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Study Country Study questions Conclusion Koperna 90 Osman et al 91 Xinopoulos et al 92 Binkert et al 93 Austria Comparison of low anterior resections (LAR) with or without defunctioning stomas United Kingdom Assessment of costs and outcomes for stenting vs surgical decompression Greece Assessment of cost and outcomes for selfexpanding metallic stents vs stoma for patients with inoperable malignant obstructions Switzerland Assessment of cost and outcomes for selfexpanding metallic stents as either a preoperative procedure or palliation Rate of defunctioning stomas should be reduced due to effect on overall costs, especially in patients with low leakage rates. Patients (without stoma) with anastomotic leakage need significantly longer hospital stay (45.3 vs 17.5 and 18 days for no stoma and stoma). Costs for LAR without stoma/no leakage, with stoma, and with leakage were €8400, €13,985 and €42,450 ($A15,549, $A25,888 and $A78,580). ICER for with stoma is €158,705 ($A293,780) and €60,915 ($A112,760)/leakage avoided (leakage rates
Study Country Study questions Conclusion Bissett et al 94 Beard et al 95 Miller et al 96 New Zealand United Kingdom United States 22.9.2 Chemotherapy Comparison of extrafascial excision (EFE) vs conventional surgery Comparison of hepatic liver resection vs standard nonsurgical cytotoxic treatment (palliative) Comparison of surgical resection vs diagnostic/ palliative surgery vs nonoperative treatment EFE reduces local recurrence and appears to be associated with improved survival at costs similar to conventional surgery. For conventional vs EFE, rates for local recurrence were 21% vs 6%, 5yr actuarial local recurrence were 30% vs 10%, cancer-free survival were 63% vs 74%, and 5yr overall survival were 54% vs 60%). Average cost per local recurrence was an additional $NZ10,471 ($A12,468). Hepatic resection is cost-effective compared with non-surgical treatment. At 5yr survival, marginal benefit is 1.6LYG (undiscounted) at a marginal cost of ₤6742 ($A18,435). If 17% have only palliative resections, cost is ₤5236 ($A14,317)/LYG (₤5985 ($A16,365) discounted). For 20yr survival, approximate costs are ₤1821 ($A4979) (₤2793 ($A7637) discounted). Sensitivity analysis shows costs/LYG are consistently less than ₤15,000 ($A41,076). Diagnostic/palliative surgery is expensive and affects QALY survival adversely (1.92yr). Surgical resection may be costeffective, particularly if calculated using patient preferences. ICER/QALY gained using health care professional preferences, and patient preferences were $US109,777 and $US56,698 ($A188,124 and $A97,163). Numerous studies have investigated the effectiveness and cost-effectiveness of various chemotherapy regimes or agents, methods of delivery, timing and setting. Methodologies used and comparisons made varied considerably across studies. The majority of the studies have conducted costeffectiveness, cost-utility, cost-benefit or cost-minimisation analyses. There have also been several cost and consequences, economic, and cost analyses, as well as a few reviews. The results of studies conducting analyses are summarised in Table 22.10. Reviews are summarised in Table 22.11. Although these studies indicate some regimes or agents, delivery methods, timing or setting appear to be relatively more cost-effective or cost saving than others, there is insufficient evidence at this stage to recommend one over others on the basis of cost-effectiveness. It should also be noted that extrapolating these results to the Australian context is not appropriate, as relative cost-effectiveness is largely driven by the costs of the different chemotherapy regimes and modes of delivery, which can very internationally. The studies at best provide an indication of possible cost-effectiveness or cost savings for particular regimes or agents, delivery methods, timing or setting. 272 The prevention, early detection and management of colorectal cancer
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Clinical Practice Guidelines FOR TH
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© The Cancer Council Australia/Aus
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2.11 Conclusions...................
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11.2 High ligation ................
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17.4 Cost effectiveness of follow u
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Table 14.3 Pathological TNM staging
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Executive Summary • Colorectal Ca
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STRENGTH OF RECOMMENDATIONS 2,3 The
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Should red meat intake be altered t
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Chapter Recommendations 4 COMMUNICA
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Chapter 8 Recommendations How shoul
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Chapter Recommendations Should bowe
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Chapter Recommendations When should
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Chapter 17 Recommendations What pos
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Section I Early Colorectal Cancer
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Adenomatous polyps (adenomas) are b
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17. South Australian Cancer Registr
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CHAPTER 2 PRIMARY PREVENTION Studie
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Colorectal adenomas, especially adv
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vegetable (3.5 serves/1000 kcals) d
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mustard greens, swedes and turnips)
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for protection against Colorectal C
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Does selenium supplementation reduc
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the optimal duration of use, and ad
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References 1. Jass JR. Pathogenesis
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34. Kushi L, Giovannucci E. Dietary
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67. Fearon ER, Vogelstein B. A gene
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100. Il'yasova D, Hodgson ME, Marti
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133. Meyskens FL, Jr., Gerner EW. D
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CHAPTER 3 POPULATION SCREENING FOR
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studies also demonstrate that age i
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• symptoms • family medical his
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Should screening be recommended? Gu
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Box 3.3 Screening Pathway used in t
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References 1. Young GP, Levin B, Ro
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33. Alexander F, Weller D. Evaluati
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CHAPTER 4 COMMUNICATION WITH THE PA
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4.6 Coordination of care Treatment
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• assistance with and care of chi
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17. National Breast Cancer Centre,
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CHAPTER 5 THE PATIENT WITH SYMPTOMS
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considered (see 8.1.5). Double cont
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58 The prevention, early detection
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diagnoses prove difficult to confir
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What recommendations are there for
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References 1. Woolf CM. A genetic s
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34. Australian Health Technology Ad
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CHAPTER 7 HIGH-RISK FAMILIAL COLORE
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offered predictive genetic testing.
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endoscopically uncontrollable numbe
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mutation carriers. 52 There is also
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standard for consideration of MSI a
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added to transvaginal ultrasound. 8
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category 2, see Chapter 6) but may
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What screening is recommended for e
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References 1. Vasen HF, Griffioen G
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33. Giardiello FM, Hamilton SR, Kru
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international criteria for the dete
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96. Burt RW, Jass JR. Hyperplastic
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8.1.2 Sigmoidoscopy: rigid versus f
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For radiological imaging of the lar
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8.2.3 Staging for distant metastase
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The feelings and fears of the patie
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18. Rex DK, Cutler CS, Lemmel GT et
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52. Liu SK, Church JM, Lavery IC, F
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strong family history of Colorectal
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A screening interval of 4-6 years i
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BRAF mutation, particularly when mu
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18. Jass JR, Young J, Leggett BA. E
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52. Jass JR, Young J, Leggett BA. H
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What is the role of the stomal ther
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What happens if a blood transfusion
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References 1. Bass EM, Del Pino A,
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32. The National Working Party on t
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CHAPTER 11 ELECTIVE SURGERY FOR COL
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Total or subtotal colectomy may be
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11.12 Self-expanding metal stents f
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18. Gall FP, Tonak J, Altendorf A.
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etween 1993 and 1999. The local rec
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When should local excision of recta
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What factors influence sphincter pr
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It has been demonstrated that there
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References 1. Smith TJ, Hillner BE,
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36. Vernava AM, III, Moran M, Rothe
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69. Pimentel JM, Duarte A, Gregorio
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A clinical diagnosis of large bowel
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When should primary anastomosis be
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17. Deans GT, Krukowski ZH, Irwin S
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Table 14.1 Clinicopathological stag
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The ACPS system embodies the simpli
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14.4 Translation between staging sy
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16. Shepherd NA, Baxter KJ, Love SB
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CHAPTER 15 ADJUVANT CHEMOTHERAPY FO
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isk of death-favouring treatment (H
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improvement in survival at five yea
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There has been one trial 55 of intr
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References 1. National Institute of
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30. Zaniboni A, Labianca R, Marsoni
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57. Gastrointestinal Tumour Study G
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CHAPTER 16 ADJUVANT THERAPY FOR REC
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preoperative RT 45Gy over 5 weeks s
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This suggests that a policy of preo
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Mortality from non-cancer causes wa
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References 1. Fu KK. Interactions o
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29. Swedish Rectal Cancer Trial. Im
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Rates of intraluminal recurrence an
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Ultrasonographic screening Ultrason
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References 1. Nava HR, Pagana TJ. P
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• those with a history of psychia
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References 1. Maisey NR, Norman A,
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CHAPTER 19 RECURRENT AND ADVANCED C
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What are the recommendations for in
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References 1. National Health and M
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31. Phillips RK, Hittinger R, Bleso
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Page 347 and 348: However, in some cases it was also
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Dr Russel Stitz Surgeon, Royal Bris
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14. Dr Michael Izard Radiation Onco
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Mrs Avis Mcphee Consumer (June 9 an
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DVT deep venous thrombosis ECOG Eur
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TNM tumour, node, metastasis stagin
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Chemotherapy The use of drugs (whic
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Malignant Cancerous Malignant cells
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with a specific disease might survi
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