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Purpose – Objective measures of a new treatment's expected ability to improve patients’ health are presumed to be significant factors influencing physicians’ treatment decisions. Physicians’ behavior may also be influenced by their patients’ disease severity and insurance reimbursement policies, firm promotional activities and public media reports. This chapter examines how objective evidence of the incremental effectiveness of novel drugs to treat cancer (“chemotherapies”) impacts the rate at which physicians’ adopt these treatments into practice, holding constant other factors.

Design/methodology – The novelty of the analysis resides in the dataset and estimation strategy employed. Data is derived from a United States population-based chemotherapy order entry system, IntrinsiQ Intellidose. Quality/price endogeneity is overcome by employing sample selection methods and an estimation strategy that exploits quality variation at the molecule-indication level. Pooled diffusion rates across molecule-indication pairs are estimated using nonparametric hazard models.

Findings – Results suggest incremental effectiveness is negatively and nonsignificantly associated with the diffusion of new chemotherapies; faster rates of diffusion are positively and significantly related to low five-year survival probabilities and measures of perceived clinical significance. Results are robust to numerous specification checks, including a measure of alternative therapeutic availability. We discuss the magnitude and potential direction of bias introduced by several threats to internal validity. Evidence of incremental effectiveness does not appear to motivate the rate of specialty physician diffusion of new medical treatment; in all models high risk of disease mortality and perceptions of therapeutic quality are significant drivers of physician use of novel chemotherapies.

Value/originality – Understanding the rate of technological advance across different clinical settings, as well as the product-, provider-, and patient-level determinants of this rate, is an important subject for future research.

This paper aims to study the impact of combination Lactobacillus Rhamnosus Heriz I and Beta glucan on quality of life (QOL) in breast cancer (BC) patients receiving chemotherapy.

In all, 30 women with BC were enrolled in this randomized double-blind placebo-controlled clinical trial. Intervention group received either daily one capsule of L. rhamnosus strain Heriz I (2 × 10⁷ CFU) and two 10-mg capsules of soluble1–3,1–6,D-beta glucan and the placebo group receiving placebo, interval between two courses of chemotherapy. Health-related QOL was evaluated at baseline and end of the trial using the EORTC QOL Questionnaire version.3.0 (EORTC QLQ-C30).

The results showed that combination of L. rhamnosus Heriz I and Beta glucan supplementation in BC patients during chemotherapy improved functional scales score from 37.3 ± 12.1 to 39.8 ± 6.8 and this increase in comparison with placebo was significant after adjusting baseline value (p = 0.015). Changes in symptoms scores were not significant after intervention (p = 0.05) but the decreased score (66.1 ± 12.9 to 60.6 ± 9.4) was considerable clinically. As well as, changes in global health status/QOL score in intervention group in comparison with the placebo group was not significant (p = 0.93).

The findings suggest that combination of L. rhamnosus Heriz I and Beta glucan may be associated for improving functional scales and symptoms in patients with BC who underwent chemotherapy. To prove positive effect of supplements on other aspects of QOL, further studies are needed.

This brief chapter explores my experiences with music and death throughout my cancer treatment. Though I constantly confronted my mortality throughout my cancer treatment, music also helped to distract me from unpleasant, lengthy or boring treatments, as well as helping me to process my feelings about my own mortality. It thus served two distinct purposes, both focusing my mind on death and pain and distancing me from it.

The purpose of this paper is to identify actual (as-is) patient pathway variation among breast cancer patients and to investigate the relationship between pathways and the cost incurred by patients.

Both quantitative and qualitative methods were employed to analyze data from four Swedish hospital groups. Quantitative methods include event-log data mining and statistical analyses on the related patient cost from the Swedish breast cancer quality registry and case-costing system. Qualitative methods included collaboration with and interviewing domain experts.

Unique pathways, followed by only one patient, were generally costlier than the most and less frequent pathways. Earlier study findings are confirmed for mastectomy patients, with more frequent pathways having a lower cost, whereas contradicting and inconclusive results emerged for the partial mastectomy patient groups. Highest variation in pathways was identified for patients receiving chemotherapy.

The common belief – if one follows a standardized patient pathway, then the cost will be lower – should be re-examined based on the actual pathways that occur in reality.

The relationships between patient pathways and patient cost allow more complex insights, beyond the general causal relationship between successfully implementing a “to-be” care pathway and lower cost. This highlights data-driven research’s importance, where actual pathways (as-is) provide more useful information than to-be care pathways.

Breast cancer is a type of cancer affecting the health of women in many countries. The aim of this study is to determine the effect of breast cancer and its treatment procedures on the quality of life.

The study was carried out in Hacettepe University Oncology Hospital and The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and Breast Cancer Module were used.

It was found that 29.8 per cent of the patients were in phase 4 of the disease, 86.8 per cent already had an operation while 84.1 per cent had chemotherapy. There were statistically significant differences between the levels of the life quality for pain dimension in the symptom scale, body image dimension in the module functional scale, sexual function dimension in the module functional scale, arm symptoms dimension in module symptom scale and age groups; the levels of life quality for dyspnoea dimension in the symptom scale, anorexia dimension of the symptom scale, financial difficulties dimension of the symptom scale and the duration of the disease; the levels of life quality for fatigue dimension in the symptom scale, diarrhea dimension in the symptom scale and the phase of the cancer; the levels of life quality for physical functionality dimension in the functional scale, constipation dimension in the symptom scale and receiving chemotherapy. In the light of the findings, attempts to improve health and creation of different behaviours are important for life quality.

This is original research that sheds light on life quality issues for women diagnosed with breast cancer.

The purpose of this paper is to develop a chemotherapy scheduling template that accounts for nurse resource availability and patient treatment needs to alleviate the mid-day patient load and provide quality services for patients.

Owing to treatment complexity in chemotherapy administration, nurses are required at the beginning, end and during treatment. When nurses are not available to continue treatment, the service is compromised, and the resource constraint is violated, which leads to inevitable delay that risks service quality. Consequently, an optimization method is used to create a scheduling template that minimizes the violation between resource assignment and treatment requirements, while leveling patient load throughout a day. A case study from a typical clinic day is presented to understand current scheduling issues, describe nursing resource constraints, and develop a constraint-based optimization model and leveling algorithm for the final template.

The approach is expected to reduce the variation in the system by 24 percent and result in five fewer chemo chairs used during peak hours. Adjusting staffing levels could further reduce resource constraint violations and more savings on chair occupancy. The actual implementation results indicate a 33 percent reduction on resource constraint violations and positive feedback from nursing staff for workload.

Other delays, including laboratory test, physician visit and treatment assignment, are potential research areas.

The study demonstrates significant improvement in mid-day patient load and meeting treatment needs using optimization with a unique objective.

The purpose of this paper is to identify the extent of actual malnutrition and its risk among cancer patients receiving radiotherapy and/or chemotherapy in the Libyan city of Benghazi.

A cross‐sectional nutritional assessment study using the patient‐generated subjective global assessment (PG‐SGA) was carried out on 200 (91 males and 109 females) cancer patients undergoing chemotherapy and/or radiotherapy.

A total of 25 per cent of the subjects were severely malnourished while 73.5 per cent were either at risk of malnutrition or suspected to be malnourished. Almost all (99.5 per cent) needed some degree of intervention (critical in nature for 83.5 per cent). Family income and physical activity were associated with nutritional status (p<0.05). Body Mass Index alone is an insensitive criterion for identifying malnutrition among such patients. All the sections and subsections of the PG‐SGA had a statistically significant positively correlation with its total score (r=0.51‐0.96, p<0.05). Dieticians played a very limited role in patient nutritional care.

It is suggested that dieticians should play a more participatory and prominent role in a multidisciplinary team involved in patient nutritional care. The PG‐SGA can help identify areas where tailor made strategies to counteract specific malnutrition or its risk can be planned, implemented and monitored.

There exists a considerable prevalence of malnutrition among Benghazi cancer patients undergoing chemotherapy and/or radiotherapy, most of whom need critical intervention.

This paper deals with the use of the combined Adomian/Alienor methods for solving the problem of optimal cancer chemotherapy model.

The combination of the Adomian decomposition method and the Alienor reducing transformation method allows us to solve the control problem as if it were a classical one dimensional minimization problem. The mathematical model used here describes specific model based on cell‐cycle kinetics.

It was found that the goal is to maintain the number of the cancerous cells around a desired value while keeping the toxicity to the normal tissues acceptable.

Simulation results are given for illustration.

New combined approach to optimal control of cancer chemotherapy using Adomian/Alienor Methods.

Cancer has become a priority among today’s health problems. Therefore, providing facilities that ensure high-quality cancer treatment has become an essential design problem. Additionally, a considerable number of studies have introduced the ‘healing environment concept’ as a substantial input for healthcare buildings. The purpose of this paper is to present a design guide for cancer treatment services that is compatible with the healing environment concept.

In this context, studies on the healing environment have been analyzed, and the legislation of some selected countries has been assessed. Then, all the filtered data are used to form the design guideline for chemotherapy department, radiation oncology department and inpatient care services under a new series of analysis criteria.

The resulting principles are revealed according to the criteria of general settlement principles, internal function relations, medical necessities, user experience, interior design, social interaction/privacy, safety, landscape design and outdoor relations by the help of proposed plans, diagrams and schematic drawings.

This research constitutes the first and yet only study in its field that aims to increase efficiency and user satisfaction and provide better patient-centered care while providing a design guide on health-care architecture.