Medication overuse in oncology: current trends and future implications for patients and society

Schleicher, Stephen M.; Matsoukas, Konstantina; Korenstein, Deborah

doi:10.1016/s1470-2045(18)30099-8

Cited by 37 publications

(33 citation statements)

References 92 publications

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“…The discussion about changing the focus of treatment to providing symptomatic and supportive care is complex. Little literature addresses the magnitude of financial, psychological, or physical harms of medication overuse in cancer, even when it could be substantial [ 45 ]. Smith and Hillner have proposed for patients with advanced cancer, changes in medical oncologists’ behavior, and changes in their attitudes and practices that will bend the cancer-cost curve [ 46 ].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of systemic oncological treatments in patients with advanced esophageal or gastric cancers at high risk of dying in the middle and short term: an overview of systematic reviews

et al. 2021

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Background Esophageal and gastric cancers are a significant public health problem worldwide, with most patients presenting with advanced-stage disease and, consequently, poor prognosis. Systemic oncological treatments (SOT) have been widely used over more conservative approaches, such as supportive care. Nevertheless, its effectiveness in this scenario is not sufficiently clear. This paper provides an overview of systematic reviews that assessed the effectiveness of SOT compared with the best supportive care (BSC) or placebo in patients with advanced esophageal or gastric cancers in an end-of-life context. Methods We searched MEDLINE, EMBASE, The Cochrane Library, Epistemonikos, and PROSPERO for eligible systematic reviews (SRs) published from 2008 onwards. The primary outcomes were overall survival (OS), progression-free survival (PFS), functional status, and toxicity. Two authors assessed eligibility and extracted data independently. We evaluated the methodological quality of included SRs using the AMSTAR-2 tool and the overlap of primary studies (corrected covered area, CCA). Also, we performed a de novo meta-analysis with data reported for each primary study when it was possible. We assessed the certainty of evidence using the GRADE approach. Results We identified 16 SRs (19 included trials) for inclusion within this overview. Most reviews had a critically low methodological quality, and there was a very high overlap of primary studies. It is uncertain whether SOT improves OS and PFS over more conservative approaches due to the very low certainty of evidence. Conclusions The evidence is very uncertain about the effectiveness of SOT for advanced esophageal or gastric cancers. High-quality SRs and further randomized clinical trials that include a thorough assessment of patient-centered outcomes are needed. Trial registration Open Science Framework, 10.17605/OSF.IO/7CHX6.

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Section: Discussionmentioning

confidence: 99%

Efficacy of systemic oncological treatments in patients with advanced esophageal or gastric cancers at high risk of dying in the middle and short term: an overview of systematic reviews

et al. 2021

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“…This is surprising given how many services have been identi ed as low-value in cancer care. The lack of de-implementation interventions to reduce low-value care may explain why low-value cancer care persists, despite signi cant forces over the past decade to reduce low-value care [13,14]. While educational campaigns and medical guidelines have shown some potential in raising awareness regarding low-value services in cancer care [26], recent studies demonstrate that, in many areas, those recommendations had a limited effect on reducing low-value care [27,28].…”

Section: Discussionmentioning

confidence: 99%

“…Medical societies have developed several guidelines and recommendations pertaining to low-value tests, treatments, and follow-up processes across the cancer care continuum [10][11][12]. However, recent reviews found that a considerable proportion of services that cancer patients receive could still be classi ed as low-value [13,14]. For example, both the American Society for Clinical Oncology and Choosing Wisely Canada [15,16] recommend not to use imaging in early-stage breast cancer; despite these recommendations, about one-third of early-stage breast cancer patients underwent at least one advanced imaging exam (e.g., bone scan, positron-emission tomography) for staging [17,18].…”

Section: Introductionmentioning

confidence: 99%

De-implementing Low-Value Care in Cancer Care Delivery: A Systematic Review

Tabriz

Turner

Clary

et al. 2021

Preprint

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Background Accumulating evidence suggests that interventions to de-implement low-value services are urgently needed. While medical societies and educational campaigns such as Choosing Wisely have developed several guidelines and recommendations pertaining to low-value care, little is known about interventions that exist to de-implement low-value care in oncology settings. We conducted this review to summarize the literature on interventions to de-implement low-value care in oncology settings, define an agenda for future research, and inform the literature about opportunities for additional work. Methods We systematically reviewed the published literature in PubMed, Embase, CINAHL Plus, and Scopus. We screened the retrieved abstracts for eligibility against inclusion criteria and conducted a full-text review of all eligible studies on de-implementation interventions in cancer care delivery. We used the framework analysis approach to summarize included studies' key characteristics including design; outcome(s); type of cancer, objective(s); and de-implementation interventions, determinants of the use ofthe use of de-implementation interventions, and their effectiveness. We assessed included studies’ quality using the NIH Quality Assessment Tools. Results Out of 2,793 studies, 13 met our inclusion criteria. Included studies have been published between 2003 and 2020, and the majority (n = 9) of them were conducted in the USA. They covered several cancer types including prostate cancer (n = 4), multiple cancers (n = 3), hematologic cancers (n = 3), lung cancer (n = 1), breast cancer (n = 1), and gastrointestinal cancer (n = 1). Four studies were focused on de-implementing low-value diagnostic tests, six studies focused on de-implementing low-value treatment procedures, and three studies focused on low-value screening services. Most of the de-implementation interventions (n = 11) were effective in reducing low-value care. No study assessed the determinants of the use of de-implementation interventions. Conclusions This review showed that to accelerate the reduction of low-value cancer care, instead of solely relying on diffusion new evidence and guidelines (i.e., passive de-implementation), healthcare organizations should initiate de-implementation interventions and implement strategies purposefully aimed at reducing low-value care (i.e., active de-implementation). Additionally, future research should include a broader range of variables such as patients’ perspectives and preferences, unintended effects of de-implementing low-value care, and system-level factors when studying de-implementation.

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“…Currently, the definition of the diagnostic and therapeutic strategy for melanoma patients involves choosing between multiple alternative courses of action that impact cost structure and performance for patient survival. On the other hand, for most healthcare systems, the unaffordability of new technologies is a widespread phenomenon [ 3 ], and a large percentage of patients have restricted access to the necessary healthcare resources [ 4 , 5 ]. In particular, Brazil has a population of over 200 million, and almost 76% of the population have to rely exclusively on public healthcare, which is very limited regarding access to health innovations and medical aid [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Cutaneous melanoma: cost of illness under Brazilian health system perspectives

Veiga

Souza

et al. 2021

BMC Health Serv Res

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Background The landscape of cutaneous melanoma (CM) diagnosis, staging, prognosis, and treatment has undergone fundamental changes in the past decade. While the benefits of new health resources are recognized, there is a distinct lack of accurate cost-of-illness information to aid healthcare decision makers. Methods The cost-of-illness study for CM was conducted from the perspective of two health systems in Brazil: the public health system (Unified Health System, SUS) and the private health system (Health Management Organization, HMO). The study considered the direct medical cost in a bottom-up analysis, using melanoma incidence, knowledge of the disease’s progression, and the overall survival rates. The executional costs for the complete healthcare delivery cycle were investigated considering different disease stages and possible clinical course variations. The structural cost was assessed qualitatively considering the health value chain in Brazil. Results CM represents a critical financial burden in Brazil, and the cost of illness varied according to the health system and by stage at diagnosis. HMO patient costs are approximately 10-fold and 90-fold more than a SUS patient in the early-stage and advanced disease, respectively. Overall, spending on advanced disease patients can be up to 34-fold (SUS) or 270-fold (HMO) higher than that required for the early-stage disease. Given the massive amount of resources spent by the SUS and HMO, significant efforts must be made to improve the health value chain to deliver the right mix of medical care goods and services using available resources. Conclusion The cost-of-illness study for CM has the potential to inform policymakers and decision-makers regarding the economic burden that melanoma impose on a society in terms of the use of health care services, assisting them in making projections of future health care costs and resource allocation decisions. We believe that cost-of-illness analysis from a strategic perspective could be of help in assessing executional costs and be used to support the change in structural costs required for long-term strategies related to the health value chain.

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Medication overuse in oncology: current trends and future implications for patients and society

Cited by 37 publications

References 92 publications

Efficacy of systemic oncological treatments in patients with advanced esophageal or gastric cancers at high risk of dying in the middle and short term: an overview of systematic reviews

Efficacy of systemic oncological treatments in patients with advanced esophageal or gastric cancers at high risk of dying in the middle and short term: an overview of systematic reviews

De-implementing Low-Value Care in Cancer Care Delivery: A Systematic Review

Cutaneous melanoma: cost of illness under Brazilian health system perspectives

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