Bulletin du cancer
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Health expenditures keep increasing regularly for many years and the medical cost of cancer as well. French Social Security estimated in 1994 that reimbursed health care expenditures for cancer reached 5.3 billions euros (8% of health care budget). Two French studies based on 1996 and 1999 diagnosis related groups data suggest that 15 % to 25 % of stays in public hospitals are related to cancer. ⋯ The price of the new drugs explains a part of the burden of cancer in France as in the other countries. However other factors need to be highlighted especially the increasing incidence of cancer, the ageing of population and the enlarged number of eligible patients for chemotherapy. Finally, one should note that current French reimbursement system for chemotherapy modifies the management of patients (day care versus inpatient care) and the repartition of care between the public and private sectors.
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The increasing costs of care make it important to identify those strategies of greatest value from both an effectiveness and cost perspective. Economic analysis is characterized by a simultaneous consideration of alternatives costs and outcomes, and can provide useful data for managerial decision making. In this paper, methods of economic evaluations in general and in cancer in particular is reviewed. ⋯ Economic evaluation have become increasingly important in oncology because of the proliferation of expensive new treatments. Furthermore, considering quality of life effects is particularly important in oncology, where many treatments obtain modest improvements in response or survival. Quality of life measurements are also reviewed.
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Review Practice Guideline Guideline
[Standards, Options and Recommendations 2002 for the management of adult patients with intracranial gliomas (summary report)].
The "Standards, Options and Recommendations" (SOR) project, which started in 1993, is a collaboration between the Federation of French Cancer Centers (FNCLCC), the 20 French Regional Cancer Centers, and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. ⋯ This article is a summary version of the full document presenting the clinical practice guidelines with algorithms. The main recommendations concern the place of the surgery, radiotherapy, chemiotherapy, imagery and concomitant medical treatments in the specific treatment strategy of grade III and IV glioma, grade II glioma, gliomatosis cerebri, pilocytic astrocytoma, subependymoma, xanthoastrocytoma, intracranial ependymoma and brain stem glioma.
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Analysis of results of stereotactic irradiation for brain metastases for patients older than 70 years. ⋯ Radiosurgery in the elderly was efficient and well tolerated. Age alone should not be used to deny potentially beneficial radiosurgery to any patient with brain metastases.
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Practice Guideline Guideline
[Standards, options and recommendations for the use of medical analgesics for the treatment of pain arising from excess nociception in adults with cancer (update 2002): opioid analgesics with the exception of morphine by mouth and the rotation].
The "Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the federation of French Cancer Centers (FNCLCC), the 20 French cancer centers, and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. ⋯ For this update, only a few randomised clinical trials were identified, and their conclusions were generally weak. Thus much of the information in this document is based on the World Health Organisation (WHO) guidelines and represents the "state of the art" on this subject in France and is supported by expert agreement. Some changes to the original SOR are presented, particularly for the prescription of new opioids and opioid rotation. The full text of this SOR is available on the FNCLCC web site (http ://www.fnclcc.fr).