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The use of the biosimilar drug can lead to large health care savings that can be reinvested for continued innovation: Analysis of consumption of an Italian health care company 使用生物仿制药可节省大量医疗费用,这些费用可再投资于持续创新:意大利一家医疗保健公司的消费分析。
IF 1.3 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-03-18 DOI: 10.1016/j.jcpo.2024.100473
Francesco Ferrara , Maurizio Capuozzo , Roberto Langella , Ugo Trama , Eduardo Nava , Andrea Zovi

Background

Biosimilar drugs offer an opportunity for all global healthcare systems because they provide significant cost savings while ensuring equal efficacy and safety in the treatment of chronic diseases. These savings can be allocated to support ongoing innovation.

Methods

An analysis of the usage of major biosimilar drugs across various therapeutic areas has been conducted within an Italian healthcare company serving a population of over one million. Data on consumption, expenditure, and the number of treated patients has been extracted from the company's databases. Finally, a comparison with the year 2021 has been performed to determine if biosimilar drug usage increased in 2022.

Results

In 2022, the data reveals that a substantial portion of the analysed active ingredients are being used as biosimilar drugs, except in a few residual cases. However, among the most consumed drugs, resistance still exists in the case of Adalimumab and Etanercept, for which expenditure on originator drugs exceeds 2 million euros.

Conclusion

The 2022–2021 comparison highlights the increasing use of biosimilar drugs. This data is encouraging and suggests that in the coming months, we may achieve total utilization, which would be to the benefit of the National Health System (NHS) and the citizens who can rely on an efficient and sustainable healthcare policy that is continually improving.

背景:生物类似药为全球所有医疗保健系统提供了机遇,因为它们在确保治疗慢性疾病的同等疗效和安全性的同时,还能节省大量成本。这些节省下来的费用可用于支持持续创新:方法:在一家服务人口超过 100 万的意大利医疗保健公司内,对各治疗领域主要生物类似药的使用情况进行了分析。从该公司的数据库中提取了有关消费、支出和治疗患者人数的数据。最后,与 2021 年进行了比较,以确定 2022 年生物类似药的使用量是否有所增加:结果:数据显示,2022 年,除少数残留病例外,大部分被分析的活性成分都被用作生物类似药。然而,在消费量最大的药物中,阿达木单抗(Adalimumab)和依那西普(Etanercept)仍然存在抗药性,这两种药物的原研药支出超过了 200 万欧元:2022-2021 年的对比显示,生物仿制药的使用量在不断增加。这一数据令人鼓舞,表明在未来几个月内,我们可能会实现全部使用,这将有利于国家卫生系统(NHS)和公民,他们可以依赖于不断改进的高效、可持续的医疗保健政策。
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引用次数: 0
Cancer advocacy in residency education: From principles to competencies 住院医生教育中的癌症宣传:从原则到能力。
IF 1.3 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-03-11 DOI: 10.1016/j.jcpo.2024.100470
Klaus Puschel , Beti Thompson , Andrea Rioseco , Augusto Leon , Carolina Goic , Isabella Fuentes , Zdenka Vescovi

Introduction

The global cancer burden is increasing. Current global evidence indicates there will be a 47% rise of cancer cases for the period 2020–2040. The cancer rate differential also is evident within countries and regions. Efforts have been used to reduce the health disparities; however, the inequity prevails. One potential way to help reduce the disparity is through advocacy by physicians.

Methods

Two recent systematic review articles on advocacy among physicians note that physicians are unlikely to be taught advocacy in medical education, and also note there are no advocacy competencies or skill sets that are either taught or valued in medical education. We explore literature and develop a model to understand the components of advocacy in medical education, specifically in resident training. We follow the model’s main components by examining principles of advocacy, relevant domains of advocacy, and competencies and values for advocacy education.

Results

Four ethical principles of advocacy education are identified: beneficence, non-maleficence, autonomy, and justice. These principles must be applied in meaningful, culturally sensitive, respectful, and promotion of the well-being ways.

Three domains are identified: the practice domain (provider-patient interaction), the community domain (provider-community collaboration), and the health policy domain (the larger social environment). Advocacy occurs differently within each domain.

Finally, competencies in the form of knowledge, skills, and values are described. We present a table noting where each competency occurs (by domain) as well as the value of each knowledge and skill.

Policy summary

The significance of including advocacy instruction in medical education requires a change in the current medical education field. Besides valuing the concept of including advocacy, principles, domains, and competencies of inclusion are critical. In summary, we encourage the inclusion of advocacy education in resident medical programs so physicians become competent medical providers at diverse levels of society.

导言全球癌症负担日益加重。目前的全球证据表明,在 2020 年至 2040 年期间,癌症病例将增加 47%。各国和各地区的癌症发病率差异也很明显。为缩小健康差距,人们做出了各种努力,但不公平现象依然存在。帮助缩小差距的一个潜在方法是由医生进行宣传:方法:最近两篇关于医生宣传的系统性综述文章指出,医生不太可能在医学教育中学习宣传,还指出医学教育中没有教授或重视宣传能力或技能组合。我们对文献进行了探讨,并建立了一个模型,以了解医学教育(尤其是住院医师培训)中宣传的组成部分。我们按照该模型的主要组成部分,研究了宣传原则、宣传的相关领域以及宣传教育的能力和价值观:结果:我们确定了宣传教育的四项伦理原则:有利、无弊、自主和公正。这些原则必须以有意义、对文化敏感、尊重和促进福祉的方式加以应用。确定了三个领域:实践领域(医疗服务提供者与患者之间的互动)、社区领域(医疗服务提供者与社区之间的合作)和卫生政策领域(更大的社会环境)。在每个领域中,宣传的方式各不相同。最后,以知识、技能和价值观的形式描述了能力。我们以表格的形式列出了每种能力(按领域划分)出现的位置以及每种知识和技能的价值。政策摘要:将宣传教学纳入医学教育的意义要求改变当前的医学教育领域。除了重视纳入宣传的概念外,纳入的原则、领域和能力也至关重要。总之,我们鼓励在住院医师项目中纳入宣传教育,使医生成为社会不同层面的合格医疗服务提供者。
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引用次数: 0
Skin in the game: The cost consequences of skin cancer diagnosis, treatment and care in Northern Ireland 游戏中的皮肤:北爱尔兰皮肤癌诊断、治疗和护理的成本后果。
IF 1.3 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-02-02 DOI: 10.1016/j.jcpo.2024.100468
Ethna McFerran , Sarah Donaldson , Olivia Dolan , Mark Lawler

Background

Skin cancer is a prevalent cancer in the UK. Its rising incidence and mortality rates are expected to result in substantial financial implications, particularly on diagnostic and treatment services for skin cancer management in Northern Ireland (NI). Such anticipated disease increases underscore the need for prevention and control measures that should help guide policymaking and planning efforts.

Methods

We conducted a cost of illness study to assess the economic impact of skin cancer in NI from the healthcare system's perspective, using a bottom-up method, employing NHS reference costs (UK£) for skin cancer diagnosis and treatment patient pathways in 2021/22. Sensitivity analyses varied diagnostic volumes by applying multipliers for benign cases, assuming a diagnostic conversion rate of 6.8%, and examined an alternative chemotherapy regimen compliance rate of 75%. Additionally, proportional cost increases were projected based on future estimated increases of 9% and 28% to malignant melanoma (MM) cases for diagnostic, treatment, and follow-up volumes.

Results

Significant numbers of non-melanoma skin cancers (NMSC) and MM cases were recorded, 4289 NMSCs and 439 MM cases. The total cost for managing NMSC was £ 3,365,350. Total costs for MM skin cancer were £ 13,740,681, including £ 8,753,494 for procurement, administration, and chemotherapy drug use. Overall healthcare spending on skin cancer care totalled £ 21,167,651. Sensitivity analysis suggested diagnostic cost may increase significantly to £ 12,374,478 based on referral volume assumptions. If base case rates rise by 9 or 28% estimated total costs of treating skin cancer will increase to £ 22.3 million and £ 24.9 million, respectively.

Conclusions

Skin cancer management costs in NI totalled ∼£ 21.1 million to £ 32.1 million, depending on diagnostic referral assumptions. Costs have risen ∼10-fold over the past decade for MM due largely to chemotherapy costs. A predicted 28% increase in MM cases by 2040 would lead to ∼£ 3.8 million of additional expenditures, providing a significant challenge for cancer health systems.

背景:皮肤癌是英国的一种常见癌症。其发病率和死亡率的上升预计将带来巨大的财务影响,尤其是对北爱尔兰(NI)皮肤癌管理的诊断和治疗服务。这种疾病的预期增长强调了采取预防和控制措施的必要性,这些措施应有助于指导决策和规划工作:我们进行了一项疾病成本研究,从医疗保健系统的角度评估皮肤癌对北爱尔兰的经济影响,采用自下而上的方法,使用 2021/22 年皮肤癌诊断和治疗患者路径的 NHS 参考成本(英镑)。敏感性分析通过对良性病例应用乘数来改变诊断量,假设诊断转换率为 6.8%,并研究了 75% 的替代化疗方案达标率。此外,根据未来恶性黑色素瘤(MM)病例诊断、治疗和随访量分别增加 9% 和 28% 的估计,预测了成本增加的比例:记录了大量非黑色素瘤皮肤癌(NMSC)和恶性黑色素瘤病例,其中 NMSC 4289 例,MM 439 例。治疗非黑色素瘤皮肤癌的总费用为 3,365,350 英镑。MM 皮肤癌的总费用为 13,740,681 英镑,其中包括 8,753,494 英镑的采购、管理和化疗药物使用费用。皮肤癌治疗的总医疗支出为 21,167,651 英镑。敏感性分析表明,根据转诊量假设,诊断成本可能会大幅增加至 12374478 英镑。如果基准费率上升 9% 或 28%,估计治疗皮肤癌的总成本将分别增至 2230 万英镑和 2490 万英镑:根据诊断转诊假设,北爱尔兰的皮肤癌治疗总成本约为 2,110 万英镑至 3,210 万英镑。在过去十年中,MM 的治疗费用增长了约 10 倍,这主要归因于化疗费用。预计到 2040 年,MM 病例将增加 28%,这将导致约 380 万英镑的额外支出,给癌症医疗系统带来巨大挑战。
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引用次数: 0
Exploring the financial burden due to additional mobility among cancer patients: A cross-sectional study based on National Sample Survey 探究癌症患者因额外行动而产生的经济负担:基于全国抽样调查的横断面研究。
IF 1.3 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-01-24 DOI: 10.1016/j.jcpo.2024.100469
Mohit Pandey, Mahadev Bramhankar, Abhishek Anand

Background

Cancer imposes a substantial economic burden due to treatment costs, supportive care, and loss of productivity. Besides all the affecting factors, major concerns lead to significant financial burdens of cancer treatment, bringing unwanted huge unbearable direct and indirect treatment costs. The aim was to explore the nature of additional mobility/travel required for accessing health care for cancer patients and also to assess financial burden due to additional mobility/travel costs for cancer treatment.

Methods

This study employed unit-level cross-sectional data from the 75th round (2017–18) of India's National Sample Survey (NSS). The primary analysis commenced with descriptive and bivariate analyses to explore mean health spending and out-of-pocket expenses. Subsequently, multivariable logistic regression models were utilized to estimate the associations between catastrophic health expenditure, distress financing, and the treatment location.

Results

The findings highlight distinct healthcare utilization patterns: inpatient treatments predominantly occur within the same district (50.4 %), followed by a different district (38.8 %), and a smaller share in other states (10.8 %). Outpatients largely receive treatment in the same district (65.5 %), followed by a different district (26.8 %), and around 8 % percent in other states. Urban areas show higher inpatient visits within the same district (41.8 %) and different districts (33.5 %). Outpatients, particularly those seeking treatment in other states, experience higher total expenditures, notably with higher out-of-pocket expenses. Distress financing is more common among inpatients (20.6 %) and combined inpatient/outpatient cases (23.9 %), while outpatients exhibit a lower rate (6.8 %).

Conclusion

The findings collectively suggest the importance of developing local healthcare infrastructures to reduce the additional mobility of cancer patients. The policy should focus to train and deploy oncologists in non-urban areas can help bridge the gap in cancer care proficiency and reduce the need for patients to travel long distances for treatment.

背景:由于治疗费用、支持性护理和生产力损失,癌症造成了巨大的经济负担。除所有影响因素外,癌症治疗的主要顾虑也会导致巨大的经济负担,带来难以承受的巨额直接和间接治疗费用。本研究旨在探讨癌症患者为获得医疗服务而需要的额外流动/旅行的性质,并评估因癌症治疗而产生的额外流动/旅行费用所造成的经济负担:本研究采用了第 75 轮(2017-18 年)印度全国抽样调查(NSS)中的单位层面横截面数据。主要分析从描述性分析和双变量分析开始,探讨平均医疗支出和自付费用。随后,利用多变量逻辑回归模型估算灾难性医疗支出、困境融资和治疗地点之间的关联:研究结果表明了不同的医疗保健使用模式:住院治疗主要发生在同一地区(50.4%),其次是不同地区(38.8%),在其他州接受治疗的比例较小(10.8%)。门诊病人主要在同一地区接受治疗(65.5%),其次是不同地区(26.8%),在其他州接受治疗的比例约为 8%。城市地区在同一地区(41.8%)和不同地区(33.5%)接受住院治疗的比例较高。门诊病人,特别是在其他州就医的病人,总支出较高,尤其是自付费用较高。住院病人(20.6%)和住院病人/门诊病人合并病例(23.9%)中的不良融资更为常见,而门诊病人的不良融资率较低(6.8%):这些研究结果共同表明,发展当地医疗基础设施以减少癌症患者的额外流动性非常重要。政策应侧重于在非城市地区培训和部署肿瘤学家,这有助于缩小癌症护理能力方面的差距,减少患者长途跋涉接受治疗的需要。
{"title":"Exploring the financial burden due to additional mobility among cancer patients: A cross-sectional study based on National Sample Survey","authors":"Mohit Pandey,&nbsp;Mahadev Bramhankar,&nbsp;Abhishek Anand","doi":"10.1016/j.jcpo.2024.100469","DOIUrl":"10.1016/j.jcpo.2024.100469","url":null,"abstract":"<div><h3>Background</h3><p><span>Cancer imposes a substantial economic burden due to treatment costs, supportive care, and loss of productivity. Besides all the affecting factors, major concerns lead to significant financial burdens </span>of cancer treatment<span>, bringing unwanted huge unbearable direct and indirect treatment costs. The aim was to explore the nature of additional mobility/travel required for accessing health care for cancer patients and also to assess financial burden due to additional mobility/travel costs for cancer treatment.</span></p></div><div><h3>Methods</h3><p>This study employed unit-level cross-sectional data from the 75th round (2017–18) of India's National Sample Survey (NSS). The primary analysis commenced with descriptive and bivariate analyses to explore mean health spending and out-of-pocket expenses. Subsequently, multivariable logistic regression models were utilized to estimate the associations between catastrophic health expenditure, distress financing, and the treatment location.</p></div><div><h3>Results</h3><p>The findings highlight distinct healthcare utilization patterns: inpatient treatments predominantly occur within the same district (50.4 %), followed by a different district (38.8 %), and a smaller share in other states (10.8 %). Outpatients largely receive treatment in the same district (65.5 %), followed by a different district (26.8 %), and around 8 % percent in other states. Urban areas show higher inpatient visits within the same district (41.8 %) and different districts (33.5 %). Outpatients, particularly those seeking treatment in other states, experience higher total expenditures, notably with higher out-of-pocket expenses. Distress financing is more common among inpatients (20.6 %) and combined inpatient/outpatient cases (23.9 %), while outpatients exhibit a lower rate (6.8 %).</p></div><div><h3>Conclusion</h3><p>The findings collectively suggest the importance of developing local healthcare infrastructures to reduce the additional mobility of cancer patients. The policy should focus to train and deploy oncologists in non-urban areas can help bridge the gap in cancer care proficiency and reduce the need for patients to travel long distances for treatment.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"39 ","pages":"Article 100469"},"PeriodicalIF":1.3,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139567431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Role of life satisfaction, emotional support, and feeling of social isolation on adherence to breast cancer screening recommendations among US women 美国妇女的生活满意度、情感支持和社会孤立感对遵守乳腺癌筛查建议的影响。
IF 1.3 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-01-21 DOI: 10.1016/j.jcpo.2024.100467
Biplab Kumar Datta , Aneesha Gummadi , Steven S. Coughlin

Background

Psychosocial factors can play important roles in promoting preventive health behaviors. This study aimed to assess how life satisfaction, receipt of emotional support, and feeling of social isolation were associated with adherence to the USPSTF recommendation of breast cancer screening in a nationally representative US population.

Methods

Using data on 71,583 women aged 50 to 74 years, from the 2022 Behavioral Risk Factor Surveillance System (BRFSS) survey, we estimated multivariable logistic regressions to assess the odds of adherence across different categories of the respective psychosocial constructs. We accounted for various demographic and socioeconomic correlates and checked the robustness of the relationship within income and educational sub-groups.

Results

We found that women who were dissatisfied with their life were 52.0% less likely to adhere compared to women who reported to be very satisfied. Similarly, women who rarely/never got emotional support and who always/usually felt socially isolated were 51.6% and 39.9% less likely to adhere, compared to women who always got support and never felt isolated, respectively. These results were robust across different levels of income and educational attainment.

Conclusion

Our findings demonstrated a strong association between social environment, psychological wellbeing, and adherence to breast cancer screening, and thus suggested scope of potential psychosocial interventions to improve adherence.

Policy summary

Efforts to improve women’s psychosocial wellbeing could facilitate compliance with breast cancer screening recommendations.

背景:社会心理因素在促进预防性健康行为方面可发挥重要作用。本研究旨在评估在具有全国代表性的美国人群中,生活满意度、获得情感支持和社会孤立感与遵守 USPSTF 建议进行乳腺癌筛查的相关性:利用 2022 年行为风险因素监测系统 (BRFSS) 调查中 71,583 名 50 至 74 岁女性的数据,我们估算了多变量逻辑回归,以评估不同社会心理因素类别下坚持筛查的几率。我们考虑了各种人口统计学和社会经济学相关因素,并检验了收入和教育程度分组内关系的稳健性:结果:我们发现,对自己生活不满意的女性与表示非常满意的女性相比,坚持治疗的可能性要低 52.0%。同样,很少/从未获得情感支持和总是/经常感到社会孤立的妇女与总是获得支持和从未感到社会孤立的妇女相比,坚持的可能性分别降低了 51.6% 和 39.9%。这些结果在不同收入水平和教育程度的人群中都是稳健的:我们的研究结果表明,社会环境、心理健康与乳腺癌筛查的依从性之间存在密切联系,因此建议采取潜在的社会心理干预措施,以提高乳腺癌筛查的依从性。
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引用次数: 0
Implementing the European code of cancer practice in rural settings 在农村地区实施《欧洲癌症治疗规范》。
IF 1.3 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-01-04 DOI: 10.1016/j.jcpo.2023.100465
David Nelson , Peter Selby , Ros Kane , Ava Harding-Bell , Amanda Kenny , Kathie McPeake , Samuel Cooke , Todd Hogue , Kathy Oliver , Mark Gussy , Mark Lawler

Existing evidence often indicates higher cancer incidence and mortality rates, later diagnosis, lower screening uptake and poorer long-term survival for people living in rural compared to more urbanised areas. Despite wide inequities and variation in cancer care and outcomes across Europe, much of the scientific literature explicitly exploring the impact of rurality on cancer continues to come from Australia and North America. The European Code of Cancer Practice or “The Code” is a citizen and patient-centred statement of the most salient requirements for good clinical cancer practice and has been extensively co-produced by cancer patients, cancer professionals and patient advocates. It contains 10 key overarching Rights that a cancer patient should expect from their healthcare system, regardless of where they live and has been strongly endorsed by professional and patient cancer organisations as well as the European Commission. In this article, we use these 10 fundamental Rights as a framework to argue that (i) the issues and needs identified in The Code are generally more profound for rural people with cancer; (ii) addressing these issues is also more challenging in rural contexts; (iii) interventions and support must explicitly account for the unique needs of rural residents living with and affected by cancer and (iv) new innovative approaches are urgently required to successfully overcome the challenges faced by rural people with cancer and their caregivers. Despite equitable healthcare being a key European policy focus, the needs of rural people living with cancer have largely been neglected.

现有证据通常表明,与城市化程度较高的地区相比,生活在农村地区的人癌症发病率和死亡率较高,确诊时间较晚,接受筛查的人数较少,长期存活率较低。尽管整个欧洲在癌症治疗和结果方面存在广泛的不平等和差异,但明确探讨农村地区对癌症影响的大部分科学文献仍然来自澳大利亚和北美。欧洲癌症治疗规范》或 "规范 "是一份以公民和患者为中心的声明,阐述了良好的癌症临床实践的最突出要求,并由癌症患者、癌症专业人士和患者权益倡导者广泛共同制定。它包含癌症患者应从医疗保健系统中享有的 10 项主要权利,无论他们生活在哪里,并得到了癌症专业组织和患者组织以及欧盟委员会的大力支持。在本文中,我们以这 10 项基本权利为框架,论证:(i) 《准则》中指出的问题和需求对于农村癌症患者而言通常更为深刻;(ii) 在农村环境中解决这些问题也更具挑战性;(iii) 干预和支持措施必须明确考虑到农村癌症患者及其护理人员的独特需求;(iv) 迫切需要新的创新方法来成功克服农村癌症患者及其护理人员所面临的挑战。尽管公平医疗保健是欧洲政策的重点,但农村癌症患者的需求在很大程度上被忽视了。
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引用次数: 0
Dealing with digital paralysis: Surviving a cyberattack in a National Cancer center 应对数字瘫痪:国家癌症中心在网络攻击中幸存。
IF 1.3 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-01-02 DOI: 10.1016/j.jcpo.2023.100466
Rachel J. Keogh , Harry Harvey , Claire Brady , Edel Hassett , Seán J. Costelloe , Martin J. O’Sullivan , Maria Twomey , Mary Jane O’Leary , Mary R. Cahill , Aideen O’Riordan , Caroline M. Joyce , Ger Moloney , Aileen Flavin , Richard M Bambury , Deirdre Murray , Kathleen Bennett , Maeve Mullooly , Seamus O’Reilly
<div><h3>Introduction</h3><p>Cyberattacks represent a growing threat for healthcare delivery globally. We assess the impact and implications of a cyberattack on a cancer center in Ireland.</p></div><div><h3>Methods</h3><p>On May 14th 2021 (day 0) Cork University Hospital (CUH) Cancer Center was involved in the first national healthcare ransomware attack in Ireland. Contingency plans were only present in laboratory services who had previously experienced information technology (IT) failures. No hospital cyberattack emergency plan was in place. Departmental logs of activity for 120 days after the attack were reviewed and compared with historical activity records. Daily sample deficits (routine daily number of samples analyzed – number of samples analyzed during cyberattack) were calculated. Categorical variables are reported as median and range. Qualitative data were collected via reflective essays and interviews with key stakeholders from affected departments in CUH.</p></div><div><h3>Results</h3><p><span><span>On day 0, all IT systems were shut down. Radiotherapy (RT) treatment and cancer surgeries stopped, outpatient activity fell by 50%. </span>hematology<span>, biochemistry and radiology<span> capacity fell by 90% (daily sample deficit (DSD) 2700 samples), 75% (DSD 2250 samples), and 90% (100% mammography/PET scan) respectively. Histopathology reporting times doubled (7 to 15 days). Radiotherapy (RT) was interrupted for 113 patients in CUH. The median treatment gap duration was six days for category 1 patients and 10 for the remaining patients. Partner organizations paused all IT links with CUH. Outsourcing of radiology and radiotherapy commenced, alternative communication networks and national conference calls in RT and </span></span></span>Clinical Trials were established. By day 28 Email communication was restored. By day 210 reporting and data storage backlogs were cleared and over 2000 computers were checked/replaced.</p></div><div><h3>Conclusion</h3><p>Cyberattacks have rapid, profound and protracted impacts. While laboratory and diagnostic deficits were readily quantified, the impact of disrupted/delayed care on patient outcomes is less readily quantifiable. Cyberawareness and cyberattack plans need to be embedded in healthcare.</p></div><div><h3>Policy Summary</h3><p>Cyberattacks pose significant challenges for healthcare systems, impacting patient care, clinical outcomes, and staff wellbeing. This study provides a comprehensive review of the impact of the Conti ransomware attack on cancer services in Cork University Hospital (CUH), the first cyberattack on a national health service. Our study highlights the widespread disruption caused by a cyberattack including shutdown of information technology (IT) services, marked reduction in outpatient activity, temporary cessation of essential services such as radiation therapy. We provide a framework for other institutions for mitigating the impact of a cyberattack, underscoring the need for a
导言:网络攻击对全球医疗服务的威胁与日俱增。我们评估了网络攻击对爱尔兰一家癌症中心的影响:2021 年 5 月 14 日(第 0 天),科克大学医院(CUH)癌症中心遭遇爱尔兰首次全国性医疗勒索软件攻击。只有曾经历过信息技术(IT)故障的实验室服务部门制定了应急计划。医院没有制定网络攻击应急计划。对攻击发生后 120 天内的部门活动日志进行了审查,并与历史活动记录进行了比较。计算了每日样本赤字(每日常规分析样本数-网络攻击期间分析样本数)。分类变量以中位数和范围进行报告。定性数据通过反思论文和与中大医院受影响部门的主要利益相关者的访谈收集:第 0 天,所有 IT 系统关闭。放疗(RT)治疗和癌症手术停止,门诊活动减少了 50%。血液学、生物化学和放射学的处理能力分别下降了 90%(日样本赤字 (DSD) 为 2700 个样本)、75%(DSD 为 2250 个样本)和 90%(100% 乳房 X 线照相术/PET 扫描)。组织病理学报告时间增加了一倍(从 7 天增加到 15 天)。中大医院有 113 名患者中断了放疗(RT)。1 类患者的治疗间隙时间中位数为 6 天,其余患者为 10 天。合作机构暂停了与中大医院的所有信息技术连接。开始外包放射科和放射治疗,建立了替代通信网络以及 RT 和临床试验方面的全国电话会议。第 28 天,恢复了电子邮件通信。第 210 天,报告和数据存储积压得到清理,2000 多台计算机得到检查/更换:网络攻击的影响迅速、深远而持久。虽然实验室和诊断方面的缺陷很容易量化,但中断/延迟护理对患者预后的影响却不那么容易量化。政策摘要:网络攻击给医疗保健系统带来了重大挑战,影响了患者护理、临床结果和员工福利。本研究全面回顾了 Conti 勒索软件攻击对科克大学医院(CUH)癌症服务的影响,这是对国家医疗服务的首次网络攻击。我们的研究强调了网络攻击造成的广泛破坏,包括信息技术 (IT) 服务的关闭、门诊活动的显著减少、放射治疗等基本服务的暂时停止。我们为其他机构提供了一个减轻网络攻击影响的框架,强调了制定类似于自然灾害网络准备计划的必要性,以及网络攻击对患者护理的深远影响。
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引用次数: 0
Roadmap to improve the organized cancer screening programs – The case of colorectal cancer screening in Montenegro 改善有组织癌症筛查计划的路线图--黑山的大肠癌筛查案例。
IF 1.3 Q3 HEALTH POLICY & SERVICES Pub Date : 2023-12-15 DOI: 10.1016/j.jcpo.2023.100464
Ivana Nikčević Kovačević , Adrijana Vujović , Milica Stanišić , Jovana Vuković-Leković , Iris Lansdorp-Vogelaar , Dominika Novak Mlakar , Carlo Senore , Judit Józwiak-Hagymásy , György Széles , Zoltán Vokó , Marcell Csanádi

Background

Implementation of organized cancer screening programs comes with many challenges and barriers, which may inhibit the achievement of the screening activities’ desired benefits. In this paper we outline a plan for improving the colorectal cancer (CRC) screening system in Montenegro.

Methods

We formulated a roadmap, which was generally defined as a country-specific strategic plan to improve cancer screening programs. The roadmap development was an iterative, step-by-step process. First, we described the current screening program, then identified and described key barriers, and finally proposed actions to overcome them. Multiple sources of information (e.g., documents, expert opinions) were collected and processed by local and international stakeholders.

Results

The CRC screening program was implemented between 2013–2019 by gradually increasing the invitation of the target population. Key barriers of the implementation were defined: 1) Lack of colonoscopy capacity in the northern part of the country; 2) Inadequate information technology systems; 3) Inadequate public promotion of screening. The defined actions were related to overcoming lack of available resources (e.g., financial, human and technological), to improve the policy environment and the knowledge, and to facilitate information sharing.

Conclusion

The collaboration between local stakeholders of CRC screening and researchers experienced in planning and evaluating screening programs resulted in the first comprehensive description of CRC screening in Montenegro, detailed understanding of key barriers that emerged during implementation and a carefully designed list of actions. The implementation of these actions and the evaluation of whether barriers were solved will be captured in the upcoming period by maintaining this collaboration.

背景:实施有组织的癌症筛查计划会遇到许多挑战和障碍,这些挑战和障碍可能会阻碍筛查活动取得预期效益。在本文中,我们概述了改善黑山结直肠癌(CRC)筛查系统的计划:我们制定了一个路线图,它一般被定义为改善癌症筛查计划的国别战略计划。路线图的制定是一个迭代、循序渐进的过程。首先,我们描述了当前的筛查计划,然后确定并描述了主要障碍,最后提出了克服这些障碍的行动建议。当地和国际利益相关者收集并处理了多种信息来源(如文件、专家意见等):结果:2013-2019 年间,通过逐步增加目标人群的邀请,实施了 CRC 筛查计划。实施过程中遇到的主要障碍包括1) 该国北部地区缺乏结肠镜检查能力;2) 信息技术系统不足;3) 公众对筛查的宣传不足。确定的行动涉及克服可用资源(如资金、人力和技术)的缺乏,改善政策环境和知识,以及促进信息共享:CRC 筛查的当地利益相关者与在规划和评估筛查计划方面经验丰富的研究人员合作,首次全面描述了黑山的 CRC 筛查情况,详细了解了实施过程中出现的主要障碍,并精心设计了一份行动清单。在接下来的时间里,将通过保持这种合作关系来了解这些行动的实施情况以及对障碍是否得到解决进行评估。
{"title":"Roadmap to improve the organized cancer screening programs – The case of colorectal cancer screening in Montenegro","authors":"Ivana Nikčević Kovačević ,&nbsp;Adrijana Vujović ,&nbsp;Milica Stanišić ,&nbsp;Jovana Vuković-Leković ,&nbsp;Iris Lansdorp-Vogelaar ,&nbsp;Dominika Novak Mlakar ,&nbsp;Carlo Senore ,&nbsp;Judit Józwiak-Hagymásy ,&nbsp;György Széles ,&nbsp;Zoltán Vokó ,&nbsp;Marcell Csanádi","doi":"10.1016/j.jcpo.2023.100464","DOIUrl":"10.1016/j.jcpo.2023.100464","url":null,"abstract":"<div><h3>Background</h3><p>Implementation of organized cancer screening programs comes with many challenges and barriers, which may inhibit the achievement of the screening activities’ desired benefits. In this paper we outline a plan for improving the colorectal cancer (CRC) screening system in Montenegro.</p></div><div><h3>Methods</h3><p>We formulated a roadmap, which was generally defined as a country-specific strategic plan to improve cancer screening programs. The roadmap development was an iterative, step-by-step process. First, we described the current screening program, then identified and described key barriers, and finally proposed actions to overcome them. Multiple sources of information (e.g., documents, expert opinions) were collected and processed by local and international stakeholders.</p></div><div><h3>Results</h3><p>The CRC screening program was implemented between 2013–2019 by gradually increasing the invitation of the target population. Key barriers of the implementation were defined: 1) Lack of colonoscopy capacity in the northern part of the country; 2) Inadequate information technology systems; 3) Inadequate public promotion of screening. The defined actions were related to overcoming lack of available resources (e.g., financial, human and technological), to improve the policy environment and the knowledge, and to facilitate information sharing.</p></div><div><h3>Conclusion</h3><p>The collaboration between local stakeholders of CRC screening and researchers experienced in planning and evaluating screening programs resulted in the first comprehensive description of CRC screening in Montenegro, detailed understanding of key barriers that emerged during implementation and a carefully designed list of actions. The implementation of these actions and the evaluation of whether barriers were solved will be captured in the upcoming period by maintaining this collaboration.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"39 ","pages":"Article 100464"},"PeriodicalIF":1.3,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213538323000814/pdfft?md5=5fd89540d0273730f231299d7e1c03e2&pid=1-s2.0-S2213538323000814-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138795610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The effectiveness of smoking cessation interventions after cancer diagnosis: A systematic review and meta-analysis 癌症确诊后戒烟干预的有效性:系统回顾和荟萃分析
IF 1.3 Q3 HEALTH POLICY & SERVICES Pub Date : 2023-12-06 DOI: 10.1016/j.jcpo.2023.100463
Peter R. Scholten , Lukas J.A. Stalpers , Iris Bronsema , Rob M. van Os , Henrike Westerveld , Luc R.C.W. van Lonkhuijzen

Objectives

patients with cancer who smoke have more side effects during and after treatment, and a lower survival rate than patients with cancer who quit smoking. Supporting patients with cancer to quit smoking should be standard care. The aim of this systematic review was to determine the most effective smoking cessation method for patients diagnosed with cancer.

Methods

PubMed, Embase, Web of Science and Google Scholar were systematically searched. Included were randomized controlled trials and observational studies published after January 2000 with any smoking cessation intervention in patients with any type of cancer. Result of these studies were evaluated in a meta-analysis.

Results

A total of 18,780 papers were retrieved. After duplicate removal and exclusion based on title and abstract, 72 publications were left. After full text screening, 19 (randomized) controlled trials and 20 observational studies were included. The overall methodological quality of the included studies, rated by GRADE criteria, was very low. Two out of 21 combined intervention trials showed a statistical significant effect. Meta-analysis of 18 RCTs and 3 observational studies showed a significant benefit of combined modality interventions (OR 1.67, 95% C.I.: 1.24–2.26, p = 0.0008) and behavioural interventions (OR 1.33, 95% C.I.: 1.02 – 1.74, p = 0.03), but not for single modality pharmacological interventions (OR 1.11; 95% C.I.: 0.69–1.78, p = 0.66).

Conclusion

A combination of pharmacological and behavioural interventions may be the most effective intervention for smoking cessation in patients with cancer.

目标与戒烟的癌症患者相比,吸烟的癌症患者在治疗期间和治疗后副作用更大,生存率更低。支持癌症患者戒烟应成为标准护理。本系统综述旨在确定对确诊癌症患者最有效的戒烟方法。纳入的研究包括 2000 年 1 月以后发表的针对任何类型癌症患者的任何戒烟干预措施的随机对照试验和观察性研究。结果 共检索到 18,780 篇论文。根据标题和摘要去除重复内容并进行排除后,剩下 72 篇论文。经过全文筛选,共纳入 19 项(随机)对照试验和 20 项观察性研究。根据 GRADE 标准,纳入研究的总体方法学质量很低。在 21 项综合干预试验中,有两项试验显示出显著的统计学效果。对 18 项研究性试验和 3 项观察性研究进行的元分析表明,综合干预方式(OR 1.67,95% C.I.:1.24-2.26,p = 0.0008)和行为干预方式(OR 1.33,95% C.I.:1.02-1.74,p = 0.03)具有显著疗效。结论药物和行为干预相结合可能是癌症患者最有效的戒烟干预方法。
{"title":"The effectiveness of smoking cessation interventions after cancer diagnosis: A systematic review and meta-analysis","authors":"Peter R. Scholten ,&nbsp;Lukas J.A. Stalpers ,&nbsp;Iris Bronsema ,&nbsp;Rob M. van Os ,&nbsp;Henrike Westerveld ,&nbsp;Luc R.C.W. van Lonkhuijzen","doi":"10.1016/j.jcpo.2023.100463","DOIUrl":"https://doi.org/10.1016/j.jcpo.2023.100463","url":null,"abstract":"<div><h3>Objectives</h3><p>patients with cancer who smoke have more side effects during and after treatment, and a lower survival rate than patients with cancer who quit smoking. Supporting patients with cancer to quit smoking should be standard care. The aim of this systematic review was to determine the most effective smoking cessation method for patients diagnosed with cancer.</p></div><div><h3>Methods</h3><p>PubMed, Embase, Web of Science and Google Scholar were systematically searched. Included were randomized controlled trials and observational studies published after January 2000 with any smoking cessation intervention in patients with any type of cancer. Result of these studies were evaluated in a meta-analysis.</p></div><div><h3>Results</h3><p>A total of 18,780 papers were retrieved. After duplicate removal and exclusion based on title and abstract, 72 publications were left. After full text screening, 19 (randomized) controlled trials and 20 observational studies were included. The overall methodological quality of the included studies, rated by GRADE criteria, was very low. Two out of 21 combined intervention trials showed a statistical significant effect. Meta-analysis of 18 RCTs and 3 observational studies showed a significant benefit of combined modality interventions (OR 1.67, 95% C.I.: 1.24–2.26, p = 0.0008) and behavioural interventions (OR 1.33, 95% C.I.: 1.02 – 1.74, p = 0.03), but not for single modality pharmacological interventions (OR 1.11; 95% C.I.: 0.69–1.78, p = 0.66).</p></div><div><h3>Conclusion</h3><p>A combination of pharmacological and behavioural interventions may be the most effective intervention for smoking cessation in patients with cancer.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"39 ","pages":"Article 100463"},"PeriodicalIF":1.3,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213538323000802/pdfft?md5=30bd12ea2dd2c95fa8f0af9078874086&pid=1-s2.0-S2213538323000802-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138558918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Use of subjective minimizing language at hematology and oncology conferences: A systematic review 在血液学和肿瘤学会议上使用主观性最小化语言:系统回顾
IF 1.3 Q3 HEALTH POLICY & SERVICES Pub Date : 2023-12-05 DOI: 10.1016/j.jcpo.2023.100461
Abdel-Azez Abusamak , Mohammad Abusamak , Mohammed Al-Abbadi , Abdallah Rayyan , Omar Oran , Ghulam Rehman Mohyuddin , Amar H. Kelkar , Aaron M. Goodman , Rajshekhar Chakraborty , Edward R.Scheffer Cliff , Samer Al Hadidi

Background

Subjective minimizing language in oncology conferences may undermine patient-centered care and hinder comprehensive treatment strategies. Subjective terms like "safe," "tolerable," and "well-tolerated" can vary in interpretation among individuals, making it difficult to compare results across trials and potentially downplaying significant risks and limitations associated with treatments.

Methods

This study evaluates subjective minimizing language in major oncology conferences and its use in adverse event reporting. We conducted a search of three electronic databases, ASCO, ASH, and ESMO, for published abstracts from January 1, 2019, to December 31, 2021. This study included prospective cohort studies or clinical trials in humans that used safety terms like "safe," "well-tolerated," "tolerable," "no new safety signal," or "no new safety concern" in the abstract text.

Results

Out of 34,975 reviewed records, 5299 (15.2%) abstracts used subjective minimizing language terms. The analysis included 2797 (52.8%) abstracts meeting the inclusion criteria. The majority of studies were Phase 1 trials (45.5%), followed by Phase 2 (29.6%) and Phase 3 trials (7.4%). Solid tumors accounted for the most common disease category (56.5%), followed by malignant hematology following (37.1%). Subjective minimizing terms like "safe" (69.2%), "well-tolerated" (53.2%), "tolerable" (25.6%), and "no new safety signal/concerns" (10%) were used frequently. Of the abstracts using subjective minimizing language (n = 2797), 81.9% reported data on any grade adverse events (AEs). Grade I/II AEs were reported in 62.6% of abstracts, Grade III/IV AEs in 78%, and Grade V AEs (death related to AEs) in 8.8%. Discontinuation due to AEs occurred in 11.4% (SD 9.5%) of studies using subjective minimizing language terms.

Conclusions

Frequent use of subjective minimizing language in major oncology conferences' abstracts may obscure interpretation of study results and the safety of novel treatments. Researchers and clinicians should provide precise and standardized information to avoid overstatement of benefits and understand the true impact of interventions on patients' safety and well-being.

背景肿瘤学会议中主观性最小化的语言可能会破坏以患者为中心的护理,阻碍综合治疗策略的实施。安全"、"可耐受 "和 "耐受性良好 "等主观用语可能因人而异,从而难以比较不同试验的结果,并可能淡化与治疗相关的重大风险和局限性。方法本研究评估了主要肿瘤学会议中的主观最小化用语及其在不良事件报告中的使用情况。我们在 ASCO、ASH 和 ESMO 三个电子数据库中检索了 2019 年 1 月 1 日至 2021 年 12 月 31 日期间发表的摘要。本研究纳入了在摘要文本中使用了 "安全"、"耐受性良好"、"可耐受"、"无新的安全信号 "或 "无新的安全问题 "等安全性术语的前瞻性队列研究或人体临床试验。结果在34975条审查记录中,5299条(15.2%)摘要使用了主观最小化语言术语。分析包括 2797 份(52.8%)符合纳入标准的摘要。大多数研究是 1 期试验(45.5%),其次是 2 期试验(29.6%)和 3 期试验(7.4%)。实体瘤是最常见的疾病类别(56.5%),其次是恶性血液病(37.1%)。主观最小化术语的使用频率很高,如 "安全"(69.2%)、"耐受性良好"(53.2%)、"可耐受"(25.6%)和 "无新的安全信号/疑虑"(10%)。在使用主观性最小化语言的摘要(n = 2797)中,81.9%报告了任何级别的不良事件(AEs)数据。62.6% 的摘要报告了 I/II 级不良事件,78% 报告了 III/IV 级不良事件,8.8% 报告了 V 级不良事件(与不良事件相关的死亡)。在使用主观最小化语言术语的研究中,11.4%(标准差 9.5%)的研究因 AEs 而终止。研究人员和临床医生应提供准确和标准化的信息,以避免夸大疗效,并了解干预措施对患者安全和福祉的真正影响。
{"title":"Use of subjective minimizing language at hematology and oncology conferences: A systematic review","authors":"Abdel-Azez Abusamak ,&nbsp;Mohammad Abusamak ,&nbsp;Mohammed Al-Abbadi ,&nbsp;Abdallah Rayyan ,&nbsp;Omar Oran ,&nbsp;Ghulam Rehman Mohyuddin ,&nbsp;Amar H. Kelkar ,&nbsp;Aaron M. Goodman ,&nbsp;Rajshekhar Chakraborty ,&nbsp;Edward R.Scheffer Cliff ,&nbsp;Samer Al Hadidi","doi":"10.1016/j.jcpo.2023.100461","DOIUrl":"https://doi.org/10.1016/j.jcpo.2023.100461","url":null,"abstract":"<div><h3>Background</h3><p>Subjective minimizing language in oncology<span> conferences may undermine patient-centered care and hinder comprehensive treatment strategies. Subjective terms like \"safe,\" \"tolerable,\" and \"well-tolerated\" can vary in interpretation among individuals, making it difficult to compare results across trials and potentially downplaying significant risks and limitations associated with treatments.</span></p></div><div><h3>Methods</h3><p><span><span>This study evaluates subjective minimizing language in major oncology conferences and its use in adverse event reporting. We conducted a search of three electronic databases, ASCO, </span>ASH<span>, and ESMO<span>, for published abstracts from January 1, 2019, to December 31, 2021. This study included prospective cohort studies or </span></span></span>clinical trials in humans that used safety terms like \"safe,\" \"well-tolerated,\" \"tolerable,\" \"no new safety signal,\" or \"no new safety concern\" in the abstract text.</p></div><div><h3>Results</h3><p>Out of 34,975 reviewed records, 5299 (15.2%) abstracts used subjective minimizing language terms. The analysis included 2797 (52.8%) abstracts meeting the inclusion criteria. The majority of studies were Phase 1 trials (45.5%), followed by Phase 2 (29.6%) and Phase 3 trials (7.4%). Solid tumors<span> accounted for the most common disease category (56.5%), followed by malignant hematology following (37.1%). Subjective minimizing terms like \"safe\" (69.2%), \"well-tolerated\" (53.2%), \"tolerable\" (25.6%), and \"no new safety signal/concerns\" (10%) were used frequently. Of the abstracts using subjective minimizing language (n = 2797), 81.9% reported data on any grade adverse events (AEs). Grade I/II AEs were reported in 62.6% of abstracts, Grade III/IV AEs in 78%, and Grade V AEs (death related to AEs) in 8.8%. Discontinuation due to AEs occurred in 11.4% (SD 9.5%) of studies using subjective minimizing language terms.</span></p></div><div><h3>Conclusions</h3><p>Frequent use of subjective minimizing language in major oncology conferences' abstracts may obscure interpretation of study results and the safety of novel treatments. Researchers and clinicians should provide precise and standardized information to avoid overstatement of benefits and understand the true impact of interventions on patients' safety and well-being.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"39 ","pages":"Article 100461"},"PeriodicalIF":1.3,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138581974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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