Browsing by Subject "keuhkosyöpä"
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(2020)Keuhkosyöpä on kolmanneksi yleisin todettu uusi syöpä Suomessa ja leikkaus on sen ainoa parantava hoito. Potilaan on tultava toimeen leikkauksen jälkeisellä keuhkojen toiminnalla, joten leikkauskelpoisuus on selvitettävä ennen toimenpidettä. Spirometria, diffuusiokapasiteettitutkimus ja suorituskykytestit ovat ensivaiheen tutkimuksia keuhkotoiminnan ennustamisessa. Ventilaation ja perfuusion gammakuvausta eli radiospirometriaa voidan käyttää riskinarvion tarkentamiseksi. Sen avulla selvitetään keuhkojen perfuusion ja ventilaation alueellinen jakautuminen. Ventilaation ja perfuusion gammakuvaus suoritetaan tällä hetkellä kaksiulotteisella gammakuvauksen tasokuvantamismenetelmällä. Tutkimuksessani selvitän uuden SPECT/TT hybridikuvantamismenetelmän hyötyä verrattuna nykyiseen kaksiulotteiseen menetelmään sekä muihin vaihtoehtoisiin laskennallisiin menetelmiin keuhkosyöpäleikkauksen jälkeisen keuhkojen toiminnan arvioinnissa. Tutkimusaineistona on kymmenen kliinisellä indikaatiolla radiospirometrialla kuvattua potilasta, jotka ovat menossa keuhkosyöpäleikkaukseen Meilahden sairaalassa vuonna 2019-2020. Nykyinen kaksiulotteinen gammakuvauksen tasokuvantamismenetelmä tuotti kolmiulotteisen SPECT/TT-menetelmän kanssa varsin yhteneviä tuloksia koko keuhkon poiston osalta. Suunniteltaessa lohkon poistoa menetelmien erot lisääntyivät. Kliininen laskuri tuotti kuvantamista matalampia arvoja. Vain kaksiulotteiseen gammakuvauksen kuva-analyysiin perustuva menetelmä erosi merkittävästi muista menetelmistä, mikä vastaa aiempien tutkimusten tuloksia. SPECT/TT mahdollistaa kajoamattoman ventilaation ja perfuusion mittaamisen sekä tarkan keuhkosyöpäleikkauksen riskinarvion huomioiden erityisesti oikean keuhkon monimutkaisen kolmiulotteisen anatomian. Menetelmä otetaan HUS isotooppilääketieteellä käyttöön ensisijaiseksi radiospirometrian kuvantamismenetelmäksi.
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Incidence trends and risk factors of lung cancer in never smokers : pooled analyses of seven cohorts (2021)The trends in incidence of lung cancer in never smokers are unclear as well as the significance of risk factors. We studied time trends in the incidence and risk factors of lung cancer in never smokers in Finland in a large, pooled cohort. We pooled data from seven Finnish health cohorts from the period between 1972 and 2015 with 106 193 never smokers. The harmonized risk factors included education, alcohol consumption, physical activity, height, and BMI. We retrieved incident lung cancers from the nation-wide Finnish Cancer Registry. We estimated average annual percent change (AAPC) and the effects of risk factors on cause-specific hazard ratios (HRs) of lung cancer using Poisson regression. We detected 47 lung cancers in never smoking men (n=31 859) and 155 in never smoking women (n=74 334). The AAPC of lung cancer incidence was -3.30% (95% confidence interval (CI): -5.68% - -0.88%, p=0.009) in never smoking men and 0.00% (95% CI: -1.57%-1.60%, p=0.996) in never smoking women. Of the five studied risk factors only greater height in women had a statistically significant increased risk of lung cancer (multivariate HR=1.84, 95%CI: 1.08-3.12). It is plausible that tobacco control measures focused on working places have reduced passive smoking among men more than among women, which could explain the declining trend in lung cancer incidence in never smoker men but not in never smoker women. As tobacco control measures have not been targeted to domestic environments, it is likely that women’s exposure to passive smoking has continued longer.
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(2022)More and more drugs for the treatment of lung cancer are entering the market with limited research evidence and high cost. However, health care resources are limited. To provide rationale and sustainable treatment for all patients, the need for health technology assessments has increased. International value frameworks with varying uses, structures, and components have also been developed to help assess the value of drug therapies. The purpose of the study is to illustrate how physicians, authorities, and pharmaceutical industry experts define the value and the effectiveness of drug therapy. The study also aims to chart the attitudes of health care professionals towards international value assessment frameworks and to describe the current challenges in health technology assessments focusing on lung cancer therapy. In addition, the purpose of the study is to evaluate the importance of therapeutic and economic evaluation of lung cancer therapies. The research material includes interviews with physicians (n=2), authorities (n=3), and pharmaceutical industry experts (n=5). The interviews were conducted as an individual (n=8) and pair interviews (n=1). The interview method used was a semi-structured thematic interview. The interviews were analyzed by using inductive and abductive content analysis and theming. The theoretical framework in the study was related to the challenges of assessing the therapeutic and economic value of pharmacotherapies. According to the study, the value and effectiveness of drug therapy are determined in a varied and perspective-dependent manner. The value of drug therapy can be divided into three dimensions, which were therapeutic, social, and economic impact. Treatment’s effectiveness was primarily determined by the health benefits gained and by the effects the therapy has on patients, society and care pathways. Based on the data, the current challenges of the therapeutic and economic evaluation of pharmacotherapies are related to the implementation methods and criteria of evaluation and decision-making, resources, cooperation needs, scientific evidence, ethics, the structure of the health care system and legislation. Based on the results, physicians, authorities, and pharmaceutical industry experts have different opinions of the need for cooperation. The interviewees also evaluated differently the status of the current development activities and the importance of international evaluations. There were also differences in the opinions on how important the therapeutic and economic evaluation of lung cancer therapies was considered. If the importance was considered low, the importance of the evaluations was expected to increase only after the refinement of treatment recommendations and guidelines. According to the data, the international value frameworks are not actively used in Finland and their significance will be considered insignificant in the future as well. The usefulness of the value frameworks was primarily limited due to structural factors, the assessment of reliability and the current evaluation system in Finland. The benefits of the value frameworks were primarily related to the coherence of the evaluation process, easing the evaluation process and improving patient equality.
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