Journal of global oncology最新文献

{"title":"Expanding Coverage of Oncology Drugs in an Aging, Upper-Middle-Income Country: Analyses of Public and Private Expenditures in Chile.","authors":"Veronica Vargas, Christine Leopold, Marianela Castillo-Riquelme, Jonathan J Darrow","doi":"10.1200/JGO.19.00223","DOIUrl":"10.1200/JGO.19.00223","url":null,"abstract":"<p><strong>Purpose: </strong>The population of Chile has aged, and in 2017, cancer became the leading cause of death. Since 2005, a national health program has expanded coverage of drugs for 13 types of cancer and related palliative care. We describe the trends in public and private oncology drug expenditures in Chile and consider how increasing expenditures might be addressed.</p><p><strong>Methods: </strong>We analyzed total quarterly drug expenditures for 131 oncology drugs from quarter (Q)3 2012 until Q1 2017, including public and private insurance payments and patient out-of-pocket spending. The data were analyzed by drug-mix, sources of funding, growth, and intellectual property status. The Laspeyres Price Index was used to analyze expenditure growth.</p><p><strong>Results: </strong>We found 131 oncology drugs associated with 87,129 observations. Spending on drugs rose 120% from the first period, spanning from the first 3 quarters (Q3, Q4, Q1 2012-2013) to the last period (Q3, Q4, Q1 2016-2017), corresponding to an annualized rate of 19.2% and totaling US$398 million (in 2017 dollars). The public sector accounted for 84.2% of spending, which included 50 drugs in the official treatment protocols, whereas private insurance accounted for 7.3% in on-protocol drugs. The remaining 8.5% was paid out of pocket. In the public sector, more than 90% of growth resulted from increased use. Seven drugs, including 3 with nonexpired patents, accounted for 50% of total expenditures.</p><p><strong>Conclusion: </strong>Increased use and access enabled by expanded public expenditures drove most of the growth in oncology drug expenditures. However, the rate of public expenditure growth may be fiscally unsustainable. Policies are urgently needed to promote the use of generic drugs, the appropriate mix of on-protocol versus off-protocol drugs, and the curbing of off-label prescribing.</p>","PeriodicalId":15862,"journal":{"name":"Journal of global oncology","volume":"5 ","pages":"1-17"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JGO.19.00223","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37477798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Refractory and Relapsed Hodgkin Lymphoma With Autologous Stem-Cell Transplantation: A Single Institution Experience","authors":"R. Wali, H. Saeed, Naveed Patrus, S. Javed, Saadiya Khan","doi":"10.1200/JGO.19.00051","DOIUrl":"https://doi.org/10.1200/JGO.19.00051","url":null,"abstract":"PURPOSE Hodgkin lymphoma is the most common cancer in children, adolescents, and young adults. Overall survival is approximately 80% to 90%. A subset of these patients has refractory disease or experience disease relapse. Conventional salvage therapies and autologous stem-cell transplantation is usually considered the standard of care for these patients. Our analysis reports outcomes in these patients. PATIENTS AND METHODS After institutional review board approval, a retrospective analysis of patients with Hodgkin lymphoma who were up to 18 years of age and who had refractory or relapsed disease at Shaukat Khanum Memorial Cancer Hospital and Research Centre from September 2009 to December 2013 was performed. Patients who underwent high-dose chemotherapy followed by stem-cell rescue were included in this analysis. RESULTS A total of 567 patients with Hodgkin lymphoma registered at the hospital. Sixty of the patients (10.6%) had either primary progressive or refractory disease or relapse after finishing with first-line chemotherapy. High-dose chemotherapy followed by stem cell was administered to 25 of these patients (42%). Thirteen patients (40%) had progressive disease (PD), five (22%) had early relapse, and seven (38%) had late relapse. A number of salvage regimens were used, including etoposide, prednisolone, ifosfamide, and cisplatin; dexamethasone, cytarabine, and carboplatin; and gemcitabine plus vinorelbine. Re-evaluation was performed before taking patients to a high dose, and it showed complete response in 17 patients (68%), partial response in six patients (24%), and PD in two patients (8%). Twenty-one patients (84%) are in remission after transplantation, with two patients (8%) having died as a result of disease progression and two patients (2%) having relapsed after treatment. Overall survival is 92% at 4 years, with event-free survival of 80% at 4 years. CONCLUSION Our retrospective analysis shows good outcomes in patients who had PD or refractory disease. Disease response before transplantation is important in predicting outcomes.","PeriodicalId":15862,"journal":{"name":"Journal of global oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JGO.19.00051","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42530489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of Hematologic Malignancies in Real-World Settings: Findings From the Hemato-Oncology Latin America Observational Registry Study","authors":"Vania Tietsche de Moraes Hungría, C. Chiattone, M. Pavlovsky, Lina Abenoza, Gladys P Agreda, Jorge Armenta, C. Arrais, Oscar Avendaño Flores, F. Barroso, A. Basquiera, C. Cao, M. Cugliari, A. Enrico, Laura M Foggliatto, K. Gálvez, D. Gomez, A. Gomez, Daniel de Iracema, Danielle Farias, L. López, W. Mantilla, D. Martínez, M. Mela, Carlos E. Miguel, R. Ovilla, L. Palmer, C. Pavlovsky, C. Ramos, G. Remaggi, R. Santucci, S. Schusterschitz, C. Sossa, Elena Tuna-Aguilar, J. Vela, T. Santos, Odin de la Mora, G. Machnicki, Mariana Fernandez, Paula Barreyro","doi":"10.1200/JGO.19.00025","DOIUrl":"https://doi.org/10.1200/JGO.19.00025","url":null,"abstract":"PURPOSE Limited information is available on multiple myeloma (MM), chronic lymphocytic leukemia (CLL), and non-Hodgkin lymphoma (NHL) management in Latin America. The primary objective of the Hemato-Oncology Latin America (HOLA) study was to describe patient characteristics and treatment patterns of Latin American patients with MM, CLL, and NHL. METHODS This study was a multicenter, retrospective, medical chart review of patients with MM, CLL, and NHL in Latin America identified between January 1, 2006, and December 31, 2015. Included were adults with at least 1 year of follow-up (except in cases of death within 1 year of diagnosis) treated at 30 oncology hospitals (Argentina, 5; Brazil, 9; Chile, 1; Colombia, 5; Mexico, 6; Panama/Guatemala, 4). RESULTS Of 5,140 patients, 2,967 (57.7%) had NHL, 1,518 (29.5%) MM, and 655 (12.7%) CLL. Median follow-up was 2.2 years for MM, 3.0 years for CLL, and 2.2 years for NHL, and approximately 26% died during the study observation period. Most patients had at least one comorbidity at diagnosis. The most frequent induction regimen was thalidomide-based chemotherapy for MM and chlorambucil with or without prednisone for CLL. Most patients with NHL had diffuse large B-cell lymphoma (DLBCL; 49.1%) or follicular lymphoma (FL; 19.5%). The majority of patients with DLBCL or FL received rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone. CONCLUSION The HOLA study generated an unprecedented level of high-quality, real-world evidence on characteristics and treatment patterns of patients with hematologic malignancies. Regional disparities in patient characteristics may reflect differences in ethnoracial identity and level of access to care. These data provide needed real-world evidence to understand the disease landscape in Latin America and may be used to inform clinical and health policy decision making.","PeriodicalId":15862,"journal":{"name":"Journal of global oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JGO.19.00025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49223161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breast Cancer Care Quality in South Africa’s Public Health System: An Evaluation Using American Society of Clinical Oncology/National Quality Forum Measures","authors":"Daniel S. O'Neil, W. Chen, O. Ayeni, S. Nietz, I. Buccimazza, U. Singh, S. Čačala, L. Stopforth, M. Joffe, K. Crew, J. Jacobson, A. Neugut, P. Ruff, H. Cubasch","doi":"10.1200/JGO.19.00171","DOIUrl":"https://doi.org/10.1200/JGO.19.00171","url":null,"abstract":"PURPOSE The quality of breast cancer care in sub-Saharan Africa contributes to the region’s dismal breast cancer mortality. ASCO has issued quality measures focusing on delivery of adjuvant chemotherapy, radiotherapy, and endocrine therapy. We applied these measures in five South African public hospitals and analyzed factors associated with care concordance. MATERIALS AND METHODS Among 1,736 women with breast cancer who were enrolled in the South African Breast Cancer and HIV Outcomes study over 24 months, we evaluated care using ASCO’s three measures. We also evaluated adjuvant chemotherapy receipt in 957 women with an indication. We used logistic regression to estimate associations between measure-concordant care and patient factors. RESULTS Of 235 women with hormone receptor–negative cancer, 173 (74%) began adjuvant chemotherapy within 120 days from diagnosis. Of 194 patients who received breast-conserving surgery, 73 (37%) began radiotherapy within 365 days from diagnosis. Of 999 women with hormone receptor–positive cancer, 719 (72%) initiated endocrine therapy within 365 days from diagnosis. Chemotherapy and radiotherapy measure-concordant care were more common among women residing < 20 km from the hospital (odds ratio [OR], 1.79; 95% CI, 1.32 to 2.44 and OR, 3.17; 95% CI, 1.57 to 6.42). Endocrine therapy measure-concordant care was more common among English-speaking women (OR, 2.12; 95% CI, 1.12 to 4.02). Participating hospitals varied in care concordance. HIV infection did not affect care quality. CONCLUSION More timely delivery of chemotherapy, radiotherapy, and endocrine therapy is needed in South Africa, particularly for women living > 20 km from the hospital or not speaking English. Focused quality improvement efforts could support that goal.","PeriodicalId":15862,"journal":{"name":"Journal of global oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JGO.19.00171","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45267231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Cancer Outcomes In Low- and Middle-Income Countries","authors":"R. Love","doi":"10.1200/JGO.19.00297","DOIUrl":"https://doi.org/10.1200/JGO.19.00297","url":null,"abstract":"The common high-income country framework for improving cancer care that is applied globally leads to calls for workforce development (or capacity building), national cancer control plans, medical professional education, well-defined quality care, clinical practice guidelines, multidisciplinary care, certification programs for outpatient care, research (generally, and not specifically implementation research), and registries. The challenges are responded to by technology transfer interventions—most commonly educational activities— with very limited and hardly rigorous evaluations of their impacts. It is hard not to compare these approaches with those of advocates for economic development generally for the past half century that were found by many to have been so wanting. As we have written, “We believe that, in fact, the major issues are broader than these and that, in any event, these current dominant framework foci can hardly be successfully addressed without attention to bigger ecological issues and themes, such as weak, dysfunctional, and underfinanced health systems, overall, dominated by operational business/money making models; governance, corruption and transparency; human rights shortcomings; incomplete knowledge about diseases, patient/host factors; and cost-effective interventions” applicable in lowand middle-income country settings.","PeriodicalId":15862,"journal":{"name":"Journal of global oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JGO.19.00297","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46446065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dermatology-Driven Quality Improvement Interventions to Decrease Diagnostic Delays for Kaposi Sarcoma in Botswana.","authors":"Victoria L Williams, Mohan Narasimhamurthy, Olaf Rodriguez, Karen Mosojane, Thapelo Bale, Koorileng Kesalopa, Mukendi A Kayembe, Surbhi Grover","doi":"10.1200/JGO.19.00181","DOIUrl":"10.1200/JGO.19.00181","url":null,"abstract":"<p><strong>Purpose: </strong>Kaposi sarcoma (KS) is an HIV-associated skin cancer that is highly prevalent in Botswana and associated with significant morbidity and mortality. Histopathology-confirmed diagnosis is required for chemotherapeutic interventions in Botswana, which creates barriers to care because of limited biopsy and pathology services. We sought to understand the role a dermatology specialist can play in improving KS care through quality improvement (QI) initiatives to reduce histologic turnaround times (TATs) for KS.</p><p><strong>Methods: </strong>Employment of a dermatology specialist within a public health care system that previously lacked a local dermatologist generated quality improvements in KS care. Retrospective review identified patients diagnosed with KS by skin biopsy in the predermatology QI interval (January 1, 2015, to December 31, 2015) versus the postdermatology QI interval (January 1, 2016, to November 31, 2017). Histology TATs and clinical characteristics were recorded. A <i>t</i> test compared the median histology TATs in the pre- and post-QI intervals.</p><p><strong>Results: </strong>A total of 192 cases of KS were diagnosed by skin biopsy. Nearly all (98.4%) were HIV-positive; and 52.8% of patients were male with a median age of 39 years. Median TAT in the postdermatology QI interval was 11 days (interquartile range, 12-23 days) compared with 32 days in the predermatology QI interval (interquartile range, 24-56 days; <i>P</i> < .00).</p><p><strong>Conclusion: </strong>Dermatology-led QI initiatives to improve multispecialty care coordination can significantly decrease histology TATs for KS. The reduction of diagnostic delays is a key first step to decreasing the morbidity and mortality associated with this cancer in resource-limited settings.</p>","PeriodicalId":15862,"journal":{"name":"Journal of global oncology","volume":" ","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6882519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42055951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying and Prioritizing Family Education Needs at Pediatric Oncology Centers in Central America and Mexico.","authors":"Erin McCann,&nbsp;Soad Fuentes-Alabí,&nbsp;Federico Antillón,&nbsp;Lourdes Vega-Vega,&nbsp;Maria Sabina Sanchez,&nbsp;Irini Albanti","doi":"10.1200/JGO.19.00272","DOIUrl":"https://doi.org/10.1200/JGO.19.00272","url":null,"abstract":"<p><strong>Methods: </strong>A qualitative study involving 72 in-person interviews and 4 focus groups was conducted using a semistructured interview guide. Key informants included family members, physicians, nurses, psychosocial providers, foundation leadership, volunteers, and communication professionals. The study sites included pediatric oncology centers in El Salvador, Guatemala, Mexico, and Panama. NVivo was used for thematic analysis.</p><p><strong>Results: </strong>Across all sites, parents had common questions and educational needs. Questions from families focused on their child's likelihood of dying from cancer and feelings of guilt that were based on their perception that they caused the disease. The origin of cancer, nutrition, and psychosocial support were the most important educational themes. However, the prioritization of different educational themes varied on the basis of cultural or social influences unique to each site. Some of these differences included a need for education surrounding amputations, sibling support, and alternative or traditional healers.</p><p><strong>Conclusion: </strong>This study demonstrates that although many educational needs were consistent across hospitals, some of the educational priorities differed by site despite geographic proximity and shared language. Developing an educational program in resource-limited settings can be challenging, but it is an important contributor to improving childhood cancer outcomes that should be tailored to the specific needs of a site. This study can be used as a guide for other programs with limited resources wanting to develop relevant educational materials for families.</p>","PeriodicalId":15862,"journal":{"name":"Journal of global oncology","volume":"5 ","pages":"1-10"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JGO.19.00272","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37455224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Interim PET Scan After 2 Cycles of ABVD Predict Outcome in Hodgkin Lymphoma? Real-World Evidence.","authors":"Arun Seshachalam,&nbsp;Shashidhar V Karpurmath,&nbsp;Krishnakumar Rathnam,&nbsp;S Ganapathi Raman,&nbsp;Murugesan Janarthinakani,&nbsp;Krishna Prasad,&nbsp;Channappa Patil,&nbsp;Parameswaran Anoop,&nbsp;Neelesh Reddy,&nbsp;Satish Kumar Anumula,&nbsp;Sirigeri Prabhakar Roopa,&nbsp;Krishna Reddy Golamari,&nbsp;Madhav Danthala,&nbsp;Prasad Gunari,&nbsp;Basawantrao Malipatil,&nbsp;Bharath Rangarajan,&nbsp;Karthik S Udupa,&nbsp;Manjunath Nandennavar,&nbsp;Kesavan Niraimathi,&nbsp;Hemant Deepak Shewade","doi":"10.1200/JGO.19.00179","DOIUrl":"https://doi.org/10.1200/JGO.19.00179","url":null,"abstract":"<p><strong>Purpose: </strong>Escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) improves overall survival (OS) in patients with Hodgkin lymphoma (HL) relative to ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) therapy. However, the associated higher cost and toxicity discourage clinicians from prescribing it. Identifying high-risk patients and administering escalated BEACOPP remains an effective strategy. We assessed the significance of interim positron emission tomography (iPET) scan after 2 cycles (iPET2) in identifying this high-risk subset.</p><p><strong>Patients and methods: </strong>This cohort study used secondary data from 12 tertiary care centers in South India gathered over 10 years (2008-2018). OS, event-free survival (EFS), determinants of EFS, and complete response (CR) in iPET2 were assessed.</p><p><strong>Results: </strong>The study included 409 patients with HL (mean age, 34.5 years; male/female ratio, 1.4:1). The median duration of follow-up was 2.8 years. Of 409 patients, 63% underwent PET-based staging and 37% underwent computerized tomography (CT) staging. Stage IV (28.9%) and bone involvement (9.2%) were seen more often with PET than with CT staging (9.2% and 2%, respectively). Among 171 patients with iPET2 results, 24% did not achieve CR, and no factors were significantly associated. The 5-year EFS and OS rates of the entire cohort were 78% and 97%, respectively. The 5-year EFS and OS rates of patients with CR on iPET2 were 90% and 99%, respectively, whereas these were 65% and 100%, respectively, for patients not achieving CR. On univariable analysis, sex, stage, and iPET2 response significantly predicted inferior EFS. On multivariate analysis, only iPET2 response significantly predicted EFS (<i>P</i> < .000).</p><p><strong>Conclusion: </strong>Our study supports the use of PET for staging and iPET2 for response assessment. Nonachievement of CR on iPET2 indicates unfavorable outcome, and such patients may benefit from more intensive treatment.</p>","PeriodicalId":15862,"journal":{"name":"Journal of global oncology","volume":"5 ","pages":"1-13"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JGO.19.00179","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37455576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"To Tell or Not to Tell: Exploring the Preferences and Attitudes of Patients and Family Caregivers on Disclosure of a Cancer-Related Diagnosis and Prognosis","authors":"A. Ghoshal, N. Salins, A. Damani, Jayeeta Chowdhury, Arundhati Chitre, M. Muckaden, J. Deodhar, R. Badwe","doi":"10.1200/JGO.19.00132","DOIUrl":"https://doi.org/10.1200/JGO.19.00132","url":null,"abstract":"PURPOSE To understand the preferences and attitudes of patients and family caregivers on disclosure of cancer diagnosis and prognosis in an Indian setting. METHODS Overall, 250 adult patients with cancer and 250 family caregivers attending the outpatients of a tertiary cancer hospital for the first time were recruited purposively. The mean ages of patients and caregivers were 49.9 years (range, 23-80 years) and 37.9 years (range, 19-67 years), respectively. Separately, they completed prevalidated, close-ended preference questions and were interviewed for open-ended attitude questions. RESULTS A total of 250 adult patients (response rate, 47.17% overall, 73.2% in men, and 26.8% in women) and 250 family caregivers (response rate, 40.65% overall, 84.0% in men, and 16.0% in women) participated. Significant differences were observed in the preference to full disclosure of the name of illness between patients (81.2%) and caregivers (34.0%) and with the expected length of survival between patients (72.8%) and caregivers (8.8%; P < .001). The patients felt that knowing a diagnosis and prognosis may help them be prepared, plan additional treatment, anticipate complications, and plan for future and family. The caregivers felt that patients knowing a diagnosis and prognosis may negatively affect the future course of illness and cause patients to experience stress, depression, loss of hope, and confidence. CONCLUSION Patients with cancer preferred full disclosure of their diagnoses and prognoses, whereas the family caregivers preferred nondisclosure of the same to their patients. This novel information obtained through a large study with varied participants from different parts of the country will help formulate communication strategies for cancer care.","PeriodicalId":15862,"journal":{"name":"Journal of global oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JGO.19.00132","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41720201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of the New Process for Unapproved Drug Use: Dilemma of Universal Health Care Coverage in Japan","authors":"S. Nishiwaki, Y. Ando","doi":"10.1200/JGO.19.00313","DOIUrl":"https://doi.org/10.1200/JGO.19.00313","url":null,"abstract":"Patient-proposed health services (PPHS; kanjya mouside ryouyou in Japanese), a new Japanese government program that allows patients to use publicly insured and uninsured therapies—a so-called mixed medical care service that is prohibited in principal— was introduced in April 2016. Under PPHS, a patient can petition the Ministry of Health, Labour, and Welfare (MHLW) to assess an unapproved treatment by submitting documents from a Medical Service Act– certificated core clinical research hospital, where a study protocol is prepared after a review of the proposed treatment from the following points of view: (1) no possible participation in the existing system, such as ongoing clinical trials or Advanced Medical Care B; (2) the safety and efficacy of the treatment; and (3) the possibility of future approval of the treatment. The distinctive feature of this system is that the required care is performed as clinical research to accelerate the approval of the treatment. PPHS is a unique system designed to support patient wishes regarding the earliest possible advanced medical care without disrupting Japan’s universal health care coverage.","PeriodicalId":15862,"journal":{"name":"Journal of global oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JGO.19.00313","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47440323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}