Health Insurance–Motivated Disability Enrollment and the ACA, by Jae Kennedy and Elizabeth Blodgett, (The New England Journal of Medicine)
What Business Are We In? The Emergence of Health as the Business of Health Care, by David A. Asch and Kevin G. Volpp (The New England Journal of Medicine)
From Sick Care to Health Care — Reengineering Prevention into the U.S. System, by Farshad Fani Marvasti and Randall S. Stafford (The New England Journal of Medicine)
Intermittent Androgen Suppression for Rising PSA Level after Radiotherapy, by Juanita M. Crook, Christopher J. O’Callaghan, Graeme Duncan, David P. Dearnaley, Celestia S. Higano, Eric M. Horwitz, Eliot Frymire, Shawn Malone, Joseph Chin, Abdenour Nabid, Padraig Warde, Thomas Corbett, Steve Angyalfi, S. Larry Goldenberg, Mary K. Gospodarowicz, Fred Saad, John P. Logue, Emma Hall, Paul F. Schellhammer, Keyue Ding and Laurence Klotz (The New England Journal of Medicine)
Background
Intermittent androgen deprivation for prostate-specific antigen (PSA) elevation after radiotherapy may improve quality of life and delay hormone resistance. We assessed overall survival with intermittent versus continuous androgen deprivation in a noninferiority randomized trial.
Methods
We enrolled patients with a PSA level greater than 3 ng per milliliter more than 1 year after primary or salvage radiotherapy for localized prostate cancer. Intermittent treatment was provided in 8-month cycles, with nontreatment periods determined according to the PSA level. The primary end point was overall survival. Secondary end points included quality of life, time to castration-resistant disease, and duration of nontreatment intervals.
Results
Of 1386 enrolled patients, 690 were randomly assigned to intermittent therapy and 696 to continuous therapy. Median follow-up was 6.9 years. There were no significant between-group differences in adverse events. In the intermittent-therapy group, full testosterone recovery occurred in 35% of patients, and testosterone recovery to the trial-entry threshold occurred in 79%. Intermittent therapy provided potential benefits with respect to physical function, fatigue, urinary problems, hot flashes, libido, and erectile function. There were 268 deaths in the intermittent-therapy group and 256 in the continuous-therapy group. Median overall survival was 8.8 years in the intermittent-therapy group versus 9.1 years in the continuous-therapy group (hazard ratio for death, 1.02; 95% confidence interval, 0.86 to 1.21). The estimated 7-year cumulative rates of disease-related death were 18% and 15% in the two groups, respectively (P=0.24).
Conclusions
Intermittent androgen deprivation was noninferior to continuous therapy with respect to overall survival. Some quality-of-life factors improved with intermittent therapy.
Androgen Deprivation — Continuous, Intermittent, or None at All?, by Oliver Sartor (The New England Journal of Medicine)
Health Care Reform and the Dynamics of Insurance Coverage — Lessons from Massachusetts, by John A. Graves and Katherine Swartz (The New England Journal of Medicine)
