Social value of a quality-adjusted life year (QALY) in Spain: the point of view of oncologists.

PURPOSE: The economic situation showed that the resources devoted to health spending are limited, making rationalisation of their consumption necessary. The relevance of pharmacoeconomic analyses is becoming crucial. The ECO Foundation, promoting the quality of oncology care, set out to analyse the consensus on the new therapeutic targets inclusion and the integration of pharmacoeconomics when evaluating their effectiveness. METHODS: Study about pharmacoeconomic estimations was performed during the first ECO-Seminar (2010). It was developed using a modified Delphi method, in four stages: (1) committee coordinator establishment, (2) expert-panel selection, (3) preparation and submission of survey (1 question) by email, and (4) analysis of the degree of consensus reached. RESULTS: Results were obtained from surveys completed by 35 experts. Regarding the tolerable annual cost for the approval of new drugs, 68.8 % of the respondents considered a cost per quality-adjusted life year (QALY) gained between €30,000 and 100,000 acceptable (34.4 % €30,000-60,000; 34.4 % €60,000-100,000), 21.9 % of the respondents found costs between €100,000-150,000/QALY and 9.3 % of the respondents found costs above €150,000/QALY acceptable. CONCLUSIONS: The costs of new drugs are higher than traditional treatments, making it a priority to identify subgroups of patients with specific molecular profiles as candidates for higher-efficiency-targeted therapies. The allocation of the available resources to the most effective interventions, to achieve the best clinical outcomes with lower costs and best subjective profile possible, allows expenditure to be rationalised. Pharmacoeconomic studies are a basic tool for obtaining better health outcomes according to the available resources, while also considering the other needs of the population.

Oncological translational research in the Spanish national health system: the INTRO study.

OBJECTIVES: Under the auspices of the Foundation for Excellence and Quality in Oncology (ECO), the Translational Research in Oncology Medical Services Study (INTRO) was conducted with the aim of describing the current state of, and future expectations for translational cancer research in Spanish medical centres. The first step in the investigation was intended to analyse the current condition of the national Medical Oncology Services network by examining different aspects of the oncology research field. METHODS: A descriptive and observational multicentre study was performed at a statewide level; information was collected by surveying a cross-section of all those responsible for Medical Oncology Services in Spain. RESULTS: The survey was completed by key informants, who were selected independently by each service, between September 2010 and April 2011. We were able to gather comprehensive data from a total of 27 Spanish hospitals. These data enabled us to describe the allocation of human and material resources devoted to clinical and translational research across the Medical Oncology Services and to describe the organisational and functional components of these services and units. These data included information pertaining to the activities developed, their funding sources, and their functional dependence on other internal or external bodies. Finally, we explored the degree of dissemination and use of some specific techniques used for the genetic diagnosis of cancer, which have recently been introduced in Medical Oncology within the Spanish healthcare system. CONCLUSIONS: A wide range of variability exists between different oncology services in Spanish hospitals. Time should be spent reflecting on the need and opportunities for improvement in the development of translational research within the field of oncology.

Adjuvant treatment of melanoma.

Melanomas represent 4% of all malignant tumors of the skin, yet account for 80% of deaths from skin cancer.While in the early stages patients can be successfully treated with surgical resection, metastatic melanoma prognosis is dismal. Several oncogenes have been identified in melanoma as BRAF, NRAS, c-Kit, and GNA11 GNAQ, each capable of activating MAPK pathway that increases cell proliferation and promotes angiogenesis, although NRAS and c-Kit also activate PI3 kinase pathway, including being more commonly BRAF activated oncogene. The treatment of choice for localised primary cutaneous melanoma is surgery plus lymphadenectomy if regional lymph nodes are involved. The justification for treatment in addition to surgery is based on the poor prognosis for high risk melanomas with a relapse index of 50-80%. Patients included in the high risk group should be assessed for adjuvant treatment with high doses of Interferon- α 2b, as it is the only treatment shown to significantly improve disease free and possibly global survival. In the future we will have to analyze all these therapeutic possibilities on specific targets, probably associated with chemotherapy and/or interferon in the adjuvant treatment, if we want to change the natural history of melanomas.

[Treatment of indolent non-Hodgkin's lymphomas]. / Tratamiento de los linfomas no hodgkinianos indolentes.

Non-Hodgkin's Lymphomas (NHLs) are a heterogeneous group of entities with different pathologies. A total of 80% of these lymphomas are B-cell origin and only 20% T-cell. B-cell lymphomas express CD-20 antigen, a specific target for the current treatment with monoclonal antibodies. Indolent lymphomas in localized stages (I and II) account for 20%, only 10% being in pathological stages. The possibilities for cure with radiotherapy and/or chemotherapy are approximately 50-70%. Advanced stages (IIB, III and IV) of phenotype B types account for 80-90% of the cases and are candidates for systemic treatments with immunochemotherapy for those of phenotype B. Rescue treatment is one of the most important problems in this type of lymphomas, many of them needing second line treatments, with survival rates under five years, in spite of the 50% response rate. In these cases, immunochemotherapy includes more aggressive regimens, high-dose chemotherapy and combined chemoimmunoradiotherapy.

[Treatment of aggressive non-Hodgkin's lymphomas]. / Tratamiento de los linfomas no hodgkinianos agresivos.

Aggressive non-Hodgkin's lymphomas (NHL) in localized stages I and II, without bulky areas and a fair International Prognostic Factor (IPI) (30% of all cases) have high possibilities of cure (80%) when treated with combined chemotherapy, CHOP or CHOP-like (3-4 courses) followed by locoregional radiation therapy. Localized aggressive non-Hodgkin's lymphomas with signs of poor prognosis or advanced stages (III and IV) must be treated with rituximab-containing immunochemotherapy. As second line in responding patients (DHAP, ESHAP, MINE, VIM, DICE, etc., and rituximab) high doses chemotherapy with hematopoietic growth factor support should be considered, although not in refractory patients.

Spanish Society of Medical Oncology consensus for the use of haematopoietic colony-stimulating factors in cancer patients

Neutropenia is a common complication of cancer chemotherapy. Colony-stimulating factors (CSF) may be used to avoid neutropenia-associated complications. The Spanish Society of Medical Oncology (SEOM) recently constituted a working group to review the main issues concerning the use of CSF and carried out a consensus process about the use of CSF in cancer patients, held in Madrid on 26 May 2006. The group concluded the following recommendations: prophylactic use of CSF is recommended when a rate of febrile neutropenia (FN) higher than 20% is expected without the use of CSF or when additional risk factors for neutropenia exist; therapeutic use of CSF is recommended in order to treat FN episodes but not to treat afebrile neutropenic episodes. In addition, the use of CSF is considered effective when used to mobilise stem cells before high-dose chemotherapy and when used for chemotherapy schedule optimisation in dose-dense and in dose-intense regimens (AU)

Diagnosis and medical treatment of breast cancer. Cordoba Consensus of 2007

Many important studies have changed the perspective from which breast cancer is approached, and they may change what have to date been the standards applicable to the diagnosis and treatment of breast cancer. In 2007, just over 200 oncologists from all over Spain met in Cordoba in order to review the latest evidence related to breast cancer and reach a consensus on the most important aspects of its diagnosis and treatment in different clinical situations: neoadjuvance, adjuvance and advanced disease. In view of these important changes, opinions on some specific aspects may be varied and all are justified. This document represents a review of the current state of the evidence (AU)

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Protein energy malnutrition (PEM) in cancer patients

INTRODUCTION: Cancer patients show protein energy malnutrition (PEM) throughout the evolution of the disease. The main objective of this work is to find out the prevalence of PEM in the studied sample, as well as how to assess the nutritional state of patients. MATERIAL AND METHODS: Non-interventionist, longitudinal and prospective study. Cancer patients from 103 researchers (6 specialties) from 65 hospitals of 15 Spanish Autonomous Communities. Results 561 patients were included in the study. The mean age was 62.6 years and 68.8% were men. The average basal body mass index (BMI) was 22.1 kg/m2. In 18.2% the BMI was low; 21.6% were overweight, pre-obese or obese; 22.9% had a localised tumour and 77.1% had an advanced one, first and foremost located in the head and neck, digestive system and lungs. In 72.7% of cases, it was treated with chemotherapy (CT) and in 38.3% with CT and radiotherapy (RT). 96.4% had nutrition problems: 70.9% (398/561) had anorexia, 34.8% (195/561) gastrointestinal pro blems, 32.6% (183/561) dysgeusia, 40.5% (227/561) dysphagia and others 8.6% (48/561). Weight loss occurred in 90.7% (an average of 4.2 months). CONCLUSION: If we analyse the BMI of patients, it can be seen that 60.2% have an adequate weight according to their size against 17.3% of patients who are overweight or preobese, and the remaining 4.3% are obese. Only 18.2% of patients are underweight. Over 90% have suffered recent weight loss (AU)

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Linfoma Hodgkin óseo: dos casos y revisión / Bone Hodgkin lymphoma: two patients and literature review

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Tratamiento del dolor en el paciente oncológico / Pain treatment in cancer patients

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Prevalencia de la malnutrición en pacientes con cáncer: estudio NUPAC

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A propósito de un caso: linfoma mediastínico y cirugía / Mediastinal lymphoma and surgery. About a case

- Propósito: el linfoma B primario mediastínico (LBPM) es una entidad clínico-patológica diferenciada reconocida en la clasificación REAL1. Constituye una entidad agresiva, que afecta fundamentalmente a jóvenes, es potencialmente curable y presenta gran dificultad en su manejo. El tratamiento habitualmente empleado incluye tanto la quimioterapia como la radioterapia.- Material y métodos: se presenta el caso de un varón de 14 años, en el que la cirugía y los nuevos avances en el tratamiento han conseguido la curación del paciente.- Resultados y conclusiones: se revisa el tratamiento del linfoma B primario mediastínico, aportando el papel de la cirugía en los casos refractarios (AU)

Enfermedad de Hodgkin epitroclear. Aportación de un nuevo caso / Hodgkin´s disease presenting in epitrochlear nodes. A new case

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Valores de los marcadores séricos tumorales en el diagnóstico precoz de las neoplasias y en los exámenes de salud a personas asintomáticas / Value of serum tumor markers for the early diagnosis of neoplams and in health exams for asymptomatic persons

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Degeneración cerebelosa paraneoplásica y carcinoma de ovario / Paraneoplasiic cerebellar degeneration and ovarian carcinoma

Propósito: Efectuar una revisión bibliográfica de la degeneración cerebelosa subaguada paraneoplásica. Material y métodos: Presentamos el caso de una mujer con degeneración cerebelosa, anticuerpos anti-Yo positivos y cáncer de ovario. Revisamos la literatura médica relacionada con este síndrome. Conclusiones: La degeneración cerebelosa paraneoplásica debe sospecharse en pacientes con afectación cerebolsa simétrica y progresiva. No existe un tratamiento definitivo para esta enfermedad, se han documentado mejorías tras el tratamiento del tumor primario (AU)