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Previous studies have shown that a 'Preventive Exercise Program' (PREP) is cost-effective compared to the standard exercise program provided in 'Usual Care' (UC) in patients with advanced head and neck cancer. The current paper specifically estimates the cost-effectiveness of the TheraBite jaw rehabilitation device (TB) which is used as part of the PREP, compared to Speech Language Pathology (SLP) sessions as part of UC, and herewith intents to inform reimbursement discussions regarding the TheraBite device. Costs and outcomes [quality-adjusted life-years (QALYs)] of the TB compared to SLP were estimated using a Markov model of advanced head and neck cancer patients. Secondary outcome variables were trismus, feeding substitutes, facial pain, and pneumonia. The incremental cost-effectiveness ratio (ICER) was estimated from a health care perspective of the Netherlands, with a time horizon of 2 years. The total health care costs per patient were estimated to amount to €5,129 for the TB strategy and €6,915 for the SLP strategy. Based on the current data, the TB strategy yielded more quality-adjusted life-years (1.28) compared to the SLP strategy (1.24). Thus, the TB strategy seems more effective (+0.04) and less costly (−€1,786) than the SLP only strategy. At the prevailing threshold of €20,000/QALY the probability for the TB strategy being cost-effective compared to SLP was 70 %. To conclude, analysis of presently available data indicates that TB is expected to be cost-effective compared to SLP in a preventive exercise program for concomitant chemo-radiotherapy for advanced head and neck cancer patients. [ABSTRACT FROM AUTHOR]

Background:Eight years after the Institute of Medicine recommended survivorship care plans (SCPs) for all cancer survivors, this study systematically reviewed the evidence for their use.Methods:Studies evaluating outcomes after implementation of SCPs for cancer survivors were identified by searching databases (MEDLINE, EMBASE and Cochrane). Data were extracted and summarised.Results:Ten prospective studies (2286 survivors) met inclusion criteria (5 randomised controlled trials (RCTs)). Study populations included survivors of breast, gynaecological, colorectal and childhood cancer. Several models of SCP were evaluated (paper based/on-line, oncologist/nurse/primary-care physician-delivered and different templates). No significant effect of SCPs was found on survivor distress, satisfaction with care, cancer-care coordination or oncological outcomes in RCTs. Breast cancer survivors with SCPs were better able to correctly identify the clinician responsible for their follow-up care. One study suggested a positive impact on reducing unmet needs. Levels of survivor satisfaction with, and self-reported understanding of, their SCP were very high. Feasibility was raised by health professionals as a significant barrier, as SCPs took 1-4 h of their time to develop.Conclusions:Emerging evidence shows very few measurable benefits of SCPs. Survivors reported high levels of satisfaction with SCPs. Resource issues were identified as a significant barrier to implementation. [ABSTRACT FROM AUTHOR]

Purpose: From a cancer survivor perspective, the purpose of this paper is to explore what has changed in their lives that they attribute to the disease. The rationale for the study is that evidence of the extent to which cancer disrupts people's lives in the longer term is contradictory. Methods: Written accounts from 40 cancer survivors were analysed using interpretative methods. The researchers drew on the concept of biographical disruption as a framework for analysis. Results: Cancer survivors construct cancer as a biographically disruptive event with ongoing physical and psychosocial impacts. Cancer is constructed as a permanent threat to life which is responsible for increasing their awareness of their own mortality and invoking positive changes to self. These formulations of living with cancer were found across a range of participants, including those who defined themselves as currently free of cancer, those who had recurrence, those who had been diagnosed 5 years ago and those who had been free of cancer for a long time. Conclusions: This study adds to the body of literature exploring how to enhance supportive care for cancer survivors by reflecting on biographical disruption and continuity, and the complexities within individual constructions of changes in life that they attribute to cancer. Cancer survivors should be given opportunities to articulate the impact of cancer, thus giving legitimate space to talk about cancer's ongoing resonance on life so that problems and difficulties are not dismissed or trivialised. [ABSTRACT FROM AUTHOR]