Paddock S.,Rose Li and Associates Inc. |
Brum L.,Rose Li and Associates Inc. |
Sorrow K.,Rose Li and Associates Inc. |
Thomas S.,Rose Li and Associates Inc. |
And 12 more authors.
Concerns about rising health care costs and the often incremental nature of improvements in health outcomes continue to fuel intense debates about 'progress' and 'value' in cancer research. In times of tightening fiscal constraints, it is increasingly important for patients and their representatives to define what constitutes 'value' to them. It is clear that diverse stakeholders have different priorities. Harmonisation of values may be neither possible nor desirable. Stakeholders lack tools to visualise or otherwise express these differences and to track progress in cancer treatments based on variable sets of values. The Patient Access to Cancer care Excellence (PACE) Continuous Innovation Indicators are novel, scientifically rigorous progress trackers that employ a three-step process to quantify progress in cancer treatments: 1) mine the literature to determine the strength of the evidence supporting each treatment; 2) allow users to weight the analysis according to their priorities and values; and 3) calculate Evidence Scores (E-Scores), a novel measure to track progress, based on the strength of the evidence weighted by the assigned value. We herein introduce a novel, flexible value model, show how the values from the model can be used to weight the evidence from the scientific literature to obtain E-Scores, and illustrate how assigning different values to new treatments influences the E-Scores. © the authors; licensee ecancermedicalscience. Source
Simpson Prof. L.A.,Child Policy Research Center |
Peterson L.,University of Pennsylvania |
Lannon C.M.,Agency for Healthcare Research and Quality |
Lannon C.M.,Center for Health Care Quality |
And 5 more authors.
The United States is undertaking a major expansion of comparative effectiveness research, with the potential to achieve systemwide improvements in health care quality, outcomes, and resource allocation. However, to achieve these improvements in children's health and health care, comparative effectiveness research needs to be targeted, designed, conducted, and reported in ways that are responsive to the unique circumstances of children and adolescents. These include clinically important differences in the type and course of disease in children; demographic differences between the overall child and adult population in the United States, such as racial and ethnic makeup; and methodological issues involving study design. Our overarching point is that the base of evidence in pediatrics must not fall even further behind that for the adult population in an era of rapid advancement and funding of comparative effectiveness research. © 2010 Project HOPE-The People-to-People Health Foundation, Inc. Source
Lin C.-H.,National Taiwan University Hospital |
Chuang P.-Y.,Taipei Medical University |
Chiang C.-J.,National Taiwan University |
Lu Y.-S.,National Taiwan University Hospital |
And 8 more authors.
Background. Arapid surge of young-female breast cancer (YFBC) has been observed in Taiwan and other East Asian countries. We recently reported that these cases of YFBC, in contrast to their Western counterparts, are predominantly luminal A subtype. YFBC in Asia may have distinct clinicopathological features and out comes. Methods. Data collected prospectively by participating hospitals were retrieved from the Taiwan Cancer Database. A total of 15,881 women with newly diagnosed stage I-III breast cancer in 2002-2006 were included. The age at diagnosis was categorized into nine 5-year groups (from < 30 years to ≥ 65 years). Clinicopathological variables and patient disease-free survival (DFS) were compared by age group. Results. The rates of stage I, estrogen receptor-positive (ER+), and progesterone receptor-positive breast cancer were higher in the younger patients (< 50 years) than in the older patients (≥ 50 years). Univariate analysis showed that the 40-44 and 45-49 age groups were significantly associated with longer DFS than the other age groups. In the ER+ subgroup, multivariate analysis consistently showed that the 40-44 age group was significantly associated with longer DFS than the other age groups except for the 45-49 age group. In contrast, multivariate analysis of the ER-negative subgroup revealed no significant difference of DFS between the 40-44 age group and other age groups. Conclusion. Emerging YFBC in Taiwan is uniquely associated with favorable pathological features and better outcomes and should not be regarded as the mirror image of its Western counterpart. © AlphaMed Press 2014. Source
Kuo H.-Y.,National Taiwan University Hospital |
Lin Z.-Z.,National Taiwan University Hospital |
Kuo R.,Center for Comparative Effectiveness Research |
Shau W.-Y.,Center for Drug Evaluation |
And 14 more authors.
Background. Many studies have shown that type 2 diabetes mellitus (DM) increases the risk for several types of cancer but not cervical cancer (CC). Although DM and insulin-like growth factor 1 have preclinical and clinical implications for CC, less is known about the prognostic impact of DM on patients with early stage CC. Patients and Methods. We used the nationwide Taiwan Cancer Registry database to collect the characteristics of stage I-IIA cervical cancer patients diagnosed between 2004 and 2008. DM and other comorbidities were retrieved from the National Health Insurance database. Cervical cancer-specific survival (CSS) and overall survival (OS) times of patients according to DM status were estimated using the Kaplan-Meier method. We used a Cox proportional hazards model to calculate adjusted hazard ratios (HRs) for the effects of DM and other risk factors on mortality. Results. A total of 2,946 patients had primary stage I-IIA CC and received curative treatments, and 284 (9.6%) had DM.The 5-year CSS and OS rates for patients with DM were significantly lower than those without DM (CSS: 85.4% vs. 91.5%; OS: 73.9% vs. 87.9%). After adjusting for clinicopathologic variables and comorbidities, DM remained an independent unfavorable prognostic factor for CSS (adjusted HR: 1.46) and OS (adjusted HR: 1.55). Conclusion. In Asian patients with early cervical cancer, DM is an independent unfavorable prognostic factor influ-encing both OS and CSS, even after curative treatments. © Alpha Med Press 2015. Source