INTRODUCTION: Breast cancer is the leading cause of cancer, and the second leading cause of cancer death in women. Due to advances in medicine, the 10 year survival rate is 80%, resulting in a large and growing number of breast cancer survivors. Definitions of cancer survivorship from a number of professional organizations and researchers vary, but the research is scant on the meaning of cancer survivorship to people with and without a prior cancer history. METHODS: Two studies were conducted (1) to compare individuals with and without a prior personal cancer diagnosis in terms of those who identified as survivors vs. those who did not identify as survivors and (2) to explore explanations of those with and without a prior personal cancer for the term cancer survivor. In Study 1, individuals were surveyed at cancer-themed community health fairs. In Study 2, women were surveyed at a breast oncology clinic. RESULTS: In Study 1 comparing those with and without a prior cancer diagnosis, prior cancer history was the best predictor of survivorship identity, and only three individuals without a prior cancer history included family and friends as survivors. In Study 2 of those with a personal history, longer time since diagnosis, type of cancer (ductal), and comparative risk (higher) were associated with survivor identity. CONCLUSION: Completion of treatment was seen as a 'rite of passage', and thus, may be seen as a shift from the patient identity, which may have negative connotations, to the positive identity of survivor. IMPLICATIONS: Definitions of survivorship vary considerably, and caution should be used when applying the term to those who have no prior personal cancer diagnosis and to those who have had a more recent cancer diagnosis with a more severe disease course.

Objectives. We assess whether it is feasible for robotic hysterectomy for endometrial cancer to be less expensive to society than traditional laparoscopic hysterectomy or abdominal hysterectomy. Methods. We performed a retrospective cohort analysis of patient characteristics, operative times, complications, and hospital charges from all (n = 234) endometrial cancer patients who underwent hysterectomy in 2009 at our hospital. Per patient costs of each hysterectomy method were examined from the societal perspective. Sensitivity analysis and Monte Carlo simulation were performed using a cost-minimization model. Results. 40 (17.1%) of hysterectomies for endometrial cancer were robotic, 91 (38.9%), were abdominal, and 103 (44.0%) were laparoscopic. 96.3% of the variation in operative cost between patients was predicted by operative time (R = 0.963, P 0.01). Mean operative time for robotic hysterectomy was significantly longer than other methods (P 0.01). Abdominal hysterectomy was consistently the most expensive while the traditional laparoscopic approach was consistently least expensive. The threshold in operative time that makes robotic hysterectomy cost equivalent to the abdominal approach is within the range of our experience. Conclusion. It is feasible for robotic hysterectomy to be less expensive than abdominal hysterectomy, but unlikely for robotic hysterectomy to be less expensive than traditional laparoscopy.

OBJECTIVE: In a 3-year period, the main mode of access for hysterectomy at Brigham and Women's Hospital changed from abdominal to laparoscopic. We estimated potential effects of this shift on perioperative outcomes and costs. METHODS: We compared the perioperative outcomes and the cost of care for all hysterectomies performed in 2006 and 2009 at an urban academic tertiary care center using the χ² test or Fisher's exact test for categorical variables and two-sided Student's t test for continuous variables. A multivariate regression analysis was also performed for the major perioperative outcomes across the study groups. Cost data were gathered from the hospital's billing system; the remainder of data was extracted from patients' medical records. RESULTS: This retrospective study included 2,133 patients. The total number of hysterectomies performed remained stable (1,054 procedures in 2006 compared with 1,079 in 2009) but the relative proportions of abdominal and laparoscopic cases changed markedly during the 3-year period (64.7% to 35.8% for abdominal, P.001; and 17.7% to 46% for laparoscopic cases, P.001). The overall rate of intraoperative complications and minor postoperative complications decreased significantly (7.2% to 4%, P.002; and 18% to 5.7%, P.001, respectively). Operative costs increased significantly for all procedures aside from robotic hysterectomy, although no significant change was noted in total mean costs. CONCLUSION: A change from majority abdominal hysterectomy to minimally invasive hysterectomy was accompanied by a significant decrease in procedure-related complications without an increase in total mean costs.

Cisplatin was one of the first chemotherapeutic agents to exhibit broad efficacy in solid tumors and it remains among the most widely used agents in the treatment of cancer. Its introduction inspired great efforts to design similarly effective platinum agents that overcome the three main limitations of cisplatin: toxicity, tumor resistance and poor oral bioavailability. However, 40 years after the initial discovery of cisplatin, only two platinum agents have garnered US FDA approval: carboplatin and oxaliplatin. Although hundreds of promising agents were tested in clinical trials during the 1990s, only oxaliplatin made it past clinical development. For a brief period, the economic cost of these unsuccessful efforts retarded further efforts to develop new agents. However, two exciting platinum agents have been brought to Phase III trials: satraplatin in hormone-refractory prostate cancer and picoplatin in small-cell lung cancer. If successful, they may inspire a new effort to bring better-designed platinum agents to market. This article reviews the clinical development of platinum agents to date and speculates on the role of platinum agents in the near future.