Better strategies for shared decision making between physicians and patients may be needed when there is no evidence to support benefit of a treatment or when patients have terminal illnesses that cannot be cured.
The authors compared the types of treatments prostate cancer patients received from county hospitals and private providers as part of a statewide public assistance program in a cohort study of 559 men enrolled in a state-funded program for low-income patients known as Improving Access, Counseling, and Treatment for Californians With Prostate Cancer (IMPACT).
Decision making for treatment of localized prostate cancer is often guided by therapeutic side-effect profiles. The authors sought to assess health-related quality-of-life outcomes for patients 48 months after treatment for localized prostate cancer. Men treated for localized prostate cancer were evaluated before treatment and at 11 intervals during the 48 months after intervention. Changes in mean health-related quality-of-life scores and the probability of regaining baseline levels of health-related quality of life were compared between treatment groups.
Economic evaluations of health care can be used by policy makers and other decision makers to compare the cost effectiveness of different treatment strategies and to make decisions about the allocation of scarce resources, such as dollars spent on health care.
The authors demonstrated that rates of a discretionary surgical procedure differ according to nonclinical factors, such as treatment site and type of insurance, and that such unwarranted variation decreases over time with diminishing uncertainty and in an era of diffusion of clinical guidelines.
Unlike other malignancies, there is no literature supporting the accuracy of medical claims data for identifying surgical treatments among patients with kidney cancer. The authors sought to validate externally a previously published Medicare-claims-based algorithm for classifying surgical treatments among patients with early-stage kidney cancer.
Evaluates the relationship of sex and race with the receipt of timely and clinically appropriate non-small-cell lung cancer (NSCLC) treatment for each stage of diagnosis using Surveillance Epidemiology and End Result data linked to Medicare claims for beneficiaries diagnosed with NSCLC between 1995 and 1999 while controlling for other demographic characteristics, comorbidities, socioeconomic status, and provider supply.
The authors surveyed cancer physicians to understand how patients' age and comorbidity influence adjuvant chemotherapy recommendations and whether physician or practice characteristics also affect these recommendations.
Studies how symptoms for women with incident breast cancer are addressed by physicians and how management varies with patient characteristics. Black and Spanish-speaking Hispanic women were significantly more likely to report an unmet need.
Most men diagnosed with prostate cancer will die of other causes. Accurate stratification by risk of other cause mortality may reduce needless treatment. Future studies should consider stratifying patients by or at least reporting these variables.
Identifies symptom clusters that include urinary and erectile dysfunction among men treated for prostate cancer. Fatigue and emotional distress may be seen together or in combination with prostate cancer-specific symptoms.
Examines progress in supportive cancer care, which encompasses direct and treatment-related impacts of cancer, including management of pain and other symptoms, and the psychosocial context, including spirituality and challenges of caregiving.
Details how the factors that drove clinical use of high-dose chemotherapy with autologous bone marrow transplantation (HDC/ABMT) converged to propel the procedure forward despite a lack of proven clinical effectiveness.