Variability in hospital treatment costs: A time-driven activity-based costing approach for early-stage invasive breast cancer patients

Objectives: Using a standardised diagnostic and generic treatment path for breast cancer, and the molecular subtype perspective, we aim to measure the impact of several patient and disease characteristics on the overall treatment cost for patients. Additionally, we aim to generate insights into the drivers of cost variability within one medical domain. Design: setting and participants. We conducted a retrospective study at a breast clinic in Belgium. We used 14 anonymous patient files for conducting our analysis. Results: Significant cost variations within each molecular subtype and across molecular subtypes were found. For the luminal A classification, the cost differential amounts to roughly 166%, with the greatest treatment cost amounting to US$29 780 relative to US$11 208 for a patient requiring fewer medical activities. The major driver for these cost variations relates to disease characteristics. For the luminal B classification, a cost difference of roughly 242% exists due to both disease-related and patient-related factors. The average treatment cost for triple negative patients amounted to US$26 923, this is considered to be a more aggressive type of cancer. The overall cost for HER2-enriched is driven by the inclusion of Herceptin, thus this subtype is impacted by disease characteristics. Cost variability across molecular classifications is impacted by the severity of the disease, thus disease-related factors are the major drivers of cost. Conclusions: Given the cost challenge in healthcare, the need for greater cost transparency has become imperative. Through our analysis, we generate initial insights into the drivers of cost variability for breast cancer. We found evidence that disease characteristics such as severity and more aggressive cancer forms such as HER2-enriched and triple negative have a significant impact on treatment cost across the different subtypes. Similarly, patient factors such as age and presence of gene mutation contribute to differences in treatment cost variability within molecular subtypes.Co--funded by an unconditional grant provided by Xperthis in Belgium, but no conflict of interest to be reported

Intraoperative ketorolac in high-risk breast cancer patients : A prospective, randomized, placebo-controlled clinical trial

Funding: This work is financed by grants received by PF, in the name of his institution: the Anticancer Fund (no grant number) (www.anticancerfund.org); the Belgian Society of Anaesthesia and Resuscitation (no grant number) (www.sarb.be); the Fondation Saint-Luc (no grant number) (www.uclouvain.be); the Commission du Patrimoine of the Université catholique de Louvain, St-Luc Hospital (exceptional grant, no number) (www.uclouvain.be). None of the funders had any role in the study design, data collection and analysis, decision to publish or preparation of the manuscript except the scientific advise of GB, scientific director of the Anticancer Fund.Peer reviewedPublisher PD

Case Report of a Poorly Differentiated Uterine Tumour with t(10;17) Translocation and Neuroectodermal Phenotype

Endometrial stromal sarcoma (ESS) with primitive neuroectodermal differentiation is a very uncommon entity. Such a case presenting as stage IIIc (International Federation of Gynaecology and Obstetrics (FIGO) 2010) disease in a 51-year-old female is described. Microscopy suggested a small blue round cell tumour. Cytogenetic and multicolour fluorescent in situ hybridisation (M-FISH) analysis revealed a complex karyotype with the presence of unbalanced t(10;17)(q22;p13) translocation, indicating ESS. Peripheral Ewing´s sarcoma was excluded based on FISH and RT-PCR fusion transcripts analysis. After surgical staging, the patient received bleomycin-etoposide-cisplatin combination chemotherapy. A detailed analysis of the histopathology and genetic findings forms the basis of this report.status: publishe

Semi-automatic segmentation and tracking of the left ventricle in healthy horses and horses with severe aortic valve regurgitation using an optical flow-based B-spline explicit active trackin of surfaces (ofBEATS) method

In human medicine, optical flow-based B-spline explicit active tracking of surfaces (ofBEATS) is a semi-automatic segmentation and tracking technique for determination of left ventricular diameter, length, area and curvature and is used for volumetric assessment. The objective was to evaluate the use of ofBEATS in normal horses and horses with severe aortic valve regurgitation. ofBEATS was applied on the left ventricle in a four chamber view image of 15 normal horses and 12 horses with severe aortic valve regurgitation. The end-diastolic mean ± standard deviation length, basal diameter (20% of total length from mitral valve annulus), apical diameter (20% of the total length from apex), total area and apical curvature in the normal horses and horses with severe aortic valve regurgitation were 17.6±1.9 cm, 12.5±1.3 cm, 7.1±0.8 cm, 170.3±28.5 cm², 25.5±3.4 cm-1 and 19.9±2.0 cm, 15.0±1.9 cm, 9.3±2.1 cm, 237.8±53.4 cm², 19.8±3.7 cm-1, respectively. The mean length, basal diameter, apical diameter, total area and apical curvature at end-systole in the normal horses and horses with severe aortic valve regurgitation were 12.6±1.5 cm, 9.7±1.4 cm, 3.1±1.0 cm, 82.9±14.8 cm², 85.0±98.8 cm-1 and 14.8±3.1 cm, 11.8±2.3 cm, 5.1±2.8 cm, 131.1±57.7 cm², 41.4±18.5 cm-1, respectively. All measurements, except the end-systolic curvature value, were significantly different in the horses with severe aortic valve regurgitation. ofBEATS can be used in equine echocardiography. Besides differences in left ventricular size and area it also allowed objective quantification of left ventricular apical curvature which was significantly different in horses with severe aortic valve regurgitation

Tamoxifen Metabolism and Efficacy in Breast Cancer: A Prospective Multicenter Trial.

Levels of endoxifen, the most active metabolite of tamoxifen, vary by the highly polymorphic cytochrome P450 (CYP) 2D6 enzyme. We prospectively investigated tamoxifen efficacy by serum endoxifen levels and the tamoxifen activity score (TAS). A prospective observational multicenter study included postmenopausal women with an estrogen receptor-positive breast cancer receiving first-line tamoxifen, 20 mg daily in the neoadjuvant or metastatic setting, recruited between February 2009 and May 2014. The primary endpoint was the objective response rate (ORR) using RECIST criteria 1.0. Secondary endpoints were clinical benefit (CB), progression-free survival (PFS), and tolerability of tamoxifen. The main analysis used logistic regression to relate ORR to serum endoxifen levels after 3 months. Endpoints were also related to other tamoxifen metabolites and to TAS. Endoxifen levels were available for 247 of all 297 patients (83%), of which 209 with target lesions (85%). Median follow-up time for PFS was 32.5 months, and 62% progressed. ORR and CB were 45% and 84%, respectively. ORR was not related to endoxifen, and the OR of ORR was 1.008 per μg/L increase in endoxifen (95% confidence interval, 0.971-1.046; = ). In general, none of the endpoints was associated with endoxifen levels, tamoxifen metabolites, or TAS. Under the prespecified assumptions, the results from this prospective clinical trial do not suggest therapeutic drug monitoring of endoxifen to be of clinical value in postmenopausal women treated with tamoxifen for breast cancer in the neoadjuvant or metastatic setting.