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J Norum

Publications and source records attributed to J Norum.

At least 37 records · Page 2Linked to original sources
PubMed1997

Lumpectomy or mastectomy? Is breast conserving surgery too expensive?

In the last decade, breast cancer patients have enjoyed an increase in breast conserving surgery (BCS). At present, modified radical mastectomy (MRM) and BCS offers equal expectations of survival. During the last few years, however, a drop in the frequency of BCS has been reported by several authors. Is this new trend due to economic concerns? To clarify the costs of breast cancer therapy (stage I and II), we review the literature and include a cost-utility and a cost-minimisation analysis comparing MRM and BCS. The treatment cost (per patient) of BCS and MRM in Norway was calculated at $9,564 and $5,596, respectively. Employing a quality of life gain in BCS of 0.03 (0-1 scale) and a 5% discount rate, the cost per QALY in BCS compared to MRM was $20,508. In cost-minimising analysis, BCS and mastectomy followed by reconstructive surgery had a cost of $10,748 and $8,538, respectively. This indicates that BCS remains within reasonable cost and should not be displaced by mastectomy on economic grounds.

Breast Neoplasms↗
PubMed1997

A cost-effectiveness approach to the Norwegian follow-up programme in colorectal cancer.

BACKGROUND: Today, continued periodic follow-up of patients treated for colorectal cancer (CRC) seems often to be routine because of tradition, rather than its demonstrated value. Recently, the Norwegian Gastrointestinal Cancer Group (NGICG) has recommended a standard surveillance programme in this malignancy. In this protocol patients are suggested followed for four years with CEA monitoring, ultrasound of the liver, chest radiograph and colonoscopy at regular intervals. MATERIALS AND METHODS: In this study, the cost-effectiveness of this programme was addressed employing Norwegian cost data and data from the Cancer Registry of Norway. Clinical data from the existing English language literature was used in the analysis. RESULTS: The basic cost of the NGICG recommended programme was 1,232 Pounds per patient. Including extended investigation due to suspected relapse in 45% of cases, the figure raised to 1,943 Pounds per patient. The cost per life year saved was indicated to 9,525 Pounds-16,192 Pounds. The corresponding cost per quality adjusted life year (QALY) was indicated to 11,476 Pounds-19,508 Pounds. CONCLUSION: We conclude the NGICG recommended follow-up programme in CRC cost-effective. Excluding CEA monitoring may improve the cost-effectiveness.

Carcinoembryonic Antigen↗
PubMed1997

Adjuvant chemotherapy (5-fluorouracil and levamisole) in Dukes' B and C colorectal carcinoma. A cost-effectiveness analysis.

BACKGROUND: Adjuvant chemotherapy (5-fluorouracil, levamisole) is now standard practice in the treatment of Dukes' B and C coloretal carcinoma (CRC), and this has increased the financial burden on health care systems world-wide. PATIENTS AND METHODS: Between 1993 and 1996, 95 patients in northern Norway were included in a national randomised CRC study, and assigned to surgery plus adjuvant chemotherapy or surgery alone. In April 1996, 94 of the patients were evaluable and 82 were still alive. The total treatment costs (hospital stay, surgery, chemotherapy, administrative and travelling costs) were calculated. A questionnaire was mailed to all survivors for assessment of the quality of their lives (QoL) (EuroQol questionnaire, a simple QoL-scale, global QoL-measure of the EORTC QLQ-C30), and 62 of them (76%) responded. RESULTS: Adjuvant chemotherapy in Dukes' B and C CRC raised the total treatment costs by 3,369 pounds. The median QoL was 0.83 (0-1 scale) in both arms. Employing a 5% discount rate and an improved survival of adjuvant therapy ranging from 5% to 15%, we calculated the cost of one gained quality-adjusted life-year (QALY) to be between 4,800 pounds and 16,800 pounds. CONCLUSION: Using a cut-off point level of 20,000 pounds per QALY, adjuvant chemotherapy in CRC appears to be cost-effective only when the improvement in 5-year survival is > or = 5%. Adjuvant chemotherapy does not affect short-term QoL.

Adult↗
PubMed1997

Intrapleurally instilled mitoxantrone in metastatic pleural effusions: a phase II study.

Thirty cases (breast cancer-20 cases, malignant lymphoma-4 cases, different malignancies-6 cases) of histologically/cytologically verified malignant pleural effusion (MPE) in 29 patients were treated with intrapleurally instilled mitoxantrone (30 mg). The therapy was well tolerated. At evaluation, 25 patients had died of progressive disease. The median survival was 3 months (range 0.3-21.3 months). There were 26 responders (12 complete responses (CR), 14 partial responses (PR)), whereas 4 patients relapsed and 3 of these had an early relapse (within 3 months). Patients achieving PR or CR had a low risk (15%) of treatment failure. Five patients were subjected to a pharmacokinetic evaluation. This demonstrated rapidly declining plasma and pleural exudate levels of mitoxantrone within the first 6 hours. At 24 hours after instillation, mitoxantrone was only detected in circulating mononuclear cells. This study shows that mitoxantrone is efficacious in the treatment of MPE, and may represent a cost-effective alternative.

Adolescent↗
PubMed1996

Quality of life in survivors of Hodgkin's disease.

The great majority of patients with Hodgkin's disease (HD) are successfully treated. However, several reports on treatment sequela have been published. The object of this study was to examine the quality of life (QOL) among survivors of HD focusing on gender and treatment modalities. All patients treated for HD at our oncological unit between 1985 and 1993 (n = 55) were registered. In December 1994, 49 survivors were mailed a questionnaire consisting of the EORTC QLQ-C30. Forty-two patients responded (86%). They reported a low frequency of symptoms and a high level of functioning. There was a significant correlation between mantle field irradiation and dyspnoea (p = 0.023). Females reported a significantly superior global quality of life (p = 0.016) and a lower fatigue score (p = 0.040) compared to males. Almost half of the patients reported financial difficulties. To improve QOL among survivors of HD, groups at risk have to be identified. Patients treated with mantle field irradiation and males seems to be at a higher risk. Should the treatment of HD be altered towards less radiotherapy and more chemotherapy?

Activities of Daily Living↗
PubMed1996

Psychological distress in survivors of Hodgkin's disease.

The object of this study was to reveal the psychological distress among survivors of Hodgkin's disease. Between 1985 and 1993, 55 patients were treated for Hodgkin's disease at our small oncological unit. In December 1994 all 49 survivors were mailed a questionnaire consisting of the Impact-of-Event Scale and a visual-analogue scale measuring quality of life, to which 42 patients responded (86%). Half of the patients reported moderate to high levels of psychological distress. Scores predicting significant stress response syndrome were revealed in 19% of the patients. Women reported statistically significant lower psychological distress on the intrusion (P = 0.025) and avoidance scale (P = 0.047) and a higher quality of life (P = 0.032). In order to improve patients' care and support, cases at risk should be identified. Among patients with Hodgkin's disease, men seems to be at highest risk. This study should be helpful for developing supportive interventions for survivors of Hodgkin's disease.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1996

Spiritual healing among Norwegian hospitalised cancer patients and patients' religious needs and preferences of pastoral services.

In a national questionnaire-based multicentre study, the use of 'alternative medicine', here called non-proven therapy (NPT), was examined. Five questions about the patients' religious beliefs and their preferences concerning pastoral services in the hospitals were included. Among the 911 invited patients, 642 (70.5%) were included in the analysis. Spiritual healing, defined as faith healing and healing by hand, was the most frequently used NPT among Norwegian cancer patients. Almost 50% of cancer patients using spiritual healing had used NPTs, mainly spiritual healing, prior to the diagnosis of cancer. Women, elderly people and patients using faith healing described themselves more often as religious. 139 (23%) of the responding patients reported a strengthening of their religious belief after the diagnosis of cancer. Patients less than 45 years of age and better educated patients expressed more frequently that all patients should be offered pastoral services during the hospital stay. Older patients, in spite of being more religious, expressed that the patients themselves had to request such services.

Adolescent↗
PubMed1996

Treatment costs in Hodgkin's disease: a cost-utility analysis.

The aim of this study was to estimate costs of treatment for Hodgkin's disease (HD) and the outcome in health in terms of quality-adjusted life-years (QALYs), and compare these to a constructed nontreatment alternative. All 55 patients treated for HD at the oncological unit of the University Hospital of Tromsø between 1985 and 1993 were included. The total treatment costs (medication, hospital stay, hospital hotel stay, radiotherapy, travelling, loss in production, i.e. work) were retrospectively estimated for all patients. In December 1994, the 49 survivors were sent a EuroQol questionnaire recording quality of life: 42 responded. The mean quality of life score was 0.78 on a 0-1 scale, and the mean total cost of treatment was pounds 12512. The total treatment costs were significantly higher in patients with advanced clinical stages of the disease (P = 0.0006), B-symptoms (fever, sweats, weight loss) (P = 0.0027) and relapse (P < 0.0001). The costs of one QALY (with production gains included and using a 10% discount rate) were estimated at pounds 1651. When excluding production gains and using a 5% discount rate, the figures became pounds 1327. This makes HD one of the most cost-effective malignancies to treat.

Adolescent↗
PubMed1995

[Testicular cancer treated at the regional hospital in Tromsø 1985-1993].

The case histories of 98 patients (47 seminomas and 51 non-seminomas) treated at the Department of Oncology, University Hospital of Tromsø between January 1985 and March 1993 were retrospectively analysed in August 1994. The analysis was undertaken to ascertain whether a small centre can achieve state of the art results. Complete remission was achieved in all cases. During a four year median follow-up period (range 1-10 years), three seminomas and eight non-seminomas relapsed. Only one retroperitoneally located relapse was revealed after retroperitoneal lymph node dissection. Two patients (one seminoma, one non-seminoma) died of progressive disease. A statistically significant correlation was found between stage of disease and human chorionic gonadotropin, lactate dehydrogenate and alpha-fetoprotein in non-seminoma. Our results are similar to those of the major oncological centres. Hence our unit is able to achieve state of the art results in the treatment of testicular carcinomas.

Adolescent↗
PubMed1995

Testicular cancer treated in a minor general oncology department.

The question of where to treat testicular cancer and by whom has been debated in several medical journals over the last few year. Here we present data from 98 patients (47 seminomas, 51 non-seminomas) treated between January 1985 and March 1993 at the Department of Oncology, University Hospital of Tromsø, Norway. During a 4-year median follow-up period 2 patients died of progressive disease. Our results are similar to those of major specialised oncology centres. We argue that within the context of multicentre cooperative studies or treatment protocols, patients with testicular cancer can be treated in a small general oncology centre with the same expectations of cure and treatment-related mortality and morbidity as achieved in major centres.

Adolescent↗
PubMed1995

Chemotherapy in gastric cancer: an economic evaluation of the FAM (5-fluorouracil, adriamycin, mitomycin C) versus ELF (etoposide, leucovorin, 5-fluorouracil) regimens.

The prognosis in gastric cancer has been almost unchanged for the last 20 years. At the time of diagnosis the majority of patients have disseminated disease. The 5-year survival is only about 15%. Several efforts with numerous antineoplastic regimens have been studied. The most widely used regimen has been the FAM (5-fluorouracil, adriamycin, mitomycin C) regimen. Because of the cardiotoxicity and dose intensity of the FAM regimen, a low toxicity regimen, the ELF (etoposide, leucovorin, 5-fluorouracil) regimen, has been introduced. We present the data from the treatment of 26 patients (17 FAM, 9 ELF) with advanced gastric cancer at the University Hospital of Tromsø. The monthly costs of FAM and ELF treatment were calculated to a price of 553 pounds and 2976 pounds (British pounds). The median survival of 5 months (FAM) and 6 months (ELF) is in accordance with other studies. Assuming that the median survival in our study is correct, the cost of one year saved was 123,834 pounds, while the cost of one QALY (quality adjusted life year) employing the ELF compared to the FAM regimen was 104,334 pounds. We conclude that the standard ELF regimen too expensive in the treatment of gastric cancer.

Adult↗
PubMed1994

Intrapleural bleomycin in the treatment of chylothorax.

Chylothorax is an accumulation of thoracic lymph or chyle in the pleural cavity. It is a rare condition and is usually caused by trauma or malignant disease. We present three cases with chylothorax due to malignant non-Hodgkin's lymphoma [high grade malignant (1 case) and low grade malignant (2 cases)] treated with pleurodesis with bleomycin and systemic chemotherapy (CHOP, CNOP, trofosfamide). Complete remissions (CR) were achieved in all three cases. Two patients had a recurrent chylothorax 3 and 12 months after initial treatment. They were treated with a second intrapleural installation of bleomycin and continuing systemic chemotherapy (CNOP, trofosfamide) and are still alive in CR with a follow-up period of 28 and 30 months respectively. One patient died of relapsing non-Hodgkin's lymphoma after 23 months of follow-up. There was no sign of recurrent chylothorax. We conclude that chylothorax caused by lymphoma can be satisfactorily controlled by pleurodesis with bleomycin combined with systemic chemotherapy. Immediate action is necessary to prevent great loss of lipids and proteins. The underlying malignancy must be controlled to achieve a good prognosis.

Antineoplastic Agents↗
PubMed1994

Multiple lymphomatous polyposis of the gut.

Multiple lymphomatous polyposis is very rare. We report two cases affecting duodenum, small intestine and colon/rectum, both with extensive disease, making radical surgery impossible and chemotherapy the treatment of choice. One patient died 23 days after initial treatment of myocardial infiltration, and the other is still alive 21 months after initial treatment.

Aged↗