Philadelphia, PA, United States
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Stopeck A.,Arizona Cancer Center | Rader M.,Nyack Hospital | Henry D.,Joan Karnell Cancer Center | Danese M.,Outcomes Insights Inc | And 5 more authors.
Journal of Medical Economics | Year: 2012

Objective: With increasing healthcare resource constraints, it has become important to understand the incremental cost-effectiveness of new medicines. Subcutaneous denosumab is superior to intravenous zoledronic acid (ZA) for the prevention of skeletal-related events (SREs) in patients with advanced solid tumors and bone metastases. This study sought to determine the lifetime cost-effectiveness of denosumab vs ZA in this setting, from a US managed-care perspective. Methods: A lifetime Markov model was developed, with relative rate reductions in SREs for denosumab vs ZA derived from three pivotal Phase 3 trials involving patients with castration-resistant prostate cancer (CRPC), breast cancer, and non-small-cell lung cancer (NSCLC), and bone metastases. The real-world SRE rates in ZA-treated patients were derived from a large commercial database. SRE and treatment administration quality-adjusted life year (QALY) decrements were estimated with time-trade-off studies. SRE costs were estimated from a nationally representative commercial claims database. Drug, drug administration, and renal monitoring costs were included. Costs and QALYs were discounted at 3 annually. One-way and probabilistic sensitivity analyses were conducted. Results: Across tumor types, denosumab was associated with a reduced number of SREs, increased QALYs, and increased lifetime total costs vs ZA. The costs per QALY gained for denosumab vs ZA in CRPC, breast cancer, and NSCLC were $49,405, $78,915, and $67,931, respectively, commonly considered good value in the US. Costs per SRE avoided were $8567, $13,557, and $10,513, respectively. Results were sensitive to drug costs and SRE rates. Limitations: Differences in pain severity and analgesic use favoring denosumab over ZA were not captured. Mortality was extrapolated from fitted generalized gamma function beyond the trial duration. Conclusion: Denosumab is a cost-effective treatment option for the prevention of SREs in patients with advanced solid tumors and bone metastases compared to ZA. The overall value of denosumab is based on superior efficacy, favorable safety, and more efficient administration. © 2012 Informa UK Ltd All rights reserved.


News Article | November 14, 2016
Site: www.prweb.com

Eating Recovery Center, Illinois (ERC Illinois), a trusted provider of comprehensive treatment for eating disorders, announced today the addition of Dr. Lauren Kofod to its clinical leadership team. Dr. Kofod will join the multi-disciplinary team as an Attending Psychiatrist working with adults at ERC Illinois’s Residential and Partial Hospitalization (PHP) programs, as well as Insight’s Residential and PHP Mood and Anxiety disorder treatment programs. Board certified in Psychiatry and Psychosomatic Medicine, Lauren Kofod, M.D., has vast experience in treating eating disorder patients, and has unique expertise in treating co-occurring and co-morbid psychiatric disorders. Prior to ERC, Dr. Kofod served as a psychiatrist at two other eating disorder treatment facilities, Timberline Knolls and The Renfrew Center. She also worked in a private psychiatry practice, focusing on the treatment of mood and anxiety disorders, substance abuse, and adult ADHD. Previously, Dr. Kofod served as a psychiatrist on duty at Hall Mercer Crisis Response in PA, where she was responsible for patient care and teaching residents, and at Joan Karnell Cancer Center in PA, where she served as liaison and team leader for the palliative care team. She also provided psychiatric evaluation and management for patients of the cancer center and their families. Dr. Kofod completed her undergraduate degree at Cornell University where she graduated with a B.A. with distinction in Biological Sciences. She then graduated with a M.D. from the University of Pennsylvania, School of Medicine, and completed her Residency in Adult Psychiatry and Fellowship in Psychosomatic Medicine from the University of Pennsylvania, Department of Psychiatry. In addition, she has had advanced psychotherapy training in the areas of hypnosis, prolonged exposure therapy for post-traumatic stress disorder, and exposure and response prevention for the treatment of obsessive compulsive disorder. “We are pleased to have a renowned expert like Dr. Kofod in the service of our many patients with eating and related disorders,” says Susan McClanahan, PhD, CEDS, Chief Development Officer of ERC Illinois and President and Founder of Insight. “Dr. Kofod will be an instrumental member of our clinical team treating eating disorder patients, as well as patients struggling with mood and anxiety disorders.” ERC Illinois also recently welcomed two other additions to their clinical team: Diana Chu, M.D., a psychiatrist for ERC Illinois’s binge eating treatment and recovery program, and Thomas Hartman, M.D., a child and adolescent psychiatrist specializing in eating, mood and anxiety disorders. For additional information about ERC Illinois and Insight Behavioral Health Centers, call (312) 487-2418, email inquiries(at)insightillinois(dot)com, visit http://www.eatingrecoverycenter.com or http://www.insightbhc.com to speak with a Masters-level clinician. About Eating Recovery Center Eating Recovery Center (ERC) is the only national, vertically integrated, health care system dedicated to the treatment of serious eating and related disorders at any stage of the illness. ERC offers best-in-class treatment programs for all patients, no matter their age or gender, struggling from: anorexia, bulimia, binge eating disorder, eating and weight disorder, unspecified eating disorders, as well as comorbid, co-occurring and dual diagnoses. Led by the world’s leading experts in eating disorder treatment, ERC provides a full spectrum of eating disorder recovery services through an unmatched network of multiple locations across seven states. About Insight Behavioral Health Centers Insight Behavioral Health Centers provides specialized treatment for mood and anxiety disorders at five Chicago, Illinois treatment centers and one center near Austin, Texas. Accredited by the Joint Commission and led by a nationally recognized team of experts across multiple behavioral healthcare disciplines, Insight offers comprehensive, mindfulness-based treatment approaches to support adults, adolescents and families struggling with serious behavioral health concerns.


D'Jaen G.,Virginia Mason Medical Center | Pantanowitz L.,Tufts University | Bower M.,Chelsea and Westminster Hospital | Buskin S.,Public Health Seattle and King County | And 12 more authors.
Clinical Lung Cancer | Year: 2010

Background: Human immunodeficiency virus (HIV)-infected individuals are at increased risk for primary lung cancer (LC). We wished to compare the clinicopathologic features and treatment outcome of HIV-LC patients with HIV-indeterminate LC patients. We also sought to compare behavioral characteristics and immunologic features of HIV-LC patients with HIV-positive patients without LC. Patients and Methods: A database of 75 HIV-positive patients with primary LC in the HAART era was established from an international collaboration. These cases were drawn from the archives of contributing physicians who subspecialize in HIV malignancies. Patient characteristics were compared with registry data from the Surveillance Epidemiology and End Results program (SEER; n = 169,091 participants) and with HIV-positive individuals without LC from the Adult and Adolescent Spectrum of HIV-related Diseases project (ASD; n = 36,569 participants). Results: The median age at HIV-related LC diagnosis was 50 years compared with 68 years for SEER participants (P < .001). HIV-LC patients, like their SEER counterparts, most frequently presented with stage IIIB/IV cancers (77% vs. 70%), usually with adenocarcinoma (46% vs. 47%) or squamous carcinoma (35% vs. 25%) histologies. HIV-LC patients and ASD participants had comparable median nadir CD4+ cell counts (138 cells/μL vs. 160 cells/μL). At LC diagnosis, their median CD4+ count was 340 cells/μL and 86% were receiving HAART. Sixty-three HIV-LC patients (84%) received cancer-specific treatments, but chemotherapy-associated toxicity was substantial. The median survival for both HIV-LC patients and SEER participants with stage IIIB/IV was 9 months. Conclusion: Most HIV-positive patients were receiving HAART and had substantial improvement in CD4+ cell count at time of LC diagnosis. They were able to receive LC treatments; their tumor types and overall survival were similar to SEER LC participants. However, HIV-LC patients were diagnosed with LC at a younger age than their HIV-indeterminate counterparts. Future research should explore how screening, diagnostic and treatment strategies directed toward the general population may apply to HIV-positive patients at risk for LC. Copyright Clearance Center.


Roop C.,Joan Karnell Cancer Center | Piscitelli M.,Joan Karnell Cancer Center | Lynch M.P.,Pennsylvania Hospital
Clinical Journal of Oncology Nursing | Year: 2010

An intervention with the Scored Patient-Generated Subjective Global Assessment was implemented at a community cancer center to identify patients with sarcoma at risk for malnutrition. This population usually is not considered to be at nutritional risk because of young age and the site of diagnosis; however, 60% of patients assessed were at risk for malnutrition or were severely malnourished. Nurses and dietitians should be aware of potential nutritional risk in this population and learn about possible interventions.


PubMed | Joan Karnell Cancer Center
Type: Journal Article | Journal: Clinical journal of oncology nursing | Year: 2010

An intervention with the Scored Patient-Generated Subjective Global Assessment was implemented at a community cancer center to identify patients with sarcoma at risk for malnutrition. This population usually is not considered to be at nutritional risk because of young age and the site of diagnosis; however, 60% of patients assessed were at risk for malnutrition or were severely malnourished. Nurses and dietitians should be aware of potential nutritional risk in this population and learn about possible interventions.


PubMed | Joan Karnell Cancer Center
Type: Journal Article | Journal: Oncology nursing forum | Year: 2011

To examine symptom distress and quality of life (QOL) in newly diagnosed patients with sarcoma receiving chemotherapy.Pilot study; descriptive, quantitative.Urban community cancer center in the northeastern United States.11 newly diagnosed patients with sarcoma.Participants completed the Edmonton Symptom Assessment Scale and the Functional Assessment of Cancer Therapy-General at baseline and on days 1, 15, and 21 of their chemotherapy treatment.Symptom distress and QOL.Fatigue was the most prevalent and pervasive symptom. Anxiety, well-being, lack of appetite, drowsiness, and depression were the most commonly reported symptoms during chemotherapy. QOL was negatively affected. The lowest mean score reported was for functional well-being. Outcome profiles for symptom distress increased over time, whereas QOL profiles decreased over time. Exploratory analyses of age, race, sex, and diagnosis group suggested differences that warrant further study.Overall, increasing symptom distress and reduced QOL over time were reported by patients with sarcoma during chemotherapy. Exploratory analysis by demographic variables and treatment group suggested the need for further research of predictors for symptom distress and QOL.Clinical and research implications included the need for better understanding about symptom distress and QOL predictors in patients with sarcoma, as well as the evaluation of interventions directed to address this populations specific needs.


PubMed | Joan Karnell Cancer Center
Type: Clinical Trial, Phase III | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2011

This study compared denosumab, a fully human monoclonal anti-receptor activator of nuclear factor kappa-B ligand antibody, with zoledronic acid (ZA) for delaying or preventing skeletal-related events (SRE) in patients with advanced cancer and bone metastases (excluding breast and prostate) or myeloma.Eligible patients were randomly assigned in a double-blind, double-dummy design to receive monthly subcutaneous denosumab 120 mg (n = 886) or intravenous ZA 4 mg (dose adjusted for renal impairment; n = 890). Daily supplemental calcium and vitamin D were strongly recommended. The primary end point was time to first on-study SRE (pathologic fracture, radiation or surgery to bone, or spinal cord compression).Denosumab was noninferior to ZA in delaying time to first on-study SRE (hazard ratio, 0.84; 95% CI, 0.71 to 0.98; P = .0007). Although directionally favorable, denosumab was not statistically superior to ZA in delaying time to first on-study SRE (P = .03 unadjusted; P = .06 adjusted for multiplicity) or time to first-and-subsequent (multiple) SRE (rate ratio, 0.90; 95% CI, 0.77 to 1.04; P = .14). Overall survival and disease progression were similar between groups. Hypocalcemia occurred more frequently with denosumab. Osteonecrosis of the jaw occurred at similarly low rates in both groups. Acute-phase reactions after the first dose occurred more frequently with ZA, as did renal adverse events and elevations in serum creatinine based on National Cancer Institute Common Toxicity Criteria for Adverse Events grading.Denosumab was noninferior (trending to superiority) to ZA in preventing or delaying first on-study SRE in patients with advanced cancer metastatic to bone or myeloma. Denosumab represents a potential novel treatment option with the convenience of subcutaneous administration and no requirement for renal monitoring or dose adjustment.

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