...de Souza et al. BMC Health Services Research 2012, 12:481 http://www.biomedcentral.com/1472-6963/12/481 RESEARCH ARTICLE Open Access Unsupported off-label chemotherapy in metastatic colon cancer Jonas A de Souza1,2*, Blase Polite1,2,3, Monica Perkins4, Neal J Meropol5, Mark J Ratain1,2,6, Lee N Newcomer4 and G Caleb Alexander7 Abstract Background: Newer systemic therapies have the potential to decrease morbidity and mortality from metastatic colorectal cancer, yet such therapies are costly and have side effects. Little is known about their non-evidence-based use. Methods: We conducted a retrospective cohort study using commercial insurance claims from UnitedHealthcare, and identified incident cases of metastatic colon cancer (mCC) from July 2007 through April 2010. We evaluated the use of three regimens with recommendations against their use in the National Comprehensive Cancer Center Network Guidelines, a commonly used standard of care: 1) bevacizumab beyond progression; 2) single agent capecitabine as a salvage therapy after failure on a fluoropyridimidine-containing regimen; 3) panitumumab or cetuximab after progression on a prior epidermal growth factor receptor antibody. We performed sensitivity analyses of key assumptions regarding cohort selection. Costs from a payer perspective were estimated using the average sales price for the entire duration and based on the number of claims. Results: A total of 7642 patients with incident colon cancer were identified...
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...Oral Oncology 50 (2014) 577–586 Contents lists available at ScienceDirect Oral Oncology journal homepage: www.elsevier.com/locate/oraloncology Review ACR Appropriateness CriteriaÒ thyroid carcinoma Joseph K. Salama a,⇑, Daniel W. Golden b, Sue S. Yom c, Madhur Kumar Garg d, Joshua Lawson e, Mark W. McDonald f, Harry Quon g, John A. Ridge h, Nabil Saba i, Richard V. Smith j, Francis Worden k, Anamaria Reyna Yeung l, Jonathan J. Beitler m a Duke University, Durham, NC, United States University of Chicago Hospital, Chicago, IL, United States University of California San Francisco, San Francisco, CA, United States d Montefiore Medical Center, Bronx, NY, United States e Lexington Medical Center, West Columbia, SC, United States f Indiana University School of Medicine, Indianapolis, IN, United States g Johns Hopkins University, Baltimore, MD, United States h American College of Surgeons, Fox Chase Cancer Center, Philadelphia, PA, United States i American Society of Clinical Oncology, Emory University, Atlanta, GA, United States j American College of Surgeons, Montefiore Medical Center, Bronx, NY, United States k American Society of Clinical Oncology, University of Michigan, Ann Arbor, Michigan, United States l University of Florida, Gainesville, FL, United States m Emory University School of Medicine, Atlanta, GA, United States b c a r t i c l e i n f o s u m m a r y The ACR Head and Neck Cancer Appropriateness Criteria Committee reviewed relevant medical...
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...304 Letters Vol. 30 No. 4 October 2005 Ignazio Cutaia, MD Irene Parrino, MD Archimede Center, Palermo, Italy Alessandra Casuccio, MD Univeristy of Palermo, Palermo, Italy doi:10.1016/j.jpainsymman.2005.08.010 Topical Morphine in the Treatment of Painful Ulcers To the Editor: In a previous issue of the journal, Zeppetella et al. published data regarding the use of topical morphine in the treatment of painful ulcers, confirming the results of a pilot study. Topical morphine seems to be safe and efficacious in the treatment of ulcer-related pain.1,2 At the Medical Oncology Department of the University of L’Aquila, five patients with malignant or benign painful ulcers were observed recently. All were affected by metastatic cancer and were receiving opioids; none was receiving disease-oriented therapies. On admission, all patients reported pain localized to ulcers, which was no longer controlled by systemic treatment; pain scores were O 5 on a numerical rating scale (NRS). Morphine was topically applied to ulcers three times daily (morphine sulfate injection 10 mg in 8 g Intrasite gelÒ, Smith & Nephew, Agrate Brianza, Italy). The morphine dose was the same in all patients, regardless of the ulcer size and the scheduled systemic treatment. Ulcers were washed before treatment with a ringer lactate and metronidazole solution. Systemic treatment was not modified. Pain was assessed daily by the patients using the NRS; nurses reported local and/or systemic adverse effects related...
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...Vemurafenib: A Potentially New Standard of Care? Vemurafenib: A Potentially New Standard of Care? Melanoma is the most deadly form of skin cancer. Advanced metastatic melanoma, stage III or IV, has been incurable and relatively untreatable with “less than 10% of patients responding to traditional chemotherapy” regimens (PubMed Health, 2011). Progress in this area of oncology research has been very slow with the “average prognosis for patients with stage IV metastatic melanoma being 8-18 months” (Chapman., 2011). Proven research shows that the standard chemotherapy regimens don’t actually extend the lives of these patients. The standard first line treatment for late stage metastatic melanoma is dacarbazine (DTIC), used either alone as a single agent or in combination with other chemotherapy agents, and the effects have been minimal. The dacarbazine regimen usually shrinks the tumors for a temporary period, “about 3-6 months,” and then they begin to grow again. (Melanoma Skin Cancer, 2011). Recent research in the past five years has led to some targeted immunotherapy drugs like ipilimumab and peginterferon alpha-2b which have shown some promising results in helping to extend life expectancies for these patients. On August 17, 2011 the Food and Drug Administration gave some much needed hope to these patients with the approval of vemurafenib (Zelboraf). An orally administered targeted chemotherapy agent that has shown statistically significant results in “reducing the...
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...Baderman Island Resort Executive Summary Baderman Island is accepting design bids for its seasonal annual marketing campaign. Team B is asked to design the following: * An 11” x 14” poster designed for print delivered as an unflattened PSD file smaller than 10 MB. * A 300 x 300 pixel web advertisement delivered as an unflattened PSD file smaller than 10 MB and a flattened JPEG of no more than 200 KB. * The color scheme must be consistent with the color scheme established on the Baderman Island website. * Both the poster and web advertisements to include the Baderman Island logo, located in the banner at the top of the Baderman Island home page. * Designs to include at least three different examples of text to include: The Baderman Island motto. A new additional slogan created by Design Team B. The company name Baderman Island, modified from text into a graphic. In order for Team B to create these designs, it is beneficial for them to learn more about the Baderman Island Resort, such as the accommodations, amenities, and restaurants. The site also has a blog that could be useful in finding out what guests look for most when coming to visit Baderman Island Resort. History “Welcome to Baderman Island: where paradise is reality.” "Established in 2004, leisure and convention center focused Baderman Island is dedicated in providing unique and quality experiences to Island guests and daily visitors. The Board of Directors and operational...
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...Club Med 'The Club Med (A) case is a big-picture case that examines the strategy of an international chain of all-inclusive vacation resorts. It outlines the forces that shape the industry's structure, and presents the particular factors that contribute to Club Med's success. Of critical concern are the potential areas where Club Med can establish a defensible competitive advantage. What are the essential ingredients of Club Med’s service-delivery system? Can the process be appropriated? We think the Club Med has diverse unique service-delivery system such as AI(all-inclusive) vocation package Unique concept to GM that means nothing to worry about except relaxing and enjoying themselves Guest-friendly talented Staff Advance distribution network for example indirect sales through travel agencies as well as direct sales to customers “Word of Mouth” of market strategy Location for eco-friend resort environment Customer centralized information: easy to use and share for future opportunity What are the determinants of service quality at Club Med? We think the Club Med has diverse unique systems. For example The Club Med has a lot of talented GO having passion and energy for customer’s satisfaction The Club Med rotate its GOs from one resort to another every 6 months, resulting in new ideas and better practices In pricing strategy, the Club Med provide a service with all-inclusive approach and provide membership programs. The Club Med think Word...
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...University of Texas MD Anderson Cancer Center organizational structure has allowed them to become one of the prominent organizations for treating cancer, research, and schooling. Since the early 90’s, they successfully restructured from being a physically organized cancer center in regards to clinical fields into a hospital that was structured into disease centered combined practice components termed multidisciplinary centers of care. These components were reinforced by an organizational structure plan in which doctors conveyed information both to management of educational units and disease centered care centers. As their ability to research and at the same time educate future health care personnel keeps them in forefront. Though these multidisciplinary centers of care do not operate simultaneously as one team focus on an individual patient they communicate focusing on particular cancer treatment and research with the same mission and goal. Keywords: cancer, research, students The University of Texas MD Anderson Cancer Center Organization& Stakeholder Relationship Knowledge and Comprehension The University of Texas MD Anderson Cancer Center being one of the United States most valued centers dedicated entirely to the care of patients with cancer, education and research. Located in Houston, Texas Medical Center, established in 1941 MD Anderson was a part of “The University of Texas System”. Further research shows The University of Texas MD Anderson Cancer Center is...
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...Baderman Island HM/486 02 December 2013 University of Phoenix Professor Lequrica Gaskins Baderman Island Baderman Island offers guests an all-inclusive vacation, destination wedding, or conference experience. Part of the Baderman Island mission statement includes offering price ranges for all budgets while providing a premium guest experience. The property, on an island in the Kelsey River boasts a size of approximately 930 acres. The lodging options include The Tenney, a couple’s retreat featuring only suites, The Melancon Conference Center, equipped to handle groups of nearly any size, and The Baderman Main Hotel, which accommodates the largest variety of guests. The main hotel caters primarily to family vacationers, and the facility is designed to accommodate all ages. In addition to the various lodging options, Baderman Island also hosts food services including several fine dining restaurants, cafes, and bistros. Currently reservations for dinner at any of the fine restaurants can be made online. The island features spas, art galleries, and boutiques as well as gift shops. The convention center offers full event services including access to recreational pursuits popular with conference attendees. These include an 18-hole golf course, water sports, and a botanical garden. The garden property alone consists of nearly one third of Baderman Island’s total acreage. At 375 acres, the Botanical Gardens offer some of the most intriguing of...
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...Case Analysis Club Med Luya Li (999651880) Lec 02 Professor Tarun Dewan 23rd January 23, 2015 OVERVIEW Club Mediterranee, or Club Med, is a corporation in the hotel and travel industry. It was originally founded as a sports association by a group of French sports enthusiasts in 1950, as the customer demand and business opportunities increased, it transformed from an association into a travel company with the help of the managing director Gilbert Trigano. Club Med created the all-inclusive vacation concept and later became the market leader in the resort industry. Throughout the years, the corporation had enjoyed financial growth and geographically expanded its business throughout the world. In 1984 and 1985, both Club Med S.A and its subsidiary, Club Med. Inc. went public and offered their shares on major stock exchange. However, the company should pay close attention to its potential weakness given the pace of commerce and heated competition. This report will list the comparative advantages of Club Med and explain the reasons for its success over the past years. It will also highlight the company’s unique corporate culture. Moreover, the report will point out Club Med’s potential problems, and provide recommendation in regards to Club Med’s future strategy. ANALYSIS Club Med’s success can be measured both financially and non-financially. After transforming into a travel and hotel company, Club Med further expanded its business by forming the U.S. subsidiary...
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...Cancer of the Brain Brain cancer is a rare disease effecting one out of every five-thousand people in the U.S. Eighty-five percent of cases occur in adults that are over the age forty and as for the other fifteen percent it is seen in children and young adults up to the age of twenty. Research has also found that more men are affected by brain cancer than women. There are two classifications of a brain tumor that are formed. One is called primary brain cancer. A primary brain tumor occurs when one type of cell changes it characteristics and multiplies in abnormal ways causing a tumor or mass to grow in the brain. The most common primary brain tumors are gliomas, meningiomas, pituitary adenomas, vestibular schwannomas, and primitive neuroectodermal tumors. These brain tumors are called primary because they start and form in the brain. The second type of brain tumor is called metastatic brain cancer. Metastatic brain tumors are caused by cancerous cells in a tumor elsewhere in the body. These cancerous cells spread to the brain from a cancerous tumor in the body causing a cancerous tumor in the brain. This process is called metastasis. This process occurs in about twenty-five percent of tumors found in the body. There are many types of brain tumors. Not all tumors found in the brain are cancer. Tumors can be malignant (cancer) or benign (not cancer). A malignant tumor is a cancerous tumor that in some cases can spread to other parts of the brain...
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...Cost and Consumerism Presentation Cassie Springer HCO/HC 561 Carol Szerszen May 16, 2011 Introduction In today’s economy, insurance is not always an option. Below are some scenarios and discussion of out of pocket expenses and options for paying for treatment. Scenario 1 A single, 23 year old female who is generally healthy, is a non-smoker, non-drinker is pregnant and without health insurance. She must find options for paying for prenatal care and delivery of the baby. Option one in the state of Kentucky would be to apply for Medicaid. Under Medicaid eligibility requirements most women will qualify if they meet the poverty guidelines (CMS.gov, 2011 ). If she were ineligible for Medicaid a second option would be to go to the local Health Department where fees are based on income. The Health Department has an OBGYN on staff full time. The Health Department also works with the University of Kentucky for delivery and other necessary testing she may need. If she were unable for any reason to qualify for services at the Health Department, the costs would be expensive. According to CostHelper.com prenatal visits could approximate to be around $3200. That’s not to mention the cost of delivery. A vaginal delivery with an epidural could range around $8000, if a caesarian section would be needed the cost could range to be around $30,000 (CostHelper, 2011 ). Financing this would be out of the question for someone this age. If she were to make a minimum...
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...Chronic Lymphocytic Leukemia is a condition characterized by an accumulation of abnormal lymphocytes (a type of white blood cells), in the blood and bone marrow. Hepatitis C is another type of cancer that will be affecting primarily the liver. There is not a cure for either of these diseases but the chances of survival have improved greatly over the years. Chronic Lymphocytic Leukemia (CLL) and Hepatitis C (HCV) are both forms of cancer so you cannot treat one without worsening the damage of the other. CLL is a lymphoid malignancy that occurs in a heterogeneous patient population. Lymphoid malignancy is a term used to describe a cancerous tumor that can spread and invades surrounding lymph nodes. CLL is caused by the overproduction of abnormal b lymphocytes. This is in contrast to the term begin, which references conditions are not necessarily invasive and do not spread throughout the body. Heterogeneous can be described as the diversity of nearly anything whether its population, classrooms, or collections. Patients may be risk stratified into low, intermediate, and high-risk categories based on prognostic factors, which may influence the approach to treatments. Differences in cell morphology, immunophenotype, cytogenetics, and molecular characteristics impact the clinical courses of disease and individual patient response. Cell morphology is essential in identifying the shape, structure, form, and size of cells. In cancer, for instance, cell morphology pertains to the shape...
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..."SHARE THIS INFORMATION FIRST AND READ AFTERWARDS.....SAVE LIFE Share this as much as you can. "10000 times stronger killer of CANCER than Chemo".. do share it.. can save many lives, fill up hopes and build confidence in the patients... The Sour Sop or the fruit from the graviola tree is a miraculous natural cancer cell killer 10,000 times stronger than Chemo. Why are we not aware of this? Its because some big corporation want to make back their money spent on years of research by trying to make a synthetic version of it for sale. So, since you know it now you can help a friend in need by letting him know or just drink some sour sop juice yourself as prevention from time to time. The taste is not bad after all. It’s completely natural and definitely has no side effects. If you have the space, plant one in your garden. The other parts of the tree are also useful. The next time you have a fruit juice, ask for a sour sop. How many people died in vain while this billion-dollar drug maker concealed the secret of the miraculous Graviola tree? This tree is low and is called graviola ! in Brazi l, guanabana in Spanish and has the uninspiring name “soursop” in English. The fruit is very large and the subacid sweet white pulp is eaten out of hand or, more commonly, used to make fruit drinks, sherbets and such. The principal interest in this plant is because of its strong anti-cancer effects. Although it is effective for a number of medical conditions, it is its...
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...Living with Cancer Living with Cancer “Cancer does not discriminate against race, sex or age; there are many types of cancer and there are not always available treatments.” “Nothing in life is to be feared. It is only to be understood” –Marie Curie. Every year people are affected by cancer. Living with cancer is hard on all involved with any person that has cancer. They will need all the support they can get even if it’s just a phone call to say hi. Don’t feel sorry or pity the person. Instead do things that can cheer them up asking how they’re doing and ask if you can do anything for them. Many find going to support groups helpful to accept the fact they have or lost someone to cancer. The awareness does show favoritism toward to certain cancers rather than all. It covers the ones with higher rates and more known killers. Doing your own research helps in many ways; if there are areas you don’t understand you can look to see if you can understand better before you ask your doctor questions. Doing research on different stages and about the cancer itself makes it easier to understand what you’re going or will be going through. Whenever you get a chance always ask your doctor questions. If you are the family, you also may find the need to ask the doctor question to put your own mind at ease. Become aware of all of treatments that may interest you than ask your doctor if that treatment could be better. Just because you went through something like a loved one or friend...
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...BREAST CANCER PREVENTION 1 Breast Cancer Prevention Venita Conley University of Phoenix 2 Breast Cancer Prevention Breast cancer is the second leading cause of cancer deaths in women at the age of 45-50. The number of women diagnosed with breast cancer increases every year, but if detected early, the survival rate is better. Breast cancer can also occur in men, but is less common. Breast cancer in men can happen at any age, but is most common in men between the ages of 60 and 70 years old. Statistics reveals that white women are at a higher risk of developing malignant breast cancer than Asians or Hispanics. (Rising Tide, Kft 2009) Breast cancer is the number two cancer killer and the number one female cancer in women age 15 to 54. Early preventive steps and annual breast exams can help in monitoring early signs of breast cancer in women as early as 20 years of age. Breast cancer is a malignant tumor that starts in the cells of the breast. It is also the uncontrollable growth and spread of cells in the breast, and if not controlled can lead to death. There are many types of breast cancers. The three main types of breast cancers are: the first type is Ductal Carcinoma In-Situ which is a type of early breast cancer confined to the inside of the ductal system, and is the most common...
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