologous stem cell rescue for the treatment of chemotherapy-sensitive relapsed or refractory, or high-risk first complete remission (CR) patients with diffuse large B cell non-Hodgkin's lymphoma (DLBCL). Forty patients with chemotherapy-sensitive persistent or relapsed or high/intermediate or high international prognostic index DLCBL were treated in a phase II trial combining 75 cGy 131-Iodine tositumomab with high-dose BEAM followed by autologous stem cell transplantation. The CR rate after transplantation was 78%, and the overall response rate was 80%. Short-term and long-term toxicities were similar to historical control patients treated with BEAM alone. With a median follow-up of 6 years (range, 3-10 years), the 5-year overall survival (OS) was 72% (95% confidence interval [CI], 55%-83%), and the 5-year progression-free survival (PFS) rate was 70% (95% CI, 53%-82%). The PFS and OS were encouraging in this group of chemotherapy-sensitive persistent, relapsed, or high-risk patients with DLBCL. A follow-up phase III trial with 131-Iodine tositumomab/BEAM vs rituximab/BEAM was planned based on this information.


Asunto(s)
Anticuerpos Monoclonales/administración & dosificación , Antineoplásicos/administración & dosificación , Linfoma de Células B Grandes Difuso/mortalidad , Linfoma de Células B Grandes Difuso/prevención & control , Trasplante de Células Madre , Adulto , Anciano , Anticuerpos Monoclonales/efectos adversos , Antineoplásicos/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Carmustina/administración & dosificación , Carmustina/efectos adversos , Citarabina/administración & dosificación , Citarabina/efectos adversos , Supervivencia sin Enfermedad , Estudios de Seguimiento , Humanos , Masculino , Melfalán/administración & dosificación , Melfalán/efectos adversos , Persona de Mediana Edad , Podofilotoxina/administración & dosificación , Podofilotoxina/efectos adversos , Recurrencia , Tasa de Supervivencia , Trasplante Autólogo
4.
Cancer Causes Control ; 13(7): 647-55, 2002 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-12296512

RESUMEN

OBJECTIVE: To investigate potential associations between diet and adult glioma. METHODS: We conducted a population-based case-control study of adult glioma in eastern Nebraska. Nutrient and food group intakes were estimated for 236 glioma cases and 449 controls using information obtained from a food-frequency questionnaire. RESULTS: After adjusting for potential confounders, inverse associations with risk of adult glioma were observed for intakes of dark yellow vegetables (highest quartile versus lowest: OR = 0.6, Ptrend = 0.03) and beans (OR = 0.4, Ptrend = 0.0003), but no associations were seen for dietary sources of preformed nitrosamines or high-nitrate vegetables. Our nutrient analysis revealed significant inverse associations between risk of adult glioma and dietary intake of pro-vitamin A carotenoids (highest quartile versus lowest: OR = 0.5, Ptrend = 0.005), a-carotene (OR = 0.5, Ptrend = 001), beta-carotene (OR = 0.5, Ptrend = 0.01), dietary fiber (OR=0.6, Ptrend = 0.048) and fiber from beans (OR = 0.5, Ptrend = 0.0002). We observed no significant associations with risk of adult glioma for intakes of other nutrients or compounds including nitrate, nitrite, vitamin C, vitamin E, saturated fat, cholesterol, dietary fiber from grain products, or fiber from fruit and vegetables. CONCLUSION: Our study does not support the N-nitroso compound hypothesis, but suggests potential roles for carotenoids and possibly other phytochemicals in reducing risk of adult glioma.


Asunto(s)
Antioxidantes/administración & dosificación , Neoplasias Encefálicas/epidemiología , Neoplasias Encefálicas/prevención & control , Dieta , Suplementos Dietéticos , Glioma/epidemiología , Glioma/prevención & control , Adulto , Distribución por Edad , Anciano , Estudios de Casos y Controles , Intervalos de Confianza , Ingestión de Energía , Femenino , Humanos , Incidencia , Modelos Logísticos , Masculino , Persona de Mediana Edad , Nebraska/epidemiología , Oportunidad Relativa , Vigilancia de la Población , Probabilidad , Medición de Riesgo , Población Rural , Distribución por Sexo , Encuestas y Cuestionarios
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