Microsimulation modelling for the evaluation of treatment and surveillance in early-stage Non- Small Cell Lung Cancer
| Autor: | Wolff, Henri Bernard |
|---|---|
| Přispěvatelé: | Coupé, Veerle, Schramel, F.M.N.H., Epidemiology and Data Science, Coupé, V.M.H., Schramel, Franz Martin Nikolaus Hermann |
| Jazyk: | angličtina |
| Rok vydání: | 2022 |
| Předmět: | |
| Zdroj: | Wolff, HB 2022, ' Microsimulation modelling for the evaluation of treatment and surveillance in early-stage Non-Small Cell Lung Cancer ', Doctor of Philosophy . < https://hdl.handle.net/1871.1/17feb4c3-4dc5-4f8d-ad55-8873b40bb8b7 > Wolff, H B 2022, ' Microsimulation modelling for the evaluation of treatment and surveillance in early-stage non-small cell lung cancer ', PhD, Vrije Universiteit Amsterdam, Amsterdam . |
| Popis: | Clinical decision making requires information on the advantages and risks of treatment options. To further this goal in early-stage Non-Small Cell Lung Cancer (NSCLC), we focus on how the quality of life of patients is negatively affected by surgical treatment or stereotactic body radiation therapy of early stage NSCLC patients. The average difference in health utility between the SBRT and surgery groups was 0.026 (95% confidence interval: 0.028–0.080). Differences were most prominent in role functioning, pain and fatigue shortly after treatment, but these differences disappeared over time. Most patients that are diagnosed with early stage NSCLC will be advised to undergo surgery, because surgery has better survival rates according to some literature, while patients that are too frail to undergo surgery are advised to be treated with stereotactic body radiation therapy instead. It has been argued that the survival advantage of surgery as described in literature may not be accurate because of selection bias based on the fitness of patients. The cost-effectiveness analysis showed that although differences in overall survival and quality of life are very small between the two treatments, video assisted thoracic surgery was more expensive because of a variety of post-treatment hospitalization costs, leading to the conclusion that stereotactic body radiation therapy is cost-effective compared to surgery. Metachronous oligo-metastases are defined as one to five metastases detected after treatment of the primary tumor, with surgery or with stereotactic body radiation therapy, and after a disease-free interval. If metachronous oligo-metastases are detected, surgically removing these metastases is considered. Although the intent of this treatment is curative, studies have shown that the 5-year recurrence-free survival in this group of patients is only 16%. This means that, in hindsight, removal of all metastases was not successful, and these patients have undergone burdensome treatments unnecessarily. The prediction-model showed that patients with metastases with a high growth rate tend to have larger metastases once detected, and these metastases are less likely to be missed on follow-up scans. Therefore, curative treatment of larger metachronous oligo-metastases is less likely to result in detection of new recurrences at a later point in time. According to medical guidelines, patients with early stage NSCLC should undergo intensive surveillance after curative treatment of their primary tumor. Here, the goal of surveillance is to prolong life by early detection of recurrences of the primary tumor and new unrelated second primary lung cancers. The model showed that detection of second primary lung cancers has the largest effect on survival, because these can be treated curatively, unless the patient also has recurrences of the primary tumor. Thus, detection of a second primary tumor has the largest survival advantage when the chance of finding recurrences is low. Intensive scanning in the first two years after curative treatment when the chance of finding recurrences is high is therefore less useful than previously thought, and the model suggests a surveillance schedule of scanning every 2 years starting 1 year after curative treatment. Cost-effectiveness analyses combine information from several sources to determine how much additional health benefits would cost. Policymakers should also take the uncertainty around cost-effectiveness predictions into account, as well as the potential consequences of making a wrong decision. Therefore, a literature search was performed. The cost-effectiveness acceptability curve scored good on most items, but only provided information on the probability of cost-effectiveness. The expected loss curve also scored good on most items, but only provided information on the consequences of making a wrong decision. We therefore combined both methods into a heatmap to integrate all relevant information on risk assessment required for health policy and medical decision-making. |
| Databáze: | OpenAIRE |
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