ONCOLOGY Vol 9 No 6

This timely and informative review describes the components of a cost-effectiveness analysis and provides useful commentary on various ways to measure them. It may be helpful, however, to take a step back and compare cost-effectiveness analysis to the other basic approaches to economic analysis.

The failure to contain health-care costs and curtail growth is a growing national economic concern and public policy issue. The marketplace is rapidly changing how health care is paid for by moving from fee-for-service mechanisms to prospective payment, diagnosis-related groups, and increasing exclusion of some treatment(s).

Historically, new therapeutic strategies for cancer have been evaluated on the basis of safety and clinical efficacy. However, the current national emphasis on efficiency of resource allocation has led to the inclusion of economic assessments in oncology studies. Economic assessments measure patients' health status and resource consumption associated with a therapeutic strategy, and combine these in a cost-effectiveness analysis. Study design can include prospective analysis of clinical trials, retrospective analysis of a clinical trial or administrative databases, or a decision analytic model. Economic analysis is being used increasingly in oncology and will continue to provide meaningful data to assist clinicians in determining the optimal treatment strategies for cancer patients and to help inform health policy decision-makers about the importance of specific cancer therapeutic strategies. [ONCOLOGY 9(6):523-538, 1995]

Counseling and testing are important components of state and local HIV prevention programs [1]. Analysis of national data sources indicates that HIV antibody tests are obtained from a variety of

Like a colorblind coach who can see all the players but cannot tell who is friendly, x-ray mammography is effective in finding suspicious breast lesions but is not reliable in determining which ones are cancerous. Because of this uncertainty, about

African-Americans and Caucasians who have the same type of esophageal cancer and receive the same quality of treatment have a similar survival rate, preliminary results of a national study show.

This is the seventh in a well-known series of conference summaries, organized and edited by Dr. Salmon. A perusal of the contents of these volumes over the past two decades reveals the evolution of concepts related to combined-modality therapy

Race does not appear to be a major factor in breast cancer survival when information on stage of disease, income level, education, and access to care also are reviewed, a number of studies show.

A study of 166 women with suspicious mammograms who underwent ultrasound-guided fine-needle aspiration cytology (USFNAC) showed the technique to be 100% accurate in diagnosing cancers, reported Dr. Thomas G. Frazier at the annual

Swedish researchers have, for the first time, used a combination of methods to accurately diagnose high-risk patents with early-stage ovarian cancer, thereby identifying those who would benefit from more aggressive treatment.

A new blood substitute with broad life-saving potential is being tested at the University of Medicine and Dentistry of New Jersey (UMDNJ). The unique blood product is made with a patented chemical modification process developed by Enzon

By literally freezing prostate cancer cells to death, radiologists can effectively treat prostate cancer in some patients while reducing complication rates, preliminary results of a study show. The new procedure, trans- rectal ultrasound-guided

The combination of vinorelbine tartrate (Navelbine) and paclitaxel (Taxol) appears promising for the treatment of patients with metastatic breast cancer, including some patients who had previously receivedanthracycline-based adjuvant therapy,

African-American men with prostate cancer live as long as their white counterparts if they receive the same treatment, two cancer research studies show. African-American men, however, are not receiving comparable treatment, says Dr. Mack

Race does not play a stastically significant role in lung cancer patients'survival, a recent analysis shows. Instead, cigarette use, stage of disease, and other factors appear to be reasons more African-Americans die of lung cancer than their Caucasian

Disadvantaged Americans are far more likely to die of the most treatable form of lung cancer--not because of their health habits, but because they don't receive the proper treatment

An estimated 22 million US women were current smokers in 1993; of these, 73% wanted to quit smoking [1]. However, attempts to quit smoking and to remain abstinent are hindered by nicotine addiction and by the subsequent effects of nicotine

Prostate-specific antigen (PSA) testing has changed the face of prostate cancer, leading to earlier diagnosis and improved outcome, says David F. Paulson, md, professor and chairman, Division of Urology, Duke University Medical School.

The first description of percutaneous biliary drainage in the United States appeared in 1965 [1]. The percutaneously placed catheters were left in the obstructed biliary tract for drainage for up to 5 days. Since then, biliary drainage techniques have advanced substantially, and options have proliferated. Now, the nonsurgical palliation of malignant biliary obstruction, accomplished either endoscopically or percutaneously, is a well-established therapeutic modality.

The treatment of advanced non-small-cell lung cancer has undergone incremental improvement over the last three decades of investigation. When this incremental history is reviewed, three distinct subdivisions emerge: (1) the minimal-activity era

Dr. Vokes provides information about integrating a new chemotherapeutic agent, vinorelbine (Navelbine), into the current treatment regimens for patients with advanced-stage non-small-cell lung cancer. He reviews the phase II activity of

Management of the neck lymph nodes is a critical factor in the success of treatment for patients with malignant head and neck tumors. Recurrence in the neck is an important cause of treatment failure, second in frequency only to recurrence at the primary site [1,2].

Dr. Stringer has done an excellent job of reviewing the anatomic, biologic, diagnostic, and therapeutic considerations that impact on the management of nodal metastases from head and neck malignancies. This is a thorough summary of the current

The estimated risk of HIV transmission from doctor to patient during an invasive radiologic procedure is quite low, slightly less than the risk during surgery, according to a study from the University of Texas Southwestern Medical Center at Dallas

Meta-analyses of randomized clinical studies comparing combination chemotherapy versus "best supportive care" for advanced non-small-cell lung cancer have revealed a small, but statistically significant survival

Biliary tract drainage, with or without placement of an endoprosthesis, is used as a palliative therapy for malignant biliary obstruction. The first truly internal endoprostheses represented a distinct improvement over internal-external catheters but still remained patent for only 4 to 6 months. Metallic stents have a long-term patency of 6 to 8 months. At present, it appears that patients with unresectable pancreatic cancer should be palliated with endoscopically placed plastic or metal stents, whereas those with malignant obstructions higher in the biliary tree are probably better managed with transhepatically placed stents. The combination of brachytherapy plus external-beam radiation followed by implantation of a Gianturco metal stent may be a viable approach to treating obstructions in patients with cholangiocarcinoma. For those with other noncholangiocarcinomas, particularly when life expectancy exceeds anticipated stent patency duration, the Wallstent may be the device of choice. [ONCOLOGY 9(6):493-504, 1995]

There has been a significant accumulation of collective experience with percutaneous biliary drainage (PCD) during the past 20 years. As experience with the technique has increased, its role has undergone a series of redefinitions, although early enthusiasm for percutaneous drainage has been tempered by the realities of numbers and statistics.

This article will address modified, selective, and radical neck dissection as well as other surgical considerations, and will review the surgical techniques currently available for neck treatment.