Jürgen Wasem | University of Duisburg-Essen (original) (raw)

Abstracts by Jürgen Wasem

Kongress der Deutschen Gesellschaft für Sozialmedizin und Prävention, 2009

Zusammenfassung: Das hier untersuchte Betreuungsprogramm (HeartNetCare-HF©) ist aufgrund der Senk... more Zusammenfassung: Das hier untersuchte Betreuungsprogramm (HeartNetCare-HF©) ist aufgrund der Senkung der Mortalität sowie der Steigerung der Lebensqualität der Patienten in der Interventionsgruppe klinisch effektiv. Desweiteren konnte aufgezeigt werden, dass dieses im Vergleich zu anderen kardiologischen Maßnahmen kosteneffektiv ist.

Papers by Jürgen Wasem

Cephalalgia, 2011

Background: Cluster headache (CH) is the most frequent trigemino-autonomic cephalgia. CH can mani... more Background: Cluster headache (CH) is the most frequent trigemino-autonomic cephalgia. CH can manifest as episodic (eCH) or chronic cluster headache (cCH) causing significant burden of disease and requiring attack therapy and prophylactic treatment.Methods: Treatment costs (direct costs) due to healthcare utilisation, as well as costs caused by disability and reduction in earning capacity (indirect costs), were obtained using a questionnaire

Value in Health, 2010

OBJECTIVES: To perform SR with MA of all randomized controlled trials (RCT) comparing the effi ca... more OBJECTIVES: To perform SR with MA of all randomized controlled trials (RCT) comparing the effi cacy of BEV-CT versus CT alone in previously untreated locally advanced or metastatic NSCLC. METHODS: We searched MEDLINE, EMBASE, LILACS, and CENTRAL among others. Primary end points were overall survival (OS) and progression-free survival (PFS). Adverse events (AE) were analyzed. Extracted data were combined using hazard ratio (HR) or risk ratio (RR) with 95% confi dence intervals (CI 95%). RESULTS: 544 references were identifi ed and screened, three trials comprising 2020 patients were included. Overall response rate (RR = 0.53; CI 95% = 0.44 to 0.64; P < 0.00001) and PFS were higher in BEV-CT (HR = 0.71, CI 95% = 0.63 to 0.80; P < 0.00001), however with signifi cant heterogeneity (χ 2 = 4.9, df = 2 [P = 0.09]; I 2 = 59%) and (χ 2 = 4.33, df = 2 [P = 0.11]; I 2 = 54%), respectively. Random-efffects model analysis favored BEV-CT. OS was higher in BEV-CT but with signifi cant heterogeneity (χ 2 = 5.92, df = 3 [P = 0.12]; I 2 = 49%) and random-effects model analysis was not statistically signifi cant (HR = 0.86, CI 95% = 0.71 to 1.05; P = 0.15). Neutropenia (RR = 0.77; CI 95% = 0.65 to 0.91; P = 0.002) and febrile neutropenia (RR = 0.42; CI 95% = 0.22 to 0.81; P = 0.009) were higher on BEV-CT. Rates of anemia (RR = 1.41; CI 95% = 0.93 to 2.13; P = 0.1) and thrombocytopenia (RR = 0.91; CI 95% = 0.69 to 1.20; P = 0.50) were similar. Non-hematologic toxicities were higher on BEV-CT: hemoptysis (RR = 0.28; CI 95% = 0.09 to 0.90; P = 0.03), hypertension (RR = 0.15; CI 95% = 0.07 to 0.30; P < 0.00001), proteinuria (RR = 0.05; CI 95% = 0.01 to 0.41; P = 0.005), venous thromboembolic events (RR = 0.87; CI 95% = 0.51 to 1.47; P = 0.6), vomiting (RR = 0.41; CI 95% = 0.22 to 0.77; P = 0.005), rash (RR = 0.19; CI 95% = 0.04 to 0.88; P = 0.03), epistaxis (RR = 0.32; CI 95% = 0.03 to 3.10; P = 0.33) and bleeding events (RR = 0.27; CI 95% = 0.13 to 0.56; P = 0.0004). CONCLUSIONS: The combination BEV-CT increased the response rate and PFS in patients with NSCLC. Benefi ts in overall survival remain uncertain, and toxicity rates were higher in the combination group.

Background: Children with congenital hearing impairment benefit from early detection and treatmen... more Background: Children with congenital hearing impairment benefit from early detection and treatment. At present, no model exists which explicitly quantifies the effectiveness of universal newborn hearing screening (UNHS) versus other programme alternatives in terms of early diagnosis. It has yet to be considered whether early diagnosis (within the first few months) of hearing impairment is of importance with regard to the further development of the child compared with effects resulting from a later diagnosis. The objective was to systematically compare two screening strategies for the early detection of new-born hearing disorders, UNHS and risk factor screening, with no systematic screening regarding their influence on early diagnosis.

In the next years the population of most western countries will age rapidly. Beside socioeconomic... more In the next years the population of most western countries will age rapidly. Beside socioeconomic and social problems sustainable consequences on the health care system are expected. Ageing of the population will place a corresponding growth in demand of health care services and relating expenditures. The following analysis assesses the impact of demographic factors on hospital admissions and related costs over the next 30 years. German Federal Statistical Office 12th coordinated population projection, diagnosis statistics and cost of illness data were used to develop a projection of future hospital admissions and associated economic burden. The model considers age- and sex-specific differences. Ageing will increase all-cause hospital admissions by 12% between 2010 and 2040. Diseases of the circulatory system will have one of the most tremendous increases with an expected rise of 34% until 2040. In contrast, hospital stays because of mental and behavioural disorders will decrease by 9%. As hospital admissions rise we expect a further increase in overall expenditures for hospitalisations. Ageing of the population will further increase the demand for inpatient hospital services during the coming years. Nevertheless, the increase of hospital admissions will differ concerning single illness groups. The development of new care strategies should take these aspects into consideration.

Vaccine, 2014

Objective: Rotavirus is the most common cause of severe diarrhea in children. Two rotavirus vacci... more Objective: Rotavirus is the most common cause of severe diarrhea in children. Two rotavirus vaccines (RotaTeq and Rotarix) have been licensed in Taiwan. We have investigated whether routine infant immunization with either vaccine could be cost-effective in Taiwan. Methods: We modeled specific disease outcomes including hospitalization, emergency department visits, hospital outpatient visits, physician office visits, and death. Cost-effectiveness was analyzed from the perspectives of the health care system and society. A decision tree was used to estimate the disease burden and costs based on data from published and unpublished sources. Results: A routine rotavirus immunization program would prevent 146,470 (Rotarix) or 149,937 (RotaTeq) cases of rotavirus diarrhea per year, and would prevent 21,106 (Rotarix) and 23,057 (RotaTeq) serious cases

Journal of Public Health, 2010

Peripheral arterial disease (PAD), a marker of elevated vascular risk, is highly prevalent in gen... more Peripheral arterial disease (PAD), a marker of elevated vascular risk, is highly prevalent in general practice. We aimed to investigate patient characteristics and outcomes of PAD patients treated according to the guidelines versus those who were not. Methods. PACE-PAD was a multicentre, cluster-randomised prospective, longitudinal cohort study of patients with PAD in primary care, who were followed-up for death or vascular events over 18 months. Guideline-orientation was assumed, if patients received anti¬coagu¬lant/antiplatelet therapy, exercise training, and (if applicable) advice for smoking cessation and therapy of diabetes mellitus, hypertension, or hypercholesterolemia, respectively. Results. The 5099 PAD patients (mean age 68.0 ± 9.0 years, 68.5% males) who were followed-up were in Fontaine stages I, IIa, IIb, III, and IV in 22.5%, 34.6%, 30.1%, 7.8%, and 3.5% (1.5% not specified). Comprehensive guideline orientation was reported in 28.4% only, however, patients in lower Fontaine stages received more often guideline-oriented therapy (I: 30.3%; IIa: 31.6%, IIb: 29.1%, III: 9.8%, IV: 18.0%). During 18 months, 457 patients died (224 due to cerebrovascular or coronary deaths), 319 had instable angina pectoris, 116 myocardial infarction, and 140 an ischemic stroke event. In total, 24% of patients had experienced any vascular event (19.1% a first event). Event rates did not differ between patients treated according to guidelines, and those who were not. Conclusion. The present PAD cohort was a high-risk sample with an unexpectedly high rate of deaths and vascular events. While physicians appear to focus on the treatment of individual risk factors, rates of comprehensive PAD management in line with guideline recommendations are still suboptimal. Factors contributing to the lacking difference between outcomes in the guideline-oriented and nonguideline-oriented groups may comprise low treatment intensity or other reasons for unsatisfactory effect of treatment, misclassification of events, patient's non-compliance with therapy.

Journal of Public Health, 2010

Peripheral arterial disease (PAD), a marker of elevated vascular risk, is highly prevalent in gen... more Peripheral arterial disease (PAD), a marker of elevated vascular risk, is highly prevalent in general practice. We aimed to investigate patient characteristics and outcomes of PAD patients treated according to the guidelines versus those who were not. Methods. PACE-PAD was a multicentre, cluster-randomised prospective, longitudinal cohort study of patients with PAD in primary care, who were followed-up for death or vascular events over 18 months. Guideline-orientation was assumed, if patients received anti¬coagu¬lant/antiplatelet therapy, exercise training, and (if applicable) advice for smoking cessation and therapy of diabetes mellitus, hypertension, or hypercholesterolemia, respectively. Results. The 5099 PAD patients (mean age 68.0 ± 9.0 years, 68.5% males) who were followed-up were in Fontaine stages I, IIa, IIb, III, and IV in 22.5%, 34.6%, 30.1%, 7.8%, and 3.5% (1.5% not specified). Comprehensive guideline orientation was reported in 28.4% only, however, patients in lower Fontaine stages received more often guideline-oriented therapy (I: 30.3%; IIa: 31.6%, IIb: 29.1%, III: 9.8%, IV: 18.0%). During 18 months, 457 patients died (224 due to cerebrovascular or coronary deaths), 319 had instable angina pectoris, 116 myocardial infarction, and 140 an ischemic stroke event. In total, 24% of patients had experienced any vascular event (19.1% a first event). Event rates did not differ between patients treated according to guidelines, and those who were not. Conclusion. The present PAD cohort was a high-risk sample with an unexpectedly high rate of deaths and vascular events. While physicians appear to focus on the treatment of individual risk factors, rates of comprehensive PAD management in line with guideline recommendations are still suboptimal. Factors contributing to the lacking difference between outcomes in the guideline-oriented and nonguideline-oriented groups may comprise low treatment intensity or other reasons for unsatisfactory effect of treatment, misclassification of events, patient's non-compliance with therapy.

International Journal of Technology Assessment in Health Care, 2010

Dieser HTA-Bericht ist publiziert in der DAHTA-Datenbank des DIMDI (www.dimdi.de -HTA) und in der... more Dieser HTA-Bericht ist publiziert in der DAHTA-Datenbank des DIMDI (www.dimdi.de -HTA) und in der elektronischen Zeitschrift GMS Health Technology Assessment (www.egms.de).

International Journal of Cardiology, 2010

Health Policy, 2003

From the mid-1990s citizens in Belgium, Germany, Israel, the Netherlands and Switzerland have a g... more From the mid-1990s citizens in Belgium, Germany, Israel, the Netherlands and Switzerland have a guaranteed periodic choice among risk-bearing sickness funds, who are responsible for purchasing their care or providing them with medical care. The rationale of this arrangement is to stimulate the sickness funds to improve efficiency in health care production and to respond to consumers' preferences. To achieve solidarity, all five countries have implemented a system of risk-adjusted premium subsidies (or risk equalization across risk groups), along with strict regulation of the consumers' direct premium contribution to their sickness fund. In this article we present a conceptual framework for understanding risk adjustment and comparing the systems in the five countries. We conclude that in the case of imperfect risk adjustment */as is the case in all five countries in the year 2001 */the sickness funds have financial incentives for risk selection, which may threaten solidarity, efficiency, quality of care and consumer satisfaction. We expect that without substantial improvements in the risk adjustment formulae, risk selection will increase in all five countries. The issue is particularly serious in Germany and Switzerland. We strongly recommend therefore that policy makers in the five countries give top priority to the improvement of the system of risk adjustment. That would enhance solidarity, cost-control, efficiency and client satisfaction in a system of competing, risk-bearing sickness funds. # (W.P.M.M. van de Ven). Health Policy 65 (2003) 75 Á/98 www.elsevier.com/locate/healthpol 0168-8510/02/$ -see front matter # 2002 Elsevier Science Ireland Ltd. All rights reserved. PII: S 0 1 6 8 -8 5 1 0 ( 0 2 ) 0 0 1 1 8 -5

European Journal of Cancer, 2011

Cervical cancer

Kongress der Deutschen Gesellschaft für Sozialmedizin und Prävention, 2009

Zusammenfassung: Das hier untersuchte Betreuungsprogramm (HeartNetCare-HF©) ist aufgrund der Senk... more Zusammenfassung: Das hier untersuchte Betreuungsprogramm (HeartNetCare-HF©) ist aufgrund der Senkung der Mortalität sowie der Steigerung der Lebensqualität der Patienten in der Interventionsgruppe klinisch effektiv. Desweiteren konnte aufgezeigt werden, dass dieses im Vergleich zu anderen kardiologischen Maßnahmen kosteneffektiv ist.

Cephalalgia, 2011

Background: Cluster headache (CH) is the most frequent trigemino-autonomic cephalgia. CH can mani... more Background: Cluster headache (CH) is the most frequent trigemino-autonomic cephalgia. CH can manifest as episodic (eCH) or chronic cluster headache (cCH) causing significant burden of disease and requiring attack therapy and prophylactic treatment.Methods: Treatment costs (direct costs) due to healthcare utilisation, as well as costs caused by disability and reduction in earning capacity (indirect costs), were obtained using a questionnaire

Value in Health, 2010

OBJECTIVES: To perform SR with MA of all randomized controlled trials (RCT) comparing the effi ca... more OBJECTIVES: To perform SR with MA of all randomized controlled trials (RCT) comparing the effi cacy of BEV-CT versus CT alone in previously untreated locally advanced or metastatic NSCLC. METHODS: We searched MEDLINE, EMBASE, LILACS, and CENTRAL among others. Primary end points were overall survival (OS) and progression-free survival (PFS). Adverse events (AE) were analyzed. Extracted data were combined using hazard ratio (HR) or risk ratio (RR) with 95% confi dence intervals (CI 95%). RESULTS: 544 references were identifi ed and screened, three trials comprising 2020 patients were included. Overall response rate (RR = 0.53; CI 95% = 0.44 to 0.64; P < 0.00001) and PFS were higher in BEV-CT (HR = 0.71, CI 95% = 0.63 to 0.80; P < 0.00001), however with signifi cant heterogeneity (χ 2 = 4.9, df = 2 [P = 0.09]; I 2 = 59%) and (χ 2 = 4.33, df = 2 [P = 0.11]; I 2 = 54%), respectively. Random-efffects model analysis favored BEV-CT. OS was higher in BEV-CT but with signifi cant heterogeneity (χ 2 = 5.92, df = 3 [P = 0.12]; I 2 = 49%) and random-effects model analysis was not statistically signifi cant (HR = 0.86, CI 95% = 0.71 to 1.05; P = 0.15). Neutropenia (RR = 0.77; CI 95% = 0.65 to 0.91; P = 0.002) and febrile neutropenia (RR = 0.42; CI 95% = 0.22 to 0.81; P = 0.009) were higher on BEV-CT. Rates of anemia (RR = 1.41; CI 95% = 0.93 to 2.13; P = 0.1) and thrombocytopenia (RR = 0.91; CI 95% = 0.69 to 1.20; P = 0.50) were similar. Non-hematologic toxicities were higher on BEV-CT: hemoptysis (RR = 0.28; CI 95% = 0.09 to 0.90; P = 0.03), hypertension (RR = 0.15; CI 95% = 0.07 to 0.30; P < 0.00001), proteinuria (RR = 0.05; CI 95% = 0.01 to 0.41; P = 0.005), venous thromboembolic events (RR = 0.87; CI 95% = 0.51 to 1.47; P = 0.6), vomiting (RR = 0.41; CI 95% = 0.22 to 0.77; P = 0.005), rash (RR = 0.19; CI 95% = 0.04 to 0.88; P = 0.03), epistaxis (RR = 0.32; CI 95% = 0.03 to 3.10; P = 0.33) and bleeding events (RR = 0.27; CI 95% = 0.13 to 0.56; P = 0.0004). CONCLUSIONS: The combination BEV-CT increased the response rate and PFS in patients with NSCLC. Benefi ts in overall survival remain uncertain, and toxicity rates were higher in the combination group.

Background: Children with congenital hearing impairment benefit from early detection and treatmen... more Background: Children with congenital hearing impairment benefit from early detection and treatment. At present, no model exists which explicitly quantifies the effectiveness of universal newborn hearing screening (UNHS) versus other programme alternatives in terms of early diagnosis. It has yet to be considered whether early diagnosis (within the first few months) of hearing impairment is of importance with regard to the further development of the child compared with effects resulting from a later diagnosis. The objective was to systematically compare two screening strategies for the early detection of new-born hearing disorders, UNHS and risk factor screening, with no systematic screening regarding their influence on early diagnosis.

In the next years the population of most western countries will age rapidly. Beside socioeconomic... more In the next years the population of most western countries will age rapidly. Beside socioeconomic and social problems sustainable consequences on the health care system are expected. Ageing of the population will place a corresponding growth in demand of health care services and relating expenditures. The following analysis assesses the impact of demographic factors on hospital admissions and related costs over the next 30 years. German Federal Statistical Office 12th coordinated population projection, diagnosis statistics and cost of illness data were used to develop a projection of future hospital admissions and associated economic burden. The model considers age- and sex-specific differences. Ageing will increase all-cause hospital admissions by 12% between 2010 and 2040. Diseases of the circulatory system will have one of the most tremendous increases with an expected rise of 34% until 2040. In contrast, hospital stays because of mental and behavioural disorders will decrease by 9%. As hospital admissions rise we expect a further increase in overall expenditures for hospitalisations. Ageing of the population will further increase the demand for inpatient hospital services during the coming years. Nevertheless, the increase of hospital admissions will differ concerning single illness groups. The development of new care strategies should take these aspects into consideration.

Vaccine, 2014

Objective: Rotavirus is the most common cause of severe diarrhea in children. Two rotavirus vacci... more Objective: Rotavirus is the most common cause of severe diarrhea in children. Two rotavirus vaccines (RotaTeq and Rotarix) have been licensed in Taiwan. We have investigated whether routine infant immunization with either vaccine could be cost-effective in Taiwan. Methods: We modeled specific disease outcomes including hospitalization, emergency department visits, hospital outpatient visits, physician office visits, and death. Cost-effectiveness was analyzed from the perspectives of the health care system and society. A decision tree was used to estimate the disease burden and costs based on data from published and unpublished sources. Results: A routine rotavirus immunization program would prevent 146,470 (Rotarix) or 149,937 (RotaTeq) cases of rotavirus diarrhea per year, and would prevent 21,106 (Rotarix) and 23,057 (RotaTeq) serious cases

Journal of Public Health, 2010

Peripheral arterial disease (PAD), a marker of elevated vascular risk, is highly prevalent in gen... more Peripheral arterial disease (PAD), a marker of elevated vascular risk, is highly prevalent in general practice. We aimed to investigate patient characteristics and outcomes of PAD patients treated according to the guidelines versus those who were not. Methods. PACE-PAD was a multicentre, cluster-randomised prospective, longitudinal cohort study of patients with PAD in primary care, who were followed-up for death or vascular events over 18 months. Guideline-orientation was assumed, if patients received anti¬coagu¬lant/antiplatelet therapy, exercise training, and (if applicable) advice for smoking cessation and therapy of diabetes mellitus, hypertension, or hypercholesterolemia, respectively. Results. The 5099 PAD patients (mean age 68.0 ± 9.0 years, 68.5% males) who were followed-up were in Fontaine stages I, IIa, IIb, III, and IV in 22.5%, 34.6%, 30.1%, 7.8%, and 3.5% (1.5% not specified). Comprehensive guideline orientation was reported in 28.4% only, however, patients in lower Fontaine stages received more often guideline-oriented therapy (I: 30.3%; IIa: 31.6%, IIb: 29.1%, III: 9.8%, IV: 18.0%). During 18 months, 457 patients died (224 due to cerebrovascular or coronary deaths), 319 had instable angina pectoris, 116 myocardial infarction, and 140 an ischemic stroke event. In total, 24% of patients had experienced any vascular event (19.1% a first event). Event rates did not differ between patients treated according to guidelines, and those who were not. Conclusion. The present PAD cohort was a high-risk sample with an unexpectedly high rate of deaths and vascular events. While physicians appear to focus on the treatment of individual risk factors, rates of comprehensive PAD management in line with guideline recommendations are still suboptimal. Factors contributing to the lacking difference between outcomes in the guideline-oriented and nonguideline-oriented groups may comprise low treatment intensity or other reasons for unsatisfactory effect of treatment, misclassification of events, patient's non-compliance with therapy.

Journal of Public Health, 2010

Peripheral arterial disease (PAD), a marker of elevated vascular risk, is highly prevalent in gen... more Peripheral arterial disease (PAD), a marker of elevated vascular risk, is highly prevalent in general practice. We aimed to investigate patient characteristics and outcomes of PAD patients treated according to the guidelines versus those who were not. Methods. PACE-PAD was a multicentre, cluster-randomised prospective, longitudinal cohort study of patients with PAD in primary care, who were followed-up for death or vascular events over 18 months. Guideline-orientation was assumed, if patients received anti¬coagu¬lant/antiplatelet therapy, exercise training, and (if applicable) advice for smoking cessation and therapy of diabetes mellitus, hypertension, or hypercholesterolemia, respectively. Results. The 5099 PAD patients (mean age 68.0 ± 9.0 years, 68.5% males) who were followed-up were in Fontaine stages I, IIa, IIb, III, and IV in 22.5%, 34.6%, 30.1%, 7.8%, and 3.5% (1.5% not specified). Comprehensive guideline orientation was reported in 28.4% only, however, patients in lower Fontaine stages received more often guideline-oriented therapy (I: 30.3%; IIa: 31.6%, IIb: 29.1%, III: 9.8%, IV: 18.0%). During 18 months, 457 patients died (224 due to cerebrovascular or coronary deaths), 319 had instable angina pectoris, 116 myocardial infarction, and 140 an ischemic stroke event. In total, 24% of patients had experienced any vascular event (19.1% a first event). Event rates did not differ between patients treated according to guidelines, and those who were not. Conclusion. The present PAD cohort was a high-risk sample with an unexpectedly high rate of deaths and vascular events. While physicians appear to focus on the treatment of individual risk factors, rates of comprehensive PAD management in line with guideline recommendations are still suboptimal. Factors contributing to the lacking difference between outcomes in the guideline-oriented and nonguideline-oriented groups may comprise low treatment intensity or other reasons for unsatisfactory effect of treatment, misclassification of events, patient's non-compliance with therapy.

International Journal of Technology Assessment in Health Care, 2010

Dieser HTA-Bericht ist publiziert in der DAHTA-Datenbank des DIMDI (www.dimdi.de -HTA) und in der... more Dieser HTA-Bericht ist publiziert in der DAHTA-Datenbank des DIMDI (www.dimdi.de -HTA) und in der elektronischen Zeitschrift GMS Health Technology Assessment (www.egms.de).

International Journal of Cardiology, 2010

Health Policy, 2003

From the mid-1990s citizens in Belgium, Germany, Israel, the Netherlands and Switzerland have a g... more From the mid-1990s citizens in Belgium, Germany, Israel, the Netherlands and Switzerland have a guaranteed periodic choice among risk-bearing sickness funds, who are responsible for purchasing their care or providing them with medical care. The rationale of this arrangement is to stimulate the sickness funds to improve efficiency in health care production and to respond to consumers' preferences. To achieve solidarity, all five countries have implemented a system of risk-adjusted premium subsidies (or risk equalization across risk groups), along with strict regulation of the consumers' direct premium contribution to their sickness fund. In this article we present a conceptual framework for understanding risk adjustment and comparing the systems in the five countries. We conclude that in the case of imperfect risk adjustment */as is the case in all five countries in the year 2001 */the sickness funds have financial incentives for risk selection, which may threaten solidarity, efficiency, quality of care and consumer satisfaction. We expect that without substantial improvements in the risk adjustment formulae, risk selection will increase in all five countries. The issue is particularly serious in Germany and Switzerland. We strongly recommend therefore that policy makers in the five countries give top priority to the improvement of the system of risk adjustment. That would enhance solidarity, cost-control, efficiency and client satisfaction in a system of competing, risk-bearing sickness funds. # (W.P.M.M. van de Ven). Health Policy 65 (2003) 75 Á/98 www.elsevier.com/locate/healthpol 0168-8510/02/$ -see front matter # 2002 Elsevier Science Ireland Ltd. All rights reserved. PII: S 0 1 6 8 -8 5 1 0 ( 0 2 ) 0 0 1 1 8 -5

European Journal of Cancer, 2011

Cervical cancer