1
|
Oyama R, Endo M, Shimada E, Matsunobu T, Setsu N, Ishihara S, Kanahori M, Kawaguchi K, Hirose T, Nabeshima A, Fujiwara T, Yoshimoto M, Maekawa A, Hanada M, Yokoyama N, Matsumoto Y, Nakashima Y. Impact of COVID-19 pandemic on bone and soft tissue sarcoma patients' consultation and diagnosis. Sci Rep 2024; 14:20627. [PMID: 39232087 PMCID: PMC11374780 DOI: 10.1038/s41598-024-71830-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 08/30/2024] [Indexed: 09/06/2024] Open
Abstract
The coronavirus disease (COVID-19) pandemic negatively affected the diagnosis and treatment of several cancer types. However, this pandemic's exact impact and extent on bone and soft tissue sarcomas need to be clarified. We aimed to investigate the effect of the COVID-19 pandemic and emergency declaration by the local government on consultation behavior and clinical stage at diagnosis of bone and soft tissue sarcoma. A total of 403 patients diagnosed with bone and soft tissue sarcoma who initially visited three sarcoma treatment hospitals between January 2018 and December 2021 were included. The monthly number of newly diagnosed soft tissue sarcoma patients was reduced by 25%, and the proportion of soft tissue patients with stage IV disease at diagnosis significantly increased by 9% during the COVID-19 pandemic compared to before the COVID-19 pandemic. Furthermore, the monthly number of new primary bone and soft tissue sarcoma patients significantly decreased by 43% during the state of emergency declaration. The COVID-19 pandemic had a negative impact on soft tissue sarcoma patients' consultation behavior and increased the proportion of advanced-stage patients at initial diagnosis. An emergency declaration by the local government also negatively affected primary bone and soft tissue sarcoma patients' consultation behavior.
Collapse
Affiliation(s)
- Ryunosuke Oyama
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Makoto Endo
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Eijiro Shimada
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Tomoya Matsunobu
- Department of Orthopaedic Surgery, Kyushu Rosai Hospital, Fukuoka, Japan
| | - Nokitaka Setsu
- Department of Orthopaedic Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Shin Ishihara
- Department of Orthopaedic Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Masaya Kanahori
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kengo Kawaguchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Takeshi Hirose
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Akira Nabeshima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Toshifumi Fujiwara
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Masato Yoshimoto
- Department of Orthopaedic Surgery, Kyushu Rosai Hospital, Fukuoka, Japan
| | - Akira Maekawa
- Department of Orthopaedic Surgery, Kyushu Rosai Hospital, Fukuoka, Japan
| | - Masuo Hanada
- Department of Orthopaedic Surgery, Kyushu Rosai Hospital, Fukuoka, Japan
| | - Nobuhiko Yokoyama
- Department of Orthopaedic Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Yoshihiro Matsumoto
- Department of Orthopaedic Surgery, Fukushima Medical University, Fukushima, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| |
Collapse
|
2
|
Anderson AB, Kim E, Park AB, Zhu K, Lin J, Shriver CD, Potter BK. Bone Sarcoma Survival in the US Military Health System: Comparison With the SEER Program. J Am Acad Orthop Surg 2024; 32:e651-e660. [PMID: 38684126 DOI: 10.5435/jaaos-d-23-00897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 12/25/2023] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Access to care is associated with cancer survival. The US Military Health System (MHS) provides universal health care to all beneficiaries. However, it is unknown whether survival among patients with bone sarcoma in a health system providing universal care is better than that in the general population. The aim of the study was to compare survival of patients with bone sarcoma in the US MHS with that of the US general population. METHODS The MHS data were obtained from the Department of Defense Automated Central Tumor Registry (ACTUR). The US general population data were obtained from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry. Adult patients were defined as those aged 25 years or older with a histologically confirmed musculoskeletal bone sarcoma diagnosed from January 1, 1987, to December 31, 2013. Kaplan-Meier survival curves and multivariable Cox proportional hazards models were used to compare the overall survival of the two populations. RESULTS The final analysis included 2,273 bone sarcoma cases from ACTUR and 9,092 bone sarcoma cases from SEER. ACTUR patients had significant lower 5-year all-cause death (hazard ratio = 0.72; 95% CI, 0.66 to 0.78) after adjustment for the potential confounders. ACTUR patients with bone sarcoma also exhibited significantly lower risk of all-cause death during the entire follow-up period than the SEER patients (hazard ratio = 0.75; 95% CI, 0.6 to 0.81). CONCLUSIONS MHS beneficiaries with bone sarcoma may have longer survival than SEER patients. Our findings support the role of universal access to high-quality care in improving bone sarcoma outcomes.
Collapse
Affiliation(s)
- Ashley B Anderson
- From the Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD (Anderson, Kim, Zhu, Lin, Shriver, and Potter), Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD (Park, Zhu, and Lin), John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD (Zhu, Lin, and Shriver), and the Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD (Zhu and Lin)
| | | | | | | | | | | | | |
Collapse
|
3
|
Tupper CJ, Reeson EA, Burdyny MR, Eaton VP, Silberstein PT. Extent of Surgery and Survival of Osteosarcoma: A Retrospective Population-Based Study. Cureus 2024; 16:e56030. [PMID: 38606239 PMCID: PMC11008610 DOI: 10.7759/cureus.56030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2024] [Indexed: 04/13/2024] Open
Abstract
Background Osteosarcoma (OSC) is the most common primary bone tumor and is often managed surgically. Few prior investigations have assessed differences in OSC survival by specific surgical techniques at a national registry level. We sought to compare survival based on surgical subtypes for OSC patients in the Surveillance, Epidemiology, and End Results (SEER) database. Methodology We searched the SEER database for malignant OSCs diagnosed between 2000 and 2019 which were surgically managed. Separate survival comparisons were made for one and five years for wide excision (local tumor destruction or resection versus partial resection) and radical excision (radical resection with limb-sparing versus limb amputation with or without girdle resection). Results A total of 4,303 patients were included, of whom 3,587 were surgically managed. There were no survival differences between local destruction and partial resection (hazard ratio = 0.826, p = 0.303). However, younger age, lower staging, and management without radiation were associated with improved survival. The radical excision comparison showed limb amputation was associated with worse survival than limb-sparing surgery (hazard ratio = 1.531, p < 0.001). Younger age, female sex, lower stage, receipt of chemotherapy, and neoadjuvant plus adjuvant chemotherapy were associated with improved survival while Black and American Indian or Alaska Native were associated with worse survival. Conclusions Our findings show that patients managed with limb-sparing radical resection survived significantly compared to limb amputation. There were no differences in survival for wide excision surgeries. The use of a combination of neoadjuvant and adjuvant chemotherapy also yields improved survival. OSC survival may be optimized with limb-sparing surgery with a combination of neoadjuvant and adjuvant chemotherapy.
Collapse
Affiliation(s)
- Connor J Tupper
- Department of Orthopaedics, Creighton University School of Medicine, St. Joseph's Hospital and Medical Center, Phoenix, USA
| | - Emily A Reeson
- Department of Orthopaedics, Creighton University School of Medicine, St. Joseph's Hospital and Medical Center, Phoenix, USA
| | - Michael R Burdyny
- Department of Orthopaedics, Creighton University School of Medicine, Omaha, USA
| | - Vincent P Eaton
- Department of Orthopaedics, Creighton University School of Medicine, Omaha, USA
| | - Peter T Silberstein
- Department of Hematology and Oncology, Creighton University School of Medicine, Omaha, USA
| |
Collapse
|
4
|
Wang JC, Liu KC, Gettleman BS, Piple AS, Chen MS, Menendez LR, Heckmann ND, Christ AB. Medicare Advantage in Soft Tissue Sarcoma May Be Associated with Worse Patient Outcomes. J Clin Med 2023; 12:5122. [PMID: 37568523 PMCID: PMC10420157 DOI: 10.3390/jcm12155122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/16/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Medicare Advantage healthcare plans may present undue impediments that result in disparities in patient outcomes. This study aims to compare the outcomes of patients who underwent STS resection based on enrollment in either traditional Medicare (TM) or Medicare Advantage (MA) plans. The Premier Healthcare Database was utilized to identify all patients ≥65 years old who underwent surgery for resection of a lower-extremity STS from 2015 to 2021. These patients were then subdivided based on their Medicare enrollment status (i.e., TM or MA). Patient characteristics, hospital factors, and comorbidities were recorded for each cohort. Bivariable analysis was performed to assess the 90-day risk of postoperative complications. Multivariable analysis controlling for patient sex, as well as demographic and hospital factors found to be significantly different between the cohorts, was also performed. From 2015 to 2021, 1858 patients underwent resection of STS. Of these, 595 (32.0%) had MA coverage and 1048 (56.4%) had TM coverage. The only comorbidities with a significant difference between the cohorts were peripheral vascular disease (p = 0.027) and hypothyroidism (p = 0.022), both with greater frequency in MA patients. After controlling for confounders, MA trended towards having significantly higher odds of pulmonary embolism (adjusted odds ratio (aOR): 1.98, 95% confidence interval (95%-CI): 0.58-6.79), stroke (aOR: 1.14, 95%-CI: 0.20-6.31), surgical site infection (aOR: 1.59, 95%-CI: 0.75-3.37), and 90-day in-hospital death (aOR 1.38, 95%-CI: 0.60-3.19). Overall, statistically significant differences in postoperative outcomes were not achieved in this study. The authors of this study hypothesize that this may be due to study underpowering or the inability to control for other oncologic factors not available in the Premier database. Further research with higher power, such as through multi-institutional collaboration, is warranted to better assess if there truly are no differences in outcomes by Medicare subtype for this patient population.
Collapse
Affiliation(s)
- Jennifer C. Wang
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033, USA (K.C.L.); (M.S.C.)
| | - Kevin C. Liu
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033, USA (K.C.L.); (M.S.C.)
| | - Brandon S. Gettleman
- Department of Orthopaedic Surgery, University of South Carolina School of Medicine, Columbia, SC 29209, USA;
| | - Amit S. Piple
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033, USA (K.C.L.); (M.S.C.)
| | - Matthew S. Chen
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033, USA (K.C.L.); (M.S.C.)
| | - Lawrence R. Menendez
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033, USA (K.C.L.); (M.S.C.)
| | - Nathanael D. Heckmann
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033, USA (K.C.L.); (M.S.C.)
| | - Alexander B. Christ
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033, USA (K.C.L.); (M.S.C.)
| |
Collapse
|
5
|
Yeo S, Lee U, Xu YH, Simmons C, Smrke A, Wang Y. Survival Outcomes of Ewing Sarcoma and Rhabdomyosarcoma by High- versus Low-Volume Cancer Centres in British Columbia, Canada. Diagnostics (Basel) 2023; 13:diagnostics13111973. [PMID: 37296824 DOI: 10.3390/diagnostics13111973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/19/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Due to the rarity and complexity of treatment for Ewing sarcoma and rhabdomyosarcoma, studies demonstrate improved patient outcomes when managed by a multidisciplinary team at high-volume centres (HVCs). Our study explores the difference in outcomes of Ewing sarcoma and rhabdomyosarcoma patients based on the centre of initial consultation in British Columbia, Canada. This retrospective study assessed adults diagnosed with Ewing sarcoma and rhabdomyosarcoma between 1 January 2000 and 31 December 2020 undergoing curative intent therapy in one of five cancer centres across the province. Seventy-seven patients were included, 46 seen at HVCs and 31 at low-volume centres (LVCs). Patients at HVCs were younger (32.1 vs. 40.8 years, p = 0.020) and more likely to receive curative intent radiation (88% vs. 67%, p = 0.047). The time from diagnosis to first chemotherapy was 24 days shorter at HVCs (26 vs. 50 days, p = 0.120). There was no significant difference in overall survival by treatment centre (HR 0.850, 95% CI 0.448-1.614). Variations in care exist amongst patients treated at HVCs vs. LVCs, which may reflect differences in access to resources, clinical specialists, and varying practice patterns across centres. This study can be used to inform decisions regarding triaging and centralization of Ewing sarcoma and rhabdomyosarcoma patient treatment.
Collapse
Affiliation(s)
- Sarah Yeo
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Ursula Lee
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- BC Cancer Surrey, Surrey, BC V3V 1Z2, Canada
| | - Ying Hui Xu
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Christine Simmons
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- BC Cancer Vancouver, Vancouver, BC V5Z 4E6, Canada
| | - Alannah Smrke
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- BC Cancer Vancouver, Vancouver, BC V5Z 4E6, Canada
| | - Ying Wang
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- BC Cancer Vancouver, Vancouver, BC V5Z 4E6, Canada
| |
Collapse
|
6
|
Lawrenz JM, Vega JF, George J, Curtis GL, Gordon J, Maggiotto A, Tullio K, Shepard DR, Reith JD, Schwartz HS, Nystrom LM, Mesko NW. Accuracy of Time to Treatment Initiation Data in Musculoskeletal Soft Tissue Sarcoma. Sarcoma 2023; 2023:9022770. [PMID: 37261268 PMCID: PMC10229237 DOI: 10.1155/2023/9022770] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/15/2023] [Accepted: 05/16/2023] [Indexed: 06/02/2023] Open
Abstract
Background Time to treatment initiation (TTI) is a quality metric in cancer care. The purpose of this study is to determine the accuracy of TTI data from a single cancer center registry that reports to the National Cancer Database (NCDB) for sarcoma diagnoses. Methods A retrospective analysis of a single Commission on Cancer (CoC)-accredited cancer center's tumor registry between 2006 and 2016 identified 402 patients who underwent treatment of a musculoskeletal soft tissue sarcoma and had TTI data available. Registry-reported TTI was extracted from the tumor registry. Effective TTI was manually calculated by medical record review as the number of days from the date of tissue diagnosis to initiation of first effective treatment. Effective treatment was defined as oncologic surgical excision or initiation of radiation therapy or chemotherapy. Registry-reported TTI and effective TTI values were compared for concordance in all patients. Results In the entire cohort, 25% (99/402) of patients had TTI data discordance, all related to surgical treatment definition. For patients with a registry-reported value of TTI = 0 days, 74% (87/118) had a diagnostic surgical procedure coded as their first treatment event, with 73 unplanned incomplete excision procedures and 14 incisional biopsies. In these patients, effective TTI was on average 59 days (P < 0.001). For patients with a registry-reported value of TTI >0 days, only 4% (12/284) had discordant TTI values. Conclusions Nearly three-fourths of patients with a registry-reported value of TTI = 0 days in a large, CoC-accredited cancer center registry had a diagnostic procedure coded as their first treatment event, though their effective treatment had not yet started. These data suggest that TTI is likely longer than what is reported to the NCDB. Redefinition of what constitutes surgical treatment should be considered to improve the accuracy of data used in measuring TTI in sarcoma.
Collapse
Affiliation(s)
- Joshua M. Lawrenz
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Jose F. Vega
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Jaiben George
- Department of Orthopaedic Surgery, AIIMS Hospital, New Delhi, India
| | - Gannon L. Curtis
- Department of Urology, University Health Center, Wayne State University, Detroit, MI 48201, USA
| | - Jaymeson Gordon
- Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Amanda Maggiotto
- Taussig Cancer Center, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Katherine Tullio
- Taussig Cancer Center, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Dale R. Shepard
- Taussig Cancer Center, Cleveland Clinic, Cleveland, OH 44195, USA
| | - John D. Reith
- Department of Pathology, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Herbert S. Schwartz
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Lukas M. Nystrom
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Nathan W. Mesko
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH 44195, USA
| |
Collapse
|
7
|
Ryu JH, Rahman J, Deo S, Flint M. Effects of time to treatment initiation on outcomes for soft tissue sarcomas. J Surg Oncol 2023; 127:1174-1186. [PMID: 36939055 DOI: 10.1002/jso.27237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/01/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND AND OBJECTIVES Few studies have investigated the effects of time to treatment initiation (TTI) for soft tissue sarcomas (STS). Our objective was to investigate the risk factors for prolonged TTI and the effects of prolonged TTI on local recurrence free survival (LRFS), distant metastasis free survival (DMFS), and disease specific survival (DSS). METHOD Patients diagnosed with high-grade STS of the extremities and trunk from 2011 to 2020 were included. TTI was grouped into two groups (treatment provided in less than vs. more than or equal to 30 days). Two-year and 5-year survival probabilities were calculated for LRFS, DMFS, and DSS. Cox regression and Kruskal-Wallis tests in univariate analysis were conducted to find risk factors affecting TTI and the survival outcomes. RESULTS In the univariate analysis, diagnosis in the later 5-year period of the study, tumor size, and treatment modality were associated with prolonged TTI. TTI ≥30 days was associated with higher DMFS but no association was found with LRFS or DSS. Tumor size, surgical margins, and provision of surgery were associated with DSS. CONCLUSION Despite the delay in treatment for STS patients caused by the COVID-19 pandemic, our study showed TTI of more than 30 days does not negatively impact patients.
Collapse
Affiliation(s)
- Jae Hong Ryu
- Department of Orthopaedic Surgery, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand
| | - Juma Rahman
- Research and Evaluation Office, Counties Manukau Health, Auckland, New Zealand
| | - Shaneel Deo
- Department of Orthopaedic Surgery, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand
| | - Michael Flint
- Department of Orthopaedic Surgery, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand
| |
Collapse
|
8
|
Lawrenz JM, Johnson SR, Hajdu KS, Chi A, Bendfeldt GA, Kang H, Halpern JL, Holt GE, Schwartz HS. Is the Number of National Database Research Studies in Musculoskeletal Sarcoma Increasing, and Are These Studies Reliable? Clin Orthop Relat Res 2023; 481:491-508. [PMID: 35767810 PMCID: PMC9928832 DOI: 10.1097/corr.0000000000002282] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/27/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Large national databases have become a common source of information on patterns of cancer care in the United States, particularly for low-incidence diseases such as sarcoma. Although aggregating information from many hospitals can achieve statistical power, this may come at a cost when complex variables must be abstracted from the medical record. There is a current lack of understanding of the frequency of use of the Surveillance, Epidemiology, and End Results (SEER) database and the National Cancer Database (NCDB) over the last two decades in musculoskeletal sarcoma research and whether their use tends to produce papers with conflicting findings. QUESTIONS/PURPOSES (1) Is the number of published studies using the SEER and NCDB databases in musculoskeletal sarcoma research increasing over time? (2) What are the author, journal, and content characteristics of these studies? (3) Do studies using the SEER and the NCDB databases for similar diagnoses and study questions report concordant or discordant key findings? (4) Are the administrative data reported by our institution to the SEER and the NCDB databases concordant with the data in our longitudinally maintained, physician-run orthopaedic oncology dataset? METHODS To answer our first three questions, PubMed was searched from 2001 through 2020 for all studies using the SEER or the NCDB databases to evaluate sarcoma. Studies were excluded from the review if they did not use these databases or studied anatomic locations other than the extremities, nonretroperitoneal pelvis, trunk, chest wall, or spine. To answer our first question, the number of SEER and NCDB studies were counted by year. The publication rate over the 20-year span was assessed with simple linear regression modeling. The difference in the mean number of studies between 5-year intervals (2001-2005, 2006-2010, 2011-2015, 2016-2020) was also assessed with Student t-tests. To answer our second question, we recorded and summarized descriptive data regarding author, journal, and content for these studies. To answer our third question, we grouped all studies by diagnosis, and then identified studies that shared the same diagnosis and a similar major study question with at least one other study. We then categorized study questions (and their associated studies) as having concordant findings, discordant findings, or mixed findings. Proportions of studies with concordant, discordant, or mixed findings were compared. To answer our fourth question, a coding audit was performed assessing the concordance of nationally reported administrative data from our institution with data from our longitudinally maintained, physician-run orthopaedic oncology dataset in a series of patients during the past 3 years. Our orthopaedic oncology dataset is maintained on a weekly basis by the senior author who manually records data directly from the medical record and sarcoma tumor board consensus notes; this dataset served as the gold standard for data comparison. We compared date of birth, surgery date, margin status, tumor size, clinical stage, and adjuvant treatment. RESULTS The number of musculoskeletal sarcoma studies using the SEER and the NCDB databases has steadily increased over time in a linear regression model (β = 2.51; p < 0.001). The mean number of studies per year more than tripled during 2016-2020 compared with 2011-2015 (39 versus 13 studies; mean difference 26 ± 11; p = 0.03). Of the 299 studies in total, 56% (168 of 299) have been published since 2018. Nineteen institutions published more than five studies, and the most studies from one institution was 13. Orthopaedic surgeons authored 35% (104 of 299) of studies, and medical oncology journals published 44% (130 of 299). Of the 94 studies (31% of total [94 of 299]) that shared a major study question with at least one other study, 35% (33 of 94) reported discordant key findings, 29% (27 of 94) reported mixed key findings, and 44% (41 of 94) reported concordant key findings. Both concordant and discordant groups included papers on prognostic factors, demographic factors, and treatment strategies. When we compared nationally reported administrative data from our institution with our orthopaedic oncology dataset, we found clinically important discrepancies in adjuvant treatment (19% [15 of 77]), tumor size (21% [16 of 77]), surgery date (23% [18 of 77]), surgical margins (38% [29 of 77]), and clinical stage (77% [59 of 77]). CONCLUSION Appropriate use of databases in musculoskeletal cancer research is essential to promote clear interpretation of findings, as almost two-thirds of studies we evaluated that asked similar study questions produced discordant or mixed key findings. Readers should be mindful of the differences in what each database seeks to convey because asking the same questions of different databases may result in different answers depending on what information each database captures. Likewise, differences in how studies determine which patients to include or exclude, how they handle missing data, and what they choose to emphasize may result in different messages getting drawn from large-database studies. Still, given the rarity and heterogeneity of sarcomas, these databases remain particularly useful in musculoskeletal cancer research for nationwide incidence estimations, risk factor/prognostic factor assessment, patient demographic and hospital-level variable assessment, patterns of care over time, and hypothesis generation for future prospective studies. LEVEL OF EVIDENCE Level III, therapeutic study.
Collapse
Affiliation(s)
- Joshua M. Lawrenz
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Samuel R. Johnson
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Katherine S. Hajdu
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrew Chi
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gabriel A. Bendfeldt
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hakmook Kang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jennifer L. Halpern
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ginger E. Holt
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Herbert S. Schwartz
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
9
|
Time-to-treatment initiation for cutaneous melanoma reflects disparities in healthcare access in Brazil: a retrospective study. Public Health 2022; 210:1-7. [PMID: 35863157 DOI: 10.1016/j.puhe.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 05/24/2022] [Accepted: 06/11/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES This study aimed at identifying the sociodemographic and first treatment characteristics affecting time-to-treatment initiation (TTI) of patients with cutaneous melanoma assisted by the Brazilian Unified Health System (SUS). STUDY DESIGN Retrospective observational study using cutaneous melanoma cases recorded in the Brazilian Hospital-Based Cancer Registries (HBCR). METHODS A total of 12,783 cutaneous melanoma cases were included in the analysis. Based on the legislation, TTI in Brazil is 60 days; therefore, the cohort was dichotomized into TTI within 60 days and over. The association among variables was evaluated through the Chi-squared test. Kaplan-Meier method and log-rank hypothesis test were used to determine the probability of initiating treatment within 60 days. Cox proportional hazards regression model was used for multivariate analysis. RESULTS Median TTI was 28 days (95% CI, 25-29). First treatment in SUS provided more than 60 days after diagnosis (34.8%) was associated with females; low level of formal education; living or getting treatment in northern Brazil; being diagnosed in SUS and treated at different healthcare facilities, in addition to starting treatment with radiotherapy or systemic therapy. There were no significant differences in access to health care before and after the enactment of the 60-day law. CONCLUSION Increased TTI for cutaneous melanoma is associated with sociodemographic and first treatment characteristics in Brazil; approximately one-third of cases did not have access to first treatment within the period established by law. Receiving the diagnosis and treatment at different healthcare facilities (transitions in care) is the main independent factor associated with TTI longer than 60 days.
Collapse
|
10
|
Arroyo-Hernández M, Casas-Ramos P, Saldaña-Díaz A, Mellado-Romero M, Puertas-García-Sandoval J, Ortiz-Cruz E. [Translated article] The computer application “SCAE” in the early diagnosis of musculoskeletal cancer in the healthcare area of the “Hospital Universitario 12 de Octubre”. Analysis of its effectiveness and proposals for improvement. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022. [DOI: 10.1016/j.recot.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
11
|
Anderson AB, Park AB, Zhu K, Lin J, Shriver CD, Potter BK. Soft-tissue Sarcoma Survival in the US Military Health System: Comparison With the SEER Program. J Am Acad Orthop Surg Glob Res Rev 2022; 6:e22.00122. [PMID: 35727910 PMCID: PMC10566816 DOI: 10.5435/jaaosglobal-d-22-00122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 04/28/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The US Military Health System (MHS) provides universal health care to beneficiaries. Few studies have evaluated the potential influence of access to universal care on survival outcomes for sarcoma. This study compared the survival of adult patients with soft-tissue sarcoma in the MHS with the US general population. METHODS MHS data were obtained from the Department of Defense Automated Central Tumor Registry (ACTUR). US population data were obtained from the National Cancer Institute's Surveillance, Epidemiology, and End Results registry. Patients who were 25 years or older with a histologically confirmed musculoskeletal soft-tissue sarcoma were matched based on age, sex, and race. Kaplan-Meier survival curves and Cox proportional hazards models were used to compare 5-year survival in the two groups. RESULTS Adult patients in ACTUR had markedly lower 5-year mortality for soft-tissue sarcomas (hazard ratio=0.82; 95% confidence interval, 0.73 to 0.92) after adjustment for potential confounders. Lower 5-year mortality was found in most demographic subgroups for ACTUR patients compared with Surveillance, Epidemiology, and End Results patients. CONCLUSION Five-year survival in the MHS compared with the US general population may suggest an important role of universal health care in improving the survival of patients with soft-tissue sarcoma.
Collapse
Affiliation(s)
- Ashley B. Anderson
- From the Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center (Dr. Anderson, Dr. Park, Dr. Zhu, Dr. Lin, Dr. Shriver, and Dr. Potter); the Henry M. Jackson Foundation for the Advancement of Military Medicine (Dr. Park, Dr. Zhu, and Dr. Lin); the John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center (Dr. Zhu, Dr. Lin, and Dr. Shriver); and the Department of Preventive Medicine and Biostatistics (Dr. Zhu and Dr. Lin), Uniformed Services University of the Health Sciences
| | - Amie B. Park
- From the Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center (Dr. Anderson, Dr. Park, Dr. Zhu, Dr. Lin, Dr. Shriver, and Dr. Potter); the Henry M. Jackson Foundation for the Advancement of Military Medicine (Dr. Park, Dr. Zhu, and Dr. Lin); the John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center (Dr. Zhu, Dr. Lin, and Dr. Shriver); and the Department of Preventive Medicine and Biostatistics (Dr. Zhu and Dr. Lin), Uniformed Services University of the Health Sciences
| | - Kangmin Zhu
- From the Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center (Dr. Anderson, Dr. Park, Dr. Zhu, Dr. Lin, Dr. Shriver, and Dr. Potter); the Henry M. Jackson Foundation for the Advancement of Military Medicine (Dr. Park, Dr. Zhu, and Dr. Lin); the John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center (Dr. Zhu, Dr. Lin, and Dr. Shriver); and the Department of Preventive Medicine and Biostatistics (Dr. Zhu and Dr. Lin), Uniformed Services University of the Health Sciences
| | - Jie Lin
- From the Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center (Dr. Anderson, Dr. Park, Dr. Zhu, Dr. Lin, Dr. Shriver, and Dr. Potter); the Henry M. Jackson Foundation for the Advancement of Military Medicine (Dr. Park, Dr. Zhu, and Dr. Lin); the John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center (Dr. Zhu, Dr. Lin, and Dr. Shriver); and the Department of Preventive Medicine and Biostatistics (Dr. Zhu and Dr. Lin), Uniformed Services University of the Health Sciences
| | - Craig D. Shriver
- From the Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center (Dr. Anderson, Dr. Park, Dr. Zhu, Dr. Lin, Dr. Shriver, and Dr. Potter); the Henry M. Jackson Foundation for the Advancement of Military Medicine (Dr. Park, Dr. Zhu, and Dr. Lin); the John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center (Dr. Zhu, Dr. Lin, and Dr. Shriver); and the Department of Preventive Medicine and Biostatistics (Dr. Zhu and Dr. Lin), Uniformed Services University of the Health Sciences
| | - Benjamin K. Potter
- From the Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center (Dr. Anderson, Dr. Park, Dr. Zhu, Dr. Lin, Dr. Shriver, and Dr. Potter); the Henry M. Jackson Foundation for the Advancement of Military Medicine (Dr. Park, Dr. Zhu, and Dr. Lin); the John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center (Dr. Zhu, Dr. Lin, and Dr. Shriver); and the Department of Preventive Medicine and Biostatistics (Dr. Zhu and Dr. Lin), Uniformed Services University of the Health Sciences
| |
Collapse
|
12
|
Lee L, Kazmer A, Colman MW, Gitelis S, Batus M, Blank AT. PET-CT staging affects time to treatment in sarcoma. Surg Oncol 2022; 41:101732. [DOI: 10.1016/j.suronc.2022.101732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/10/2022] [Accepted: 02/22/2022] [Indexed: 10/19/2022]
|
13
|
Clinical Impact of Systemic Staging Studies in Secondary Breast Angiosarcoma. SURGERY IN PRACTICE AND SCIENCE 2022. [DOI: 10.1016/j.sipas.2022.100081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
14
|
Roth M, Berkman A, Andersen CR, Cuglievan B, Andrew Livingston J, Hildebrandt M, Bleyer A. Improved Survival of Young Adults with Cancer Following the Passage of the Affordable Care Act. Oncologist 2022; 27:135-143. [PMID: 35641206 PMCID: PMC8895735 DOI: 10.1093/oncolo/oyab049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/05/2021] [Indexed: 12/04/2022] Open
Abstract
Background Compared with their ensured counterparts, uninsured adolescents and young adults (AYAs) with cancer are more likely to present with advanced disease and have poor prognoses. The Patient Protection and Affordable Care Act (ACA), enacted in 2010, provided health care coverage to millions of uninsured young adults by allowing them to remain on their parents’ insurance until age 26 years (the Dependent Care Expansion, DCE). The impact of the expansion of insurance coverage on survival outcomes for young adults with cancer has not been assessed. Participants Utilizing the Surveillance, Epidemiology, and End Results database, we identified all patients aged 12-16 (younger-AYAs), 19-23 (middle-AYAs), and 26-30 (older-AYAs) who were diagnosed with cancer between 2006-2008 (pre-ACA) and 2011-2013 (post-ACA). Methods In this population-based cohort study, we used an accelerated failure time model to assess changes in survival rates before and after the enactment of the ACA DCE. Results Middle-AYAs ages 19-23 (thus eligible to remain on their parents’ insurance) experienced significantly increased 2-year survival after the enactment of the ACA DCE (survival time ratio 1.25, 95% confidence interval: 0.75-2.43, P = .029) and that did not occur in younger-AYAs (ages 12-16). Patients with sarcoma and acute myeloid leukemia accounted for the majority of improvement in survival. Middle-AYAs of hispanic ethnicity and those with low socioeconomic status experienced trends of improved survival after the ACA DCE was enacted. Conclusion Survival outcomes improved for young adults with cancer following the expansion of health insurance coverage. Efforts are needed to expand coverage for the millions of young adults who do not have health insurance.
Collapse
Affiliation(s)
- Michael Roth
- Division of Pediatrics and Patient Care, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amy Berkman
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Clark R Andersen
- Division of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Branko Cuglievan
- Division of Pediatrics and Patient Care, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J Andrew Livingston
- Division of Pediatrics and Patient Care, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michelle Hildebrandt
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Archie Bleyer
- Department of Radiation Medicine, Oregon Health and Science University, Portland, OR, USA
- Department of Pediatrics, McGovern Medical School, University of Texas, TX, USA
| |
Collapse
|
15
|
Nigam A, Aminpour N, Zeymo A, Desale S, Villano AM, Unger KR, Aboulafia AJ, Al-Refaie WB. National evaluation of patterns and predictors of underuse of multimodal therapy for high-risk extremity soft tissue sarcoma. Surgery 2022; 171:1348-1357. [DOI: 10.1016/j.surg.2021.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 12/01/2022]
|
16
|
Socioeconomic factors associated with limb salvage versus amputation for adult extremity bone sarcomas in patients with insurance coverage. Surg Oncol 2021; 39:101664. [PMID: 34571448 DOI: 10.1016/j.suronc.2021.101664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/11/2021] [Accepted: 09/19/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Limb salvage (LS) has become the preferred treatment for adult patients with bone sarcoma of the extremities. The decision to perform LS versus an amputation is often dictated by tumor characteristics, however there may be socioeconomic factors associated with LS. Previously this has been linked to insurance status, however currently there is a paucity of data examining socioeconomic factors in patients with medical insurance at the time of sarcoma diagnosis. Therefore, the purpose of the current study was to examine socioeconomic factors which could be associated with the decision to perform LS versus amputation for adult bone sarcoma patients. METHODS Data from Optum Labs Data Warehouse, a national administrative claims database, was analyzed to identify patients with extremity bone sarcomas from 2006 to 2017. Bivariate regression was used to identify factors associated with LS versus amputation. RESULTS Of 1,390 (743 males, 647 female) patients, 252 (18%) under amputation while 1,138 (82%) underwent LS. Lower extremity tumors (OR 4.72, p < 0.001), income <$75,000 (OR 1.85, p = 0.03), being treated a public hospital (OR 1.41, p = 0.04) and a hospital with <200 beds (OR 1.90, p = 0.006) were associated with amputation. Income ≥$125,000 (OR 0.62, 0.04) were associated with LS. CONCLUSION In adult patients with medical insurance at the time of diagnosis, socioeconomic and hospital factors were associated with an amputation for bone sarcoma, with poorer patients, and those treated at smaller, and public hospitals more likely to undergo amputation.
Collapse
|
17
|
Errani C, Mavrogenis AF, Tsukamoto S. What's new in musculoskeletal oncology. BMC Musculoskelet Disord 2021; 22:704. [PMID: 34404379 PMCID: PMC8369444 DOI: 10.1186/s12891-021-04590-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 08/05/2021] [Indexed: 12/26/2022] Open
Abstract
We reviewed the recent literature related to primary musculoskeletal tumors and metastatic bone tumors. With regard to primary bone tumors, computer navigation systems and three-dimensional-printed prostheses seem to be new treatment options, especially in challenging anatomical locations, such as the sacrum and pelvis. Regarding the treatment of giant cell tumor of bone, recent studies have suggested that denosumab administration is related to a higher local recurrence rate following curettage, but a lower local recurrence rate following en bloc resection. In addition, there was no difference in the local recurrence rate at five years after surgery between short-term and long-term denosumab therapy. With regard to soft tissue tumors, percutaneous cryoablation appears to be a new treatment option for extra-abdominal desmoid tumors, with encouraging results. Regarding soft tissue sarcomas, a negative surgical margin of < 1 mm is sufficient to control local recurrence. Pexidartinib seems to be a promising systemic therapy for the treatment of tenosynovial giant cell tumors for which surgery is not expected to improve the function of the affected limb. Finally, the life expectancy of patients is the most important factor in determining the optimal surgical procedure for patients with impending or pathological fractures of the long bone due to metastatic bone tumors. Elevated C-reactive protein level was found to be an independent poor prognostic factor at 1 year after surgery for long bone metastases.
Collapse
Affiliation(s)
- Costantino Errani
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.
| | - Andreas F Mavrogenis
- First Department of Orthopedics, School of Medicine, National and Kapodistrian University of Athens, 41 Ventouri Street Holargos, 15562, Athens, Greece
| | - Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Nara, 634-8521, Kashihara-city, Japan
| |
Collapse
|
18
|
Arroyo Hernández M, Casas Ramos P, Saldaña Díaz A, Mellado Romero MA, Puertas García-Sandoval JP, Ortiz Cruz EJ. The computer application «SCAE» in the early diagnosis of musculoskeletal cancer in the healthcare area of the Hospital Universitario 12 de Octubre. Analysis of its effectiveness and proposals for improvement. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021; 66:290-297. [PMID: 34362701 DOI: 10.1016/j.recot.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/01/2021] [Accepted: 05/03/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The SCAE-SM (Request for an Appointment in Specialized Care-Suspicion of Malignancy) computer application is a tool available to Primary Care (PC) physicians for the referral of patients who should be evaluated by the specialist in a maximum period of 2 weeks when malignancy is suspected. The objective of our work was to analyze the usefulness of this tool and propose areas for improvement in the management of patients with suspected musculoskeletal malignancy. MATERIAL AND METHODS A descriptive cross-sectional study of 235 referrals received in the years 2012-2017 was carried out. Their origin, the information contained in the applications and the response provided by historical evaluators, without specific oncology training, were analyzed. For this study, a new blind assessment of all applications was carried out by 13 orthopedists with different levels of specific training in musculoskeletal oncology (re-evaluators). RESULTS Among all SCAE-SM, only 8.23% of patients had aggressive benign or malignant disease. The most successful re-evaluators in the adequacy of early appointment were those with moderate oncological training (5-10 years of experience). During the study, of all the patients treated in the Tumor Unit, only 18.81% accessed through the SCAE-SM circuit, with a mean waiting time of 18.11 days from the PC referral. CONCLUSIONS The SCAE-SM computer application as tool for improve the management and advance care for patients with malignant musculoskeletal tumor pathology is useful, although the use of the circuit is inadequate. It is necessary to disseminate and generalize it, as well as to implement basic oncology training programs both in the field of PC and Hospital.
Collapse
Affiliation(s)
| | - P Casas Ramos
- Complejo Asistencial Universitario de León, León, Castilla y León, España
| | - A Saldaña Díaz
- Hospital San Juan de Dios, León, Castilla y León, España
| | | | | | | |
Collapse
|
19
|
Bardet A, Fraslin AM, Marghadi J, Borget I, Faron M, Honoré C, Delaloge S, Albiges L, Planchard D, Ducreux M, Hadoux J, Colomba E, Robert C, Bouhir S, Massard C, Micol JB, Ter-Minassian L, Michiels S, Auperin A, Barlesi F, Bonastre J. Impact of COVID-19 on healthcare organisation and cancer outcomes. Eur J Cancer 2021; 153:123-132. [PMID: 34153714 PMCID: PMC8213441 DOI: 10.1016/j.ejca.2021.05.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Changes in the management of patients with cancer and delays in treatment delivery during the COVID-19 pandemic may impact the use of hospital resources and cancer mortality. PATIENTS AND METHODS Patient flows, patient pathways and use of hospital resources during the pandemic were simulated using a discrete event simulation model and patient-level data from a large French comprehensive cancer centre's discharge database, considering two scenarios of delays: massive return of patients from November 2020 (early-return) or March 2021 (late-return). Expected additional cancer deaths at 5 years and mortality rate were estimated using individual hazard ratios based on literature. RESULTS The number of patients requiring hospital care during the simulation period was 13,000. In both scenarios, 6-8% of patients were estimated to present a delay of >2 months. The overall additional cancer deaths at 5 years were estimated at 88 in early-return and 145 in late-return scenario, with increased additional deaths estimated for sarcomas, gynaecological, liver, head and neck, breast cancer and acute leukaemia. This represents a relative additional cancer mortality rate at 5 years of 4.4 and 6.8% for patients expected in year 2020, 0.5 and 1.3% in 2021 and 0.5 and 0.5% in 2022 for each scenario, respectively. CONCLUSIONS Pandemic-related diagnostic and treatment delays in patients with cancer are expected to impact patient survival. In the perspective of recurrent pandemics or alternative events requiring an intensive use of limited hospital resources, patients should be informed not to postpone care, and medical resources for patients with cancer should be sanctuarised.
Collapse
Affiliation(s)
- Aurelie Bardet
- Department of Biostatistics and Epidemiology, Gustave Roussy, Paris-Saclay University, Villejuif, France; Oncostat U1018, Inserm, Paris-Saclay University, Labeled Ligue Contre le Cancer, Villejuif, France.
| | - Alderic M Fraslin
- Department of Biostatistics and Epidemiology, Gustave Roussy, Paris-Saclay University, Villejuif, France; Oncostat U1018, Inserm, Paris-Saclay University, Labeled Ligue Contre le Cancer, Villejuif, France
| | - Jamila Marghadi
- Service of Medical Information, Gustave Roussy, Villejuif, France
| | - Isabelle Borget
- Department of Biostatistics and Epidemiology, Gustave Roussy, Paris-Saclay University, Villejuif, France; Oncostat U1018, Inserm, Paris-Saclay University, Labeled Ligue Contre le Cancer, Villejuif, France
| | - Matthieu Faron
- Department of Biostatistics and Epidemiology, Gustave Roussy, Paris-Saclay University, Villejuif, France; Oncostat U1018, Inserm, Paris-Saclay University, Labeled Ligue Contre le Cancer, Villejuif, France; Department of Surgical Oncology, Gustave Roussy, Villejuif, France
| | - Charles Honoré
- Department of Surgical Oncology, Gustave Roussy, Villejuif, France
| | - Suzette Delaloge
- Department of Cancer Medicine, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Laurence Albiges
- Department of Cancer Medicine, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - David Planchard
- Department of Cancer Medicine, Thoracic Oncology Unit, Gustave Roussy, Villejuif, France
| | - Michel Ducreux
- Department of Cancer Medicine, Gustave Roussy, Paris-Saclay University, Villejuif, France; INSERM U1279, Villejuif, France
| | - Julien Hadoux
- Department of Endocrinology, Imaging Department, Gustave Roussy, Villejuif, France
| | - Emeline Colomba
- Department of Cancer Medicine, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Caroline Robert
- Department of Cancer Medicine, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Samia Bouhir
- Department of Head and Neck Oncology, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Christophe Massard
- Department of Drug Development (DITEP), Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Jean-Baptiste Micol
- Department of Hematology, Gustave Roussy, Paris-Saclay University, Villejuif, France; INSERM U1287, Villejuif, France
| | | | - Stefan Michiels
- Department of Biostatistics and Epidemiology, Gustave Roussy, Paris-Saclay University, Villejuif, France; Oncostat U1018, Inserm, Paris-Saclay University, Labeled Ligue Contre le Cancer, Villejuif, France
| | - Anne Auperin
- Department of Biostatistics and Epidemiology, Gustave Roussy, Paris-Saclay University, Villejuif, France; Oncostat U1018, Inserm, Paris-Saclay University, Labeled Ligue Contre le Cancer, Villejuif, France
| | - Fabrice Barlesi
- Department of Cancer Medicine, Gustave Roussy, Paris-Saclay University, Villejuif, France; Aix Marseille University, CNRS, INSERM, CRCM, Marseille, France
| | - Julia Bonastre
- Department of Biostatistics and Epidemiology, Gustave Roussy, Paris-Saclay University, Villejuif, France; Oncostat U1018, Inserm, Paris-Saclay University, Labeled Ligue Contre le Cancer, Villejuif, France
| |
Collapse
|
20
|
Kellish AS, Hakim A, Shahi A, Gutowski CJ, Kleiner MT. The Delivery of Orthopaedic Care midst COVID-19 and Social Distancing. THE ARCHIVES OF BONE AND JOINT SURGERY 2021; 9:371-378. [PMID: 34423083 PMCID: PMC8359650 DOI: 10.22038/abjs.2020.48498.2406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 11/07/2020] [Indexed: 11/06/2022]
Abstract
In this paper we present the findings of a literature review covering articles published in the last three decades describing the application of telemedicine in orthopaedics. A review of the PubMed Central and Medline provided 75 articles studying the role of telemedicine, the majority directly examining the application of telemedicine in orthopaedic patients. We report the summarized findings of these studies, the financial and HIPAA considerations of using telemedicine, and provide an example of our single urban level-1 trauma center's strategy for incorporating telemedicine into the clinical practice of orthopaedic surgeons during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Alec S. Kellish
- Cooper Medical School of Rowan University, Camden New Jersey, USA
| | - Abraham Hakim
- Cooper Medical School of Rowan University, Camden New Jersey, USA
| | | | | | | |
Collapse
|
21
|
Ogura K, Fujiwara T, Healey JH. Patients with an increased time to treatment initiation have a poorer overall survival after definitive surgery for localized high-grade soft-tissue sarcoma in the extremity or trunk : report from the National Cancer Database. Bone Joint J 2021; 103-B:1142-1149. [PMID: 34058874 DOI: 10.1302/0301-620x.103b6.bjj-2020-2087.r1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Time to treatment initiation (TTI) is generally defined as the time from the histological diagnosis of malignancy to the initiation of first definitive treatment. There is no consensus on the impact of TTI on the overall survival in patients with a soft-tissue sarcoma. The purpose of this study was to determine if an increased TTI is associated with overall survival in patients with a soft-tissue sarcoma, and to identify the factors associated with a prolonged TTI. METHODS We identified 23,786 patients from the National Cancer Database who had undergone definitive surgery between 2004 and 2015 for a localized high-grade soft-tissue sarcoma of the limbs or trunk. A Cox proportional hazards model was used to examine the relationship between a number of factors and overall survival. We calculated the incidence rate ratio (IRR) using negative binomial regression models to identify the factors that affected TTI. RESULTS Patients in whom the time to treatment initiation was prolonged had poorer overall survival than those with a TTI of 0 to 30 days. These were: 31 to 60 days (hazard ratio (HR) 1.08, p = 0.011); 61 to 90 days (HR 1.11, p = 0.044); and 91 days (HR 1.22; p = 0.003). The restricted cubic spline showed that the hazard ratio increased substantially with a TTI longer than 50 days. Non-academic centres (vs academic centres; IRR ranging from 0.64 to 0.86; p < 0.001) had a shorter TTI. Those insured by Medicaid (vs private insurance; IRR 1.34), were uninsured (vs private insurance; IRR 1.17), or underwent a transition in care (IRR 1.62) had a longer TTI. CONCLUSION A time to treatment initiation of more than 30 days after diagnosis was independently associated with poorer survival. The hazard ratio showed linear increase, especially if the TTI was more than 50 days. We recommend starting treatment within 30 days of diagnosis to achieve the highest likelihood of cure for localized high-grade soft-tissue sarcomas in the limbs and trunk, even when a patient needs to be referred to a specialist centre. Cite this article: Bone Joint J 2021;103-B(6):1142-1149.
Collapse
Affiliation(s)
- Koichi Ogura
- Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tomohiro Fujiwara
- Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama City, Japan
| | - John H Healey
- Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Weill Cornell Medical College, New York, New York, USA
| |
Collapse
|
22
|
Smolle MA, van de Sande M, Hayes A, Bergovec M, Smith HG, Liegl-Atzwanger B, Tunn PU, Niethard M, Windhager R, Szkandera J, Leithner A. Comparison of the 7th and 8th version of the AJCC classification system for soft tissue sarcomas of extremities and trunk in patients with localised, intermediate or high-grade disease treated at European tertiary sarcoma centres. Eur J Surg Oncol 2021; 47:2182-2188. [PMID: 33865657 DOI: 10.1016/j.ejso.2021.03.252] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/16/2021] [Accepted: 03/24/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The updated 8th version of the AJCC-staging system for soft tissue sarcomas (STS) has been criticised for omitting tumour depth as category-defining variable and eventually not improving prognostic accuracy in comparison to the 7th version. This study aimed at investigating the prognostic accuracy of both AJCC-versions in STS-patients treated at European tertiary sarcoma centres. METHODS 1032 patients (mean age: 60.7 ± 16.3 years; 46.0% [n = 475] females; median follow-up: 38.6 months), treated at five tertiary sarcoma centres for localised, intermediate or high-grade STS of extremities and trunk were retrospectively included. Uni- and multivariate Cox-regression models and Harrell's C-indices were calculated to analyse prognostic factors for overall survival (OS) and assess prognostic accuracy. RESULTS In univariate analysis, prognostic accuracy for OS was comparable for both AJCC-versions (C-index: 0.620 [8th] vs. 0.614 [7th]). By adding margins, age, gender, and histology to the multivariate models, prognostic accuracy of both versions could be likewise improved (C-index: 0.714 [8th] vs. 0.705 [7th]). Moreover, tumour depth did not significantly contribute to prognostic accuracy of the 8th version's multivariate model (C-index for both models: 0.714). Stratification into four main T-stages based on tumour size only, as implemented in the 8th version, significantly improved prognostic accuracy between each category. However, T-stages as defined in the 7th version had poorer discriminatory power (C-index: 0.625 [8th] vs. 0.582 [7th]). CONCLUSION Both AJCC-versions perform equally well regarding prognostic accuracy. Yet, simplification of the 8 th version by omitting tumour depth as T-stage-defining parameter, whilst emphasizing the importance of tumour size, should be considered advantageous.
Collapse
Affiliation(s)
- Maria Anna Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Michiel van de Sande
- Department of Orthopaedic Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Andrew Hayes
- Department of Surgery, Royal Marsden Hospital NHS Foundation Trust, Fulham Road, SW3 6JJ, London, United Kingdom
| | - Marko Bergovec
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Henry G Smith
- Department of Surgery, Royal Marsden Hospital NHS Foundation Trust, Fulham Road, SW3 6JJ, London, United Kingdom
| | | | - Per-Ulf Tunn
- Sarcoma Centre, HELIOS-Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany
| | - Maya Niethard
- Sarcoma Centre, HELIOS-Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany
| | - Reinhard Windhager
- Department of Orthopaedics and Traumatology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Joanna Szkandera
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| |
Collapse
|
23
|
Byun DJ, Katz LM, Xiao J, Rapp TB, Paoluzzi L, Rosen G, Schiff PB. Modern Management of High-risk Soft Tissue Sarcoma With Neoadjuvant Chemoradiation: A Single-center Experience. Am J Clin Oncol 2021; 44:24-31. [PMID: 33086232 DOI: 10.1097/coc.0000000000000772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Neoadjuvant chemoradiation (NA-CRT), followed by resection of high-risk soft tissue sarcoma (STS), may offer good disease control and toxicity outcomes. We report on a single institution's modern NA-CRT experience. MATERIALS AND METHODS Delay to surgical resection, resection margin status, extent of necrosis, tumor cell viability, presence of hyalinization, positron emission tomography (PET)/computed tomography data, and treatment toxicities were collected. Using the Kaplan-Meier survival analysis, 5-year overall survival, disease-free survival, distant metastasis-free survival, and local control (LC) were estimated. Clinicopathologic features and PET/computed tomography avidity changes were assessed for their potential predictive impact using the log-rank test. RESULTS From 2011 to 2018, 37 consecutive cases of localized high-risk STS were identified. Twenty-nine patients underwent ifosfamide-based NA-CRT to a median dose of 50 Gy before en bloc resection. At a median follow-up of 40.3 months, estimated 5-year overall survival was 86.1%, disease-free survival 70.2%, distant metastasis-free survival 75.2%, and LC 86.7%. Following NA-CRT, a median reduction of 54.7% was observed in tumor PET avidity; once resected, median tumor necrosis of 60.0% with no viable tumor cells was detected in 13.8% of the cases. Posttreatment resection margins were negative in all patients, with 27.6% having a margin of ≤1 mm. Delays of over 6 weeks following the end of radiation treatment to surgical resection occurred in 20.7% cases and was suggestive of inferior LC (92.8% vs. 68.6%, P=0.025). CONCLUSIONS This single-institution series of NA-CRT demonstrates favorable disease control. Delay in surgical resection was associated with inferior LC, a finding that deserves further evaluation in a larger cohort. LEVEL OF EVIDENCE Level III-retrospective cohort study.
Collapse
Affiliation(s)
| | | | | | | | - Luca Paoluzzi
- Medicine, NYU Langone Health and Grossman School of Medicine, New York, NY
| | - Gerald Rosen
- Medicine, NYU Langone Health and Grossman School of Medicine, New York, NY
| | | |
Collapse
|
24
|
Affiliation(s)
- Peter S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
25
|
CORR Insights®: Does Advanced Imaging Have a Role in Detecting Local Recurrence of Soft-tissue Sarcoma? Clin Orthop Relat Res 2020; 478:2821-2822. [PMID: 32568890 PMCID: PMC7899389 DOI: 10.1097/corr.0000000000001375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
26
|
Wellings EP, Wagner ER, Wilke BK, Asante D, Sangaralingham LR, Rose PS, Moran SL, Houdek MT. What are the predictors of emergency department utilization and readmission following extremity bone sarcoma resection? J Surg Oncol 2020; 122:1356-1363. [PMID: 32794224 DOI: 10.1002/jso.26173] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/18/2020] [Accepted: 08/05/2020] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Treatment for bone sarcomas are large undertakings. Emergency department (ED) visits and unplanned hospital readmissions are a potential target for cost containment. The purpose of this study was to evaluate the risk factors for ED visits and unplanned readmissions following extremity bone sarcoma surgery. METHODS Data from Optum Labs Data Warehouse, a national administrative claims database, was analyzed to identify patients with extremity bone sarcomas from 2006 to 2017. Multivariable logistic regression was used to identify factors associated with ED visits and readmissions. RESULTS Of 1390 (743 males, 647 female) adult patients, 137 (12%) visited the ED and 245 (18%) were readmitted within 30 days of discharge. The most common indication for ED visits (n = 63, 45.9%) and readmission (n = 119, 48.5%) were complications of surgery. Length of stay >10 days was associated with ED utilization (OR, 1.83; P = .01) and readmission (OR, 4.47; P < .001). CONCLUSION One in ten patients will use the ED, and one in five patients will be readmitted to the hospital within 30 days of discharge following extremity bone sarcoma surgery. Length of stay was associated with ED visits and readmission. These patients could be targeted with alternative management strategies in the outpatient setting with early clinical follow-up to minimize readmission.
Collapse
Affiliation(s)
| | - Eric R Wagner
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.,Department of Orthopedic Surgery, Emory University, Atlanta, Georgia
| | - Benjamin K Wilke
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Dennis Asante
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.,OptumLabs, Cambridge, Massachusetts
| | - Lindsey R Sangaralingham
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.,OptumLabs, Cambridge, Massachusetts
| | - Peter S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Steven L Moran
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
| | - Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
27
|
Garcia D, Siegel JB, Mahvi DA, Zhang B, Mahvi DM, Camp ER, Graybill W, Savage SJ, Giordano A, Giordano S, Carneiro-Pla D, Javid M, Lesher AP, Abbott A, DeMore NK. What is Elective Oncologic Surgery in the Time of COVID-19? A Literature Review of the Impact of Surgical Delays on Outcomes in Patients with Cancer. ACTA ACUST UNITED AC 2020; 3:1-11. [PMID: 34142081 PMCID: PMC8208646 DOI: 10.31487/j.cor.2020.06.05] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background The impact of the COVID-19 pandemic has spread beyond those infected with SARS-CoV-2. Its widespread consequences have affected cancer patients whose surgeries may be delayed in order to minimize exposure and conserve resources. Methods Experts in each surgical oncology subspecialty were selected to perform a review of the relevant literature. Articles were obtained through PubMed searches in each cancer subtype using the following terms: delay to surgery, time to surgery, outcomes, and survival. Results Delays in surgery > 4 weeks in breast cancer, ductal carcinoma in situ, T1 pancreatic cancer, ovarian cancer, and pediatric osteosarcoma, negatively impacted survival. Studies on hepatocellular cancer, colon cancer, and melanoma (Stage I) demonstrated reduced survival with delays > 3 months. Conclusion Studies have shown that short-term surgical delays can result in negative impacts on patient outcomes in multiple cancer types as well as in situ carcinoma. Conversely, other cancers such as gastric cancer, advanced melanoma and pancreatic cancer, well-differentiated thyroid cancer, and several genitourinary cancers demonstrated no significant outcome differences with surgical delays.
Collapse
Affiliation(s)
- Denise Garcia
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Julie B Siegel
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - David A Mahvi
- Department of Surgery, Brigham and Women's Hospital, Boston, Boston, Massachusetts, USA
| | - Biqi Zhang
- Department of Surgery, Brigham and Women's Hospital, Boston, Boston, Massachusetts, USA
| | - David M Mahvi
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - E Ramsay Camp
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Whitney Graybill
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Stephen J Savage
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Antonio Giordano
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sara Giordano
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Denise Carneiro-Pla
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, Boston, Massachusetts, USA.,Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina, USA.,Department of Urology, Medical University of South Carolina, Charleston, South Carolina, USA.,Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mahsa Javid
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Aaron P Lesher
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Andrea Abbott
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nancy Klauber DeMore
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| |
Collapse
|
28
|
Time to Treatment Initiation and Survival in Adult Localized High-Grade Bone Sarcoma. Sarcoma 2020; 2020:2984043. [PMID: 32454786 PMCID: PMC7222487 DOI: 10.1155/2020/2984043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 04/15/2020] [Indexed: 12/26/2022] Open
Abstract
Objective Few studies have evaluated the prognostic implication of the length of time from diagnosis to treatment initiation in bone sarcoma. The purpose of this study is to determine if time to treatment initiation (TTI) influences overall survival in adults diagnosed with primary bone sarcoma. Methods A retrospective analysis of the National Cancer Database identified 2,122 patients who met inclusion criteria with localized, high-grade bone sarcoma diagnosed between 2004 and 2012. TTI was defined as length of time in days from diagnosis to initiation of treatment. Patient, disease-specific, and healthcare-related factors were also assessed for their association with overall survival. Kruskal-Wallis analysis was utilized for univariate analysis, and Cox regression modeling identified covariates associated with overall survival. Results Any 10-day increase in TTI was not associated with decreased overall survival (hazard ratio (HR) = 1.00; P=0.72). No differences in survival were detected at 1 year, 5 years, and 10 years, when comparing patients with TTI = 14, 30, 60, 90, and 150 days. Decreased survival was significantly associated (P < 0.05) with patient ages of 51–70 years (HR = 1.66; P=0.004) and > 71 years (HR = 2.89; P < 0.001), Charlson/Deyo score ≥2 (HR = 2.02; P < 0.001), pelvic tumor site (HR = 1.58; P < 0.001), tumor size >8 cm (HR = 1.52; P < 0.001), radiation (HR = 1.81; P < 0.001) as index treatment, and residing a distance of 51–100 miles from the treatment center (HR = 1.30; P=0.012). Increased survival was significantly associated (P < 0.05) with chordoma (HR = 0.27; P=0.010), chondrosarcoma (HR = 0.75; P=0.002), treatment at an academic center (HR = 0.64; P=0.039), and a private (HR = 0.67; P=0.006) or Medicare (HR = 0.71; P=0.043) insurer. A transition in care was not associated with a survival disadvantage (HR = 0.90; P=0.14). Conclusions Longer TTI was not associated with decreased overall survival in localized, high-grade primary bone sarcoma in adults. This is important in counseling patients, who may delay treatment to receive a second opinion or seek referral to a higher volume sarcoma center.
Collapse
|