Komorbide brystkræftpatienter kan de tåle behandling? Et registerstudie baseret på Danish Breast Cancer Cooperative Group

Size: px
Start display at page:

Download "Komorbide brystkræftpatienter kan de tåle behandling? Et registerstudie baseret på Danish Breast Cancer Cooperative Group"

Transcription

1 Komorbide brystkræftpatienter kan de tåle behandling? Et registerstudie baseret på Danish Breast Cancer Cooperative Group Lotte Holm Land MD, ph.d. Onkologisk Afd. R. OUH Kræft og komorbiditet - alle skal have del i de gode resultater 6. Marts

2 The impact of comorbidity on breast cancer specific mortality and other cause mortality. Comorbidity and its influence outcome after adjuvant treatment for early breast cancer The influence of specific comorbid conditions on breast cancer specific mortality and non-breast cancer mortality 2 Trine Lembrecht Jørgensen

3 Background Breast cancer is the most frequent malignant disease among women in Denmark. A total of 4,944 women diagnosed in

4 Epidemiology Incidens Dødelighed

5 Background The incidence of breast cancer as well as other chronic diseases increase with age 5

6 Prognostic factors Tumor size and grade Lymph node involvement Hormone receptor status Age at diagnosis Surgery Adjuvant treatment Year of diagnosis Comorbiditet? 6

7 Comorbidity Reasons that comorbidity could influence on prognosis in breast cancer patients Increased mortality due to the comorbid condition Delay of diagnosis Increased toxicity to treatment Suboptimal or no antineoplastic treatment Patients willingness and compliance to treatment Biological interaction 7

8 Comorbidity Guidelines for breast cancer treatment have been developed from randomized clinical trials (RCT) Older patients and patients with comorbidity are excluded from RCTs * Studies suggest that older patients without comorbidity have similar beneficial effect of guideline therapy as patients > 70 years** Majority of studies reported the influence of comorbidity on death from all causes Breast cancer deaths, reflects breast cancer treatment Death from other causes is more likely to be caused by comorbid condition * Bouchardy et al. JCO Muss et al. NEJM 2009 **Houterman et al. Br J Cancer

9 Methods Databases, Registries & Comorbidity index The Danish Breast Cancer Cooperative Group The Danish National patient Registry The Danish Civil Registration system The Danish Register of Causes of Death The Charlson Comorbidity Index 9

10 Study cohort 62,591 women diagnosed with early stage breast cancer in the period , with information on causes of death Median potential follow-up 8.2 years 36% died. (22,282). 16,316 (73%) died of breast cancer and 5,966 (27%) died of other causes. 10

11 Results 5- year OS (%) according to time periods and CCI score 5 year overall survival according to time periods (%) with 95% confidence intervals Charlson Comorbidity Score Diagnostic periods ( ) 55.8 ( ) 53.0 ( ) 42.0 ( ) ( ) 61.5 ( ) 56.9 ( ) 44.7 ( ) ( ) 68.0 ( ) 62.6 ( ) 43.5 ( ) 11

12 Results Multivariate analysis with Hazard Ratio and 95% Confidence Intervals Variable Adjusted HR 95 % CI Breast Cancer Specific Mortality CCI O CCI 1 CCI 2 CCI 3+ Reference Reference Non-Breast Cancer Mortality CCI 0 CCI 1 CCI 2 CCI 3+ Reference Reference All Cause Mortality CCI 0 CCI 1 CCI 2 CCI 3+ Reference Reference *all p-values > *Adjusted for; age, menopausal status, tumour size, nodal status, deep fascia invasion, vascular invasion, histological type and grade, hormone receptor status, year at diagnosis, type of surgery, and allocated adjuvant treatment. 12

13 Cohort with known adjuvant treatment 13

14 OS according to inclusion in DBCG treatment programme 14

15 Results Cumulative breast cancer specific mortality according to type of treatment and CCI score 15

16 Breast cancer specific mortality 16

17 Specific chronic conditions All women diagnosed with breast cancer in Denmark. N= 62,591 Patients with severe comorbidity (CCI = 3+) were excluded. N= 2,189 Charlson comorbidity score 0, 1, and 2. N= 60,402 Patients with no comorbidity (CCI=0). N=39,943 Patients with mild to moderate comorbidity (CCI= 1-2). N= 10,574 17

18 Distribution of comorbid conditions in % for each age category None DM 30 Chronic pulmonary disease 20 Cerebrovascular disease 10 Previous cancer 0 <40 years years years years years 80+ years Dementia 18

19 Distribution of treatment (%) according to specific comorbid conditions Comorbidity Treatment None Congestive heart failure Dementia Previous cancer Chronic pulmonary disease Connective tissue disease (-) Low risk 12,481 (25) 99 (13) 21 (7) 266 (16) 476 (22) 233 (21) Endocrine treatment (E) Chemotherapy +/- E 11,036 (22) 133 (17) 29 (10) 228 (14) 555 (26) 287 (26) 10,440 (21) 20 (3) 8 (3) 113 (7) 272 (13) 153 (14) Unknown 15,871 (32) 534 (68) 231 (80) 1,026 (63) 853 (40) 439 (39) Total 49, ,633 1,987 1,112 19

20 5-year Cumulative mortality in % for specific comorbid conditions 5-year Breast cancer specific mortality in % with 95% CI 5-year Other cause mortality in % with 95% CI None Chronic pulmonary disease Connective tissue disease Previous cancer DM Cerebrovascular disease Congestive heart failure Dementia

21 Results Breast cancer specific cumulative mortality (%) 21

22 Conclusions Patients with high comorbidity score had no improvement in 5 year overall survival over time Comorbidity had a prognostic impact on mortality in terms of breast cancer specific mortality, non-breast cancer mortality and all cause mortality. 22

23 Conclusions Patients enrolled in a DBCG treatment programme had an overall survival about twice that of patients not enrolled Patients with mild to moderate comorbidity (CCI 1-2) recieving chemotherapy had similar risk of breast cancer deaths compared to patients without comorbidity (CCI 0) 23

24 Conclusions Patients with Chronic pulmonary disease and Connective tissue disease, are more likely to have known adjuvant treatment, whereas patients with Congestive heart failure, Dementia and Any tumor are more likely to have treatment unknown. Comorbid conditions such as diabetes and congestive heart failure had an independent influence on breast cancer mortality, compared to other comorbid conditions. 24

25 Perspectives How do we provide optimal breast cancer treatment for the elderly with comorbidity? 25

26 Thanks for your attention! 26

27 27

Characterisation of a Palliative Care Population in a Comprehensive Cancer Centre

Characterisation of a Palliative Care Population in a Comprehensive Cancer Centre Characterisation of a Palliative Care Population in a Comprehensive Cancer Centre Kirstine Skov Benthien, Mie Nordly, Katja Videbæk, Lisbeth Grave Bendixen, Louise Christoffersen, Hans von der Maase, Geana

More information

Maria Iachina, Anders Green, Erik Jakobsen, Anders Mellemgaard, Mark Krasnik, Margreet Lüchtenborg, Henrik Møller

Maria Iachina, Anders Green, Erik Jakobsen, Anders Mellemgaard, Mark Krasnik, Margreet Lüchtenborg, Henrik Møller The effect of different comorbidity groups on the survival of patients with non-small cell lung cancer Maria Iachina, Anders Green, Erik Jakobsen, Anders Mellemgaard, Mark Krasnik, Margreet Lüchtenborg,

More information

This supplementary material has been provided by the authors to give readers additional information about their work.

This supplementary material has been provided by the authors to give readers additional information about their work. SUPPLEMENTAL MATERIAL Table S1. The logistic regression model used to calculate the propensity score. Table S2. Distribution of propensity score among the treat and control groups of the full and matched

More information

La Chemioterapia Adiuvante Dose-Dense. Lo studio GIM 2. Alessandra Fabi

La Chemioterapia Adiuvante Dose-Dense. Lo studio GIM 2. Alessandra Fabi La Chemioterapia Adiuvante Dose-Dense Lo studio GIM 2 Alessandra Fabi San Antonio Breast Cancer Symposium -December 10-14, 2013 GIM 2 study Epirubicin and Cyclophosphamide (EC) followed by Paclitaxel (T)

More information

Analysis of Prostate Cancer at Easter Connecticut Health Network Using Cancer Registry Data

Analysis of Prostate Cancer at Easter Connecticut Health Network Using Cancer Registry Data The 2014 Cancer Program Annual Public Reporting of Outcomes/Annual Site Analysis Statistical Data from 2013 More than 70 percent of all newly diagnosed cancer patients are treated in the more than 1,500

More information

La personalizzazione terapeutica: quanto influisce l età

La personalizzazione terapeutica: quanto influisce l età La personalizzazione terapeutica: quanto influisce l età PierFranco Conte University of Padova Department of Surgery, Oncology and Gastroenterology IOV Istituto Oncologico Veneto I.R.C.C.S. Breast Cancer

More information

Focussing on Inequalities: Variation in breast cancer outcomes with age and deprivation

Focussing on Inequalities: Variation in breast cancer outcomes with age and deprivation Focussing on Inequalities: Variation in breast cancer outcomes with age and deprivation West Midlands Cancer Intelligence Unit ACKNOWLEDGEMENTS ACKNOWLEDGEMENTS Acknowledgements ACKNOWLEDGEMENTS The authors

More information

Prognosis of survival for breast cancer patients

Prognosis of survival for breast cancer patients Prognosis of survival for breast cancer patients Ken Ryder Breast Cancer Unit Data Section Guy s Hospital Patrick Royston, MRC Clinical Trials Unit London Outline Introduce the data and outcomes requested

More information

Management of Postmenopausal Women with T1 ER+ Tumors: Options and Tradeoffs. Case Study. Surgery. Lumpectomy and Radiation

Management of Postmenopausal Women with T1 ER+ Tumors: Options and Tradeoffs. Case Study. Surgery. Lumpectomy and Radiation Management of Postmenopausal Women with T1 ER+ Tumors: Options and Tradeoffs Michael Alvarado, MD Associate Professor of Surgery University of California San Francisco Case Study 59 yo woman with new palpable

More information

GUIDELINES ADJUVANT SYSTEMIC BREAST CANCER

GUIDELINES ADJUVANT SYSTEMIC BREAST CANCER GUIDELINES ADJUVANT SYSTEMIC BREAST CANCER Author: Dr Susan O Reilly On behalf of the Breast CNG Written: December 2008 Agreed at CNG: June 2009 & June 2010 Review due: June 2011 Guidelines Adjuvant Systemic

More information

Early mortality rate (EMR) in Acute Myeloid Leukemia (AML)

Early mortality rate (EMR) in Acute Myeloid Leukemia (AML) Early mortality rate (EMR) in Acute Myeloid Leukemia (AML) George Yaghmour, MD Hematology Oncology Fellow PGY5 UTHSC/West cancer Center, Memphis, TN May,1st,2015 Off-Label Use Disclosure(s) I do not intend

More information

Breast Cancer Screening in Low- and Middle-Income Countries A Framework To Choose Screening Strategies

Breast Cancer Screening in Low- and Middle-Income Countries A Framework To Choose Screening Strategies Breast Cancer Screening in Low- and Middle-Income Countries A Framework To Choose Screening Strategies Richard Wender, MD Session code: www.worldcancercongress.org A Five Step Framework to Guide Screening

More information

Analysis of Population Cancer Risk Factors in National Information System SVOD

Analysis of Population Cancer Risk Factors in National Information System SVOD Analysis of Population Cancer Risk Factors in National Information System SVOD Mužík J. 1, Dušek L. 1,2, Pavliš P. 1, Koptíková J. 1, Žaloudík J. 3, Vyzula R. 3 Abstract Human risk assessment requires

More information

FULL COVERAGE FOR PREVENTIVE MEDICATIONS AFTER MYOCARDIAL INFARCTION IMPACT ON RACIAL AND ETHNIC DISPARITIES

FULL COVERAGE FOR PREVENTIVE MEDICATIONS AFTER MYOCARDIAL INFARCTION IMPACT ON RACIAL AND ETHNIC DISPARITIES FULL COVERAGE FOR PREVENTIVE MEDICATIONS AFTER MYOCARDIAL INFARCTION IMPACT ON RACIAL AND ETHNIC DISPARITIES Niteesh K. Choudhry, MD, PhD Harvard Medical School Division of Pharmacoepidemiology and Pharmacoeconomics

More information

Cancer in Ireland 2013: Annual report of the National Cancer Registry

Cancer in Ireland 2013: Annual report of the National Cancer Registry Cancer in 2013: Annual report of the National Cancer Registry ABBREVIATIONS Acronyms 95% CI 95% confidence interval APC Annual percentage change ASR Age standardised rate (European standard population)

More information

Effect of Risk and Prognosis Factors on Breast Cancer Survival: Study of a Large Dataset with a Long Term Follow-up

Effect of Risk and Prognosis Factors on Breast Cancer Survival: Study of a Large Dataset with a Long Term Follow-up Georgia State University ScholarWorks @ Georgia State University Mathematics Theses Department of Mathematics and Statistics 7-28-2012 Effect of Risk and Prognosis Factors on Breast Cancer Survival: Study

More information

Basics and limitations of adjuvant online an internet based decision tool

Basics and limitations of adjuvant online an internet based decision tool Basics and limitations of adjuvant online an internet based decision tool J. Huober SAKK, Bern 31.10.2013 Univ.-Frauenklinik Ulm Integratives Tumorzentrum des Universitätsklinikums und der Medizinischen

More information

7. Prostate cancer in PSA relapse

7. Prostate cancer in PSA relapse 7. Prostate cancer in PSA relapse A patient with prostate cancer in PSA relapse is one who, having received a primary treatment with intent to cure, has a raised PSA (prostate-specific antigen) level defined

More information

Controversites: Screening for Prostate Cancer in Older Adults

Controversites: Screening for Prostate Cancer in Older Adults Controversites: Screening for Prostate Cancer in Older Adults William Dale, MD, PhD University of Chicago Sections of Geriatrics & Palliative Medicine and Hematology/Oncology Director, Specialized Oncology

More information

Travel Distance to Healthcare Centers is Associated with Advanced Colon Cancer at Presentation

Travel Distance to Healthcare Centers is Associated with Advanced Colon Cancer at Presentation Travel Distance to Healthcare Centers is Associated with Advanced Colon Cancer at Presentation Yan Xing, MD, PhD, Ryaz B. Chagpar, MD, MS, Y Nancy You MD, MHSc, Yi Ju Chiang, MSPH, Barry W. Feig, MD, George

More information

CHILDHOOD CANCER SURVIVOR STUDY Analysis Concept Proposal

CHILDHOOD CANCER SURVIVOR STUDY Analysis Concept Proposal CHILDHOOD CANCER SURVIVOR STUDY Analysis Concept Proposal 1. STUDY TITLE: Longitudinal Assessment of Chronic Health Conditions: The Aging of Childhood Cancer Survivors 2. WORKING GROUP AND INVESTIGATORS:

More information

Types of treatment for breast cancer

Types of treatment for breast cancer Types of treatment for breast cancer Useful information for cancer patients Contents This information is about the main treatments used to treat breast cancer. There are sections on The main treatments

More information

Pathologic Assessment Of The Breast And Axilla After Preoperative Therapy

Pathologic Assessment Of The Breast And Axilla After Preoperative Therapy Pathologic Assessment Of The Breast And Axilla After Preoperative Therapy W. Fraser Symmans, M.D. Associate Professor of Pathology UT M.D. Anderson Cancer Center Pathologic Complete Response (pcr) Proof

More information

Statins and Risk for Diabetes Mellitus. Background

Statins and Risk for Diabetes Mellitus. Background Statins and Risk for Diabetes Mellitus Kevin C. Maki, PhD, FNLA Midwest Center for Metabolic & Cardiovascular Research and DePaul University, Chicago, IL 1 Background In 2012 the US Food and Drug Administration

More information

Trials in Elderly Melanoma Patients (with a focus on immunotherapy)

Trials in Elderly Melanoma Patients (with a focus on immunotherapy) Trials in Elderly Melanoma Patients (with a focus on immunotherapy) Where we were Immunotherapy Trials: past and present Relevance for real world practice Where we are SIOG October 2012 James Larkin FRCP

More information

Randomized trials versus observational studies

Randomized trials versus observational studies Randomized trials versus observational studies The case of postmenopausal hormone therapy and heart disease Miguel Hernán Harvard School of Public Health www.hsph.harvard.edu/causal Joint work with James

More information

Temporal Trends in Demographics and Overall Survival of Non Small-Cell Lung Cancer Patients at Moffitt Cancer Center From 1986 to 2008

Temporal Trends in Demographics and Overall Survival of Non Small-Cell Lung Cancer Patients at Moffitt Cancer Center From 1986 to 2008 Special Report Temporal Trends in Demographics and Overall Survival of Non Small-Cell Lung Cancer Patients at Moffitt Cancer Center From 1986 to 2008 Matthew B. Schabath, PhD, Zachary J. Thompson, PhD,

More information

Breast Cancer Care & Research

Breast Cancer Care & Research Breast Cancer Care & Research Professor John FR Robertson University of Nottingham Nottingham City Hospital Breast Cancer (BC) 15,000 BC deaths in the UK each year 20% female cancer deaths 5% all female

More information

Breast Cancer Educational Program. June 5-6, 2015

Breast Cancer Educational Program. June 5-6, 2015 Breast Cancer Educational Program June 5-6, 2015 Adjuvant Systemic Therapy For Early Breast Cancer: Who, What and for How Long? Debjani Grenier MD, FRCPC Medical Oncologist Disclosures Advisory Board Member:

More information

Advances In Chemotherapy For Hormone Refractory Prostate Cancer. TAX 327 study results & SWOG 99-16 study results presented at ASCO 2004

Advances In Chemotherapy For Hormone Refractory Prostate Cancer. TAX 327 study results & SWOG 99-16 study results presented at ASCO 2004 Ronald de Wit Rotterdam Cancer Institute The Netherlands Advances In Chemotherapy For Hormone Refractory Prostate Cancer TAX 327 study results & SWOG 99-16 study results presented at Slide 1 Prostate Cancer

More information

All. Report BREAST CANCER. A UK analysis of all symptomatic and screen-detected breast cancers diagnosed in 2006

All. Report BREAST CANCER. A UK analysis of all symptomatic and screen-detected breast cancers diagnosed in 2006 All BREAST CANCER Report A UK analysis of all symptomatic and screen-detected breast cancers diagnosed in 2006 West Midlands Cancer Intelligence Unit ACKNOWLEDGEMENTS ACKNOWLEDGEMENTS Acknowledgements

More information

Clinical trial enrollment among older cancer patients

Clinical trial enrollment among older cancer patients Clinical trial enrollment among older cancer patients Sharon H. Giordano MD, MPH Professor, Health Services Research Mariana Chavez Mac Gregor MD, MSc Assistant Professor, Breast Medical Oncology Department

More information

National Breast and Ovarian Cancer Centre and Royal Australasian College of Surgeons

National Breast and Ovarian Cancer Centre and Royal Australasian College of Surgeons National Breast and Ovarian Cancer Centre and Royal Australasian College of Surgeons National Breast Cancer Audit Public Health Monitoring Series 2008 Data Published August 2010 National Breast and Ovarian

More information

Effective Health Care Program

Effective Health Care Program Comparative Effectiveness Review Number 152 Effective Health Care Program Treatment of Nonmetastatic Muscle-Invasive Bladder Cancer Executive Summary Background Nature and Burden of Nonmetastatic Muscle-Invasive

More information

October is Breast Cancer Awareness Month!

October is Breast Cancer Awareness Month! October is Breast Cancer Awareness Month! A STUDY OF CHARACTERISTICS AND MANAGEMENT OF BREAST CANCER IN TAIWAN Eric Kam-Chuan Lau, OMS II a, Jim Yu, OMSII a, Christabel Moy, OMSII a, Jian Ming Chen, MD

More information

Cancer research in the Midland Region the prostate and bowel cancer projects

Cancer research in the Midland Region the prostate and bowel cancer projects Cancer research in the Midland Region the prostate and bowel cancer projects Ross Lawrenson Waikato Clinical School University of Auckland MoH/HRC Cancer Research agenda Lung cancer Palliative care Prostate

More information

FOCUS. Female breast cancer in the elderly; Optimizing Clinical guidelines. USing clinico-pathological and molecular data. Departmentsof Surgery

FOCUS. Female breast cancer in the elderly; Optimizing Clinical guidelines. USing clinico-pathological and molecular data. Departmentsof Surgery FOCUS Female breast cancer in the elderly; Optimizing Clinical guidelines USing clinico-pathological and molecular data Departmentsof Surgery Prof. - Surgery dr. van de Velde Dr. - Gerontology Liefers

More information

Social inequalities impacts of care management and survival in patients with non-hodgkin lymphomas (ISO-LYMPH)

Social inequalities impacts of care management and survival in patients with non-hodgkin lymphomas (ISO-LYMPH) Session 3 : Epidemiology and public health Social inequalities impacts of care management and survival in patients with non-hodgkin lymphomas (ISO-LYMPH) Le Guyader-Peyrou Sandra Bergonie Institut Context:

More information

The Clinical database of DBCG

The Clinical database of DBCG The Clinical database of DBCG (Danish Breast Cancer Cooperative Group) 1977-2008 Susanne Møller DBCG secretariate Copenhagen University Hospital 22. may 2008, SM 1 Number of patients with invasive breast

More information

Breast cancer treatment for elderly women: a systematic review

Breast cancer treatment for elderly women: a systematic review Breast cancer treatment for elderly women: a systematic review Gerlinde Pilkington Rumona Dickson Anna Sanniti Funded by the NCEI and POI Elderly people less likely to receive chemotherapy than younger

More information

Now, there are multiple risk factors that may increase the risk for contralateral second primary breast cancers. Women diagnosed at a young age with a

Now, there are multiple risk factors that may increase the risk for contralateral second primary breast cancers. Women diagnosed at a young age with a Hello. My name is Suzanne Day. I am a nurse practitioner at The University of Texas MD Anderson Cancer Center. I m here today to talk about assessing risk and preventing second primary breast cancers.

More information

January 2013 LONDON CANCER NEW DRUGS GROUP RAPID REVIEW. Summary. Contents

January 2013 LONDON CANCER NEW DRUGS GROUP RAPID REVIEW. Summary. Contents LONDON CANCER NEW DRUGS GROUP RAPID REVIEW Paclitaxel albumin (Abraxane ) as a substitute for docetaxel/paclitaxel for cancer Paclitaxel albumin (Abraxane ) as a substitute for docetaxel/ paclitaxel for

More information

Management of low grade glioma s: update on recent trials

Management of low grade glioma s: update on recent trials Management of low grade glioma s: update on recent trials M.J. van den Bent The Brain Tumor Center at Erasmus MC Cancer Center Rotterdam, the Netherlands Low grades Female, born 1976 1 st seizure 2005,

More information

Prognostic and Predictive Factors in Oncology. Mustafa Benekli, M.D.

Prognostic and Predictive Factors in Oncology. Mustafa Benekli, M.D. Prognostic and Predictive Factors in Oncology Mustafa Benekli, M.D. NCI Definitions ESMO Course -Essentials of Medical Oncology -Istanbul 2 Prognostic factor: NCI Definition A situation or condition, or

More information

Breast cancer. A guide for journalists on breast cancer and its treatment

Breast cancer. A guide for journalists on breast cancer and its treatment Breast cancer A guide for journalists on breast cancer and its treatment Contents Contents 2 3 Section 1: Breast Cancer 4 i. What is breast cancer? 4 ii. Types of breast cancer 4 iii. Causes and risk factors

More information

Issued: September 2013. NICE diagnostics guidance 10. www.nice.org.uk/dg10

Issued: September 2013. NICE diagnostics guidance 10. www.nice.org.uk/dg10 Gene expression profiling and expanded immunohistochemistry tests for guiding adjuvant chemotherapy decisions in early breast cancer management: MammaPrint, Oncotype DX, IHC4 and Mammostrat Issued: September

More information

Breast cancer close to the nipple: Does this carry a higher risk ofaxillary node metastasesupon diagnosis?

Breast cancer close to the nipple: Does this carry a higher risk ofaxillary node metastasesupon diagnosis? Breast cancer close to the nipple: Does this carry a higher risk ofaxillary node metastasesupon diagnosis? Erin I. Lewis, BUSM 2010 Cheri Nguyen, BUSM 2008 Priscilla Slanetz, M.D., MPH Al Ozonoff, Ph.d.

More information

9. Discuss guidelines for follow-up post-thyroidectomy for cancer (labs/tests) HH

9. Discuss guidelines for follow-up post-thyroidectomy for cancer (labs/tests) HH 9. Discuss guidelines for follow-up post-thyroidectomy for cancer (labs/tests) HH Differentiated thyroid cancer expresses the TSH receptor on the cell membrane and responds to TSH stimulation by increasing

More information

Type of intervention Treatment. Economic study type Cost-effectiveness analysis.

Type of intervention Treatment. Economic study type Cost-effectiveness analysis. Impact of uncertainty on cost-effectiveness analysis of medical strategies: the case of highdose chemotherapy for breast cancer patients Marino P, Siani C, Roche H, Moatti J P Record Status This is a critical

More information

HTA OF TRASTUZUMAB IN ADJUVANT TREATMENT FOR HER2 POSITIVE BREAST CANCER

HTA OF TRASTUZUMAB IN ADJUVANT TREATMENT FOR HER2 POSITIVE BREAST CANCER HTA OF TRASTUZUMAB IN ADJUVANT TREATMENT FOR HER2 POSITIVE BREAST CANCER Karianne Johansen, PhD, Senior Advisor, Torbjørn Wisløff, Researcher Inger Natvig Norderhaug, Research Director Norwegian Health

More information

Recommendation Strength Strong, supported by the evidence and expert consensus. Recommendation Benefit/Harm Evidence Quality

Recommendation Strength Strong, supported by the evidence and expert consensus. Recommendation Benefit/Harm Evidence Quality CHEMO- AND TARGETED THERAPY FOR WOMEN WITH HER2 NEGATIVE (OR UNKNOWN) ADVANCED BREAST Benefit/Harm Evidence Quality 1: Endocrine therapy, rather than chemotherapy, should be offered as the standard firstline

More information

Pharmacogenetic Activities in SWOG Breast Cancer

Pharmacogenetic Activities in SWOG Breast Cancer Pharmacogenetic Activities in SWOG Breast Cancer Pharmacogenomics: Future Plans S8897 Adjuvant CMF vs. CAF/ no Treatment Ambrosone RO1: Other genes (TBCI approved, analyses ongoing) S0221 Adjuvant Dose

More information

COMMISSIONING. for ULTRA-RADICAL SURGERY ADVANCED OVARIAN CANCER

COMMISSIONING. for ULTRA-RADICAL SURGERY ADVANCED OVARIAN CANCER COMMISSIONING for ULTRA-RADICAL SURGERY in ADVANCED OVARIAN CANCER WHY THIS MUST HAPPEN PERSPECTIVE COMMISSIONING FOR WHO, FOR WHAT? Biological Basis Surgical Basis International and national standards

More information

Treatment of Low Risk MDS. Overview. Myelodysplastic Syndromes (MDS)

Treatment of Low Risk MDS. Overview. Myelodysplastic Syndromes (MDS) Overview Amy Davidoff, Ph.D., M.S. Associate Professor Pharmaceutical Health Services Research Department, Peter Lamy Center on Drug Therapy and Aging University of Maryland School of Pharmacy Clinical

More information

ST JOSEPH REGIONAL HEALTH CENTER LUNG CANCER ANALYSIS Incidence, Diagnosis, Treatment and Survival

ST JOSEPH REGIONAL HEALTH CENTER LUNG CANCER ANALYSIS Incidence, Diagnosis, Treatment and Survival ST JOSEPH REGIONAL HEALTH CENTER LUNG CANCER ANALYSIS Incidence, Diagnosis, Treatment and Survival It is logical that the Cancer Program Committee choose to review the Lung Site, as Lung is the second

More information

Adjuvant Therapy Non Small Cell Lung Cancer. Sunil Nagpal MD Director, Thoracic Oncology Jan 30, 2015

Adjuvant Therapy Non Small Cell Lung Cancer. Sunil Nagpal MD Director, Thoracic Oncology Jan 30, 2015 Adjuvant Therapy Non Small Cell Lung Cancer Sunil Nagpal MD Director, Thoracic Oncology Jan 30, 2015 No Disclosures Number of studies Studies Per Month 12 10 8 6 4 2 0 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3

More information

Carcinoma of the Cervix. Kathleen M. Schmeler, MD Associate Professor Department of Gynecologic Oncology

Carcinoma of the Cervix. Kathleen M. Schmeler, MD Associate Professor Department of Gynecologic Oncology Carcinoma of the Cervix Kathleen M. Schmeler, MD Associate Professor Department of Gynecologic Oncology Cervical Cancer Treatment Treatment Microinvasive (Stage IA1): Simple (extrafascial) hysterectomy/cone

More information

Breast Cancer & Treatment in ACT and Surrounding Regions QUALITY ASSURANCE PROJECT. Five-year report

Breast Cancer & Treatment in ACT and Surrounding Regions QUALITY ASSURANCE PROJECT. Five-year report Breast Cancer & Treatment in ACT and Surrounding Regions QUALITY ASSURANCE PROJECT Five-year report Community Health Pathology Southern Area Health Service ACT Health General Practitioners Nurses Social

More information

L Lang-Lazdunski, A Bille, S Marshall, R Lal, D Landau, J Spicer

L Lang-Lazdunski, A Bille, S Marshall, R Lal, D Landau, J Spicer Pleurectomy/decortication, hyperthermic pleural lavage with povidone-iodine and systemic chemotherapy in malignant pleural mesothelioma. A 10-year experience. L Lang-Lazdunski, A Bille, S Marshall, R Lal,

More information

Table 16a Multiple Myeloma Average Annual Number of Cancer Cases and Age-Adjusted Incidence Rates* for 2002-2006

Table 16a Multiple Myeloma Average Annual Number of Cancer Cases and Age-Adjusted Incidence Rates* for 2002-2006 Multiple Myeloma Figure 16 Definition: Multiple myeloma forms in plasma cells that are normally found in the bone marrow. 1 The plasma cells grow out of control and form tumors (plasmacytoma) or crowd

More information

The VEdeTTE cohort study: Effectiveness of treatments for heroin addiction in retaining patients and reducing mortality

The VEdeTTE cohort study: Effectiveness of treatments for heroin addiction in retaining patients and reducing mortality The VEdeTTE cohort study: Effectiveness of treatments for heroin addiction in retaining patients and reducing mortality Federica Vigna-Taglianti www.oed.piemonte.it Piedmont Centre for Drug Addiction Epidemiology

More information

Independent Validation of the Prognostic Gene Expression Ratio Test in Formalin Fixed, Paraffin Embedded (FFPE) Mesothelioma Tumor Tissue Specimens

Independent Validation of the Prognostic Gene Expression Ratio Test in Formalin Fixed, Paraffin Embedded (FFPE) Mesothelioma Tumor Tissue Specimens Independent Validation of the Prognostic Gene Expression Ratio Test in Formalin Fixed, Paraffin Embedded (FFPE) Mesothelioma Tumor Tissue Specimens Assunta De Rienzo, Ph.D. 1, Robert W. Cook, Ph.D. 2,

More information

Stage IV Renal Cell Carcinoma. Changing Management in A Comprehensive Community Cancer Center. Susquehanna Health Cancer Center

Stage IV Renal Cell Carcinoma. Changing Management in A Comprehensive Community Cancer Center. Susquehanna Health Cancer Center Stage IV Renal Cell Carcinoma Changing Management in A Comprehensive Community Cancer Center Susquehanna Health Cancer Center 2000 2009 Warren L. Robinson, MD, FACP January 27, 2014 Introduction 65,150

More information

Theories on Metastasis: Innovative Thinking An Advocacy Perspective

Theories on Metastasis: Innovative Thinking An Advocacy Perspective Theories on Metastasis: Innovative Thinking An Advocacy Perspective Project LEAD Workshop NBCC Annual Advocacy Conference 2011 Musa Mayer AdvancedBC.org 1 The Big Question If we want to end death from

More information

Metastatic Cancer: Questions and Answers. Key Points

Metastatic Cancer: Questions and Answers. Key Points CANCER FACTS N a t i o n a l C a n c e r I n s t i t u t e N a t i o n a l I n s t i t u t e s o f H e a l t h D e p a r t m e n t o f H e a l t h a n d H u m a n S e r v i c e s Metastatic Cancer: Questions

More information

Adjuvant Therapy for Breast Cancer: Questions and Answers

Adjuvant Therapy for Breast Cancer: Questions and Answers CANCER FACTS N a t i o n a l C a n c e r I n s t i t u t e N a t i o n a l I n s t i t u t e s o f H e a l t h D e p a r t m e n t o f H e a l t h a n d H u m a n S e r v i c e s Adjuvant Therapy for Breast

More information

Disparities in Stage at Diagnosis, Survival, and Quality of Cancer Care in California by Source of Health Insurance

Disparities in Stage at Diagnosis, Survival, and Quality of Cancer Care in California by Source of Health Insurance Disparities in Stage at Diagnosis, Survival, and Quality of Cancer Care in California by Source of Health Insurance Acknowledgements and Disclaimer The collection of cancer incidence data used in this

More information

Breast Imaging Made Brief and Simple. Jane Clayton MD Associate Professor Department of Radiology LSUHSC New Orleans, LA

Breast Imaging Made Brief and Simple. Jane Clayton MD Associate Professor Department of Radiology LSUHSC New Orleans, LA Breast Imaging Made Brief and Simple Jane Clayton MD Associate Professor Department of Radiology LSUHSC New Orleans, LA What women are referred for breast imaging? Two groups of women are referred for

More information

Lung Cancer. Public Outcomes Report. Submitted by Omar A. Majid, MD

Lung Cancer. Public Outcomes Report. Submitted by Omar A. Majid, MD Public Outcomes Report Lung Cancer Submitted by Omar A. Majid, MD Lung cancer is the most common cancer-related cause of death among men and women. It has been estimated that there will be 226,1 new cases

More information

American Medical Women s Association. Position Paper on Principals of Breast Cancer Screening

American Medical Women s Association. Position Paper on Principals of Breast Cancer Screening American Medical Women s Association Position Paper on Principals of Breast Cancer Screening Breast cancer affects one woman in eight in the United States and is the most common cancer diagnosed in women

More information

FDA grants Roche s Perjeta regimen Priority Review for use before surgery in HER2-positive early-stage breast cancer

FDA grants Roche s Perjeta regimen Priority Review for use before surgery in HER2-positive early-stage breast cancer Media Release Basel, 2 July, 2013 FDA grants Roche s Perjeta regimen Priority Review for use before surgery in HER2-positive early-stage breast cancer Application follows proposed new FDA pathway designed

More information

Prostatectomy, pelvic lymphadenect. Med age 63 years Mean followup 53 months No other cancer related therapy before recurrence. Negative.

Prostatectomy, pelvic lymphadenect. Med age 63 years Mean followup 53 months No other cancer related therapy before recurrence. Negative. Adjuvante und Salvage Radiotherapie Ludwig Plasswilm Klinik für Radio-Onkologie, KSSG CANCER CONTROL WITH RADICAL PROSTATECTOMY ALONE IN 1,000 CONSECUTIVE PATIENTS 1983 1998 Clinical stage T1 and T2 Mean

More information

Understanding Your Diagnosis of Endometrial Cancer A STEP-BY-STEP GUIDE

Understanding Your Diagnosis of Endometrial Cancer A STEP-BY-STEP GUIDE Understanding Your Diagnosis of Endometrial Cancer A STEP-BY-STEP GUIDE Introduction This guide is designed to help you clarify and understand the decisions that need to be made about your care for the

More information

5.04.20. Perjeta. Perjeta (pertuzumab) Description

5.04.20. Perjeta. Perjeta (pertuzumab) Description Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.04.20 Subject: Perjeta Page: 1 of 5 Last Review Date: June 19, 2015 Perjeta Description Perjeta (pertuzumab)

More information

Overview of Breast Cancer. Donna Graham Medical Oncology SpR

Overview of Breast Cancer. Donna Graham Medical Oncology SpR Overview of Breast Cancer Donna Graham Medical Oncology SpR Learning Points Epidemiology Risk Factors Diagnosis Prognostic Markers Stage 0 III disease Stage IV disease Surveillance Incidence in Ireland

More information

OI PARP ΑΝΑΣΤΟΛΕΙΣ ΣΤΟΝ ΚΑΡΚΙΝΟ ΤΟΥ ΜΑΣΤΟΥ ΝΙΚΟΛΑΙΔΗ ΑΔΑΜΑΝΤΙΑ ΠΑΘΟΛΟΓΟΣ-ΟΓΚΟΛΟΓΟΣ Β ΟΓΚΟΛΟΓΙΚΗ ΚΛΙΝΙΚΗ ΝΟΣ. ΜΗΤΕΡΑ

OI PARP ΑΝΑΣΤΟΛΕΙΣ ΣΤΟΝ ΚΑΡΚΙΝΟ ΤΟΥ ΜΑΣΤΟΥ ΝΙΚΟΛΑΙΔΗ ΑΔΑΜΑΝΤΙΑ ΠΑΘΟΛΟΓΟΣ-ΟΓΚΟΛΟΓΟΣ Β ΟΓΚΟΛΟΓΙΚΗ ΚΛΙΝΙΚΗ ΝΟΣ. ΜΗΤΕΡΑ OI PARP ΑΝΑΣΤΟΛΕΙΣ ΣΤΟΝ ΚΑΡΚΙΝΟ ΤΟΥ ΜΑΣΤΟΥ ΝΙΚΟΛΑΙΔΗ ΑΔΑΜΑΝΤΙΑ ΠΑΘΟΛΟΓΟΣ-ΟΓΚΟΛΟΓΟΣ Β ΟΓΚΟΛΟΓΙΚΗ ΚΛΙΝΙΚΗ ΝΟΣ. ΜΗΤΕΡΑ Study Overview Inhibition of poly(adenosine diphosphate [ADP]-ribose) polymerase

More information

Histopathologic results

Histopathologic results Self evaluation 1 Clinical Case 55-year-old woman Bilateral enlargement of cervical, axillary and inguinal lymph nodes, largest diameter > 6 cm Hepatosplenomegaly. Enlargement of retroperitoneal, mesenteric

More information

Changes in Breast Cancer Reports After Second Opinion. Dr. Vicente Marco Department of Pathology Hospital Quiron Barcelona. Spain

Changes in Breast Cancer Reports After Second Opinion. Dr. Vicente Marco Department of Pathology Hospital Quiron Barcelona. Spain Changes in Breast Cancer Reports After Second Opinion Dr. Vicente Marco Department of Pathology Hospital Quiron Barcelona. Spain Second Opinion in Breast Pathology Usually requested when a patient is referred

More information

NEOPLASMS OF KIDNEY (RENAL CELL CARCINOMA) And RENAL PELVIS (TRANSITIONAL CELL CARCINOMA)

NEOPLASMS OF KIDNEY (RENAL CELL CARCINOMA) And RENAL PELVIS (TRANSITIONAL CELL CARCINOMA) NEOPLASMS OF KIDNEY (RENAL CELL CARCINOMA) And RENAL PELVIS (TRANSITIONAL CELL CARCINOMA) Merat Esfahani, MD Medical Oncologist, Hematologist Cancer Liaison Physician SwedishAmerican Regional Cancer Center

More information

Treatment of Metastatic Breast Cancer: Endocrine Therapies. Robert W. Carlson, M.D. Professor of Medicine Stanford University

Treatment of Metastatic Breast Cancer: Endocrine Therapies. Robert W. Carlson, M.D. Professor of Medicine Stanford University Treatment of Metastatic Breast Cancer: Endocrine Therapies Robert W. Carlson, M.D. Professor of Medicine Stanford University MDACC Experience with FAC in Chemotherapy-Naive MBC Greenberg et al, J Clin

More information

Aggressive lymphomas. Michael Crump Princess Margaret Hospital

Aggressive lymphomas. Michael Crump Princess Margaret Hospital Aggressive lymphomas Michael Crump Princess Margaret Hospital What are the aggressive lymphomas? Diffuse large B cell Mediastinal large B cell Anaplastic large cell Burkitt lymphoma (transformed lymphoma:

More information

Rotation Specific Goals & Objectives: University Health Network-Princess Margaret Hospital/ Sunnybrook Breast/Melanoma

Rotation Specific Goals & Objectives: University Health Network-Princess Margaret Hospital/ Sunnybrook Breast/Melanoma Rotation Specific Goals & Objectives: University Health Network-Princess Margaret Hospital/ Sunnybrook Breast/Melanoma Medical Expert: Breast Rotation Specific Competencies/Objectives 1.0 Medical History

More information

Big Data and Oncology Care Quality Improvement in the United States

Big Data and Oncology Care Quality Improvement in the United States Big Data and Oncology Care Quality Improvement in the United States Peter P. Yu, MD, FACP, FASCO President, American Society of Clinical Oncology Director of Cancer Research, Palo Alto Medical Foundation

More information

Drug/Drug Combination: Bevacizumab in combination with chemotherapy

Drug/Drug Combination: Bevacizumab in combination with chemotherapy AHFS Final Determination of Medical Acceptance: Off-label Use of Bevacizumab in Combination with Chemotherapy for the Treatment of Metastatic Breast Cancer Previously Treated with Cytotoxic Chemotherapy

More information

The Women s Health Initiative: The Role of Hormonal Therapy in Disease Prevention

The Women s Health Initiative: The Role of Hormonal Therapy in Disease Prevention The Women s Health Initiative: The Role of Hormonal Therapy in Disease Prevention Robert B. Wallace, MD, MSc Departments of Epidemiology and Internal Medicine University of Iowa College of Public Health

More information

Secondary Cancer Rates Following Breast Cancer Diagnosis

Secondary Cancer Rates Following Breast Cancer Diagnosis Copyright E 2007 Journal of Insurance Medicine J Insur Med 2007;39:98 106 ORIGINAL RESEARCH Secondary Cancer Rates Following Breast Cancer Diagnosis David Wesley, MD Life table analysis and other mortality

More information

Finnish Cancer Registry Institute for Statistical and Epidemiological Cancer Research. Survival ratios of cancer patients by area in Finland

Finnish Cancer Registry Institute for Statistical and Epidemiological Cancer Research. Survival ratios of cancer patients by area in Finland Survival ratios of cancer patients by area in Finland Pages 2 14 present the relative survival ratios for patients diagnosed in 2005 2012 and followed-up in 2010 2012 (see Methods p. 15) on different university

More information

Greg Peterson, MPA, PhD candidate Melissa McCarthy, PhD Presentation for 2013 AcademyHealth Annual Research Meeting

Greg Peterson, MPA, PhD candidate Melissa McCarthy, PhD Presentation for 2013 AcademyHealth Annual Research Meeting Greg Peterson, MPA, PhD candidate Melissa McCarthy, PhD Presentation for 2013 AcademyHealth Annual Research Meeting Medicare Coordinated Care Demonstration (MCCD) Established in Balanced Budget Act of

More information

The Danish Healthcare System and the Danish Registers

The Danish Healthcare System and the Danish Registers The Danish Healthcare System and the Danish Registers Jens Søndergaard, MD, PhD Professor, family physician, clinical pharmacologist Research Unit for General Practice, Institute of Public Health, University

More information

Chemotherapy or Not? Anthracycline or Not? Taxane or Not? Does Density Matter? Chemotherapy in Luminal Breast Cancer: Choice of Regimen.

Chemotherapy or Not? Anthracycline or Not? Taxane or Not? Does Density Matter? Chemotherapy in Luminal Breast Cancer: Choice of Regimen. Chemotherapy in Luminal Breast Cancer: Choice of Regimen Andrew D. Seidman, MD Attending Physician Breast Cancer Medicine Service Memorial Sloan Kettering Cancer Center Professor of Medicine Weill Cornell

More information

Robert Bristow MD PhD FRCPC

Robert Bristow MD PhD FRCPC Robert Bristow MD PhD FRCPC Clinician-Scientist and Professor, Radiation Oncology and Medical Biophysics, University of Toronto and Ontario Cancer Institute/ (UHN) Head, PMH-CFCRI Prostate Cancer Research

More information

Big data size isn t enough! Irene Petersen, PhD Primary Care & Population Health

Big data size isn t enough! Irene Petersen, PhD Primary Care & Population Health Big data size isn t enough! Irene Petersen, PhD Primary Care & Population Health Introduction Reader (Statistics and Epidemiology) Research team epidemiologists/statisticians/phd students Primary care

More information

Optimizing Treatment in Head and Neck Cancer with Limited Resources

Optimizing Treatment in Head and Neck Cancer with Limited Resources Optimizing Treatment in Head and Neck Cancer with Limited Resources Friday, February 19, 2016, 7:00 am MT Moderator: Randall Kimple, MD, University of Wisconsin Induction Chemotherapy Predicts Cumulative

More information

Long-term effects of adjuvant tamoxifen treatment on cardiovascular disease and cancer

Long-term effects of adjuvant tamoxifen treatment on cardiovascular disease and cancer Linköping University Medical Dissertations No. 1430 Long-term effects of adjuvant tamoxifen treatment on cardiovascular disease and cancer Johan Rosell Linköping University, Faculty of Health Sciences

More information

TNM staging and prognosis. Alexandru Eniu, MD, PhD Medical Oncologist Department of Breast Tumors Cancer Institute Ion Chiricuţă Cluj-Napoca, Romania

TNM staging and prognosis. Alexandru Eniu, MD, PhD Medical Oncologist Department of Breast Tumors Cancer Institute Ion Chiricuţă Cluj-Napoca, Romania TNM staging and prognosis Alexandru Eniu, MD, PhD Medical Oncologist Department of Breast Tumors Cancer Institute Ion Chiricuţă Cluj-Napoca, Romania The Basics of TNM Staging Premises: Cancers of the same

More information

No. prev. doc.: 8770/08 SAN 64 Subject: EMPLOYMENT, SOCIAL POLICY, HEALTH AND CONSUMER AFFAIRS COUNCIL MEETING ON 9 AND 10 JUNE 2008

No. prev. doc.: 8770/08 SAN 64 Subject: EMPLOYMENT, SOCIAL POLICY, HEALTH AND CONSUMER AFFAIRS COUNCIL MEETING ON 9 AND 10 JUNE 2008 COUNCIL OF THE EUROPEAN UNION Brussels, 22 May 2008 9636/08 SAN 87 NOTE from: Committee of Permanent Representatives (Part 1) to: Council No. prev. doc.: 8770/08 SAN 64 Subject: EMPLOYMENT, SOCIAL POLICY,

More information

Service delivery interventions

Service delivery interventions Service delivery interventions S A S H A S H E P P E R D D E P A R T M E N T O F P U B L I C H E A L T H, U N I V E R S I T Y O F O X F O R D CO- C O O R D I N A T I N G E D I T O R C O C H R A N E E P

More information

Overview of Ovarian Cancer. Dr. Sinead Noonan 13/03/2012

Overview of Ovarian Cancer. Dr. Sinead Noonan 13/03/2012 Overview of Ovarian Cancer Dr. Sinead Noonan 13/03/2012 Ovarian Cancer 4 th most common cause of cancer death in women 15,000 deaths/year in the US Each year 300 new cases in Ireland 80% epithelial cell

More information

Avastin in breast cancer: Summary of clinical data

Avastin in breast cancer: Summary of clinical data Avastin in breast cancer: Summary of clinical data Worldwide, over one million people are diagnosed with breast cancer every year 1. It is the most frequently diagnosed cancer in women 1,2, and the leading

More information

A new score predicting the survival of patients with spinal cord compression from myeloma

A new score predicting the survival of patients with spinal cord compression from myeloma A new score predicting the survival of patients with spinal cord compression from myeloma (1) Sarah Douglas, Department of Radiation Oncology, University of Lubeck, Germany; sarah_douglas@gmx.de (2) Steven

More information