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Mullins MA, Uppal S, Ruterbusch JJ, Cote ML, Clarke P, Wallner LP. Physician Influence on Variation in Receipt of Aggressive End-of-Life Care Among Women Dying of Ovarian Cancer. JCO Oncol Pract 2022; 18:e293-e303. [PMID: 34582262 PMCID: PMC8932499 DOI: 10.1200/op.21.00351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/02/2021] [Accepted: 09/01/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE End-of-life care for women with ovarian cancer is persistently aggressive, but factors associated with overuse are not well understood. We evaluated physician-level variation in receipt of aggressive end-of-life care and examined physician-level factors contributing to this variation in the SEER-Medicare data set. METHODS Medicare beneficiaries with ovarian cancer who died between 2000 and 2016 were included if they were diagnosed after age 66 years, had complete Medicare coverage between diagnosis and death, and had outpatient physician evaluation and management for their ovarian cancer. Using multilevel logistic regression, we examined physician variation in no hospice enrollment, late hospice enrollment (≤ 3 days), > 1 emergency department visit, an intensive care unit stay, terminal hospitalization, > 1 hospitalization, receiving a life-extending or invasive procedure, and chemotherapy (in the last 2 weeks). RESULTS In this sample of 6,288 women, 51% of women received at least one form of aggressive end-of-life care. Most common were no hospice enrollment (28.9%), an intensive care unit stay (18.6%), and receipt of an invasive procedure (20.7%). For not enrolling in hospice, 9.9% of variation was accounted for by physician clustering (P < .01). Chemotherapy had the highest physician variation (12.4%), with no meaningful portion of the variation explained by physician specialty, volume, region, or patient characteristics. CONCLUSION In this study, a meaningful amount of variation in aggressive end-of-life care among women dying of ovarian cancer was at the physician level, suggesting that efforts to improve the quality of this care should include interventions aimed at physician practices and decision making in end-of-life care.
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Affiliation(s)
- Megan A. Mullins
- Center for Improving Patient and Population Health and Rogel Cancer Center, University of Michigan, Ann Arbor, MI
| | - Shitanshu Uppal
- Department of Gynecologic Oncology, University of Michigan, Ann Arbor, MI
| | - Julie J. Ruterbusch
- Wayne State University School of Medicine and Karmanos Cancer Institute, Detroit, MI
| | - Michele L. Cote
- Wayne State University School of Medicine and Karmanos Cancer Institute, Detroit, MI
| | - Philippa Clarke
- Department of Epidemiology and Institute for Social Research, University of Michigan, Ann Arbor, MI
| | - Lauren P. Wallner
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
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Assessment of Travel Distance for Hyperthermic Intraperitoneal Chemotherapy in Women with Ovarian Cancer. Gynecol Oncol Rep 2022; 40:100951. [PMID: 35392128 PMCID: PMC8980495 DOI: 10.1016/j.gore.2022.100951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 11/24/2022] Open
Abstract
The median travel distance in women with EOC undergoing CRS with HIPEC was 57.0 miles in women with EOC. Over 20% of patients treated at our institution traveled more than 100 miles for HIPEC procedures. No differences were observed in post-operative complications or oncologic outcomes based upon travel distance.
Objective (s) To evaluate travel distance in women with advanced or recurrent epithelial ovarian cancer (OC) undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) and the subsequent impact upon outcomes. Methods An IRB-approved single-institution prospective registry was queried for women with OC who underwent HIPEC from 1/1/2009–12/1/2020. Demographic, oncologic, and surgical data were recorded. The patient's home zip code was compared to the institutional zip code to determine travel distance using Google Maps. Patients were divided into three strata for analysis: 1) local: ≤50 miles, 2) regional: 51–99 miles, and 3) distant: ≥100 miles and univariate analysis was performed. Results Of 127 women, the median distance travelled was 57.0 miles (IQR: 20.6, 84.6). There were no significant differences in mild (28.3% vs. 26.3 vs. 24.1%), moderate (21.7% vs. 15.8% vs. 17.2%) or severe postoperative complications (11.7% vs. 5.3% vs. 17.2%) (p = 0.75) for local, regional and distant patients, respectively. There was no difference in progression-free survival (17.4 vs. 22.2 vs. 12.8 months, p > 0.05) or overall survival (57.3 vs. 61.6 vs. 29.2 months, p > 0.05) for local, regional or distant patients, respectively. Conclusions This study demonstrates that women with OC are willing to travel for HIPEC, with over 50% traveling > 50 miles. Our results suggest that women who travel for HIPEC procedures are not at increased risk for perioperative complications or worse oncologic outcomes than those local to HIPEC centers.
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Unger JM, Hershman DL, Till C, Minasian LM, Osarogiagbon RU, Fleury ME, Vaidya R. "When Offered to Participate": A Systematic Review and Meta-Analysis of Patient Agreement to Participate in Cancer Clinical Trials. J Natl Cancer Inst 2021; 113:244-257. [PMID: 33022716 PMCID: PMC7936064 DOI: 10.1093/jnci/djaa155] [Citation(s) in RCA: 110] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/26/2020] [Accepted: 09/21/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Patient participation in clinical trials is vital for knowledge advancement and outcomes improvement. Few adult cancer patients participate in trials. Although patient. decision-making about trial participation has been frequently examined, the participation rate for patients actually offered a trial is unknown. METHODS A systematic review and meta-analysis using 3 major search engines was undertaken. We identified studies from January 1, 2000, to January 1, 2020, that examined clinical trial participation in the United States. Studies must have specified the numbers of patients offered a trial and the number enrolled. A random effects model of proportions was used. All statistical tests were 2-sided. RESULTS We identified 35 studies (30 about treatment trials and 5 about cancer control trials) among which 9759 patients were offered trial participation. Overall, 55.0% (95% confidence interval [CI] = 49.4% to 60.5%) of patients agreed to enroll. Participation rates did not differ between treatment (55.0%, 95% CI = 48.9% to 60.9%) and cancer control trials (55.3%, 95% CI = 38.9% to 71.1%; P = .98). Black patients participated at similar rates (58.4%, 95% CI = 46.8% to 69.7%) compared with White patients (55.1%, 95% CI = 44.3% to 65.6%; P = .88). The main reasons for nonparticipation were treatment choice or lack of interest. CONCLUSIONS More than half of all cancer patients offered a clinical trial do participate. These findings upend several conventional beliefs about cancer clinical trial participation, including that Black patients are less likely to agree to participate and that patient decision-making is the primary barrier to participation. Policies and interventions to improve clinical trial participation should focus more on modifiable systemic structural and clinical barriers, such as improving access to available trials and broadening eligibility criteria.
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Affiliation(s)
- Joseph M Unger
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- SWOG Statistics and Data Management Center, Seattle, WA, USA
| | | | - Cathee Till
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- SWOG Statistics and Data Management Center, Seattle, WA, USA
| | - Lori M Minasian
- National Cancer Institute, Division of Cancer Prevention, Rockville, MD, USA
| | | | - Mark E Fleury
- American Cancer Society Cancer Action Network Inc, Washington, DC, USA
| | - Riha Vaidya
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- SWOG Statistics and Data Management Center, Seattle, WA, USA
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Mamguem Kamga A, Bengrine-Lefevre L, Quipourt V, Favier L, Darut-Jouve A, Marilier S, Arveux P, Desmoulins I, Dabakuyo-Yonli TS. Long-term quality of life and sexual function of elderly people with endometrial or ovarian cancer. Health Qual Life Outcomes 2021; 19:56. [PMID: 33579310 PMCID: PMC7881660 DOI: 10.1186/s12955-021-01675-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 01/12/2021] [Indexed: 11/26/2022] Open
Abstract
Background With the growing number of older endometrial cancer (EC) and ovarian cancer (OC) survivors, data on long-term health-related quality of life (HRQoL) became an important issue in the management of older patients. So, the aim of this study was to describe and compare according to age long-term HRQoL, sexual function, and social deprivation of adults with either EC or OC. Methods A cross-sectional study was set up using data from the Côte d’Or gynecological cancer registry. A series of questionnaires assessing HRQoL (SF-12), sexual function (FSFI), anxiety/depression (HADS), social support (SSQ6) and deprivation (EPICES) were offered to women with EC or OC diagnosed between 2006 and 2013. HRQoL, sexual function, anxiety/depression, social support and deprivation scores were generated and compared according to age (< 70 years and ≥ 70 years). Results A total of 145 women with EC (N = 103) and OC (N = 42) participated in this study. Fifty-six percent and 38% of EC and OC survivors respectively were aged 70 and over. Treatment did not differ according to age either in OC or EC. The deprivation level did not differ between older and younger survivors with OC while older survivors with EC were more precarious. The physical HRQoL was more altered in older EC survivors. This deterioration concerned only physical functioning (MD = 24, p = 0.012) for OC survivors while it concerned physical functioning (MD = 30, p < 0.0001), role physical (MD = 22, p = 0.001) and bodily pain (MD = 21, p = 0.001) for EC survivors. Global health (MD = 11, p = 0.011) and role emotional (MD = 12, p = 0.018) were also deteriorated in elderly EC survivors. Sexual function was deteriorated regardless of age and cancer location with a more pronounced deterioration in elderly EC survivors for desire (p = 0.005), arousal (p = 0.015) and orgasm (p = 0.007). Social support, anxiety and depression were not affected by age regardless of location. Conclusion An average 6 years after diagnosis, the impact of cancer on HRQoL is greatest in elderly survivors with either EC or OC.
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Affiliation(s)
- Ariane Mamguem Kamga
- Epidemiology and Quality of Life Research Unit, Lipids, Nutrition, Cancer Research Center, INSERM U1231, Georges Francois Leclerc Centre - UNICANCER, 1 rue Professeur Marion, BP 77980, 21079, Dijon Cedex, France
| | - Leila Bengrine-Lefevre
- Medical Oncology Department, Centre Georges-François Leclerc, 1 rue Pr. Marion, 21000, Dijon, France.,Geriatric Oncology Coordination Unit in Burgundy, University Hospital, 21079, Dijon, France
| | - Valérie Quipourt
- Geriatric Oncology Coordination Unit in Burgundy, University Hospital, 21079, Dijon, France.,Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, 21079, Dijon, France
| | - Laure Favier
- Medical Oncology Department, Centre Georges-François Leclerc, 1 rue Pr. Marion, 21000, Dijon, France
| | | | - Sophie Marilier
- Geriatric Oncology Coordination Unit in Burgundy, University Hospital, 21079, Dijon, France.,Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, 21079, Dijon, France
| | - Patrick Arveux
- Epidemiology and Quality of Life Research Unit, Lipids, Nutrition, Cancer Research Center, INSERM U1231, Georges Francois Leclerc Centre - UNICANCER, 1 rue Professeur Marion, BP 77980, 21079, Dijon Cedex, France.,Centre for Research in Epidemiology and Population Health (CESP), INSERM U1018, University Paris-Sud, UVSQ Gustave Roussy, Villejuif, France
| | - Isabelle Desmoulins
- Medical Oncology Department, Centre Georges-François Leclerc, 1 rue Pr. Marion, 21000, Dijon, France
| | - Tienhan Sandrine Dabakuyo-Yonli
- Epidemiology and Quality of Life Research Unit, Lipids, Nutrition, Cancer Research Center, INSERM U1231, Georges Francois Leclerc Centre - UNICANCER, 1 rue Professeur Marion, BP 77980, 21079, Dijon Cedex, France. .,National Quality of Life and Cancer Platform, Dijon, France.
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Patel SN, Staples JN, Garcia C, Chatfield L, Ferriss JS, Duska L. Are ethnic and racial minority women less likely to participate in clinical trials? Gynecol Oncol 2020; 157:323-328. [PMID: 32253046 DOI: 10.1016/j.ygyno.2020.01.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/25/2020] [Accepted: 01/29/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Given the disparity that exists in enrollment of minorities to oncology clinical trials, the objective of our study was to assess whether race is associated with willingness to participate in gynecologic oncology clinical trials in a rural Southern academic medicine setting. Our secondary aim was to determine whether willingness to participate is impacted by an educational intervention. METHODS A single institution prospective survey study was performed at an academic medical center. Women presenting to the gynecologic oncology clinic with a current or prior diagnosis of gynecologic malignancy were approached to participate. The validated Attitudes to Randomized Trials Questionnaire (ARTQ) assessed willingness to participate in clinical trials. Relevant demographic and clinical data were abstracted. Characteristics were compared between those willing and unwilling to participate in clinical trials with a chi-square test for categorical variables and Wilcoxon rank sum tests for continuous data. RESULTS We enrolled 156 participants (50% White, 50% non-White) from May 2017 to January 2018. The minority group included 35% non-Hispanic Black, 9% Hispanic, 4% Asian, and 2% other. Median age was 63 years with endometrial cancer being the most common diagnosis (48%). On initial screen, only 35% were willing to participate in a clinical trial. Willingness to participate did not differ between race, age, marital status, education level, cancer type, stage, or mode of treatment. Rates improved to 82% after being provided additional educational information. Following education, White women and those with more education were significantly more willing to participate in clinical trials than their minority and less educated counterparts. CONCLUSIONS Willingness to participate improved among all sub-categories following an educational intervention. The increase in willingness was less robust among racial and ethnic minorities, suggesting that different tools are needed for recruitment of minorities to gynecologic oncology clinical trials.
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Affiliation(s)
- Shweta N Patel
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Jeanine N Staples
- Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA, United States of America.
| | - Christine Garcia
- Division of Gynecologic Oncology, The Permanente Medical Group, Kaiser Northern California, San Francisco, CA, United States of America
| | - Lindsay Chatfield
- Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Washington, DC, United States of America
| | - J Stuart Ferriss
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Linda Duska
- Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA, United States of America
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Nitecki R, Bercow AS, Gockley AA, Lee H, Penson RT, Growdon WB. Clinical trial participation and aggressive care at the end of life in patients with ovarian cancer. Int J Gynecol Cancer 2020; 30:201-206. [PMID: 31911533 DOI: 10.1136/ijgc-2019-000851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/05/2019] [Accepted: 11/14/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES In non-gynecologic cancers, clinical trial participation has been associated with aggressive care at the end of life. The objective of this investigation was to examine how trial participation affects end of life outcomes in patients with ovarian cancer. METHODS In a retrospective review of women diagnosed with ovarian cancer at our institution between January 2010 and December 2015, we collected variables identified by the National Quality Forum as measures of aggressive end of life care including chemotherapy in the last 14 days of life, intensive care unit (ICU) admission in the last 30 days of life, or death in the acute care setting. Trials investigating medications but not surgical interventions were included. The primary outcome of this study was the association between trial participation and the National Quality Forum measures of aggressive end of life care in ovarian cancer decedents. Data were analyzed with univariable and multivariable parametric and non-parametric testing, and time to event outcomes were analyzed using the Kaplan-Meier method and Cox's proportional hazard models. RESULTS Among 391 women treated for ovarian cancer, 62 patients (16%) participated in a clinical trial. Patients enrolled in clinical trials were more likely to have chemotherapy administered within 14 days of death; however, no association was found with other metrics of aggressive care at the end of life including the initiation of a new chemotherapy regimen in the last 30 days of life, ICU admissions, and death in an acute care setting. Among patients with recurrent ovarian cancer, median overall survival for trial participants was 57 months compared with only 31 months in non-trial participants (p<0.001). CONCLUSIONS In patients with ovarian cancer, clinical trial enrollment is associated with chemotherapy administration within 14 days of death, but not other measures of aggressive care at the end of life. Given the importance of clinical trial participation in improving care for women with ovarian cancer, this study suggests that concerns regarding aggressive care prior to death should not limit clinical trial participation.
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Affiliation(s)
- Roni Nitecki
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA .,Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Alexandra S Bercow
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Allison A Gockley
- Gynecologic Oncology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Hang Lee
- Department of Medicine, MGH Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Richard T Penson
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Whitfield B Growdon
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Buechel M, McGinnis A, Vesely SK, Wade KS, Moore KN, Gunderson CC. Consideration of older patients for enrollment in phase 1 clinical trials: Exploring treatment related toxicities and outcomes. Gynecol Oncol 2018; 149:28-32. [DOI: 10.1016/j.ygyno.2017.11.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 11/17/2017] [Accepted: 11/17/2017] [Indexed: 11/29/2022]
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