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woensdag 4 oktober 2017

The Lancet: [Comment] New option for cisplatin-ineligible urothelial cancer

[Comment] New option for cisplatin-ineligible urothelial cancer
Following the discovery that a subset of patients with metastatic urothelial cancer respond to cisplatin-based multidrug chemotherapy, clinicians and patients were faced with the challenge of suboptimal therapeutic options for those patients deemed unfit to receive cisplatin. One consensus definition of cisplatin ineligibility is inadequate renal function (creatinine clearance <60 mL/min), poor Eastern Cooperative Oncology Group (ECOG) performance status (ie, ECOG performance status 2 or greater), or pre-existing peripheral neuropathy or hearing loss.
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[News] Inpatient palliative care during transplantation
It is well known that patients undergoing haemopoietic stem-cell transplantation have substantial physical and psychological morbidity; however, little is known about how to best ameliorate the latter in the long term. Newly published data by Areej El-Jawahri (Massachussetts General Hospital, Boston, MA, USA) and colleagues have shown a lasting benefit to self-reported psychological symptoms from contact with trained palliative-care clinicians during the inpatient period.
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[News] Adding radiotherapy to chemotherapy in advanced NSCLC
Consolidative, non-invasive, stereotactic ablative radiotherapy (SABR) given before maintenance chemotherapy significantly improves progression-free survival in patients with limited metastatic non-small-cell lung cancer and no actionable mutations for targeted therapy, compared with maintenance chemotherapy alone, according to an interim analysis of a phase 2 randomised trial.
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[Comment] Is competition bad for our health(care)? We simply don't know
In The Lancet Oncology, Ajay Aggarwal and colleagues1 apply innovative analytics to study the movement patterns of almost 20 000 patients accessing prostate cancer surgery across the National Health Service (NHS) in England between 2010 and 2014. They find that, in the presence of pressures to centralise surgical services and intense competition, and in the absence of any publicly accessible measure of service quality to allow comparisons, those providers who invest in high tech, in this case robotic, surgery equipment, fare better than those who don't in attracting patients and growing their business.
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[Articles] Effect of patient choice and hospital competition on service configuration and technology adoption within cancer surgery: a national, population-based study
Competitive factors, in addition to policies advocating centralisation and the requirement to do minimum numbers of surgical procedures, have contributed to large-scale investment in equipment for robotic surgery without evidence of superior outcomes and contributed to the closure of cancer surgery units. If quality performance and outcome indicators are not available to guide patient choice, these policies could threaten health services' ability to deliver equitable and affordable cancer care.
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