Bioengineering and World HealthOverview of Lecture 1Course OrganizationSlide 4Four QuestionsCourse ProjectYour SituationTechnology AssessmentTechnology Assessment: OverviewThe DiseaseSlide 11Slide 12Slide 13Breast Cancer StagingTreatments for Breast CancerThe TechnologyChemotherapyHigh Dose ChemotherapyBone Marrow TransplantsSlide 20History of Bone Marrow TransplantsSlide 22Slide 23Bone Marrow Transplants: LeukemiaBone Marrow Transplants: Breast CASlide 26PBSC Transplantation with Apheresis“The Equipment”Slide 29Clinical Trials of HDCT + BMTTimelineSlide 32Slide 33Slide 34RCT ResultsSlide 36Slide 37Why was only one study positive?Current ThinkingSlide 40Slide 41What are the dangers of allowing political pressures to overwhelm science? What is the proper forum to resolve controversies?Read More About It:Assessing HealthExample of Health DataQuestions about health dataWorld Health OrganizationFunctions of the WHOUses for health measuresTypes of health dataQuantitative measures of healthSlide 52Slide 53Burden of diseaseThe study of global healthSlide 56Leading Causes of Infant Mortality in Developing Countries WHO Annual Report 2003Your Risk of Major DiseasesLife Expectancy at Birth (2000)Infant Mortality Rate (2002)Gross National Income per Capita at PPP (2001)Access to Safe Water (2000)Internet Users (2002)Questions We Will ConsiderBioengineering and World HealthLecture OneOverview of Lecture 1Course Overview:Course organizationFour questions we will answerCourse projectTechnology assessment – The big pictureWorld health: an introductionCourse OrganizationSyllabusWebsite:http://www.owlnet.rice.edu/~bioe301/kortum/class/ BIOE 301 RoadmapScience of Understanding DiseaseEmerging Health TechnologiesPreclinical TestingClinical TrialsAdoption & DiffusionAbandoned due to:• poor performance• safety concerns• ethical concerns• legal issues• social issues• economic issuesBioengineeringEthics of researchCost-EffectivenessFour QuestionsWhat are the problems in healthcare today?Who pays to solve problems in healthcare? How can we use science and technology to solve healthcare problems? Once developed, how do new healthcare technologies move from lab to bedside?Course ProjectBIOE 301:Develop and teach a global health education activity for local K-12 studentsBIOE 362:Design and implement a solution to a health challenge in a developing countrySummer internship opportunities!Your SituationYou have just been diagnosed with advanced cancerYour physician tells you that with standard treatment, there is only a 15% chance that you will survive 5 years.She informs you that she is testing a new therapy which may increase your chance of surviving 5 years by more than 40%.The new therapy has extremely painful side effects and there is limited scientific evidence that it works.The new therapy costs $150,000 and your insurance company refuses to pay for it.What do you do?Technology AssessmentWhat is it?Why do we need it?ExampleBone marrow transplants for breast cancerTechnology Assessment: OverviewThe disease:Breast CancerThe technology:High dose chemotherapy (HDCT) with autologous stem cell support (ASCS)$80,000-$150,000, high morbidity, initially high mortalityThe assessment:1980s: Small clinical trials promisingMany patients demanded treatment even though there was very little evidence that it workedWhat happened next?The DiseaseBreast Cancer211,240 new cases of breast cancer will be diagnosed in the U.S. in 2005Over 2.3 million women living in the U.S. who have been diagnosed with & treated for breast cancer2nd leading cause of cancer death among women in the U.S.Incidence and mortality rates vs. timehttp://cwx.prenhall.com/bookbind/pubbooks/silverthorn2/medialib/Image_Bank/CH22/FG22_02a.jpg http://cwx.prenhall.com/bookbind/pubbooks/silverthorn2/medialib/Image_Bank/CH24/FG24_22a.jpgBreast Cancer StagingStage Definition 5 yr survivalStage 0Cancer cells are located within a duct and have not invaded the surrounding fatty breast tissue 100%Stage IThe tumor is 2 cm or less in diameter and has not spread to lymph nodes or distant sites. 98%Stage IIThe cancer has spread to 1-3 lymph nodes close to the breast but not to distant sites76-88%Stage III(High risk)The cancer has spread to 4-9 lymph nodes close to the breast but not to distant sites49-56%Stage IV(Metastatic)Cancer has spread to distant organs such as bone, liver or lung or to lymph nodes far from the breast. 16%Treatments for Breast CancerSurgeryLumpectomyMastectomyUsed to remove small tumorsChemotherapyMay be used to shrink larger tumors so that they can be removed surgicallyMay be used following surgery to reduce risk of recurrenceMay be used to treat stage IV breast cancere.g. cyclophosphamide with doxorubicin or epirubicin Radiation TherapyMay be used following surgery to reduce risk of recurrenceHormone TherapyMay be used to shrink larger estrogen positive tumors so that they can be removed surgicallyMay be used following surgery to reduce risk of recurrencee.g. Tamoxifen – an anti-estrogen drugThe TechnologyHigh dose chemotherapy (HDCT) with autologous stem cell support (ASCS)How does chemo work?How does high dose chemo work?Why do we need ASCS?Bone marrow transplantsWhat are they?How were they developed?ChemotherapyHow does it work?Chemotherapy drugs given IV or by mouthThey travel through the bloodstream to reach cancer cells in most parts of the bodyInterfere with ability of cell to divideCancer cells cannot repair damage caused by chemotherapy drugs so they dieRapidly dividing normal cells may also be affected by chemo drugs but they can repair this damagePossible Side effectsTemporary: Nausea and vomiting, loss of appetite, hair loss, mouth sores, low blood cell count (infection, bleeding, fatigue)Permanent: Premature menopause and infertilityHigh Dose ChemotherapyDose of chemotherapyBalance between goal of completely destroying all cancer cells & causing too much damage to normal cellsDose comparison studies of chemo in metastatic breast cancer show high dose is associated with high response rateHigh dose chemotherapy (HDCT)Wipe out cancer cells with extremely high doses of chemotherapySuch doses also destroy bone marrow, including stem cells that eventually mature into cells of
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