Anthony Whitton

Self-reported comprehensive health status of adult brain tumor patients using the health utilities index

The comprehensive health status of adult survivors of brain tumors is largely unexplored.

Health Status Measurements at Diagnosis As Predictors of Survival Among Adults With Brain Tumors

PURPOSE The intent of this study was to determine whether baseline measures of functional capacity and performance could be used to predict survival in adults following the diagnosis of brain tumors. PATIENTS AND METHODS Comprehensive health status and health-related quality of life (HRQL) were measured using the Health Utilities Index (HUI; McMaster University, Hamilton, Canada) system by a self-assessment questionnaire in a survey of 100 consecutive patients. The Karnofsky Performance Score (KPS) and Folsteins Mini-Mental State Examination (MMSE) scores were measured by a physician blinded to the HUI results. The patients were observed for up to 5 years to recorded dates of death. RESULTS An HUI questionnaire was completed for 93% of the patients and 69% died within 5 years of assessment. The HUI revealed a burden of morbidity and complexity of disability that far exceeded that reported for the general population. KPS and MMSE correlated strongly with each other (r = 0.52; P < .001). A decrease of 0.1 units in HUI Mark 2 (HUI2) self-care single-attribute utility score was associated with an increased hazard of death of 30% (P = .023) for patients with low-grade tumors (n=25). For patients with high-grade tumors (n=56), a 10 unit decrease in the KPS, a 5 unit decrease in MMSE, and a 0.1 decrease in HUI Mark 3 (HUI3) speech and dexterity single-attribute scores were associated with an increased hazard of death of 20% (P = .022), 26% (P = .015), 36% (P = .021), and 18% (P = .035), respectively. CONCLUSION Scores derived from the measurement of HRQL following diagnosis can predict survival in adults with brain tumors.

Disseminated Langerhans cell histiocytosis in identical twins unresponsive to recombinant human α-interferon and total body irradiation

Monozygotic twin boys presented at 1 year of age with seborrheic skin rash, otorrhea, and hepatosplenomegaly. Skin biopsy confirmed Langerhans cell histiocytosis. Treatment with conventional antineoplastic drugs and with calf thymus extract was ineffective. The disease remained refractory to recombinant human a-interferon and to low-dose total body irradiation, and the children died between 3 and 3 years of age.

Health-related Quality of Life in Long-term Survivors of Brain Tumors in Childhood and Adolescence: A Serial Study Spanning a Decade.

Survivors of brain tumors in childhood experience adverse sequelae that are greater in prevalence and severity than those encountered by survivors of all other forms of cancer in early life, reflected in a burden of morbidity by instruments measuring health-related quality of life (HRQL). However, there are few studies of the change in HRQL over time in such populations. Patients who were above 5 years of age, at least 2 years from completion of therapy, and able to communicate in English were eligible for study of HRQL by the Health Utilities Index HUI2 and HUI3 at study entry, and again 5 and 10 years later. An initial cohort of 40 patients was reduced to 37 and 25 at the second and third time points, respectively, although only 1 death occurred during the study. HRQL showed a progressive decline over the decade, reaching conventional levels of clinical significance for the sizes of the changes. Median scores for HUI2 were 0.93, 0.90, and 0.88; and for HUI3 were 0.88, 0.85, and 0.77 at baseline, 5, and 10 years, respectively. The serial decline in HRQL demands further examination and an exploration of potential targets for therapeutic intervention.

Robotic radiosurgery for the treatment of 1-3 brain metastases: a pragmatic application of cost-benefit analysis using willingness-to-pay.

With the emergence of radiosurgery as a new radiotherapeutic technique, health care decision makers are required to incorporate community need, cost and patient preferences when allocating radiosurgery resources. Conventional patient utility measures would not reflect short term preferences and would therefore not inform decision makers when allocating radiosurgery treatment units. The goal of this article is to demonstrate the feasibility of cost-benefit analysis to elicit the yearly net monetary benefit of robotic radiosurgery. To calculate the yearly incremental cost of robotic radiosurgery as compared to fixed gantry radiosurgery we used direct local cost data. We assumed a standard 10 year replacement and 5% amortization rate. Decision boards summarizing the clinical scenario of brain metastases and the difference between robotic and fixed gantry radiosurgery in terms of immobilization, comfort and treatment time were then presented to a sample of 18 participants. Participants who preferred robotic radiosurgery were randomly assigned to either a low (

Amelanotic melanocytoma of the sella mimicking pituitary adenoma

1) or high (

65-year-old female with cerebellopontine angle lesion

5) starting point taxation based willingness-to-pay algorithm. The yearly incremental cost of providing robotic radiosurgery was

Nitric oxide and anti-cancer therapy

99,177 CAD. The mean community yearly willingness-to-pay for robotic radiosurgery was

NCOG-06. N107C/CEC.3 (ALLIANCE FOR CLINICAL TRIALS IN ONCOLOGY/CANADIAN CANCER TRIALS GROUP): PHASE III TRIAL OF POST-OPERATIVE RADIOSURGERY COMPARED WITH WHOLE BRAIN RADIOTHERAPY FOR RESECTED METASTATIC BRAIN DISEASE: COGNITIVE FUNCTION OF LONG-TERM SURVIVORS

2,300,000 CAD, ρ = 0.03. The calculated yearly net societal benefit for robotic radiosurgery was

Evaluation of Pseudoprogression in Patients With Glioblastoma (EPPIG)

2,200,823 CAD. Among participants who preferred robotic radiosurgery there was no evidence of starting point bias, ρ = 0.8. We have shown through this pilot study that it is feasible to perform cost-benefit analysis to evaluate new technologies in Radiation Oncology. Cost-benefit analysis offers an analytic method to evaluate local preferences and provide accountability when allocating limited healthcare resources.