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Background: Colorectal cancer (CRC) is the second most common cause of cancer related deaths in the United States. Colonoscopy is the gold standard for the detection of CRC. There are many colonoscopy quality measures and among these the adenoma detection rate (ADR) has demonstrated a significant impact in reducing mortality from CRC. The primary aim of our study was to compare ADR and distribution of polyp type in patients undergoing Endocuff-assisted colonoscopy (EAC) versus standard colonoscopy (SC) in a VA system. Methods: Retrospective data was collected from 496 patients who underwent routine screening, surveillance and diagnostic colonoscopies either via SC from January 6, 2014 through March 12, 2014 or EAC from September 24, 2014 through February 19, 2015. A total of 54 patients were excluded based on a personal history of CRC and prior resection, incomplete colonoscopy due to poor bowel preparation, and removal or loss of Endocuff (EC). Primary outcomes measured and compared were ADR and types of polyps found. Results: The overall ADR in the EAC group was higher at 59.91% versus 50.66% for SC, accounting for a 9% increase (P=0.0508). EAC was able to detect a total of 59 sessile serrated adenoma/polyps (SSA/Ps) compared to SC only detecting 8 (P≤0.0001). There was a significant increase in the SSA/P detection rate with EAC at 15% versus 3% in the SC group (P≤0.0001). Conclusions: EAC significantly increases the detection of SSA/P and has shown a trend in improving ADR in our veteran population.

The ZUMA-7 study demonstrated that Axicabtagene ciloleucel (axi-cel) improved event-free survival (EFS) compared to standard of care (SOC) salvage chemoimmunotherapy followed by autologous stem cell transplant in primary refractory/early relapsed diffuse large B-cell lymphoma (DLBCL) leading to its recent FDA approval in this setting. We modeled a hypothetical cohort of US adults (mean age, 65 years) with primary refractory/early relapsed DLBCL by developing a Markov model (lifetime horizon) to model the cost-effectiveness of second-line axi-cel compared to SOC using a range of plausible long-term outcomes. EFS and OS were estimated from ZUMA-7. Outcome measures were reported in incremental cost-effectiveness ratios, with a willingness-to-pay (WTP) threshold of $150,000/quality-adjusted life-year (QALY). Assuming a 5-year EFS of 35% with second-line axi-cel and 10% with SOC, axi-cel was cost-effective at a WTP of $150,000/QALY ($93,547/QALY). Axi-cel was no longer cost-effective if its 5-year EFS was ≤ 26.4% or if it cost more than $972,061 at a WTP of $150,000. Second-line axi-cel was the cost-effective strategy in 73% of the 10,000 Monte-Carlo iterations at a WTP of $150,000. If the absolute benefit in EFS is maintained over time, second-line axi-cel for aggressive RR-DLBCL is cost-effective when compared to SOC at WTPs of $150,000/QALY. However, its cost-effectiveness is highly dependent on long-term outcomes. Routine usage of second-line CAR-T would add significantly to healthcare expenditures in the USA (>$1 billion each year), even when used in a high-risk subpopulation. Further reductions in the cost of CAR-T are needed to be affordable in many regions of the world.

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Patients and methods: Chinese cancer patients referring to the LCMD set up at Istituto Nazionale Tumori of Milan (INT) between July 2016 and April 2017 were evaluated. The LCMD guarantees the presence of a LCM who supports Chinese patients during the admission to the hospital and/or diagnostic assessment, offering a service of counseling to healthcare professionals and to the patient and his/her family. General practitioners located in specific neighborhoods of Milan were provided with chinese language brochures and posters in order to expand this service to the broader chinese community. The linkage project was supported by an AIOM grant. Results: From July 2016 to May 2017, 42 chinese cancer patients referred to the LCMD. The distribution of the population based on the main characteristics is summarized in table 1. Overall 33 patients (78.6%), out of 42 Chinese cancer patients accepted and underwent treatment proposed by the physicians while 9 (21.43%) didn't follow the indications. 26 out of these 33 subjects started a treatment at INT (78.8%), while the remaining 21.2% followed the treatments indicated at other hospitals.