Journal of Cancer Policy最新文献

{"title":"The out-of-pocket cost of breast cancer care in Nigeria: A prospective analysis","authors":"Funmilola Olanike Wuraola ,&nbsp;Chloe Blackman ,&nbsp;Olalekan Olasehinde ,&nbsp;Adewale A. Aderounmu ,&nbsp;Adeoluwa Adeleye ,&nbsp;Oluwatosin Z. Omoyiola ,&nbsp;T. Peter Kingham ,&nbsp;Ryan F. Fodero ,&nbsp;Adewale O. Adisa ,&nbsp;Juliet Lumati ,&nbsp;Anna Dare ,&nbsp;Olusegun I. Alatise ,&nbsp;Gregory Knapp","doi":"10.1016/j.jcpo.2024.100518","DOIUrl":"10.1016/j.jcpo.2024.100518","url":null,"abstract":"<div><h3>Background</h3><div>Most patients pay out-of-pocket for cancer care in Nigeria, which can result in a catastrophic health care expenditure (CHE). There is a paucity of economic data on the cost of care and the impact this may have on the household. This study provides a prospective analysis of direct and indirect out-of-pocket costs for breast cancer care at a single tertiary care institution in South West Nigeria.</div></div><div><h3>Methods</h3><div>Consecutive patients undergoing curative intent treatment for a new diagnosis of breast cancer between August 2019 and September 2022 were approached for enrollment. A novel questionnaire was delivered to patients during hospital admission and again during six-month follow-up. Patients self-reported annual household income, capacity-to-pay, and all direct and indirect expenditures associated with access care. A CHE was defined using three commonly used definitions, including total healthcare expenditure that exceeds 40 % of a household's capacity-to-pay, or exceeds the proportion of annual income set at thresholds of 10 % and 25 %.</div></div><div><h3>Results</h3><div>Data were collected from 71 eligible patients with a mean age of 49.5 years (SD 11.26). Sixty-six percent (47/71, 66.2 %) of patients had ≥ Stage III disease at presentation, and 95.8 % received systemic chemotherapy. Only 23.9 % received adjuvant radiotherapy. The mean annual capacity-to-pay for the cohort was $2866.93 (SD $2749.74). The mean cost of care was $5192.77 (SD $4567.71). Out of the 71 patients enrolled in the study, between 56 (78.9 %) and 71 (100 %) experienced a CHE, depending on the included costs (direct +/- indirect) and threshold used. Sixty-six percent of patients had no form of health insurance.</div></div><div><h3>Conclusions</h3><div>Over 70 % of breast cancer patients at a tertiary care facility in Nigeria experience a CHE because of out-of-pocket costs associated with accessing care.</div></div><div><h3>Policy summary</h3><div>A more effective and accessible health insurance mechanism is required in Nigeria to protect women with breast cancer from the cost of cancer care.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"42 ","pages":"Article 100518"},"PeriodicalIF":2.0,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629988","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":"Strategies and implementation outcomes of HPV-based cervical screening studies to prevent cervical cancer in India: A systematic review","authors":"Anu Mary Oommen ,&nbsp;Maleeha Ashfaq ,&nbsp;Anne George Cherian ,&nbsp;Ana Machado Colling ,&nbsp;Arianis Tatiana Ramirez ,&nbsp;Tessa Saunders ,&nbsp;Pravin Singarayar ,&nbsp;Vinotha Thomas ,&nbsp;Anitha Thomas ,&nbsp;Tobey Ann Marcus ,&nbsp;Ruby Angeline Pricilla ,&nbsp;Claire Nightingale ,&nbsp;Julia ML Brotherton","doi":"10.1016/j.jcpo.2024.100513","DOIUrl":"10.1016/j.jcpo.2024.100513","url":null,"abstract":"<div><h3>Background</h3><div>As Indian states consider HPV testing for cervical screening, there is a need to review evidence from prior studies to inform program design and evaluate implementation research gaps.</div></div><div><h3>Design</h3><div>We conducted a systematic review of original articles in Medline, Embase, Global Health and Web of Science, published from 2000 to May 4, 2024. Articles describing use of HPV as a primary cervical screening test in India, in either community-based programs for the general population, or among women living with HIV, were included. We describe approaches to invitation, education, screening, and follow-up, and map determinants and outcomes to the RE-AIM and the Consolidated Framework for Implementation Research frameworks.</div></div><div><h3>Results</h3><div>Of 71 included articles (51 unique studies), 19 reported on screening among women living with HIV, while 52 were community-based (general population of women). Self-collection was offered by 15 studies and was acceptable to most screened women. Community-based programs were mainly facility or outreach-based, with three studies offering only home-based self-collection, including one that integrated with cardiovascular risk screening. Studies from northeastern and tribal populations were scarce. Only one self-collection study used a screen and treat (at second visit) approach, but did not report follow-up, while none offered immediate treatment following a point-of-care test.</div></div><div><h3>Conclusions</h3><div>Community-based HPV testing, including self-collection, is feasible in India, with more research needed among underrepresented populations. Further implementation research is needed on integrating HPV screening with existing health systems, feasibility of HPV test and treat models and genotyping triage, to improve follow-up in low resource settings.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"42 ","pages":"Article 100513"},"PeriodicalIF":2.0,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606298","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":"Improving cancer outcomes through enhanced leadership and strategy training for cancer healthcare professionals – A course developed by the European School of Oncology (ESO), the European Cancer Organization (ECO) and Sharing Progress in Cancer Care (SPCC)","authors":"Razvan Andrei Popescu ,&nbsp;Richard Sullivan ,&nbsp;Ajay Aggarwal ,&nbsp;Bruna Bianca Lopes David ,&nbsp;Olga Valciņa ,&nbsp;Maha al Sendi ,&nbsp;Mark Lawler ,&nbsp;Andreas Charalambous ,&nbsp;Matti Aapro ,&nbsp;Corinne Hall ,&nbsp;Alexandru Eniu ,&nbsp;Peter Selby","doi":"10.1016/j.jcpo.2024.100517","DOIUrl":"10.1016/j.jcpo.2024.100517","url":null,"abstract":"<div><div>Leadership as a key building block of a health system plays a crucial role in achieving high performance and helps deliver change and shape the policy agenda and its implementation. Echoing the emerging need for effective leaders in Oncology, the “Improving Cancer Outcomes and Leadership Course” was developed jointly by the European School of Oncology (ESO), the European Cancer Organization (ECO) and Sharing Progress in Cancer Care (SPCC). The course was offered as a hybrid event online and in Warsaw in June 2022. It aimed to introduce early and mid–career cancer healthcare professionals of all disciplines and professions to the expertise required to develop strategic plans, support and collaborate in relevant applied health research, develop implementation approaches and acquire the skill sets required to support leadership and change management within their countries and regions. A total of 47 participants, mainly from Europe, participated and prepared ‘case discussions’ of organisational challenges or projects aiming to improve health care in their regions. These were deliberated and further developed in 3 break out groups. A qualitative evaluation of the course impact performed 2 years after the course showed that most participants remained in contact with each other, the majority had implemented learnings from the course to help improve cancer outcomes, 87 % had further developed their projects that were presented during the breakout sessions and of those 89 % felt that the discussions that were held during course had actively helped them to develop and potentially apply these projects. Finally, 77 % have thought of or initiated a different project than the one they discussed during the course, based on ideas coming from the discussions during or after the course. Here we describe the course, give three examples of topics discussed in Warsaw and present plans for the future.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"43 ","pages":"Article 100517"},"PeriodicalIF":2.0,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606286","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":"Income disparities have a significant impact on thyroid cancer recurrence and survival","authors":"Mohammad H. Hussein ,&nbsp;Julia A. McGee ,&nbsp;Luu Alexandria ,&nbsp;Michelle M. Tsang ,&nbsp;Manal S. Fawzy ,&nbsp;Eman A. Toraih ,&nbsp;Emad Kandil","doi":"10.1016/j.jcpo.2024.100511","DOIUrl":"10.1016/j.jcpo.2024.100511","url":null,"abstract":"<div><h3>Purpose</h3><div>Income inequality profoundly impacts cancer outcomes, yet its specific effects on thyroid cancer remain unclear. Elucidating the influence of socioeconomic disparities is imperative to advance health equity and optimize patient care. This study evaluates associations between median household income and thyroid cancer recurrence and survival using national cancer registry data.</div></div><div><h3>Methods</h3><div>139,302 thyroid cancer patients undergoing surgery from 2000 to 2019 were analyzed from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were categorized by median annual household income at the county level (&gt; or &lt;$75,000). Multivariable regression determined the impact of income on recurrence and overall mortality.</div></div><div><h3>Results</h3><div>Higher-income patients had 26 % lower recurrence odds (OR 0.74, 95 %CI 0.55–0.99, <em>p</em>=0.042) and longer median survival (18.1 vs 17.7 years, <em>p</em>&lt;0.001) compared to lower-income patients. On multivariate analysis, high income remained an independent predictor of reduced mortality after adjusting for demographics, tumor factors, and treatment (adjusted HR=0.84, 95 %CI=0.81–0.87, <em>p</em>&lt;0.001). Cancer-directed surgery (HR=0.28, 95 %CI=0.26–0.30, <em>p</em>&lt;0.001) and radioactive iodine (HR=0.69, 95 %CI=0.66–0.71, <em>p</em>&lt;0.001) were associated with lower mortality risk.</div></div><div><h3>Conclusions</h3><div>Income disparities have a significant influence on thyroid cancer outcomes, including lower recurrence and reduced mortality. Targeting socioeconomic inequity could substantially reduce recurrence, improve survival, and promote health equity for all patients.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"42 ","pages":"Article 100511"},"PeriodicalIF":2.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509847","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":"An assessment of cancer centre level designation and guideline adherent care in those with rectal cancer: A population based retrospective cohort study","authors":"Sunil V. Patel ,&nbsp;Tyler McKechnie ,&nbsp;Chad McClintock ,&nbsp;Weidong Kong ,&nbsp;Clare Bankhead ,&nbsp;Christopher M. Booth ,&nbsp;Carl Heneghan ,&nbsp;Ameer Farooq","doi":"10.1016/j.jcpo.2024.100510","DOIUrl":"10.1016/j.jcpo.2024.100510","url":null,"abstract":"<div><h3>Background</h3><div>Institutions providing care to individuals with cancer are organized based on available resources and treatments offered. It is presumed that increasing levels of care will result in improved quality of care and outcomes. The objective is to determine whether Cancer Level Designation is associated with guideline adherent care and/or survival.</div></div><div><h3>Methods</h3><div>This is a retrospective study of individuals within the Ontario Rectal Cancer Cohort, a population-level database including all adults undergoing surgical resection for rectal cancer between 2010 – 2019 were included in Ontario, Canada. The primary exposure was Cancer Centre Level Designation as defined by Cancer Care Ontario (i.e., Level 1/2 = regional cancer center; Level 3 = affiliate cancer center; Level 4 = satellite cancer center). The primary outcomes were guideline adherent care and survival. Associations were determined using one-way analysis of variances and a multivariable Cox proportional hazards model.</div></div><div><h3>Results</h3><div>12,399 patients were included with 54 % from a Level 1/2 centre, 33 % from a Level 3 centre and 13 % from a Level 4+ centre. All assessed aspects of guideline adherent care were associated with cancer centre level designation. Unadjusted 5-year overall survival was associated with cancer centre level designation (Level 1/2 79.5 % vs. Level 3 79.1 % vs. Level 4/non-designated 75.4 %, P = 0.003). Adjusted Cox Proportional Hazard Analysis for overall survival found the following: Level 4/5 HR 1.11 (95 %CI 0.99 – 1.25); Level 3 HR 1.01 (95 % CI 0.93 – 1.11); Level 1/2 1 [Referent group].</div></div><div><h3>Conclusions</h3><div>Increasing Cancer Centre Level Designation was associated with higher likelihood of receiving the appropriate investigations and treatments in those with rectal cancer and may also be associated with survival.</div></div><div><h3>Policy Summary</h3><div>Future work should consider the centralization of complex rectal cancer care as well as quality improvement initiatives aimed at enhancing guideline adherent care across all centres managing rectal cancer.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"42 ","pages":"Article 100510"},"PeriodicalIF":2.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476884","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":"Spending on anticancer drugs among Medicare beneficiaries: Analyzing predictors of drug expenditures","authors":"Ashley Nee ,&nbsp;Alyson Haslam ,&nbsp;Vinay Prasad","doi":"10.1016/j.jcpo.2024.100509","DOIUrl":"10.1016/j.jcpo.2024.100509","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the factors associated with Medicare spending on newly approved anticancer drugs in the US from 2012 through 2021.</div></div><div><h3>Patient and methods</h3><div>Using a cross-sectional analysis, we searched US FDA new oncology drug approvals (2012–2021). We analyzed clinical attributes and institutional factors influencing the annual cost of new anticancer drugs in the US. Annual treatment cost was calculated based on average spending per beneficiary from the Centers for Medicare and Medicaid Services, with product factors sourced from the FDA’s annual New Drug Therapy Approval reports and drug package inserts at the time of approval.</div></div><div><h3>Results</h3><div>Over a ten-year period, 112 new anticancer drugs were approved, of which 97 met the study's criteria. A significant majority, 93 %, received expedited development designations from the FDA. At the time of approval, 40 % of these drugs had data on progression-free survival, and 19 % had data on overall survival; 29 % were first-in-class. The study found a significant relationship between the year of approval and factors associated with the size of the treatment population. No statistically significant relationship was found between the clinical value of a drug and its price.</div></div><div><h3>Conclusions</h3><div>Spending on anticancer drugs by Medicare are predominantly determined by reference pricing and the size of the anticipated treatment population, without an association with therapeutic value. The study advocates for reforms in reimbursement mechanisms for drugs lacking comparator arms and greater transparency for patients treated with these drugs.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"42 ","pages":"Article 100509"},"PeriodicalIF":2.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476885","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":"Barriers to identifying and addressing health-related social needs in cancer care: Patient and patient navigator perspectives","authors":"Tilicea Henry ,&nbsp;Michael Hayes ,&nbsp;Caroline D. Eisele ,&nbsp;Susan Veldheer ,&nbsp;Sophia I. Allen ,&nbsp;Brianna Hoglen ,&nbsp;Kenneth R. Houser ,&nbsp;Eugene J. Lengerich ,&nbsp;Sol M. Rodriguez-Colon ,&nbsp;Amy C. Jenkins ,&nbsp;Andrea L. Hobkirk","doi":"10.1016/j.jcpo.2024.100508","DOIUrl":"10.1016/j.jcpo.2024.100508","url":null,"abstract":"<div><h3>Background</h3><div>The study aimed to gain insight into the experiences of patients with cancer and survivors regarding the integration of social needs assessment into their care, while also gathering perspectives from patient navigators on the barriers to obtaining and utilizing social needs information during cancer care, which taken together may influence cancer care policies. By comparing the perspectives of patients and navigators, the study sought to inform best practices for integrating, identifying, and addressing social needs to improve patient experiences and outcomes.</div></div><div><h3>Methods</h3><div>We conducted qualitative interviews and self-report surveys involving patients with cancer, providers, and patient navigators or care coordinators, seeking their insights and firsthand experiences related to health-related social needs in cancer care. Interviews were transcribed, separated into memos of main themes based on deductive coding, and further analyzed for new emergent themes using inductive coding.</div></div><div><h3>Results</h3><div>The present analysis focuses solely on the perspectives of 20 patient navigators and 21 patients. Qualitative analyses revealed two overarching themes: Theme 1: Personal and health system-related factors may create barriers for patients to disclose health-related social needs information during cancer care; and Theme 2: When social needs are identified, it is best practice to acknowledge and address social needs through referrals, resources, timely follow-up, and continued care coordination. Key barriers include individual beliefs and attitudes, concerns regarding privacy and sensitivity of questions, uncertainties about the outcomes of disclosing information, and patient-provider relationships and trust.</div></div><div><h3>Conclusion</h3><div>Drawing upon the perspectives of patients and patient navigators provided valuable insight into the challenges associated with acquiring information on social needs. Their viewpoints presented feasible solutions to overcome barriers through early acknowledgment of patient needs, timely resource provision, and maintaining consistent follow-up actions. Additionally, it enhanced understanding of the pivotal role patient navigators play in oncology, serving as crucial links between screening for health-related social needs and addressing individual patient requirements.</div></div><div><h3>Policy Summary</h3><div>The policies and policy improvements our paper seeks to impact include: inequalities in cancer care and health-related social needs of cancer.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"42 ","pages":"Article 100508"},"PeriodicalIF":2.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366825","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":"Analysis of factors associated with use of real-world data in single technology appraisals of cancer drugs by the National Institute for Health and Care Excellence","authors":"Jiyeon Kang ,&nbsp;John Cairns","doi":"10.1016/j.jcpo.2024.100507","DOIUrl":"10.1016/j.jcpo.2024.100507","url":null,"abstract":"<div><h3>Objectives</h3><div>This study investigates factors associated with use of real-world data (RWD) in economic modelling for single technology appraisals (STAs) of cancer drugs by the National Institute for Health and Care Excellence (NICE) to improve systematic understanding of the use of RWD.</div></div><div><h3>Methods</h3><div>The data were extracted from STAs of cancer drugs, for which NICE issued guidance between January 2011 and December 2022 (n=267). Binary regression was used to test hypotheses concerning the greater or lesser use of RWD. Bonferroni-Holm correction was used to control error rates in multiple hypotheses tests. Several explanatory variables were considered in this analysis, including time (<em>Time</em>), incidence rate of disease (<em>IR</em>), availability of direct treatment comparison (<em>AD</em>), generalisability of trial data (<em>GE</em>), maturity of survival data in trial (<em>MS</em>) and previous technology recommendations by NICE (<em>PR</em>). The primary outcome variable was <em>any</em> use of RWD. Secondary outcome variables were specific uses of RWD in economic models.</div></div><div><h3>Results</h3><div><em>AD</em> had a statistical negative association with <em>any</em> use of RWD whereas no associations with <em>non-parametric</em> and <em>parametric</em> use of RWD were found. <em>Time</em> had several statistical associations with use of RWD (validating survival distributions for the intervention, estimating progression-free survival for the intervention, estimating overall survival for comparators and transition probabilities).</div></div><div><h3>Conclusions</h3><div>RWD were more likely to be used in economic modelling of cancer drugs when randomised controlled trials failed to provide relevant clinical information of the drug for appraisals, particularly in the absence of direct treatment comparisons. These results, based on analysis of data systematically collected from previous appraisals, suggest that uses of RWD were associated with data gaps in the economic modelling. While this result may support some of the claimed advantages of using RWD when evidence is absent, the question, the extent to which use of RWD in indirect treatment comparisons reduces uncertainty is still to be determined.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"42 ","pages":"Article 100507"},"PeriodicalIF":2.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355875","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":"Palliative Care in Turkey: Insights from experts through key informant interviews","authors":"Fahad Ahmed ,&nbsp;Tezer Kutluk ,&nbsp;Sema Yurduşen ,&nbsp;Meltem Şengelen ,&nbsp;Burça Aydın ,&nbsp;Meral Kirazli ,&nbsp;Sinem Aydın ,&nbsp;Richard Sullivan ,&nbsp;Richard Harding","doi":"10.1016/j.jcpo.2024.100506","DOIUrl":"10.1016/j.jcpo.2024.100506","url":null,"abstract":"<div><h3>Background</h3><p>The rising demand for palliative-care (PC) in Turkey, driven by cancer, has prompted increased attention since the national PC policy in 2010. Despite this, the healthcare system predominantly focuses on curative care, lacking PC integration. This is due to combination of administrative obstacles, fragmented coordination, education and training scarcity. Thus urgent strategies are required to address the growing PC gap. This qualitative study explores the perspectives of PC professionals and policymakers, providing valuable insights for national policy and program development.</p></div><div><h3>Material and method</h3><p>This study employed an exploratory approach using key informant interviews. Interviews were conducted using semi-structured questionnaire. It sought to collect relevant contextual information in order to achieve its aim. Thematic content analysis was employed to examine and interpret the data.</p></div><div><h3>Result</h3><p>Twenty-one participants, comprising nurses, specialists, and oncologists, were interviewed. The findings are encompassed by eight themes. 1) Integrated Care, highlights the importance of cohesive collaboration among diverse healthcare providers, social care services, and primary care systems to ensure comprehensive and effective care. 2) Meeting social care needs underscores significance of addressing a wide spectrum of patient requirements, including psychosocial support. 3) PC education emphasizes necessity of equipping healthcare professionals with the requisite skills and knowledge through comprehensive training. 4) Legalizing do-notresuscitate orders draws attention to the critical discussion surrounding end-of-life decisions. 5) Empowering communities recognizes bridging knowledge gaps among patients and caregivers. 6) Decision-Making underscores the importance of informed and collaborative decision-making processes. 7) Cultural considerations urge the adoption of culturally sensitive approaches. 8) Ongoing challenges shed light on persistent issues such as provider attitudes, and administrative hurdles.</p></div><div><h3>Conclusion</h3><p>This study highlights essential factors for establishing an integrated PC program for cancer patients in Turkey. The existing healthcare system in Turkey offers opportunities for advanced PC. Successful implementation demands strategic actions to facilitate meaningful transformation.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"42 ","pages":"Article 100506"},"PeriodicalIF":2.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142242630","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":"Is health-related quality of life sufficiently addressed in trials for breast cancer treatments? An assessment based on reimbursement opinions from the French health technology assessment body, 2009–2023","authors":"Maéva Kyheng ,&nbsp;Hélène Tonoli ,&nbsp;Nicolas Supah ,&nbsp;Lionel Riou França ,&nbsp;Jacques Massol","doi":"10.1016/j.jcpo.2024.100504","DOIUrl":"10.1016/j.jcpo.2024.100504","url":null,"abstract":"<div><h3>Background</h3><p>Breast cancer treatments can impact the patients’ health-related quality of life (HR-QoL). This criterion is relevant for drug reimbursement decisions. We wanted to assess the usage of HR-QoL in health technology assessments (HTA).</p></div><div><h3>Methods</h3><p>All HAS (<em>Haute Autorité de Santé</em>, the French HTA body) opinions published between January 1, 2009 and March 31, 2023 for the reimbursement of breast cancer drugs were analysed.</p></div><div><h3>Results</h3><p>51 distinct appraisals were found during the period, corresponding to 45 product-specific indications, of which 36 (80 %) including clinical studies in which HR-QoL was an endpoint. HAS explicitly rejected HR-QoL data in 25 out of 36 (69 %) indications with such data. Rejections are justified by methodological weaknesses, including lack of adjustment for type I error inflation (n=21 indications), open-label treatment (n=7), lack of a pre-specified clinically relevant HR-QoL threshold (n=6) or missing data (n=6). Regardless of rejection status, HR-QoL results were not mentioned as a determinant of value assessment in 3/36 (8 %) instances (2/25 for rejected data).</p></div><div><h3>Conclusions</h3><p>HR-QoL data are inconsistently present in HTA assessments of new breast cancer drugs. Their methodological quality often hinders their use in determining the drug’s value.</p></div><div><h3>Policy summary</h3><p>A rigorous and acceptable comparative experimental framework is expected for HR-QoL assessments. More detail on the precise impact of the absence or presence of HR-QoL data in the determination of the drug’s added value could help understanding how this dimension is influential in the assessments.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"42 ","pages":"Article 100504"},"PeriodicalIF":2.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142242629","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}