Background:It is unclear whether more timely cancer diagnosis brings favourable outcomes, with much of the previous evidence, in some cancers, being equivocal. We set out to determine whether there is an association between time to diagnosis, treatment and clinical outcomes, across all cancers for symptomatic presentations.Methods:Systematic review of the literature and narrative synthesis.Results:We included 177 articles reporting 209 studies. These studies varied in study design, the time intervals assessed and the outcomes reported. Study quality was variable, with a small number of higher-quality studies. Heterogeneity precluded definitive findings. The cancers with more reports of an association between shorter times to diagnosis and more favourable outcomes were breast, colorectal, head and neck, testicular and melanoma.Conclusions:This is the first review encompassing many cancer types, and we have demonstrated those cancers in which more evidence of an association between shorter times to diagnosis and more favourable outcomes exists, and where it is lacking. We believe that it is reasonable to assume that efforts to expedite the diagnosis of symptomatic cancer are likely to have benefits for patients in terms of improved survival, earlier-stage diagnosis and improved quality of life, although these benefits vary between cancers.
Background:Herpes zoster and cancer are associated with immunosuppression. Zoster occurs more often in patients with an established cancer diagnosis. Current evidence suggests some risk of cancer after zoster but is inconclusive. We aimed to assess the risk of cancer following zoster and the impact of prior zoster on cancer survival.Methods:A primary care database retrospective cohort study was undertaken. Subjects with zoster were matched to patients without zoster. Risk of cancer following zoster was assessed by generating hazard ratios using Cox regression. Time to cancer was generated from the index date of zoster diagnosis.Results:In total, 2054 cancers were identified in 74 029 patients (13 428 zoster, 60 601 matches). The hazard ratio for cancer diagnosis after zoster was 2.42 (95% confidence interval 2.21, 2.66) and the median time to cancer diagnosis was 815 days. Hazard ratios varied between cancers, and were highest in younger patients. There were more cancers in patients with zoster than those without for all age groups and both genders. Prior immunosuppression was not associated with change in risk, and diagnosis of zoster before cancer did not affect survival.Conclusion:This study establishes an association between zoster and future diagnosis of cancer having implications for cancer case finding after zoster diagnosis.
IntroductionBiosimilar infliximab (CT-P13) has been licensed for the treatment of IBD in Europe for over a year with the potential for significant cost savings. However, uptake in the UK has been slow primarily due to concerns over the lack of safety and efficacy data particularly with regard to switching patients from the originator product. We present the preliminary data from a controlled switch programme in a cohort of adult IBD patients.MethodsA prospective study was undertaken to assess the safety and efficacy of switching patients receiving originator infliximab (Remicade) to its biosimilar (CT-P13). Patient demographic data was collected along with disease severity scores (HBI and SCCAI), biological markers of disease activity, drug and antibody levels and PROM data (IBD-Control questionnaire) prior to the switch and at each subsequent infusion visit. Evaluation of the efficacy of biosimilar infliximab at the time of the last infusion was compared with the originator at switch over. Means, medians, and ranges were calculated. Adverse events were prospectively collected.Results78 IBD patients were included in the cohort (63 CD and 15 UC). The average age for the CD and UC patients was 43 and 42 years respectively. The average length of therapy on Remicade prior to the switch was 46 months for CD and 25 months for UC. 66/78 (85%) patients were receiving the standard dosage of 5 mg/kg 8 weekly with 12/78 (15%) either on a shortened interval or a 10 mg/kg dose. 42/63 (67%) of CD patients were in remission at switch over compared to 43/60 (72%) at the most recent infusion (4–6 months). The number of patients with mild, moderate and severe disease remained stable throughout the study period (Mild 10/63 (16%) v 11/60 (18%): Moderate 10/63 (16%) v 5/60 (8%): Severe 1/63 (2%) v 1/60 (2%)). 9/15 (60%) of UC patients were in remission at switch over compared with 11/13 (85%) at the most recent infusion. There was no difference in the mean CRP before and after the switch in either CD patients (5.4 vs 5.6 p=0.32) or UC patients (3.1 vs 3.0 p=0.73). The mean patient questionnaire score data also remained unchanged before and after the switch (CD 4.4 vs 4.0 p=0.56, UC 4.9 vs 3.1 p=0.61). Five patients (3 CD, 2 UC) discontinued infliximab during the study period (3 switched biological class, 1 infusion reaction, 1 deep remission). There were no adverse safety signals with one infusion reaction (1/283 infusions) and the rate of mild adverse events unchanged from before and after the switch.ConclusionSwitching patients with IBD from originator infliximab to biosimilar infliximab appears both safe and effective. Wider uptake in the UK would result in considerable cost savings to the NHS.Disclosure of InterestNone Declared
IntroductionBiosimilar infliximab (CT-P5013) has been licensed in the UK for over a year with the potential for significant cost savings, though uptake to-date has been surprisingly slow. We report the introduction of biosimilar infliximab through a closely managed switching programme.MethodsFollowing the licensing of biosimilar infliximab we made a decision to instigate a closely managed switching programme encompassing all patients on maintenance treatment with Remicade and all new starters. A working party was set up with strong managerial support to deliver the project. We initially estimated savings of £400,000/year to the local health economy. Following meetings with the 3 local CCGs agreement was confirmed for a 50:50 gain share agreement between the CCGs and the Trust. To facilitate and monitor the switching programme a new Band 7 IBD Biological nurse, a Band 7 IBD Biological pharmacist, and an IBD administrator were recruited. All patients were informed by letter of the planned switch and the rationale for it. A variety of clinical and biological markers were also recorded at each visit along with PROM data.ResultsTo date since the start of the project on 16th September 2015 88 patients have been treated with biosimilar infliximab. 78 (63 CD/15 UC) patients on maintenance treatment with Remicade were switched to CT-P13 with unchanged efficacy and safety (the detailed results are the basis of a separate abstract); a further 10 patients received induction therapy (7 CD/3 UC). 3/88 patients requested further clarification from the IBD team with all patients subsequently agreeing to the switch. All patients were seen by either the IBD pharmacist or IBD specialist nurse and stated they felt well informed. Over the first six months the programme has generated total cost savings of £232,576.52 with projected year savings of £540,000. Staff costs totalled £90,000. PROM data from the cohort revealed very high satisfaction with treatment with a mean score of 7.3 (Range 3–10) for overall disease control. Patient feedback was universally positive.ConclusionThe introduction of biosimilar infliximab can be achieved through a closely managed programme with very significant cost savings to the local health economy. Engaged conversations between primary and secondary care facilitate realising these savings allowing investment in the local IBD service with direct impact on patient care. Patients were overwhelmingly supportive of the project. Wider uptake in the UK would result in considerable cost savings to the NHS.Disclosure of InterestNone Declared
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.