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Quality of Life and Cost Effectiveness Issues in the Management of Patients with Hepatic Metastases from Colorectal Cancer

  • Paul H. Sugarbaker
  • Martin A. Adson
  • Ivan Barofsky
  • Edward M. CopelandIII
  • Sallie Martin Foley
  • Kevin S. Hughes
  • Frank Jones
  • M. Margaret Kemeny
  • Bernard Levin
  • Philip D. Schneider
  • Marshall Urist
  • Paul V. WoolleyIII
Part of the Developments in Oncology book series (DION, volume 42)

Summary

The intent of this chapter is to focus on relevant quality of life and cost effectiveness issues of new treatment strategies for patients who have colorectal cancer that has metastasized to the liver. At the present time, there is no potentially curative treatment except surgical excision of metastatic lesions. There is a danger of rediscovering limitations of old treatments by use of new technologies, unless carefully designed trials are performed. Unless treatment results in prolonged survival, the detrimental effects on quality of life that often accompany these chemotherapeutic regimens argue strongly against their use. It may be that the current strategy for clinical and research efforts in this field should be reexamined. The optimum management of the patient with hepatic metastases may not be part of routine cancer therapy and may still be an important area to investigate. Is it advisable that no more patients with hepatic metastases should be treated by infusion techniques unless they agree to participate in an experimental protocol? Also, should a no treatment control arm be required in all therapeutic trials? Only with a no treatment control arm can the survival, quality of life, and cost of these treatments be assessed properly.

The treatment history presentation of a patient with hepatic metastases will focus the discussion on differences in therapeutic strategies for patients with this disease. Through comments on patient management, the opinions of the participants representing several medical fields, will be presented. It is our intent to develop this discussion concerning quality of life issues so that physicians can see how these important concerns can be integrated into treatment plans for patients with incurable cancer.

Keywords

Hepatic Metastasis Adverse Side Effect Extrahepatic Disease Regional Chemotherapy Hepatic Perfusion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Wagner JS, Adson MA, van Heerden JA, Adson MH, Ilstrup DM: The natural history of hepatic metastases from colorectal cancer. A comparison with resective treatment. Ann Surg 199: 502–508, 1984.PubMedCrossRefGoogle Scholar
  2. 2.
    Cady B, McDermott WV: Major hepatic resection for metachronous metastases from colon cancer. Ann Surg 201: 204–209, 1985.PubMedCrossRefGoogle Scholar
  3. 3.
    Balch CM, Urist MM, Soony SJ, McGregor ML: A prospective phase II clinical trial of continuous FUDR regional chemotherapy for colorectal metastases to the liver using a totally implantable drug infusion pump. Ann Surg 198: 567–573, 1983.PubMedCrossRefGoogle Scholar
  4. 4.
    Barofsky I, Sugarbaker PH: Health status indexes: Disease specific vs. general population measures. Proceedings of Public Health Conference on Records and Statistics. June, 1978, Washington, D.C., Department of Health, Education and Welfare (PHS) 79–1214: 263–269, 1979.Google Scholar
  5. 5.
    Karnofsky DA, Abelman WH, Craver LF, Burchenal JH:: The use of the nitrogen mustards in the palliative treatment of carcinoma. Cancer 1: 634–656, 1948.Google Scholar
  6. 6.
    Spitzer WO, Dobson AJ, Hall J, Chesterman E, Levi J, Shephard R, Battista RN, Catchlove BR: Measuring the quality of life of cancer patients. J Chron Dis 34: 585–597, 1981.PubMedCrossRefGoogle Scholar
  7. 7.
    Schipper H, Clinch 3, McMurray A, Levitt M: Measuring the quality of life of cancer patients: The functional living index cancer: Development and validation. J Clin Oncol 2: 472–483, 1984.PubMedGoogle Scholar
  8. 8.
    Sugarbaker PH, Barofsky I, Rosenberg SA, Gianola FJ: Quality of life assessment of patients in extremity sarcoma clinical trials. Surgery 91: 17–23, 1982.PubMedGoogle Scholar

Copyright information

© Martinus Nijhoff Publishing, Boston 1986

Authors and Affiliations

  • Paul H. Sugarbaker
  • Martin A. Adson
  • Ivan Barofsky
  • Edward M. CopelandIII
  • Sallie Martin Foley
  • Kevin S. Hughes
  • Frank Jones
  • M. Margaret Kemeny
  • Bernard Levin
  • Philip D. Schneider
  • Marshall Urist
  • Paul V. WoolleyIII

There are no affiliations available

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