Behavioral science research in the cooperative group setting: the Southwest Oncology Group experience.
Explore the source record for details and available documents.
Breast Neoplasms↗
Biomedical subjects
E DeAntoni
Publications and source records attributed to E DeAntoni.
Cost-effectiveness analysis: application to endourology.
A literature review was conducted on the application of economic analysis to clinical medicine, particularly urology. The surgical management of urolithiasis and the treatment of ureteropelvic junction obstruction were used as specific disease examples to evaluate how cost-effectiveness analysis has been used to address the clinical concerns of practicing urologists. As the costs and outcomes of the treatment of kidney stone disease and ureteropelvic junction obstruction can be specifically defined, the application of cost-effectiveness analysis in these two areas meets most standards of economic analysis. Economic models that incorporate poor assumptions, incomplete data, or both are unlikely to have significant clinical utility. The most useful models are those that are structurally simple and evaluate healthcare program alternatives from the patient's, provider's, or society's perspective.
Cost-Benefit Analysis↗
Comparison of perspectives on prostate cancer: analyses of survey data.
OBJECTIVES: Prostate cancer will account for 334,500 new cases and 41,800 deaths among men in the United States in 1997. Patients and physicians are faced with many concerns related to benefits and side effects of alternative treatments, educational needs, emotional support, and costs of care. Support groups for prostate cancer patients have been established to help satisfy needs in these areas. Therefore, we addressed three issues among patients who belong to a prostate cancer support group as well as among a second group of urologists who treat prostate cancer: (1) goals for prostate cancer treatment, (2) information that is given and recalled about the disease and therapy, and (3) extent to which educational and emotional needs are being met. METHODS: Random telephone surveys were made of 1000 men with prostate cancer who belong to the prostate cancer support group US TOO, the largest prostate cancer support group in the United States, and 200 urologists who provide care to men with prostate cancer. The surveys were conducted by the Louis Harris & Associates survey research firm. RESULTS: About four fifths of patients and urologists prefer aggressive therapy for prostate cancer. Patient goals with therapy included preservation of quality of life (45%), extension of life (29%), and delaying disease progression (13%), whereas physicians overwhelmingly focused on treatment efficacy (86%), with side effects (43%) and costs (29%) being secondary considerations. Urologists and patients differed markedly in the description of the patient-physician discussion. Whereas almost 100% of physicians stated that they always discussed important considerations such as options for no therapy, life expectancy with and without therapy, patient preferences, costs, and changes in sexual function, only about one fifth of patients recalled similar discussions. Patients and physicians both believed that physicians were an excellent source of educational support, but often did not report provision of emotional support. Although support groups were viewed as good providers of educational and emotional support by 85% to 90% of patients, physicians appeared to underestimate the benefit of support groups in these areas. CONCLUSIONS: Patients who belong to US TOO have many emotional and educational needs that are not currently being fulfilled by physicians. Although the goals of therapy are viewed similarly by patients and physicians, much of the important cancer- and treatment-related information that physicians report they have provided is not recalled by patients. Policy makers would be wise to devise systematic strategies such as shared decision-making tools and better linkages to support groups to ensure that patients' needs are being met.
Aged↗
[Recent multicenter study protocols in the USA for patients with metastatic prostatic carcinoma].
Combined androgen blockade for metastatic prostate cancer has become the standard against which on-going clinical trials are measured. Benefit of combined androgen blockade with an LHRH agonist (leuprolide) and an antiandrogen (flutamide) has been noted, particularly for those with minimal disease. This has led to timely accrual of patients to a trial testing whether orchidectomy with flutamide is superior to orchidectomy alone. Positive findings with permanent and intermittent withdrawal of flutamide has prompted the design and implementation of additional trials. Suramin has been reintroduced in trials of chemohormonal intervention. Past success with combined androgen blockade in lengthening survival and improving quality of life for patients with metastatic prostate cancer has prompted enthusiasm for broadening the base of clinical studies for this disease.
Antineoplastic Agents, Hormonal↗
Prostate Cancer Awareness Week, 1992: a summary of key findings.
Prostate Cancer Awareness Week was begun in 1989 to investigate whether men could be recruited to participate in free prostate cancer screening. Initially designed to raise public awareness of "the ignored male disease", it has become the largest single cancer screening program in the United States. In 1992, more than 500,000 men were examined by digital rectal examination (DRE) and more than half of these also by measuring prostate-specific antigen (PSA). Although the populations examined have been generally better educated than the national average, predominantly white, and typically (> 40%) experiencing some symptom of prostate disease, adherence to annual prostate examinations remains low among successive cohorts of participants. Prostate cancers detected through this program exhibit a more favorable stage distribution than the national average. From 1989 through 1992, many cancers were detected by using the effective combination of DRE and PSA testing, which resulted in more stage A disease being diagnosed and fewer stage B, C, and D tumors. Data from 1992 suggest that increasing sophistication is possible with PSA test results, and age-specific PSA reference ranges have been developed.
Adult↗