PubMed Health⌕ Search

Biomedical subjects

G Silberman

Publications and source records attributed to G Silberman.

10 recordsLinked to original sources
PubMed1997

Survival rates for four forms of cancer in the United States and Ontario.

OBJECTIVES: In this study, cancer survival rates for patients diagnosed in Ontario and selected areas within the United States were compared. METHODS: Relative survival rates were computed for patients aged 15 through 84 years diagnosed with any of four forms of cancer (breast, colon, lung, and Hodgkin's disease). The cohorts represented those diagnosed over the years 1978 through 1986 in the Canadian province of Ontario and in nine regions covered by the US National Cancer Institute's Surveillance Epidemiology and End Results program. Patients were followed through the end of 1990. RESULTS: The cumulative relative survival rates were similar for American and Canadian patients. The largest difference was observed for breast cancer, where patients in the United States enjoyed a survival advantage throughout the follow-up period. CONCLUSIONS: Patients in the United States and Ontario with the diseases studied, except for breast cancer, experience very similar survival. The greater use of mammographic screening in the United States could account for that country's higher breast cancer survival rate by promoting earlier and therefore more efficacious treatment, by introducing bias, or by a combination of both treatment and bias factors.

Adolescent↗
PubMed1994

Availability and appropriateness of allogeneic bone marrow transplantation for chronic myeloid leukemia in 10 countries.

BACKGROUND: Allogeneic bone marrow transplantation, a sophisticated and expensive procedure, is the only curative therapy for chronic myeloid leukemia (CML). We examined the availability and appropriateness of allogeneic bone marrow transplantation for CML in 10 economically advanced countries with diverse health care systems. For each country we obtained data on the likelihood of transplantation to treat CML in patients under the age of 55 years, the length of time from diagnosis to transplantation, and the stage of disease at the time of transplantation. METHODS: Data were collected on 9873 allogeneic bone marrow transplantations performed at 208 centers in 10 countries from 1989 through 1991. Data were acquired from transplantation registries and by means of a mailed survey of all centers and teams that did not contribute data to registries. Data on the incidence of disease were drawn from national and regional cancer registries. RESULTS: Among the 10 countries there was a twofold difference between the lowest and highest rates of transplantation to treat CML (0.26 to 0.54 per 100,000 population per year); Swedish patients were the most likely to receive a transplant, and German patients the least likely. The median length of time from diagnosis to transplantation ranged from 6.8 to 15.4 months. In all countries, most transplantations were performed in the chronic phase of the disease, but as many as a third of patients received transplants in the less favorable accelerated or blast phase. The values for the United States fell near the middle of those for the 10 countries on all measures. CONCLUSIONS: Our findings challenge the assumption that the United States is unique in providing broad access to high-technology treatments. On no measure of the availability or appropriateness of transplantation for CML did it surpass the other nine countries studied.

Adolescent↗
PubMed1993

Cancer palliation: economic and societal implications.

The lessons of these examples are clear. If physicians will not decide on how to decide, others will. This theme replicates that expressed in the discussion of cost. Oncologists charged with providing palliative cancer care are in a field rife with growing tensions imposed by increasing demands for therapy. If the profession does not develop a strategy for resolving the crisis, the courts and legislatures will become increasingly involved in making clinical decisions. Although this is not transparently ominous, it does mean that the contribution that clinical judgement makes to treatment selection will be minimized.

Antineoplastic Agents↗
PubMed1993

A new form of meta-analysis for combining results from randomized clinical trials and medical-practice databases.

Cross-design synthesis is a new (and still evolving) strategy for providing quantitative results that capture the strengths and minimize the weaknesses of different kinds of research. The strategy, which is being developed to answer questions about the effects of treatment in medical practice, includes (a) identifying complementary research designs and studies conducted according to those designs; (b) completing an in-depth assessment of each study with respect to the chief potential bias(es) that are associated with its design; (c) making "secondary adjustments" of study results to correct known biases; and (d) developing synthesis frameworks and models that will minimize the impact of hidden biases.

Databases, Factual↗
PubMed1991

Reimbursement policies constrain the practice of oncology.

OBJECTIVE: To determine the prevalence of off-label anticancer drug use (ie, using drugs to treat conditions other than those listed on the Food and Drug Administration's approved drug label), the extent of reimbursement denials for these uses, and the effect of denials on the treatment of cancer patients. DESIGN, SETTING, AND PARTICIPANTS: A three-part questionnaire was sent to a randomized sample of oncologists taken from the 1990 membership of the American Society of Clinical Oncology in March 1990. A response rate of 56% yielded information from 681 oncologists on the drugs they prescribed to 2018 new cancer patients and on those they frequently use in treating 11 specific types of cancer. MAIN OUTCOME MEASURES: The labeled uses of the drugs prescribed and frequently used in chemotherapies were checked against the indications treated to determine whether they were prescribed for off-label uses. Three drug compendia were used as cited sources of off-label drug uses. The extent of reimbursement denials over the last 12 months and their effects on treatments were based on respondent opinions. MAIN RESULTS: Off-label drug use is prevalent and dominates the chemotherapy regimens of cancers that are more difficult to treat and for which there are no cures or agreements on standardized treatment. Most oncologists reported frustration with shifting reimbursement policies in general and with an increasing rate of denials for some off-label drug uses. Indeed, a surprising number of oncologists claimed that these policies caused them to alter preferred treatments and site of care. CONCLUSION: These findings suggest the need for public discussion of off-label drug use issues so that appropriate policies can be developed.

Antineoplastic Agents↗
PubMedDate not supplied

Estimates of the lifetime direct costs of treatment for metastatic breast cancer.

OBJECTIVE: Breast cancer remains the highest incident cancer among females in the United States and previous research suggests that a considerable portion of patients will eventually progress to the metastatic phase of the disease. This paper provides the first estimate of the lifetime direct costs of treating metastatic disease for one annual diagnostic cohort of breast cancer patients. METHODS: Incidence rates were combined with US population counts to estimate the number of breast cancer cases diagnosed in 1994. Estimates of progression to metastatic disease (from Canadian provincial cancer registry data), costs of care (derived from patients' claims histories), survival (from SEER data), and national mortality rates (from US Census Bureau) were integrated, using Statistics Canada's Population Health Model (POHEM) to calculate lifetime costs. RESULTS: This study estimates that more than 40% of the women diagnosed with breast cancer will progress to metastatic disease. On average, women with metastatic disease are expected to live 3 years and to incur direct treatment costs of approximately dollar 60,000 per case, resulting in a total lifetime cost for the cohort of almost dollar 4.2 billion. CONCLUSIONS: The high rate of recurrence of breast cancer argues for the development of interventions that can prevent or delay the onset of metastatic disease. These estimates of lifetime costs and the methodology on which they are based can be used to evaluate the cost-effectiveness of such secondary prevention strategies. These estimates also can serve as a benchmark against which the lifetime costs of treating other diseases can be assessed.

Journal Article↗