Premium Essay

Assistant Professor of Medicine

In:

Submitted By jasouza
Words 5524
Pages 23
de Souza et al. BMC Health Services Research 2012, 12:481 http://www.biomedcentral.com/1472-6963/12/481

RESEARCH ARTICLE

Open Access

Unsupported off-label chemotherapy in metastatic colon cancer
Jonas A de Souza1,2*, Blase Polite1,2,3, Monica Perkins4, Neal J Meropol5, Mark J Ratain1,2,6, Lee N Newcomer4 and G Caleb Alexander7

Abstract
Background: Newer systemic therapies have the potential to decrease morbidity and mortality from metastatic colorectal cancer, yet such therapies are costly and have side effects. Little is known about their non-evidence-based use. Methods: We conducted a retrospective cohort study using commercial insurance claims from UnitedHealthcare, and identified incident cases of metastatic colon cancer (mCC) from July 2007 through April 2010. We evaluated the use of three regimens with recommendations against their use in the National Comprehensive Cancer Center Network Guidelines, a commonly used standard of care: 1) bevacizumab beyond progression; 2) single agent capecitabine as a salvage therapy after failure on a fluoropyridimidine-containing regimen; 3) panitumumab or cetuximab after progression on a prior epidermal growth factor receptor antibody. We performed sensitivity analyses of key assumptions regarding cohort selection. Costs from a payer perspective were estimated using the average sales price for the entire duration and based on the number of claims. Results: A total of 7642 patients with incident colon cancer were identified, of which 1041 (14%) had mCC. Of those, 139 (13%) potentially received at least one of the three unsupported off-label (UOL) therapies; capecitabine was administered to 121 patients and 49 (40%) likely received it outside of clinical guidelines, at an estimated cost of $718,000 for 218 claims. Thirty-eight patients received panitumumab and six patients (16%) received it after being on cetuximab

Similar Documents

Premium Essay

Rest

...Dr. Traill is an assistant professor-clinician educator at Wayne State University's department of emergency medicine, Sinai-Grace Hospital/Detroit Medical Center. Dr. Barton is residency director at Sinai-Grace Hospital emergency medicine residency program, Wayne State University/Detroit Medical Center, and president-elect of the Michigan College of Emergency Physicians. Medical Editor Dr. Robert C. Solomon is an attending emergency physician at Southwestern Regional Medical Center in Waynesburg, Pa., and clinical assistant professor of emergency medicine at the West Virginia School of Osteopathic Medicine. Medical Editor Dr. Robert C. Solomon is an attending emergency physician at Southwest Regional Medical Center in Waynesburg, Pa., and clinical assistant professor of emergency medicine at the West Virginia School of Osteopathic Medicine, Lewisburg. Nancy Calaway is an ACEP staff member who reviews and manages the ACEP Focus On series. Disclosures In accordance with the Accreditation Council for Continuing Medical Education (ACCME) Standards and American College of Emergency Physicians policy, all individuals in control of content must disclose to the program audience the existence of significant financial interests in or relationships with manufacturers of commercial products that might have a direct interest in the subject matter. Dr. Traill, Dr. Barton, Dr. Solomon and Ms. Calaway have disclosed that they have no significant relationships with or financial interests...

Words: 335 - Pages: 2

Premium Essay

Healthcare Policy

...Health Care Policy The Patient Protection and Affordable Care Act (PPACA) signed by President Obama in 2010 will bring about changes to the health care system that affect every American. The PPACA ensures access to affordable health care with a focus on cost containment and enforcing quality of care for those who seek services. According to a Congressional Budget Office budget report the PPACA will cost tax payers an estimated $900 billion and provide coverage for more than 94% of the population who is eligible for services. The PPACA addresses several key areas quality, affordable health care, public programs, improvement to quality and efficiency, prevention, public health improvement, workforce, transparency and integrity, access to innovative therapies, community support services, and revenue provisions (Democratic Policy and Communication Center, n.d.). These areas will affect millions of individuals at some level when accessing health care. The accessibility to quality health care will benefit those individuals who presently cannot obtain health insurance or afford some type of health care coverage. Coverage alone does not make for a healthy nation and help to contain cost. The PPACA addresses the need for prevention and improvement in health care and public health. Title IV: Prevention of Chronic Disease and Improving Public Health addresses some of these needs. Health care professionals can the nation understand how certain diseases can be prevented and...

Words: 1877 - Pages: 8

Free Essay

Asthma

...Asthma Bronchial asthma; Exercise-induced asthma Last reviewed: July 14, 2010. PubMed Health U.S. National Library of Medicine National Institutes of Health National Center for Biotechnology Information U.S. National Library of Medicine National Institutes of Health Asthma is an inflammatory disorder of the airways, which causes attacks of wheezing, shortness of breath, chest tightness, and coughing. See also: Pediatric asthma Causes, incidence, and risk factors Asthma is caused by inflammation in the airways. When an asthma attack occurs, the muscles surrounding the airways become tight and the lining of the air passages swells. This reduces the amount of air that can pass by. In sensitive people, asthma symptoms can be triggered by breathing in allergy-causing substances (called allergens or triggers). Common asthma triggers include: * Animals (pet hair or dander) * Dust * Changes in weather (most often cold weather) * Chemicals in the air or in food * Exercise * Mold * Pollen * Respiratory infections, such as the common cold * Strong emotions (stress) * Tobacco smoke Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) provoke asthma in some patients. Many people with asthma have a personal or family history of allergies, such as hay fever (allergic rhinitis) or eczema. Others have no history of allergies. Symptoms Most people with asthma have attacks...

Words: 2499 - Pages: 10

Premium Essay

Medical

...MEDICAL SHOP MANAGEMENT SYSTEM A mini project submitted to the Bharathidasan University in partial fulfillment of the requirements for the award of the degree of MASTER OF COMPUTER APPLICATIONS Submitted by N.RAJA RAHINAM Register Number: 4CA104236 Under the guidance of Miss.A.Sathya, M.C.A., M.PHIL., Assistant Professor DEPARTMENT OF COMPUTER APPLICATIONS BISHOP HEBER COLLEGE (AUTONOMOUS) (Nationally Reaccredited at the A+ Level by NAAC) (Recognized by UGC as “College with Potential for Excellence”) TIRUCHIRAPPALLI-620 017 NOVEMBER – 2012 DECLARATION I hereby declare that the mini project work presented is originally done by me under the guidance of Miss.A.Sathya MCA., M.phil., Assistant Professor, Department of Computer Applications, Bishop Heber College (Autonomous), Tiruchirappalli-17 and has not been included in any other thesis/project submitted for any other degree. Name of the Candidate : N.RAJARATHINAM Register Number : 4CA104236 Batch : 2010-2013 Signature of the Candidate Miss.A.SATHYA MCA., M.PHIL.,, Assistant Professor Department of Computer Applications Bishop Heber College (Autonomous) Tiruchirappalli – 620017. Date: CERTIFICATE This is to certify that the mini project work entitled “MEDICAL SHOP MANAGEMENT SYSTEM” is a bonafide record work done by N.RAJARATHINAM, Register Number: 4CA104236 in partial fulfillment of the requirements for the award of the degree of MASTER OF COMPUTER APPLICATIONS...

Words: 2693 - Pages: 11

Free Essay

Doctor Martin's Office

...Summary of Findings The Professor felt ill and decided to go home but during the drive he experienced discomfort and in the succeeding hours experienced severe diarrhea and persistent nausea and vomiting. Eventually the nausea ceased but his stomach was still upset. The following day he called Dr. Martin, his primary health care physician. Betty, the doctor’s nurse assisted him over the phone and after the professor explained his condition she told him that Dr. Martin cannot see to him because of his packed schedule. The professor asked for a referral to go to the HealthCheck Clinic but the nurse declined claiming that Dr. Martin is not willing to send him there and was instead prescribed with medicine for the diarrhea. The prescription was placed in the pharmacy for the professor to pick up. Unsatisfied, the professor called up Candy, the director of the Employee Benefits Office, but Wendy picked up and relayed everything to Candy who then expressed her surprise and distress over the situation. She too did not understand that the request for a referral was denied as the professor asked for it. The professor picked up the medicine from the pharmacy, drove home, took a pill, and went to bed. The following day the diarrhea was under control but the gastric discomfort was still a problem. He decided to go to work but in the afternoon he gave up and went home. He called Dr. Martin’s office and once again Betty answered the phone. She informed him that the doctor is out all...

Words: 1928 - Pages: 8

Premium Essay

Molecular Medicine Personal Statement

...Thank you! For Case Western Reserve University, I am interested in the Molecular Medicine program. I will be doing research in the Cleveland Clinic, Lerner Research Institute. I first heard about this program when I was helping my sister move into her college two summers ago. I was born in Ohio and haven't visited the state since so I was intrigued by the city. After I helped my sister move in, I also made time to walk around the college town, museums, and hospitals. It was an eye-opening moment for me, personally because I didn't expect myself to move out of Oregon till then. Although CWRU seemed like a small private college, it had so many research labs and numerous projects operated my renowned researchers who are also professors, doctors, and advisors. I've also done research on professors and research projects and there are numerous projects and studies I would like to learn more about. There are many departments in this program, including Cellular and Molecular Medicine, Stem cell biology and Regenerative medicine, Cancer Biology. I am still in the process of trying to find what I would like to work on specifically and although I...

Words: 489 - Pages: 2

Premium Essay

Personal Narrative: A Career As A Physician Assistant

...What Does It Take To Be A Physician Assistant? The day I was diagnosed with Reflex Sympathetic Dystrophy (RSD) was the day I decided I wanted to be a physician assistant (PA). I went through a lot of doctor visits with many doctors. I experienced what it is like to be the patient and the frustration that comes when there is not a cause and reasoning for pain, thus I want to be the PA that can provide compassionate care, give back, and try to avoid the frustration that I had to experience. Three schools that I have chosen were Wake Forest University, Baylor College of Medicine and Rush University. I chose Rush University because it is close to my parents, thus I could probably live with them and just commute to save money. I chose the other...

Words: 681 - Pages: 3

Premium Essay

Health Care Portfolio

...extremely useful and it allowed me to brainstorm my ideas for the paper. What attracted me to this topic is I wanted to learn more about the specialty of the career I am interested in pursuing a career in. My research question for this paper was “What is the role of a family medicine physician assistant in the United States health care system?”. My title for my project began as “Family Medicine Physician Assistants”. Now, it has evolved to read “The Increasing Role of Physician Assistants in the Health Care System”. I feel now that my title reflects the material in my paper better, being that before the title did not mention any aspect of my research question. I have found that my title is very similar to scholarly articles I have read throughout this semester. In scholarly articles, I have observed that the articles typically are writing about research that was conducted. The title in those scholarly...

Words: 1798 - Pages: 8

Premium Essay

Article Summary

...Annals of Internal Medicine. Researchers at the University of Massachusetts in Amherst wanted to test a theory that increasing fiber would be an easier to follow and more effective diet than the complex American Heart Association diet.Unlike the AHA diet, which restricts dieters from consuming certain foods, the high-fiber diet simply encourages people to eat more fiber-filled foods.The researchers believed that as this approach is more permissive, people might find it easier to stick with than restrictive dieting. The researchers say that both diets were effective at providing clinically significant weight loss as well as offering protective benefits against diabetes and metabolic syndrome."We were encouraged to see the decline of fasting insulin in the high-fiber group at 12 months," says Dr. Yunsheng Ma, associate professor of medicine in the Division of Preventive and Behavioral Medicine at UMass."Long-term improvements in insulin resistance have significant clinical implications for patients with metabolic syndrome. Training and diet is not enough for obesity. In the US, around 35% of adults and 17% of children and adolescents are obese.Both the Centers for Disease Control and Prevention and the National Institutes of Health cite a healthy diet and exercise as a primary factor in combatting obesity. Is it really that simple? Not according to lead author Dr. Christopher Ochner, assistant professor of pediatrics and psychiatry at the Icahn School of Medicine at Mount Sinai...

Words: 432 - Pages: 2

Premium Essay

The Doctors Plague Summary

...“The Doctors plague: Germs, Childbed Fever, and the Strange Story of Ignac Semmelweis” is a 203 page history and fiction book that covers the related topics of medical history, biology, arrogance and scientific discovery. It was written by Sherwin B. Nuland and Published by W. W. Norton & Company in 2004. Sherwin B. Nuland, or shall we say, Dr. Nuland is among other things a “…Clinical Professor of Surgery at Yale University School of Medicine and a Fellow at Yale's Institute for Social and Policy Studies. He is the author of over ten books, including…. HOW WE DIE: Reflections on Life's Final Chapter. In addition he is a contributor to leading publications including the New Yorker, the New Republic, and the New York Review of Books.” (Gellene,...

Words: 1270 - Pages: 6

Free Essay

Politeness

...------------------------------------------------- Ei-ichi Negishi ------------------------------------------------- Akira Suzuki | English English (pdf) | Swedish Swedish (pdf) | Japanese (pdf) | |   Press Release 6 October 2010 The Royal Swedish Academy of Sciences has decided to award the Nobel Prize in Chemistry for 2010 to Richard F. Heck University of Delaware, Newark, DE, USA, Ei-ichi Negishi Purdue University, West Lafayette, IN, USA and Akira Suzuki Hokkaido University, Sapporo, Japan "for palladium-catalyzed cross couplings in organic synthesis"   Great art in a test tube Organic chemistry has developed into an art form where scientists produce marvelous chemical creations in their test tubes. Mankind benefits from this in the form of medicines, ever-more precise electronics and advanced technological materials. The Nobel Prize in Chemistry 2010 awards one of the most sophisticated tools available to chemists today. This year's Nobel Prize in Chemistry is awarded to Richard F. Heck, Ei-ichi Negishi and Akira Suzuki for the development of palladium-catalyzed cross coupling. This chemical tool has vastly improved the possibilities for chemists to create sophisticated chemicals, for example carbon-based molecules as complex as those created by nature itself. Carbon-based (organic) chemistry is the basis of life and is responsible for numerous fascinating natural phenomena: colour in flowers, snake poison and bacteria killing...

Words: 829 - Pages: 4

Free Essay

Nnsu

...Tips for Maximizing your Admission into a Professional Program Midwestern University–Glendale Campus offers the following degree programs:  Doctor of Osteopathic Medicine (D.O)  Doctor of Pharmacy (Pharm.D.)  Master of Medical Science in Physician Assistant Studies (M.M.S.)  Master of Occupational Therapy (M.O.T.)  Master (M.B.S.) of Biomedical Science  Master of Arts in in Biomedical Science (M.A.)  Master of Science in Cardiovascular Science (M.S.)  Doctor of Podiatric Medicine (D.P.M.)  Master of Science in Nurse Anesthesia (M.S.)  Master of Arts (M.A.) in Clinical Psychology and Doctor of Psychology (Psy.D.)  Doctor of Dental Medicine (D.M.D.)  Doctor of Optometry (O.D.)  Doctor of Physical Therapy (D.P.T.)  Doctor of Veterinary Medicine (D.V.M.)  Master of Science in Speech-Language Pathology (M.S.) AWARENESS • • • • • Obtain brochures from professional programs you are interested in. Learn about the career you are interested in by visiting the professions’ websites. Visit with or speak to an academic advisor from the professional program to have questions answered. Be smart about taking advice from other students. Confirm all information before making any decisions. When requesting information from a program, speak clearly so the proper information can be sent to you. RESEARCH • • • • • • Research prospective colleges and request brochures and catalog. Visit each college’s website. Be familiar with the curriculum...

Words: 1033 - Pages: 5

Premium Essay

A Career As A Physician's Assistant

...wealth made from becoming a Physician's assistant from a documentary on the career through Vice News. The reporters had gone into great detail on...

Words: 1152 - Pages: 5

Free Essay

Suppman

...1 Seeking a Referral The Professor was not feeling well. In fact, on that Tuesday afternoon, he felt tired and generally “down” physically. During the 15-minute drive home from work, he developed slight nausea and gastric discomfort. When he reached home he headed for the bathroom. For the next several hours, he experienced severe diarrhea and recurring waves of nausea and vomiting. After a few hours, the nausea had subsided somewhat, but the gastric distress persisted through most of what proved to be a long night. On the following morning, the Professor called the office of his primary care physician, Dr. Martin. Dr. Martin’s nurse, Betty, came on the line. The Professor detailed his physical problems of the previous night. “Betty, the nausea is pretty much gone, but the gastric discomfort is quite severe. I really feel that I need to see a doctor.” Betty replied, “Dr. Martin is booked solid all day, so it would be hard to see him.” “Betty,” the Professor said, “I really feel that I need to see a doctor. Suppose I go to the HealthCheck Clinic. It’s close by, and I’ve always gotten good service there. Could the doctor refer me so that the University’s insurance would cover the visit?” Betty’s voice took on a doubtful and clinical tone. “The doctor would not refer you to the clinic. However, I can ask him to prescribe something for the diarrhea. We’ll call your pharmacy and place the prescription.” Slightly perturbed, the Professor said, “But I don’t understand...

Words: 1939 - Pages: 8

Premium Essay

Obtaining A Bachelor's Degree In Genetic Research

...knowledge of biology and genetics in a way that will help those people suffering with disease and illness. Obtaining my undergraduate degree is the first step in my educational objectives. I have been accepted into the Honors College at Millersville University and will pursue a bachelor’s degree in biology. The field of biology is a broad and I hope to concentrate my education in microbiology or genetics. I plan on working closely with my college professors to help me decide on an area of study by working as a research assistant in a lab of one of my professors. This will enable me to learn about specimen processing, lab technique skills and research procedures. My determination to learn as much as possible pushed me to inquire about internship positions. In fact, after my first year of college, I have already been accepted as a summer intern at Johns Hopkins University School of Medicine in the Division of Allergy and Clinical Immunology. By accepting this internship, I am one step closer to my goal of learning as much as possible in lab medicine and disease. After obtaining my bachelor’s degree in biology, I hope to establish a career that includes both genetic research in a lab and counseling patients with genetic disorders. Working as a genetic counselor would allow me to take the knowledge I gained by working in the lab and applying that knowledge to helping patients. Genetic counselors educate and support patients and families at risk for, or diagnosed with, a variety...

Words: 499 - Pages: 2