Journal of the National Cancer Institute
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Previous studies have documented that hospice enrollment by terminally ill cancer patients varies substantially by patient characteristics and across broad geographic regions, but little is known about how local practice patterns and individual physicians contribute to these variations. We examined hospice use within a regional integrated health care delivery system that provides consistent insurance coverage and hospice availability for its members to evaluate the relative importance of patient characteristics, physician characteristics, individual physicians, and local health centers in explaining variations in hospice enrollment. ⋯ Health care within a large integrated delivery system has the potential to eliminate racial and ethnic disparities in hospice use, but substantial variation in hospice use persists among local health centers. Focused efforts to understand how patients, physicians, and hospices interact at the local level are important to ensure equal access to hospice care for all terminally ill cancer patients.
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J. Natl. Cancer Inst. · Aug 2006
Randomized Controlled Trial Multicenter StudyRandomized phase III trial of topotecan following carboplatin and paclitaxel in first-line treatment of advanced ovarian cancer: a gynecologic cancer intergroup trial of the AGO-OVAR and GINECO.
The combination of carboplatin and paclitaxel is the standard of care for the treatment of ovarian cancer, yet rates of recurrence and death remain high. We performed a prospective randomized phase III study to examine whether sequential administration of topotecan can improve the efficacy of carboplatin and paclitaxel in first-line treatment of advanced epithelial ovarian cancer. ⋯ The sequential addition of topotecan to carboplatin-paclitaxel did not result in superior overall response or progression-free or overall survival. Therefore, this regimen is not recommended as standard of care treatment for ovarian cancer.
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J. Natl. Cancer Inst. · Jul 2006
Randomized Controlled TrialRandomized double-blind factorial trial of three treatments to reduce the prevalence of precancerous gastric lesions.
Randomized trials have yielded mixed results on the effects of treatment for Helicobacter pylori and little information on the effects of vitamins or garlic supplements on precancerous gastric lesions. We conducted a randomized trial to test the effects of one-time H. pylori treatment and long-term vitamin or garlic supplements in reducing the prevalence of advanced precancerous gastric lesions. ⋯ H. pylori treatment reduces the prevalence of precancerous gastric lesions and may reduce gastric cancer incidence, but further data are needed to prove the latter point. Long-term vitamin or garlic supplementation had no beneficial effects on the prevalence of precancerous gastric lesions or on gastric cancer incidence.
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J. Natl. Cancer Inst. · Jul 2006
Effect of connective tissue growth factor on hypoxia-inducible factor 1alpha degradation and tumor angiogenesis.
Connective tissue growth factor (CTGF) inhibits the metastatic activity of human lung cancer cells in a mouse model; however, the mechanism of this modulation is unclear. We investigated the role of angiogenesis in this process. ⋯ CTGF inhibition of metastasis involves the inhibition of VEGF-A-dependent angiogenesis, possibly by promoting HIF-1alpha protein degradation.