Under-treatment of elderly patients with ovarian cancer: a population based study

International audienceAbstractBackgroundOvarian cancer is the fourth most common cancer among women in France, and mainly affects the elderly. The primary objective of this study was to compare treatment of ovarian cancer according to age.MethodsAll patients with invasive cancer (n = 1151) diagnosed between 1997 and 2011 in the Herault Department of southern France were included. Demographic data (age, area of residence), cancer characteristics (stage, histology, grade) and treatment modality (type, period and location of treatment) were analysed. Univariate and multivariate logistic regression was used to compare treatment by age.ResultsOvarian cancer was less treated in elderly compared to younger patients, regardless of the type of treatment. This difference was more pronounced for chemotherapy, and was maximal for surgery followed by chemotherapy (odds ratio (OR) for surgery for patients aged >70 vs those aged 70 vs 70 vs <70 = 0.14 [0.08–0.28]). This effect of age was independent of other variables, including stage and grade. The probability of receiving standard treatment, in accordance with recommendations, was reduced by 50 % in elderly patients compared to their younger counterparts. Overall and net survival of elderly patients with standard treatment was similar to those of younger patients treated outside standard treatment.ConclusionsElderly women with ovarian cancer were therapeutically disadvantaged compared to younger women. Further studies including co morbidities are necessary to refine these results and to improve therapeutic management of elderly patients with ovarian cancer

The influence of fiscal regulations on investment in marine fisheries: A French case study

Analysing investment drivers in fisheries is essential in understanding the long-term development of fishing capacity. This paper addresses the drivers of investment in the French commercial fishing fleets operating along the Atlantic coast, and the role of public policies have had on investment. First, we examine the changes in the capital value of the fleet, which was strongly impacted by decommissioning schemes during the nineties. We then examine drivers of investment using an unbalanced panel data set describing the investment decisions of a sample of firms over the period 1994–2004. In addition to economic variables, the estimated models account for other factors that may have an impact on investment behaviour, including the different career phases of the skipper-owners. The study concludes with a discussion of the results, and in particular of the role of fiscal policy on observed investment strategies

Medico-economic evaluation of infliximab in rheumatoid arthritis—prospective French study of a cohort of 635 patients monitored for two years

Objectives. To perform, in real conditions of prescription, the medico-economic evaluation of infliximab in severe RA. Methods. A cost-effectiveness analysis of the annual costs was done with a comparison between the previous and the following year under infliximab. The effectiveness, determined from the HAQ, was expressed in clinically significant units and in quality-adjusted life years (QALYs). The incremental net benefit (INB), defined as willingness to pay (λ), was used to express the results. Results. A cohort of 635 patients was formed. Before the use of infliximab, after 1 and 2 years, the mean annual cost per patient for the care of RA was €9832, 27 723 and 46 704, respectively. Among the direct costs, infliximab accounts for €21 182 for the first year. The distribution of the different costs was similar after 2 years. By using the INB, the difference before and after 1 year under infliximab is significant, on average by 1.86 (s.e.m. = 0.76) when the effectiveness is expressed in clinically significant units. For severe HAQ, λ is €9841 (18 593 for all HAQ). When it is expressed in QALYs, also for severe HAQ, λ >€100 000. This can be explained by a short follow-up although severe complication of RA appears later. Conclusion. An evaluation of the more long-term costs is required in order to determine whether there are any full economic benefits with this treatmen

Is there a case for cisplatin in the treatment of small-cell lung cancer? A meta-analysis of randomized trials of a cisplatin-containing regimen versus a regimen without this alkylating agent

Chemotherapy is the backbone of small-cell lung cancer therapy. However, optimal drug combinations and schedules remain to be defined and there is hitherto no world-wide accepted standard regimen. Cisplatin, an alkylating agent with high putative toxicity is currently widely used although its effectiveness in this disease has not been established firmly. We conducted a meta-analysis of published data reporting trials randomizing a cisplatin-containing regimen versus a regimen without this alkylating agent in order to determine possible differences in survival response and toxicity. Nineteen trials have been identified in medical literature (4054 evaluable patients). Ten trials randomized patients to receive a cisplatin-etoposide regimen versus a regimen without any of these two drugs. A subgroup analysis was, therefore, carried out in the nine remaining trials that randomly allocated patients between two regimens differing in the absence or presence of cisplatin, whereas etoposide was given (or not given) in both arms (1579 evaluable patients). The DerSimonian and Laird method was used to estimate the size effects and the Peto and Yusuf method was used in order to generate the odds ratios (OR) of reduction in risk of death and the increase in probability of being responders to chemotherapy. There was no significant difference between the cisplatin-containing regimen and the regimen without this drug when the risk of toxic-death was taken into account with respective probabilities of 3.1 and 2.7% (NS). Patients randomized in a cisplatin-containing regimen had an increase in probability of being responders with an OR of 1.35, 95% confidence interval (CI) of 1.18–1.55;P< 10–5corresponding to an increase of objective (partial plus complete) response rate from 0.62 to 0.69 (a result taking into account a significant heterogeneity). Patients treated with a cisplatin-containing regimen benefited from a significant reduction of risk of death at 6 months and 1 year with respective OR 0.87, 95% CI 0.75–0.98, P = 0.03, and or 0.80, 95% CI 0.69–0.93, P = 0.002 (no statistical heterogeneity). This corresponded to a significant increase in the probability of survival of 2.6% and 4.4% at 6 months and 1 year respectively. The meta-analysis restricted to the subset of nine trials without etoposide treatment imbalance reached similar conclusions. A cisplatin-containing regimen yields a higher response rate and probability of survival than does a chemotherapy containing others alkylating agents without a perceptible increase in risk of toxic-death. © 2000 Cancer Research Campaig

Comparison of Supervised Classification Methods for Protein Profiling in Cancer Diagnosis

A key challenge in clinical proteomics of cancer is the identification of biomarkers that could allow detection, diagnosis and prognosis of the diseases. Recent advances in mass spectrometry and proteomic instrumentations offer unique chance to rapidly identify these markers. These advances pose considerable challenges, similar to those created by microarray-based investigation, for the discovery of pattern of markers from high-dimensional data, specific to each pathologic state (e.g. normal vs cancer). We propose a three-step strategy to select important markers from high-dimensional mass spectrometry data using surface enhanced laser desorption/ionization (SELDI) technology. The first two steps are the selection of the most discriminating biomarkers with a construction of different classifiers. Finally, we compare and validate their performance and robustness using different supervised classification methods such as Support Vector Machine, Linear Discriminant Analysis, Quadratic Discriminant Analysis, Neural Networks, Classification Trees and Boosting Trees. We show that the proposed method is suitable for analysing high-throughput proteomics data and that the combination of logistic regression and Linear Discriminant Analysis outperform other methods tested

Integrated ecological–economic fisheries models—Evaluation, review and challenges for implementation

Marine ecosystems evolve under many interconnected and area-specific pressures. To fulfil society's intensifying and diversifying needs while ensuring ecologically sustainable development, more effective marine spatial planning and broader-scope management of marine resources is necessary. Integrated ecological-economic fisheries models (IEEFMs) of marine systems are needed to evaluate impacts and sustainability of potential management actions and understand, and anticipate ecological, economic and social dynamics at a range of scales from local to national and regional. To make these models most effective, it is important to determine how model characteristics and methods of communicating results influence the model implementation, the nature of the advice that can be provided and the impact on decisions taken by managers. This article presents a global review and comparative evaluation of 35 IEEFMs applied to marine fisheries and marine ecosystem resources to identify the characteristics that determine their usefulness, effectiveness and implementation. The focus is on fully integrated models that allow for feedbacks between ecological and human processes although not all the models reviewed achieve that. Modellers must invest more time to make models user friendly and to participate in management fora where models and model results can be explained and discussed. Such involvement is beneficial to all parties, leading to improvement of mo-dels and more effective implementation of advice, but demands substantial resources which must be built into the governance process. It takes time to develop effective processes for using IEEFMs requiring a long-term commitment to integrating multidisciplinary modelling advice into management decision-making.</p

Technological Switching in the Fisheries Sector

Technological switching and re-switching has been the subject of debates within economics. Under assumptions of malleable capital in economies with multiple sectors, the wage-rent envelope can show multiple re-switching. The interest of technological change and switching behavior for fisheries economists and managers stems from the fact that the control of effective effort remains one of the central management problems for that sector, and for many managers, the most elusive. In the fisheries, the trawling technique has been largely promoted in the seventies and eighties. Consequently, pathdependency was developing in such a way that the preferred choice of new entrants into the fishery was this technology to produce wild fish. In this context, it can be argued that technological lock-in has occurred on the trawling technique, making it the most used technique in the French fisheries sector in Atlantic, to the detriment of alternatives, called passive techniques. However, it must be questioned why technical switching, from trawling to passive methods, has not been accelerated due to poorer economic performance for the former technology. This paper addresses the diffusion process of trawling, accompanied by state subsidies. Even if trawling has been commonly defined as a major innovation in fisheries, its potential for technological adaptations or minor innovations is questionable when faced with an increasing energy price, especially in the absence of State aid.Keywords: Fish and Aquaculture Sectors Development, Fisheries Dynamics, Fisheries EconomicsKeywords: Fish and Aquaculture Sectors Development, Fisheries Dynamics, Fisheries Economic

TAFIRA [Material gráfico]

ADQUIRIDA POR EL COLECCIONISTA EN LAS PALMAS DE G.C.FOTO POSTAL DE "TAFIRA. VISTA PARCIAL"Copia digital. Madrid : Ministerio de Educación, Cultura y Deporte. Subdirección General de Coordinación Bibliotecaria, 201