ABSTRACT
Actual cases show that directly observed therapy (DOT) works with tuberculosis patients--and while DOT may increase the short-term cost of care, in the long term DOT can deter other costs.
Subject(s)
Antitubercular Agents/administration & dosage , Direct Service Costs , Home Care Services/economics , Tuberculosis, Pulmonary/drug therapy , Adult , Ambulatory Care/economics , Antitubercular Agents/economics , Cost-Benefit Analysis , Humans , Male , Pennsylvania , Self Administration/economics , Tuberculosis, Pulmonary/economicsABSTRACT
Serial metastatic bone series on 12 patients with skeletal metastases from carcinoma of breast were studied. Changes in the clinical and radiographic parameters of the patients were correlated. Patients were all treated on a research protocol evaluating "medical adrenalectomy" with aminoglutethimide or surgical adrenalectomy. Seventeen clinical changes were noted in twelve patients. Sixteen of these observations demonstrated positive clinical correlations with concurrent skeletal radiographs. A lytic bone pattern correlated clinically with progressive tumor growth. A blastic bone pattern was present when objective clinical data indicated disease remission.
Subject(s)
Bone Neoplasms/secondary , Breast Neoplasms , Adrenalectomy , Aged , Aminoglutethimide/therapeutic use , Bone Neoplasms/diagnostic imaging , Bone Neoplasms/therapy , Female , Humans , Middle Aged , RadiographyABSTRACT
Serial plasma levels of the glucoprotein tumor markers carcinoembryonic antigen (CEA) and gross cyst disease fluid protein (GCDFP) were evaluated in 83 patients undergoing treatment for predominant osseous metastases from breast carcinoma. Abnormal plasma levels of CEA (greater than 10 ng/ml) and/or GCDFP (greater than 150 ng/ml) were observed in 53 (63.8%) subjects. Fifty-six courses of hormonal and chemical therapy were evaluated. Clinical response to therapy correlated positively with alterations in serial plasma levels of CEA and/or GCDFP. Increasing plasma levels of tumor markers were associated with clinical disease progression whereas decreasing plasma levels were associated with and generally preceded clinical disease remission. Of patients with metastatic carcinoma of the breast, responses to therapy are most difficult to evaluate in those with bone metastases. Serial determinations of plasma levels of CEA and/or GCDFP provide an objective indication of disease progression and regression and appear to be useful with skeletal x-rays and bone scans in evaluating patients with carcinoma of the breast.
