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The concept of exceptionality: a legal farce?

How do we decide which treatments should be offered by the National Health Service (NHS) when we cannot afford to fund them all? In the absence of a positive appraisal by the National Institute for Health and Clinical Excellence (NICE), which mandates the provision of a treatment by the NHS, Primary Care Trusts (PCTs) are free to decide whether to provide a particular drug to some, or all, of their population. However, as public bodies, it is a well-established principle of Administrative Law that PCTs are not at liberty to fetter the exercise of their own discretion. They must recognise the p

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… Department of Health and Social Security, ‘Inequalities in Health: Report of a Working Group Chaired by Sir Douglas Black ’ (London 1980). BBC News , ‘Nurse wins breast cancer row’ (3 October 2005) < http://news.bbc.co.uk/2/hi/uk_news/england/somerset/4304586.stm > accessed 21 July 2010. …

The Past, Present, and Future of Clinically Applied Chimeric Antigen Receptor-T-Cell Therapy.

Immunotherapy represents the fourth pillar of cancer therapy after surgery, chemotherapy, and radiation. Chimeric antigen receptor (CAR)-T-cell therapy is an artificial immune cell therapy applied in clinical practice and is currently indicated for hematological malignancies, with cluster of differentiation 19 (CD19) as its target molecule. In this review, we discuss the past, present, and future of CAR-T-cell therapy. First, we summarize the various clinical trials that were conducted before the clinical application of CD19-targeted CAR-T-cell therapies began. Second, we discuss the accumulat

2022 International Cancer Education Conference Late-Breaking Abstracts

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A Multi-step Approach to Adapting a Mind-Body Resiliency Intervention for Fear of Cancer Recurrence and Uncertainty in Survivorship (IN FOCUS).

BackgroundFor cancer survivors, there is a paucity of fear of recurrence (FOR) interventions that integrate empirically supported mind-body and psychological skills for managing FOR and are delivered in scalable formats.ObjectiveTo adapt an evidence-based resiliency intervention to address FOR among cancer survivors.MethodsA multidisciplinary team of researchers, clinicians, and patient stakeholders followed an iterative intervention adaptation process (ORBIT). In Step 1, we sought to define key FOR management skills through a literature review and feedback from stakeholders. In Step 2, we int

Cancer: a looming public health crisis in Africa-a call to accelerate equitable access to medicines.

The global incidence of cancer is on the rise, with Africa experiencing a particularly steep increase in both cancer incidence and mortality. This upward trend is driven by a combination of factors, including population growth, poverty, aging, urbanization, and the adoption of lifestyles that increase the risk of cancer. It is projected that from 2022 to 2045, the incidence of cancer in Africa will increase by 106.8%, while cancer mortality will rise by 111.7% if no action is taken. In contrast, Europe is expected to see increases of only 22.5% in incidence and 32.2% in mortality. Despite glob

The Effects of Second Primary Malignancies and Frailty on Overall Survival and Mortality in Geriatric Turkish Patients with Multiple Myeloma.

The study aims to investigate second primary malignancy (SPM) development and frailty in Turkish geriatric patients with multiple myeloma (MM) and to assess the relationship between overall survival (OS) and various characteristics including SPM and frailty. Seventy-two patients diagnosed with and treated for MM were enrolled in the study. Frailty was determined by the IMWG Frailty Score. Fifty-three participants (73.6%) were found to have clinically-relevant frailty. Seven patients (9.7%) had SPM. Median follow-up was 36.5 (22-48.5) months, and 17 patients died during the follow-up period. Ov

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… Since only VCD is reimbursed by the social security institution in our country, this regimen was used as the standard induction regimen in all patients. Maintenance therapy was applied to all patients who had at least partial response to ASCT. Forty-one patients underwent ASCT. …

Resource utilization for chimeric antigen receptor T cell therapy versus autologous hematopoietic cell transplantation in patients with B cell lymphoma.

CD19-directed chimeric antigen receptor T cells (CAR-T) have emerged as a highly efficacious treatment for patients with relapsed/refractory (r/r) B cell lymphoma (BCL). The value of CAR-T for these patients is indisputable, but one-off production costs are high, and little is known about the ancillary resource consumption associated with CAR-T treatment. Here, we compared the resource use and costs of CAR-T treatment with high-dose chemotherapy followed by autologous stem cell transplantation (ASCT) for patients with r/r BCL. Standard operating procedures were used to develop a process model

Evaluation of adverse events and health-related quality of life in patients with colorectal cancer receiving ambulatory home-based chemotherapy in Thailand.

AimsTo compare adverse events and health-related quality of life in ambulatory home-based chemotherapy with those in inpatient.DesignProspective non-randomized observational study.MethodsParticipants were divided into two groups according to patients' preference receiving chemotherapy.ResultsSixty-four participants were enrolled in the inpatient, and 111 were in an ambulatory home-based chemotherapy. The frequency of anaemia, neutropenia and thrombocytopenia was significantly higher in inpatient group than in ambulatory home-based chemotherapy group (p < .001, <.001 and .002, respectively). Na

The efficacy and safety of electro-acupuncture for alleviating chemotherapy-induced peripheral neuropathy in patients with coloreactal cancer: study protocol for a single-blinded, randomized sham-controlled trial.

BackgroundColorectal cancer is the most common cancer in Hong Kong. Oxaliplatin-based chemotherapy is a major first-line conventional therapy for advanced and metastatic colorectal cancer. However, oxaliplatin causes chemotherapy-induced peripheral neuropathy (CIPN). Acupuncture has long been used to alleviate limb numbness in Chinese medicine. This study aims to examine the efficacy and safety of acupuncture for alleviating CIPN in patients with colorectal cancer in Hong Kong.Methods/designThis is a single-blinded, randomized, sham-controlled efficacy trial. Eighty-four eligible patients, who

A prospective observational study to assess clinical decision-making, prognosis, quality of life and satisfaction with care in patients with relapsed/refractory multiple myeloma: the CLARITY study protocol.

BACKGROUND: Treatment decision-making in patients with relapsed/refractory multiple myeloma (RRMM) is challenging for a number of reasons including, the heterogeneity of disease at relapse and the number of possible therapeutic approaches. This study broadly aims to generate new evidence-based data to facilitate clinical decision-making in RRMM patients. The primary objective is to investigate the prognostic value of patient self-reported fatigue severity for overall survival. METHODS: This multicenter prospective observational study will consecutively enroll 312 patients with multiple myelom

Productivity losses in patients with newly diagnosed multiple myeloma following stem cell transplantation and the impact of maintenance therapy.

OBJECTIVE: This study examined productivity losses in European patients with newly diagnosed multiple myeloma (NDMM) undergoing autologous stem cell transplantation (ASCT), to better understand and model the impact of NDMM and lenalidomide maintenance therapy on productivity from a patient and societal perspective. METHODS: A cross-sectional online patient survey was conducted across the UK, Germany, France, Spain and Italy. A partitioned survival model was used to estimate productivity loss and the impact of maintenance therapy, using human capital (HC) and friction cost approaches. RESULTS

Alternative Cancer Therapeutics: Unpatentable Compounds and Their Potential in Oncology.

Cancer remains a leading cause of death globally. Cancer patients often seek alternative therapies in addition to, or instead of, conventional treatments like chemotherapy, radiation, and surgery. The progress in medical advancements and early detection provides more treatment options; however, the development of cancer drugs requires a significant amount of time, demands substantial investments, and results in an overall low percent of regulatory approval. The complex relationship between patent protection and pharmaceutical innovation complicates cancer drug development and contributes to hi

Different attitudes towards estimating indirect costs of disease: The example of cancer.

GoalCost estimations in healthcare are crucial to make sound and adequate economic evaluations and assessments. The concept of indirect costs' estimation seems to be still not very well developed and systematized. This article is dedicated to the problem of indirect costs estimation of different types of cancer. The main aim of the article is to analyse the frequency of usage of different methods used for estimating indirect costs in economic analysis.MethodsThere are discussed various methods used for indirect costs' estimations. Among them, in details, there are described: human capital appr

Network analysis of cross-income-level collaboration on multiple myeloma in sub-Saharan Africa.

Cross-income-level collaboration (CILC) is crucial for developing global health approaches that benefit low- and middle-income countries (LMICs). Multiple myeloma (MM) is a representative example of a complex, understudied disease in sub-Saharan Africa (SSA). Based on publications, we developed a network analysis tool to assess scientific collaborations. Here, we present findings from a systematic analysis of publications retrieved from PubMed between January 2002 and June 2022. We evaluated individual institutional contributions and collaboration patterns using undirected weighted networks. O

Руководящие принципы иммунизации лиц с хроническими неврологическими расстройствами: систематический обзор.

КОЛИЧЕСТВО: Люди с хроническими неврологическими расстройствами могут быть подвержены серьезным последствиям инфекций, предотвращаемых с помощью вакцин. Вместе с тем рекомендации в отношении иммунизации этих пациентов могут быть сопряжены с трудностями при их выявлении и применении. Цель этого систематического обзора заключалась в определении и описании официальных руководящих принципов профилактической активной иммунизации лиц с хроническими неврологическими расстройствами. МЕТОДЫ: Этот систематический обзор был проведен в соответствии с предпочтенными элементами отчетности для системных обзо

Financial challenges of being on long-term, high-cost medications.

The isocitrate dehydrogenase (IDH) inhibitor, vorasidenib, may offer a promising new treatment option for patients with IDH-mutant gliomas. However, the indefinite nature of this targeted therapy raises significant financial concerns. High costs of targeted cancer therapies, often exceeding $150 000 annually, contribute to financial toxicity, characterized by medical debt, income loss, and psychological stress, and place stress on health systems. This review analyzes the drug approval and pricing mechanisms in various countries and their impact on healthcare costs and patient access, focusing

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… Unlike Grade 3 or 4 tumors, which qualify for Social Security disability benefits in the United States, low-grade tumors do not automatically qualify for additional benefits. 72 This underinsurance may place additional stress on patients and also make it difficult to obtain high-cost medications such …

Expanding access to high-cost medicines under the Universal Health Coverage scheme in Thailand: review of current practices and recommendations.

BackgroundThere has been an increasing demand to reimburse high-cost medicines, through public health insurance schemes in Thailand.MethodsA mixed method approach was employed. First, a rapid review of select high-income countries was conducted, followed by expert consultations and an in-depth review of three countries: Australia, England and Republic of Korea to understand reimbursement mechanisms of high-cost medicines. In Thailand, current pathways for reimbursing high-cost medicines reviewed, the potential opportunity cost estimated, and stakeholder consultations were conducted to identify

The effect of the holy Quran recitation and listening on anxiety, stress, and depression: A scoping review on outcomes.

Background and aimAnxiety, stress, and depressive disorders as common mental health problems have adverse effects in different populations. Holy Quran recitation and listening can help reduce these disorders. Therefore, the aim of this study was to investigate the effect of the Holy Quran on anxiety, stress, and depression.Materials and methodsTo retrieve eligible studies, we searched PubMed, Web of Science, and Scopus databases. The articles were screened and chosen by three researchers. The selection of studies and the data extraction from the studies were done by three researchers using the

Artificial Intelligence in the Management of Hereditary and Acquired Hemophilia: From Genomics to Treatment Optimization.

Hemophilia, an X-linked bleeding disorder, is characterized by a deficiency in coagulation factors. It manifests as spontaneous bleeding, leading to severe complications if not properly managed. In contrast, acquired hemophilia is an autoimmune condition marked by the development of inhibitory antibodies against coagulation factors. Both forms present significant diagnostic and therapeutic challenges, highlighting the need for advanced genetic, molecular, laboratory, and clinical assessments. Recent advances in artificial intelligence have opened new avenues for the management of hemophilia. M

Protocol for a randomised controlled feasibility trial of an integrated psychosexual intervention for sexual difficulties in people with Multiple Sclerosis: the PIMS trial.

BACKGROUND: Multiple Sclerosis (MS) is a long-term condition that significantly diminishes quality of life (QoL). Sexual difficulties (SDs) are common, but often overlooked symptom, affecting 50-80% of people with MS (PwMS). The emergence of SDs in MS results from the intricate interplay of disease processes, treatments, and psychosocial factors, contributing to a further decline in QoL and adverse effects on body image, relationships, and psychological well-being. Despite the limited treatment options, which mainly include medications and physiotherapy, there is promise in psychological inter