Richard Simcock

Group acupuncture to relieve radiation induced xerostomia: a feasibility study

Background A distressing complication of radiotherapy treatment for head and neck cancer is xerostomia (chronic oral dryness). Xerostomia is difficult to treat conventionally but there are reports that acupuncture can help. We conducted a feasibility study to examine the acceptability of a standardised group acupuncture technique and adherence to group sessions, together with acceptability of the objective and subjective measurements of xerostomia. Methods 12 males with established radiation induced xerostomia were treated in three groups of four. Each received eight weekly sessions of acupuncture using four bilateral acupuncture points (Salivary Gland 2; Modified Point Zero; Shen Men and one point in the distal radial aspect of each index finger (LI1)). Sialometry and quality of life assessments were performed at baseline and at the end of treatment. A semi-structured interview was conducted a week after completing the intervention. Results Adherence to and acceptability of the treatment and assessments was 100%. There were objective increases in the amounts of saliva produced for 6/12 patients post intervention and the majority also reported subjective improvements. Mean quality of life scores for domains related to salivation and xerostomia also showed improvement. At baseline 92% (11/12) patients reported experiencing a dry mouth “quite a bit/very much” as compared to 42% (5/12) after the treatment. Qualitative data revealed that the patients enjoyed the sessions. Conclusion The pilot study shows that a standardised group technique is deliverable and effective. The tools for objective and subjective assessment are appropriate and acceptable. Further examination in a randomised trial is now warranted.

Costs of multidisciplinary teams in cancer are small in relation to benefits

To see evidence that multidisciplinary teams are effective in cancer is a relief, given the effort required to implement them.1 Whether their efficacy derives from surgical specialisation or the addition of members such as oncologists to the team is not clear. Introducing multidisciplinary teams has come at huge organisational cost, particularly with respect …

Epidermal Growth Factor Receptor and the Changing Face of Oropharyngeal Cancer

TO THE EDITOR: In his essay “Flushing Oral Oncology Drugs Down the Toilet,” Ratain provides an interesting opportunity to save a substantial amount of money by altering the circumstances of administration to increase the bioavailability of the drug abiraterone acetate. He points out that the development of the drug did not take advantage of the increased bioavailability obtained by administering the drug with a low-fat breakfast. If done as suggested by Ratain, the correct dose would be 250 mg once daily rather than 1,000 mg, as indicated. The essay assumes that had the clinical trials been done differently and the approved dose 250 mg, the price would be 75% lower. It would not. Drug pricing is not based on costs of manufacture, or research costs, or dosage size but rather on the highest cost the market will bear. In this regard, new drugs are no different than luxury automobiles. Cost of goods has little effect on price. A new drug with advantages over existing drugs will be priced at a premium to existing drugs, regardless of the actual dose or the cost of goods. Market research will attempt to identify a value for the treatment— generally, the full cost of a course of treatment. If the drug is taken daily for a year, then 365 doses is the course of treatment. If the drug is given by injection on alternate weeks for 6 months, then 13 doses is the course of treatment. A value is put on the course of treatment, and the cost per dose is simply the full cost divided by the number of doses. Had the development plan for abiraterone acetate taken into account the food effect described by Ratain, then the approved dose would be 250 mg and the cost for a month of treatment would be

Infusion of trastuzumab maintenance doses over 30 minutes

5,000—the same as the current cost for 1,000 mg. On a milligram basis, the cost would be four times higher than the current cost. By not taking advantage of the food effect, the developer has given the treating community the opportunity to prove Ratain right and save patients and third party payers a substantial amount of money. Frankly, the developer has done us a huge favor.

The cost of oropharyngeal cancer in England: A retrospective hospital data analysis

The humanized monoclonal antibody trastuzumab is licensed for both the adjuvant treatment of early breast cancer and the palliation of metastatic breast cancer [1]. In the UK, trastuzumab is usually administered on a three weekly schedule. According to the license, it is infused over a period of 90 min and the patient is observed for 4.5 h after the loading dose, and for 30 min after all subsequent maintenance infusions. Prolonged infusion times have been justified by the risk of infusion reactions, with 54% of patients having at least one symptom with their first infusion, usually pyrexia, headache or rigors [2]. Infusion reactions are much less common with maintenance doses, particularly when premedication with steroids or antihistamines is used, and severe reactions to infusions are very rare [2, 3]. On this basis, therefore, some

Changing face of HPV related cancer in the UK

To estimate the total costs of treating head and neck cancers, specifically oropharyngeal, laryngeal and oral cavity cancer, in secondary care facilities in England during the period 2006/2007 to 2010/2011.

An unusual cause of dysphagia in ductal breast cancer due to submucosal oropharyngeal metastatic spread: a case report

As the UK nears a decision on continuation of the national human papillomavirus (HPV) vaccination programme, Jit and colleagues’ economic evaluation of the available vaccines makes compelling reading.1 When developing arguments for cost effectiveness of the bivalent and quadrivalent vaccines, the analysis bears heavily on available data for cervical cancer, …

ARIX: A randomised trial of acupuncture v oral care sessions in patients with chronic xerostomia following treatment of head and neck cancer

IntroductionInvasive ductal and lobular carcinomas represent 67.9% and 6.3% of breast carcinoma, respectively. Metastatic breast cancer typically involves the lungs, bones, brain, and liver. Studies have shown differing patterns of metastatic spread between ductal and lobular carcinoma. Lobular carcinoma is more likely to metastasise to the gastrointestinal tract.Case presentationWe report the case of a 49 year old white woman with invasive ductal carcinoma with lobular differentiation who developed submucosal oropharyngeal metastases nearly two years after her original diagnosis after presenting with odynophagia and dysphagia. The patients symptoms preceded any associated radiological or endoscopic abnormalities by at least 9 months. Repeat computed tomography scan and eventual oropharyngeal biopsy confirmed submucosal metastatic invasive ductal carcinoma, suggesting occult submucosal spread.ConclusionThis case illustrates the importance of maintaining a high index of suspicion for metastatic disease in patients with invasive breast cancer who present with unusual symptoms and a careful search for metastatic sites.