Does supportive-expressive group therapy for metastatic breast cancer patients lower health care services resource utilization
Bibliographic record
Abstract
6052 Background: Metastatic breast cancer is associated with psychological distress, which, in other diseases has been associated with higher health care resource utilization. We hypothesized that a psychosocial intervention in metastatic breast cancer will reduce health care resource utilization. Methods: Goodwin et al. reported results of a randomized controlled trial of supportive expressive group support in metastatic breast cancer (NEJM 2001;345:1719–1726). The intervention did not impact survival or quality of life (EORTC QLQ-C30) but it improved total mood disturbance (Profile of Mood States -POMS, range −32 to 200) and perception of pain (10 cm VAS). Resource utilization data were collected prospectively (data from 3 of the largest centers were used). Costing was done at 2 tertiary care U of Toronto hospitals in $2001 (Canadian) using the perspective of the health care system. A cost-minimization analysis was conducted as the primary analysis; secondarily, a cost-effectiveness analysis (CEA) was conducted for mood and perception of pain to identify costs associated with an improvement equal to 10% of the range of the scale (23.2 POMS, 1.0 cm pain VAS), an effect size considered clinically significant. Results: Average health care utilization costs for the intervention group were $25,537 +/- $21,059 and for the control group $22,461 +/- $18,686 (p = 0.43). A sensitivity analysis, of +/- 20% of hospitalization and chemotherapy costs (the two largest costs) resulted in no significant differences between groups. The CEA for POMS showed the intervention group incurred incremental costs of $6,205 per 23.2 points POMS improvement; the incremental cost per 1.0 cm VAS increase in perception of pain was $3076. Conclusions: Supportive-expressive group therapy in metastatic breast cancer does not lower health care resource utilization. Costs associated with clinically significant beneficial effects on mood and perception of pain were acceptable. No significant financial relationships to disclose.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.010 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".