A pragmatic randomised controlled trial of the cost-effectiveness of palliative therapies for patients with inoperable oesophageal cancer

Abstract

It was suggested that rigid tubes and 24-mm SEMS should no longer be recommended and bipolar electrocoagulation and ethanol tumour necrosis should not be used for primary palliation. The choice in palliation would between non-stent and 18-mm SEMS treatments, with non-stent therapies being made more available and accessible to reduce delay. A multidisciplinary team approach to palliation is also suggested. A randomised controlled clinical trial of 18-mm SEMS versus non-stent therapies with survival and quality of life end-points would be helpful, as would an audit of palliative patient admissions to determine the reasons and need for inpatient hospital care, with a view to implementing cycle-associated change to reduce inpatient stay. A study of delays in palliative radiotherapy treatment is also suggested, with a view to implementing cycle-associated change to reduce waiting time.

Treatment of T4 Esophageal Cancer. Definitive Chemo-Radiotherapy vs Chemo-Radiotherapy Followed by Surgery

“…[2][3][4] Furthermore, the combination of resection of neighboring organs with esophagectomy has not improved survival despite the high incidence of morbidity and mortality. 4,5) On the other hand, palliative resection (R1 or R2) followed by radiotherapy with or without chemotherapy has also failed to improve survival compared with nonsurgical treatment. 6) Multimodal therapies have been developed recently to control both local recurrence and distant metastasis of esophageal cancer and to prolong survival.…”

Cost-Effectiveness of Palliation of Unresectable Esophageal Cancer

“…Brachytherapy is the strategy with the highest probability of cost-effectiveness of all values yielding a positive net health benefit the advent of endoluminal therapies have permitted improvement in survival and delivery of effective methods of palliation using less invasive techniques and at lower costs. Different modalities such as Nd:YAG laser, SES and brachytherapy, are available, and numerous studies have validated their efficacy [4,[6][7][8][17][18][19][20][21][22][23][24][25]. Although palliation can be achieved with any one of the existent techniques, a systematic, cost-effective approach to manage this condition was lacking.…”

Cancer of Oesophagus or Gastricus – New Assessment of Technology of Endosonography (COGNATE): report of pragmatic randomised trial

“…153 We undertook detailed costing with oncologists, radiologists, surgeons and others at COGNATE sites for high-cost items such as multimodal treatment, neo-adjuvant therapy, surgery, chemotherapy, radiotherapy and positron emission tomography (PET) scanning. We derived the cost of a stent from Shenfine et al, 154 and inflated it to 2008 prices using the Hospital and Community Health Services Pay and Price Index. 155 We undertook detailed costing of the EUS procedure through a time-and-motion approach and discussion with oncologists, radiologists and surgeons at trial sites.…”