Onkologie
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Controlled Clinical Trial
Cost-effectiveness analysis of anastrozole versus tamoxifen in adjuvant therapy for early-stage breast cancer - a health-economic analysis based on the 100-month analysis of the ATAC trial and the German health system.
In the 'Arimidex', Tamoxifen Alone or in Combination (ATAC) trial, the aromatase inhibitor (AI) anastrozole had a significantly better efficacy and safety profile than tamoxifen as initial adjuvant therapy for hormone receptor-positive (HR+) early breast cancer (EBC) in postmenopausal patients. To compare the combined long-term clinical and economic benefits, we carried out a cost-effectiveness analysis (CEA) of anastrozole versus tamoxifen based on the data of the 100month analysis of the ATAC trial from the perspective of the German public health insurance. ⋯ This is the first CEA of an AI that is based on extended follow-up data, taking into account the carryover effect of anastrozole, which maintains the efficacy benefits beyond therapy completion after 5 years. Adjuvant treatment with anastrozole for postmenopausal women with HR+ EBC is a cost-effective alternative to tamoxifen.
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Lenalidomide is a new immunomodulatory drug, FDA-approved for the treatment of the 5q-myelodysplastic syndrome and refractory or relapsed multiple myeloma (MM). Regarding the treatment of MM, there have been published cases of acute pulmonary toxicity for the proteasome inhibitor bortezomib and the immunomodulatory drug thalidomide; only 1 case of lenalidomide-induced pulmonary toxicity has been described in the literature. ⋯ Given the frequently reported pulmonary infectious complications in patients treated with lenalidomide and a possibly underreported rate of interstitial pneumonitis, we advocate a more aggressive pulmonary workup for patients with pulmonary symptoms.
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Leadership structures in German clinics are adjusting parallel to DRG (diagnose-related groups)-induced economic reorientation of the health care system. A Chief Medical Clinic Manager (CMCM) is a new job description and an innovative approach to combine medical competence and business economics at the operational level of care. The ideal qualification is a medical specialist in the clinical field with practical experience in patient care and leadership as well as in hospital economics and quality control. ⋯ In cooperation with the director of the clinic, a CMCM develops a vision for clinic development, an investment strategy, and a business plan. The success parameters are positive operative results of the clinic, cost-covering care, increased investment rate, employee satisfaction, and implementation of innovations in research and therapy. A CMCM thereby increases financial and organizational freedom of action at the clinic level in a non-profit public health care system.
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Editorial Comment Comparative Study
Strategic options on behalf of patients with metastatic colorectal cancer: mass tumor murder versus serial tumor killing.
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There are several reasons why consultations addressing the transition to palliative care are especially challenging, and physicians are generally not very well prepared to meet these challenges. We therefore conceptualized and evaluated a concise, individualized communication skills training (CST) addressing i) communication concerning the transition to palliative care, and ii) involvement of significant others in the conversation. Core aspects of the CST and data of acceptance will be presented. ⋯ The presented specific, individualized, and concise CST is well accepted, and physicians see a high practical relevance and strong personal benefits.