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  • 1
    Electronic Resource
    Electronic Resource
    Prevention of colorectal cancer: A cost-effectiveness approach to a screening model employing sigmoidoscopy (1998)
    Springer
    Annals of oncology 9 (1998), S. 613-618 
    Details
    ISSN: 1569-8041
    Keywords: colorectal cancer ; screening ; health economy ; cost-effectiveness
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Today, only carcinoma of the bronchus kills more people thancolorectal cancer (CRC). However, CRC is both preventable and curable. InNorway, projects aiming to detect adenomas and early cancers by thescreening of a population aged about 60 years employing sigmoidoscopy havebeen discussed. Materials and methods: In this study, a mathematical model was used toestimate the cost-effectiveness of a screening programme for colorectalpolyps followed by polypectomy. A once-only sigmoidoscopy at age 60 followedby coloscopy in selected risk groups was suggested. Data from theEnglish-language literature, the National Cancer Registry of Norway, andStatistics Norway were included. Norwegian cost data from the NationalHealth Administration were also used. Costs of screening and those relatedto earlier diagnosis, and savings on health care and averted loss inproduction due to prevented CRCs were calculated. Results: The basic cost per patient invited and screened (70%compliance) in the suggested programme was estimated at £81.7 and£116.7, respectively. When gains due to prevented CRCs were included,the figures became £34.5 and £49.2. The cost per life-year savedwas calculated as £2,889. This strongly indicates that screening forthe early detection and prevention of CRC is one of the most cost-effectiveprogrammes in cancer. Conclusions: CRC screening according to the suggested programme appears tobe cost-effective. Clear evidence that screening can reduce mortality from CRCshould convince health-care policy makers that the time has come to encouragescreening for colorectal cancer.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008232729664
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  • 2
    Electronic Resource
    Electronic Resource
    Faith among patients with advanced cancer. A pilot study on patients offered "no more than" palliation (2000)
    Springer
    Supportive care in cancer 8 (2000), S. 110-114 
    Details
    ISSN: 1433-7339
    Keywords: Key words Cancer ; Belief
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Spiritual wellbeing is an important topic in cancer care. Being religious is reported by patients facing dilemmas concerning the quality and meaning of life to be potentially helpful. However, the fear of death may be close to the surface and easily stimulated. The aim of this study was to clarify patients' attitudes to faith. Between February 1998 and February 1999, 20 patients aged 37–74 years and suffering from ten different incurable cancers were enrolled in the study. An interview technique focusing on the topic by way of an open question about faith was employed. The topic was only continued if the patient signalled a clear wish for this. Half the patients had a close relative present during the conversation, and an oncology nurse was present in all cases. Most patients (18, or 90%) intimated that the topic was of interest: 85% responded by saying they believed in God, and 75% reported that they prayed. A quarter (25%) mentioned that they had visited their local Lutheran pastor before their admission to hospital. One patient reported being a Jehovah's Witness and one, a member of the Norwegian Humanistically Ethical Association (HEA). Following the conversation, 4 patients requested a visit from the hospital chaplain, 1 asked for contact with the Salvation Army to be arranged, and 1 wanted to talk to the local leader of HEA. Following the conversation all patients were observed by a nurse, and no raised level of anxiety was reported. Sixteen of the patients died within a median of 18 (1–180) days after the conversation. In conclusion, most patients responded positively to a question about faith. The topic should be addressed in the treatment of patients with advanced disease. However, care must be taken to avoid frightening the patients. Patients' attitudes with regard to what death brings deserve respect.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s005200050024
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  • 3
    Electronic Resource
    Electronic Resource
    Intracavity Fractionated Balloon Brachytherapy in Glioblastoma (1999)
    Springer
    Acta neurochirurgica 141 (1999), S. 127-133 
    Details
    ISSN: 0942-0940
    Keywords: Keywords: Glioblastoma; brachytherapy; radiotherapy; survival.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary  In order to reduce hospitalisation time for patients receiving post-operative radiotherapy a phase I–II study of intracavity balloon brachytherapy was instituted. An indwelling balloon catheter was implanted during the closing phase of the initial operation. Starting on the second or third postoperative day the catheter was afterloaded with a high dose rate isotope via a remotely controlled afterloading system. The treatment consisted of 10–12 fractions over a period of 5–6 days, with each treatment session requiring approximately 15 minutes. No external beam radiation was given.  Forty-four newly diagnosed patients were treated. A total dose of either 60 Gy (33 patients) or 72 Gy (11 patients) was given.  The overall median survival was 11.7 months, (range 2.7–50.9). The treatment was well tolerated and none of the applicators were removed prematurely. The total median hospital stay for this group of patients was significantly reduced compared to more conventional protocols.  This study indicates that intracavity high dose rate balloon brachytherapy can achieve survival rates equivalent to those of conventional radiotherapy and is both cost and time efficient.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s007010050276
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  • 4
    Electronic Resource
    Electronic Resource
    Breast cancer screening by mammography in Norway. Is it cost- effective? (1999)
    Springer
    Annals of oncology 10 (1999), S. 197-203 
    Details
    ISSN: 1569-8041
    Keywords: breast cancer ; cost-effectiveness ; mammography ; screening
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Mammography screening is a promising method for improving prognosis in breast cancer. Patients and methods: In this economic analysis, data from the Norwegian Mammography Project (NMP), the National Health Administration (NMA) and the Norwegian Medical Association (NMA) were employed in a model for cost-effectiveness analysis. According to the annual report of the NMP for 1996, 60,147 women aged 50–69 years had been invited to a two-yearly mammographic screening programme. 46,329 (77%) had been screened and 337 (0.7%) breast cancers had been revealed. The use of breast conserving surgery (BCS) was in this study estimated raised by 17% due to screening, the breast cancer mortality decreased by 30% and the number of life years saved per prevented breast cancer death was calculated 15 years. Results: The cost per woman screened was calculated £75.4, the cost per cancer detected £10,365 and the cost per life year (LY) saved £8,561. A raised frequency of BCS, diagnosis and adjuvant chemotherapy brought two years forward, follow-up costs and costs/savings due to prevented breast cancer deaths were all included in the analysis. A sensitivity analysis documented mammography screening cost-effective in Norway when four to nine years are gained per prevented breast cancer death. Conclusion: Mammography screening in Norway looks cost- effective. Time has come to encourage national screening programmes.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008376608270
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  • 5
    Electronic Resource
    Electronic Resource
    A cost-effectiveness approach to the Norwegian follow-up programme in colorectal cancer (1997)
    Springer
    Annals of oncology 8 (1997), S. 1081-1087 
    Details
    ISSN: 1569-8041
    Keywords: colorectal cancer ; cost-effectiveness ; follow-up
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Today, continued periodic follow-up of patients treated for colorectal cancer (CRC) seems often to be routine because of tradition, rather than its demonstrated value. Recently, the Norwegian Gastrointestinal Cancer Group (NGICG) has recommended a standard surveillance programme in this malignancy. In this protocol patients are suggested followed for four years with CEA monitoring, ultrasound of the liver, chest radiograph and colonoscopy at regular intervals. Material and methods: In this study, the cost-effectiveness of this programme was addressed employing Norwegian cost data and data from the Cancer Registry of Norway. Clinical data from the existing English language literature was used in the analysis. Results: The basic cost of the NGICG recommended programme was £1,232 per patient. Including extended investigation due to suspected relapse in 45% of cases, the figure raised to £1,943 per patient. The cost per life year saved was indicated to £9,525–£16,192. The corresponding cost per quality adjusted life year (QALY) was indicated to £11,476–£19,508. Conclusion: We conclude the NGICG recommended follow-up programme in CRC cost-effective. Excluding CEA monitoring may improve the cost-effectiveness.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008265614183
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  • 6
    Electronic Resource
    Electronic Resource
    Adjuvant chemotherapy (5-fluorouracil and levamisole) in Dukes' B and C colorectal carcinoma. A cost-effectiveness analysis (1997)
    Springer
    Annals of oncology 8 (1997), S. 65-70 
    Details
    ISSN: 1569-8041
    Keywords: adjuvant therapy ; colorectal carcinoma ; cost-effectiveness analysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Adjuvant chemotherapy (5-fluorouracil, levamisole) is nowstandard practice in the treatment of Dukes' B and C coloretal carcinoma(CRC), and this has increased the financial burden on health care systemsworld-wide. Patients and methods: Between 1993 and 1996, 95 patients in northernNorway were included in a national randomised CRC study, and assigned tosurgery plus adjuvant chemotherapy or surgery alone. In April 1996, 94 of thepatients were evaluable and 82 were still alive. The total treatment costs(hospital stay, surgery, chemotherapy, administrative and travelling costs)were calculated. A questionnaire was mailed to all survivors for assessmentof the quality of their lives (QoL) (EuroQol questionnaire, a simpleQoL-scale, global QoL-measure of the EORTC QLQ-C30), and 62 of them(76%) responded. Results: Adjuvant chemotherapy in Dukes' B and C CRC raised the totaltreatment costs by £3,360. The median QoL was 0.83 (0–1 scale) in botharms. Employing a 5% discount rate and an improved survival of adjuvanttherapy ranging from 5% to 15%, we calculated the cost of onegained quality-adjusted life-year (QALY) to be between £4,800 and £16,800. Conclusion: Using a cut-off point level of £20,000 per QALY, adjuvantchemotherapy in CRC appears to be cost-effective only when the improvement in5-year survival is ≥5%. Adjuvant chemotherapy does not affectshort-term QoL.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008265905933
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  • 7
    Electronic Resource
    Electronic Resource
    Quality of life in survivors of Hodgkin's disease (1996)
    Springer
    Quality of life research 5 (1996), S. 367-374 
    Details
    ISSN: 1573-2649
    Keywords: EORTC QLQ-C30 ; Hodgkin's disease ; quality of life
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The great majority of patients with Hodgkin's disease (HD) are successfully treated. However, several reports on treatment sequela have been published. The object of this study was to examine the quality of life (QOL) among survivors of HD focusing on gender and treatment modalities. All patients treated for HD at our oncological unit between 1985 and 1993 (n=55) were registered. In December 1994, 49 survivors were mailed a questionnaire consisting of the EORTC QLQ-C30. Forty-two patients responded (86%). They reported a low frequency of symptoms and a high level of functioning. There was a significant correlation between mantle field irradiation and dyspnoea (p=0.023). Females reported a significantly superior global quality of life (p=0.016) and a lower fatigue score (p=0.040) compared to males. Almost half of the patients reported financial difficulties. To improve QOL among survivors of HD, groups at risk have to be identified. Patients treated with mantle field irradiation and males seems to be at a higher risk. Should the treatment of HD be altered towards less radiotherapy and more chemotherapy?
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00433921
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