-
Examining Lung Cancer Screening Behaviors in the Primary Care Setting: A Mixed Methods Approach
Alvie Ahsan,
Eva Zimmerman,
Elisa Marie Rodriguez,
Christy Widman,
Deborah Oates Erwin,
Frances Georgette Saad-Harfouche,
Martin Christopher Mahoney
Issue:
Volume 7, Issue 1, March 2019
Pages:
1-8
Received:
15 January 2019
Accepted:
16 February 2019
Published:
11 March 2019
Abstract: While the National Lung Screening Trials (NLST) demonstrated the efficacy of low dose chest computed tomography (LDCT) for lung cancer early detection, utilization of LDCT remains suboptimal. The purpose of this formative study was to understand attitudes and beliefs among primary care clinicians regarding LDCT lung cancer screening as well as to assess gaps in knowledge to identify opportunities for reinforcing personalized lung cancer screening that is accessible and evidence-based. A 20-item closed and open-ended interview was conducted with a targeted group of primary care clinicians (38 respondents; 33 physicians and 5 NPs/PAs). Quantitative data were analyzed using descriptive statistics while qualitative data was analyzed thematically. Although 50.0% of clinicians characterized LDCT as “very effective”, only 47.4% of clinicians reported that they frequently or often recommend LDCT as a lung cancer screening tool. Respondents were generally unconcerned with the high rate of false positive test results. The majority of clinicians were referring patients for LDCT based on smoking history, however other factors were also considered (e.g., health status, sex, family history, past medical history, and occupational exposures.) The majority of respondents were knowledgeable about the use of LDCT as a lung screening tool but were unsure about its effectiveness for lung cancer early detection. Some clinicians are recommending patients for LDCT based on factors which are inconsistent with evidence-based guidelines.
Abstract: While the National Lung Screening Trials (NLST) demonstrated the efficacy of low dose chest computed tomography (LDCT) for lung cancer early detection, utilization of LDCT remains suboptimal. The purpose of this formative study was to understand attitudes and beliefs among primary care clinicians regarding LDCT lung cancer screening as well as to a...
Show More
-
Implementation of a New Method to Quantify the Clinical Activity in a Comprehensive Cancer Center
César Muñoz,
Rafael Álvarez,
Jesús Rodriguez,
Lisardo Ugidos,
Enrique Sanz,
Antonio Cubillo
Issue:
Volume 7, Issue 1, March 2019
Pages:
9-12
Received:
9 January 2019
Accepted:
1 March 2019
Published:
21 March 2019
Abstract: There is no generalized way of evaluating clinical care activity in a comprehensive Cancer Center. Time clinical units is the most common procedure worldwide. In a spanish group it has been developed a new system based on the daily real activity of each medical oncologist of his team. In adittion, it has been collected the daily activity from January 2016 to December 2017 of each doctor considering different values (from 1 to 4) depending on the complexity of the activity. Follow up visit of a patient [1], treatment visit [2], Clinical trial visit or Inpatient visit (3) and New Patient First visit (4). Then it was added all the daily values of each medical oncologist. Moreover, the clinical activity of each Oncology Unit changed clearly when it was applied the new method. For example, breast cancer unit change from 24% to 21 % of the global activity, GI Unit from 47% to 49%, Lung Unit from 13% to 14%. In Genitourinary and Gynecological cancer and Prostate tumor units there are no change. These changes draw the different complexity of each Oncology Unit. It was clearly useful to get a better information of the real clinical activity of each team and cancer center. To sum up, this tool can be useful to unifique and compare the different complexity in the clinical activity of Medical Oncology Teams, units and hospitals allocating resources based on this new system.
Abstract: There is no generalized way of evaluating clinical care activity in a comprehensive Cancer Center. Time clinical units is the most common procedure worldwide. In a spanish group it has been developed a new system based on the daily real activity of each medical oncologist of his team. In adittion, it has been collected the daily activity from Janua...
Show More
-
Gefitinib Plus Chemotherapy Versus Cetuximab Plus Chemotherapy in Patients with Advanced Non-small Cell Lung Cancer: A Network Meta-Analysis
Heng Shi,
Zheng Liu,
Babo Zhang,
Shuaifei Ji
Issue:
Volume 7, Issue 1, March 2019
Pages:
13-22
Received:
10 February 2019
Accepted:
11 March 2019
Published:
28 March 2019
Abstract: Recent randomized control trials have revealed the efficacy and safety of gefitinib plus chemotherapy and cetuximab plus chemotherapy on the treatment of advanced non-small cell lung cancer, but little is known about the differences between them lacking of direct evidences. Randomized control trials were selected by formal search of electronic databases (PubMed, Embase, and Cochrane Library) and trials registers on the Internet. This systematic review and meta-analysis is reported in accordance with the Preferred Items for Systematic Reviews and Meta-analysis (PRISMA) Statement and was registered at International Prospective Register of Systematic Reviews. 14 trails were identified finally, with 8 studies about gefitinib plus chemotherapy vs chemotherapy alone and 6 studies about cetuximab plus chemotherapy plus vs chemotherapy alone. For overall survival and progression-free survival, the relative HRs of gefitinib plus chemotherapy vs cetuximab plus chemotherapy were 0.96 (0.81-1.13, p=0.583) and 0.69 (0.45-1.05, p=0.080) on first-line treatment and 1.60 (1.01-2.54, p=0.044) and 0.83 (0.61-1.15, p=0.267) on second-line treatment. For objective response rate and one-year survival rate on first-line treatment, the relative RRs of gefitinib plus chemotherapy vs cetuximab plus chemotherapy were 0.89 (0.69-1.15, p=0.395) and 0.84 (0.72-0.98, p=0.026). For adverse events, the risk of relative RR of leukopenia all grades was 0.73 (0.58-0.91, p=0.006), while other events didn’t exhibit significant differences. Subgroup analysis found that comparing to cetuximab plus chemotherapy, gefitinib plus chemotherapy appeared a better improvement in one-year survival rate of USA advanced NSCLC population [RR=0.83 (0.70-0.99, p=0.042)]. It concluded that, on the treatment of advanced NSCLC patients, the efficacy and safety of gefitinib plus chemotherapy are superior to cetuximab plus chemotherapy on first-line treatment, while the latter may be a better choice as well when it occurs to second-line treatment.
Abstract: Recent randomized control trials have revealed the efficacy and safety of gefitinib plus chemotherapy and cetuximab plus chemotherapy on the treatment of advanced non-small cell lung cancer, but little is known about the differences between them lacking of direct evidences. Randomized control trials were selected by formal search of electronic data...
Show More
-
Clinico-Epidemiological Study of Elderly Breast Cancer in a Developing Country: Egypt
Noha Yehia Ibrahim,
Soha Talima,
Wael Samir Makar
Issue:
Volume 7, Issue 1, March 2019
Pages:
23-27
Received:
11 March 2019
Accepted:
26 April 2019
Published:
30 May 2019
Abstract: Context: The prognosis and treatment outcome in elderly breast cancer is not well known. Aim: To study the prognosis and treatment outcome in elderly breast cancer. Methods and materials: This a retrospective study of breast cancer patients’ ≥70years in the period from January 2005 until December 2010 in Egypt. Kaplan Meir overall survival (OS) analysis and disease-free survival (DFS) were done and they were correlated with different prognostic factors. Results: Among 186 old patients, 139 one were analyzed. The median age was 73.4 years at diagnosis with a mean of 75. Most patients (70.4%) were in the range of 70-74 from urban areas (89.2%) with performance status 1-2 (90.6%) and with ≤ 2 co-morbidity (67.6%). Stage III and IV presented 43.9%. Positive ER and PR was 83.4% and 75.5% respectively. Surgery was done in 77.7% of cases with 62.6% modified radical mastectomy and 15.1% conservative lumpectomy and axillary clearance. Treatment included mostly hormonal treatment (79.9%), radiotherapy (47.5%) and lastly chemotherapy (18.7%). The 5-year OS and DFS were 52% and 53.4% respectively. The median progression free survival (PFS) in metastatic patients was 4 months. The DFS was significantly affected by performance status (PS), tumor stage, and presence of metastasis. (P-value = 0.018, <0.001, 0.003 respectively). Conclusion: the 5-year OS was lower than the developed country. The majority of deaths (55.7%) were not related to breast cancer. Primary tumor stage and metastasis were significant prognostic factor for DFS.
Abstract: Context: The prognosis and treatment outcome in elderly breast cancer is not well known. Aim: To study the prognosis and treatment outcome in elderly breast cancer. Methods and materials: This a retrospective study of breast cancer patients’ ≥70years in the period from January 2005 until December 2010 in Egypt. Kaplan Meir overall survival (OS) ana...
Show More
