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Background A novel way to build capacity in knowledge translation (KT) is through KT-focused grant competitions. Since 2009, the Knowledge Translation Research Network (KT-Net) has had a cancer-related KT grants program. We undertook an evaluation of the program to determine if KT-Net was achieving its aims of building capacity in cancer KT, advancing the science of KT, building partnerships, and leveraging funding. Methods An adapted framework guided the evaluation. Nine funded studies from 4 competitions were included. Semi-structured telephone interviews were held with researchers, stakeholders (including knowledge users), members of grant review panels, and experts in KT. Interview transcripts were audio-recorded, transcribed, and analyzed thematically. A review of proposal and report documents was also conducted. Results Funded researchers indicated that the grant competition was an essential funding program for cancer KT research. Competitions were perceived to build capacity in cancer KT among early-career researchers and to encourage innovative cancer KT research for which alternative funding sources are limited. The grants program resulted in incremental gains in advancing the science of KT. Suggestions to improve the program included stronger partnerships between the funder and the provincial cancer-system organization to optimize the application of research that is relevant to the organization’s strategic objectives. Conclusions The grants program met many of its aims by providing cancer researchers with an opportunity to gain capacity in cancer KT and by making incremental advances in KT science. Suggestions to improve the program included closer partnerships between the funder and the cancer-system organization. [ABSTRACT FROM AUTHOR]

Background In the present study, we aimed to describe, at the population level, patterns of adjuvant treatment use after curative-intent resection for pancreatic adenocarcinoma (PCC) and to identify independent predictors of adjuvant treatment use. Methods In this observational cohort study, patients undergoing PCC resection in the province of Ontario (population 13 million) during 2005-2010 were identified using the provincial cancer registry and were linked to administrative databases that include all treatments received and outcomes experienced in the province. Patients were defined as having received chemotherapy (CTx), chemoradiation (CRT), or observation (OBS). Clinicopathologic factors associated with the use of CTx, CRT, or OBS were identified by chi-square test. Logistic regression analyses were used to identify independent predictors of adjuvant treatment versus OBS, and CTx versus CRT. Results Of the 397 patients included, 75.3% received adjuvant treatment (27.2% CRT, 48.1% CTx) and 24.7% received OBS. Within a single-payer health care system with universal coverage of costs for CTx and CRT, substantial variation by geographic region was observed. Although the likelihood of receiving adjuvant treatment increased from 2005 to 2010 (p = 0.002), multivariate analysis revealed widespread variation between the treating hospitals (p = 0.001), and even between high-volume hepatopancreatobiliary hospitals (p = 0.0006). Younger age, positive lymph nodes, and positive surgical resection margins predicted an increased likelihood of receiving adjuvant treatment. Among patients receiving adjuvant treatment, positive margins and a low comorbidity burden were associated with CRT compared with CTx. Conclusions Interinstitutional medical practice variation contributes significantly to differential patterns in the rate of adjuvant treatment for PCC. Whether such variation is warranted or unwarranted requires further investigation. [ABSTRACT FROM AUTHOR]

Objective Costs for radiation therapy (rt) and the methods used to cost rt are highly diverse across the literature. To date, no study has compared various costing methods in detail. Our objective was to perform a thorough review of the radiation costing literature to identify sources of costs and methods used. Methods A systematic review of Ovid medline, Ovid oldmedline, embase, Ovid HealthStar, and EconLit from 2005 to 23 March 2015 used search terms such as "radiation," "radiotherapy," "neoplasm," "cost," " cost analysis," and "cost benefit analysis" to locate relevant articles. Original papers were reviewed for detailed costing methods. Cost sources and methods were extracted for papers investigating rt modalities, including three-dimensional conformal rt (3D-crt), intensity-modulated rt (imrt), stereotactic body rt (sbrt), and brachytherapy (bt). All costs were translated into 2014 U.S. dollars. Results Most of the studies (91%) reported in the 33 articles retrieved provided rt costs from the health system perspective. The cost of rt ranged from US$2,687.87 to US$111,900.60 per treatment for imrt, followed by US$5,583.28 to US$90,055 for 3D-crt, US$10,544.22 to US$78,667.40 for bt, and US$6,520.58 to US$19,602.68 for sbrt. Cost drivers were professional or personnel costs and the cost of rt treatment. Most studies did not address the cost of rt equipment (85%) and institutional or facility costs (66%). Conclusions Costing methods and sources were widely variable across studies, highlighting the need for consistency in the reporting of rt costs. More work to promote comparability and consistency across studies is needed. [ABSTRACT FROM AUTHOR]

Background The incidence of hepatocellular carcinoma (HCC) and the complexity of its diagnosis and treatment are increasing. We estimated trends in net health care utilization, costs of care attributable to HCC in Ontario, and rate ratios of resource use at various stages of care. Methods This population-based retrospective cohort study identified hcc patients and non-cancer control subjects, and health care resource utilization between 2002 and 2009. Generalized estimating equations were then used to estimate net health care utilization (HCC patients vs. the matched control subjects) and net costs of care attributable to HCC. Generalized linear models were used to analyze rate ratios of resource use. Results We identified 2832 hcc patients and 2808 matched control subjects. In comparison with the control subjects, hcc patients generally used a greater number of health care services. Overall, the mean net cost of care per 30 patient-days (2013 Canadian dollars) attributable to outpatient visits and hospitalizations was highest in the pre-diagnosis (1 year before diagnosis), initial (1st year after diagnosis), and end-of-life (last 6 months before death, short-term survivors) phases. Mean net homecare costs were highest in the end-of-life phase (long-term survivors). In the end-of-life phase (short-term survivors), mean net costs attributable to outpatient visits and total services significantly increased to $14,220 from $1,547 and to $33,121 from $14,450 (2008-2009 and 2002-2003 respectively). Conclusions In HCC, our study found increasing resource use and net costs of care, particularly in the end-of-life phase among short-term survivors. Our findings offer a basis for resource allocation decisions in the area of cancer prevention and control. [ABSTRACT FROM AUTHOR]

Objective Administrative data are used to describe the pancreatic cancer (PCC) population. The analysis examines demographic details, incidence, site, survival, and factors influencing mortality in a cohort of individuals diagnosed with PCC. Methods Incident cases of PCC diagnosed in Ontario between 1 January 2004 and 31 December 2011 were extracted from the Ontario Cancer Registry. They were linked by encrypted health card number to several administrative databases to obtain demographic and mortality information. Descriptive, bivariate, and survival analyses were conducted. Results During the period of interest, 9221 new cases of PCC (4548 in men, 4673 in women) were diagnosed, for an age-adjusted standardized annual incidence in the range of 8.6-9.5 per 100,000 population. Mean age at diagnosis was 70.3 ± 12.5 years (standard deviation). Five-year survival was 7.2% (12.8% for those <60 years of age and 3.6% for those >80 years of age). Survival varied by sex, older age, rural residence, lower income, site of involvement in the pancreas, and presence of comorbidity. Conclusions The mortality rate in PCC is exceptionally high. With an increasing incidence and a mortality positively associated with age, additional support will be needed for this highly fatal disease as demographics in Ontario continue to trend toward a higher proportion of older individuals. [ABSTRACT FROM AUTHOR]

Objective The objective of the present analysis was to determine the publicly funded health care costs associated with the care of breast cancer (BCA) patients by disease stage. Methods Incident cases of female invasive BCA (2005-2009) were extracted from the Ontario Cancer Registry and linked to administrative datasets from the publicly funded system. The type and use of health care services were stratified by disease stage over the first 2 years after diagnosis. Mean costs and costs by type of clinical resource used in the care of BCA patients were compared with costs for a matched control group. The attributable cost for the 2-year time horizon was determined in 2008 Canadian dollars. Results This cohort study involved 39,655 patients with BCA and 190,520 control subjects. The average age in those groups was 61.1 and 60.9 years respectively. Most BCA patients were classified as either stage I (34.4%) or stage II (31.8%). Of the BCA cohort, 8% died within the first 2 years after diagnosis. The overall mean cost per BCA case from a public payer perspective in the first 2 years after diagnosis was $41,686. Over the 2-year time horizon, the mean cost increased by stage: I, $29,938; II, $46,893; III, $65,369; and IV, $66,627. The attributable cost of BCA was $31,732. Cost drivers were cancer clinic visits, physician billings, and hospitalizations. Conclusions Costs of care increased by stage of BCA. Cost drivers were cancer clinic visits, physician billings, and hospitalizations. These data will assist planning and decision-making for the use of limited health care resources. [ABSTRACT FROM AUTHOR]

Objective To determine utilization and costs of home care services (HCS) for individuals with a diagnosis of breast cancer (BC). Methods Incident cases of invasive BC in women were extracted from the Ontario Cancer Registry (2005-2009) and linked with other Ontario health care administrative databases. Control patients were selected from the population of women never diagnosed with any type of cancer. The types and proportions of HCS used were determined and stratified by disease stage. Attributable home care utilization and costs for BC patients were determined. Factors associated with HCS costs were assessed using regression analysis. Results Among the 39,656 BC and 198,280 control patients identified (median age: 61.6 years for both), 75.4% of BC patients used HCS (62.1% stage I; 85.7% stage II; 94.6% stage III; 79.1% stage IV) compared with 14.6% of control patients. The number of HCS used per patient-year were significantly higher for the BC patients than for the control patients (14.97 vs. 6.13, p < 0.01), resulting in higher costs per patient-year ($1,210 vs. $325; $885 attributable cost to BC, p < 0.01). The number of HCS utilized and the associated costs increased as the BC stage increased. In contrast, HCS costs decreased as income increased and as previous health care exposure decreased. Interpretation Patients with BC used twice as many HCS, resulting in costs that were almost 4 times those observed in a matched control group. Less than an additional $1000 per BC patient per year were spent on HCS utilization in the study population. [ABSTRACT FROM AUTHOR]