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Analysis Tool Shows Proton Therapy Less Expensive Than IMRT for Advanced Head and Neck Cancers

By MedImaging International staff writers
Posted on 18 Sep 2014

The episodic cost of care using intensity-modulated proton therapy (IMPT) in advanced stage head and neck cancer is less expensive than intensity-modulated radiotherapy (IMRT), according to new findings. The new proof-of-concept study uses a cost analysis tool that can be used to outline the value of competing healthcare technologies and treatments.

“This study, while focused on a small sample of patients, for the first time confirms empirically what many oncologists and radiologists believe but has not been fully borne out by research,” says senior author Steven J. Frank, MD, medical director of the center and associate professor of radiation oncology, the Proton Therapy Center at the University of Texas MD Anderson Cancer Center (Houston, USA). “Even though the upfront cost of proton radiation is higher than IMRT, its ability to minimize side effects ultimately results in fewer healthcare dollars. Also, though the study focused on shorter-term complications, we believe it would apply to long-term. This is critically important for head and neck cancer patients, as they’re more likely to be young adults with families and long lives ahead.”

The study, published September 2014 in the journal Oncology Papers, centered on two oropharyngeal cancer patients during the course of 33 daily radiation doses--one patient receiving IMPT, the most advanced type of proton radiation which can spare surrounding healthy tissue from damage, and the other receiving IMRT, which destroys both cancerous and healthy cells. The patients also had weekly chemotherapy treatments. The researchers found that even though the daily cost for proton therapy was about triple the cost of IMRT, the IMRT patients’ outcomes and quality of life measures necessitated additional clinical costs. That these included moderate to severe toxicity, a required feeding tube, nutritional and other supportive care, and weight loss that necessitated revised radiation plans. And lastly, that by the end of the patients’ treatments, the proton therapy costs were 20% less than IMRT.

These findings are based on a model called time-driven activity-based costing (TDABC), a tool that relates the measurement of costs to time—such as the time required to perform each individual medical service. The methodology is being studied across numerous areas at MD Anderson Cancer Center under the leadership of Thomas Feeley, MD, head of the Institute for Cancer Care Innovation and a coauthor of this study.

“This is an important first step in shifting a decades-old conversation strictly about the initial costs of proton therapy to a discussion about value,” said Dr. Frank. “There is a cost-based incentive to think about the value—monetary and in terms of quality of life—of avoiding some of the complications of cancer treatment in the first place.”

Dr. Frank is adding on this research with a randomized clinical trial: he has enrolled nearly 50 patients to date and is planning to recruit a total of 360 patients over the next five years. He also hopes to open the study to other cancer centers in the near future. Dr. Frank anticipates that ongoing results from the study will help inform health policy changes that are ongoing across the United States, including bundled insurance payment initiatives.

Related Links:
University of Texas MD Anderson Cancer Center

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62 (!!!!! 10014.057159424): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

63 (!!!!! 7660.8657836914): SELECT fid FROM jos_deeppockets WHERE id=294754650 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294754650 AND published='1' LIMIT 1

64 (!!!!! 4410.0284576416): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=211 ORDER BY `ordering`

65 (!!!!! 3133.0585479736): select jos_twitters.link from jos_twitters where cat=10

66 (84.877014160156): select jos_facebook.link from jos_facebook where cat=10

67 (35.04753112793): select jos_google_plus.link from jos_google_plus where cat=10

68 (29.802322387695): select jos_linkedin.link from jos_linkedin where cat=10

69 (72.002410888672): SELECT fid FROM jos_deeppockets WHERE id=294754650 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294754650 AND published='1' LIMIT 1

70 (41.007995605469): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=211 ORDER BY `ordering`

71 (771.04568481445): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294754650 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (339.03121948242): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294754650 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (58.174133300781): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

74 (88.930130004883): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (32.186508178711): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (32.186508178711): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (37.193298339844): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (91.075897216797): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294754650 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (35.04753112793): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294754650 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (46.014785766602): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

91 (101.08947753906): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (!!!!! 3309.965133667): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (81.062316894531): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (!!!!! 1334.9056243896): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (90.122222900391): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (!!!!! 2156.9728851318): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (87.976455688477): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (182.8670501709): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (82.015991210938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754650 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754650 AND published='1' LIMIT 1

106 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754650 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754650 AND published='1' LIMIT 1

107 (!!!!! 1436.9487762451): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294754650 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (613.92784118652): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294754650 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (!!!!! 2534.8663330078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754650 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754650 AND published='1' LIMIT 1

110 (!!!!! 3170.9671020508): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754650 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754650 AND published='1' LIMIT 1

111 (70.810317993164): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294754650 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (579.1187286377): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294754650 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (924.82566833496): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (!!!!! 3977.0603179932): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

115 (!!!!! 1317.024230957): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754650 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754650 AND published='1' LIMIT 1

116 (293.97010803223): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754650 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754650 AND published='1' LIMIT 1

117 (!!!!! 1043.0812835693): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754650 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754650 AND published='1' LIMIT 1

118 (169.03877258301): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754650 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754650 AND published='1' LIMIT 1

119 (!!!!! 1116.9910430908): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754650 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754650 AND published='1' LIMIT 1

120 (73.909759521484): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754650 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754650 AND published='1' LIMIT 1

121 (!!!!! 1357.0785522461): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754650 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754650 AND published='1' LIMIT 1

122 (256.06155395508): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754650 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754650 AND published='1' LIMIT 1

123 (!!!!! 2048.0155944824): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

124 (!!!!! 58156.967163086): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

125 (!!!!! 1286.0298156738): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294754650 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294754650 AND type='deeppockets_item' AND published='1' LIMIT 1

126 (!!!!! 24030.923843384): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (68.187713623047): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

128 (902.89115905762): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

129 (251.05476379395): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

130 (365.9725189209): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (273.22769165039): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

132 (360.96572875977): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

133 (750.06484985352): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

134 (617.02728271484): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

135 (43.869018554688): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

136 (!!!!! 1055.0022125244): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754650 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (820.87516784668): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754650 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (190.01960754395): SELECT name FROM jos_deeppockets WHERE id=211

139 (32.901763916016): SELECT name FROM jos_deeppockets WHERE id=211

140 (633.00132751465): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (!!!!! 1071.9299316406): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

142 (799.17907714844): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754650 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754650 AND published='1' LIMIT 1

143 (115.15617370605): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754650 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754650 AND published='1' LIMIT 1

144 (!!!!! 19607.067108154): TRUNCATE TABLE jos_trademed_module

145 (!!!!! 6949.9015808105): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294754650 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 3862.1425628662): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294754650 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (988.96026611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754650 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (361.20414733887): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754650 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (!!!!! 1174.9267578125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754650 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754650 AND published='1' LIMIT 1

150 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754650 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754650 AND published='1' LIMIT 1

151 (!!!!! 2648.1151580811): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

152 (385.04600524902): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754650 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754650 AND published='1' LIMIT 1

153 (496.14906311035): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754650 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754650 AND published='1' LIMIT 1

154 (385.99967956543): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294754650 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294754650 AND type='deeppockets_item' AND published='1' LIMIT 1

155 (983.95347595215): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

156 (39.100646972656): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

157 (840.90232849121): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

158 (947.95227050781): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754650 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754650 AND published='1' LIMIT 1

159 (58.174133300781): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754650 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754650 AND published='1' LIMIT 1

160 (!!!!! 7761.9552612305): select jos_twitters.link from jos_twitters where cat=10

161 (!!!!! 7263.18359375): select jos_facebook.link from jos_facebook where cat=10

162 (!!!!! 4938.1256103516): select jos_google_plus.link from jos_google_plus where cat=10

163 (!!!!! 1056.1943054199): select jos_linkedin.link from jos_linkedin where cat=10

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