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Sue-Chue-Lam C, Brezden-Masley C, Sutradhar R, Yu AYX, Baxter NN. The Association of Oxaliplatin-Containing Adjuvant Chemotherapy Duration with Overall and Cancer-Specific Mortality in Individuals with Stage III Colon Cancer: A Population-Based Retrospective Cohort Study. Curr Oncol 2023; 30:6508-6532. [PMID: 37504338 PMCID: PMC10378653 DOI: 10.3390/curroncol30070478] [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: 06/02/2023] [Revised: 07/04/2023] [Accepted: 07/04/2023] [Indexed: 07/29/2023] Open
Abstract
PURPOSE Few studies have examined the relationship between duration of oxaliplatin-containing adjuvant chemotherapy for stage III colon cancer and mortality in routine practice. We examined the association between treatment with 50% versus >85% of a maximal course of adjuvant therapy (eight cycles of CAPOX, twelve cycles of FOLFOX) and mortality in stage III colon cancer. METHODS Using linked databases, we identified Ontarians aged ≥18 years at diagnosis of stage III colon cancer between 2007 and 2019. In the primary comparison, we compared patients who received 50% or >85% of a maximal course of adjuvant therapy; in a secondary comparison, we evaluated a dose effect across patients who received FOLFOX in one-cycle increments from six to ten cycles against >85% (more than ten cycles) of a maximal course of FOLFOX. The main outcomes were overall and cancer-specific mortality. Follow-up began 270 days after adjuvant treatment initiation and terminated at the first of the outcome of interest, loss of eligibility for Ontario's Health Insurance Program, or study end. Overlap propensity score weights accounted for baseline between-group differences. We determined the hazard ratio, estimating the association between mortality and treatment. Non-inferiority was concluded in the primary comparison for either outcome if the upper limit of the two-sided 95% CI was ≤1.11, which is the margin used in the International Duration Evaluation of Adjuvant Chemotherapy Collaboration. RESULTS We included 3546 patients in the analysis of overall mortality; 486 (13.7%) received 50% and 3060 (86.3%) received >85% of a maximal course of therapy. Median follow-up was 5.4 years, and total follow-up was 20,510 person-years. There were 833 deaths. Treatment with 50% of a maximal course of adjuvant therapy was associated with a hazard ratio of 1.13 (95% CI 0.88 to 1.47) for overall mortality and a subdistribution hazard ratio of 1.31 (95% CI 0.91 to 1.87) for cancer-specific mortality versus >85% of a maximal course of therapy. In the secondary comparison, there was a trend toward higher overall mortality in patients treated with shorter durations of therapy, though confidence intervals overlapped considerably. CONCLUSION We could not conclude that treatment with 50% of a maximal course is non-inferior to >85% of a maximal course of adjuvant therapy for mortality in stage III colon cancer. Clinicians and patients engaging in decision-making around treatment duration in this context should carefully consider the trade-off between treatment effectiveness and adverse effects of treatment.
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Affiliation(s)
- Colin Sue-Chue-Lam
- Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
| | - Christine Brezden-Masley
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Division of Medical Oncology, Sinai Health System, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Rinku Sutradhar
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- ICES, Toronto, ON M4N 3M5, Canada
| | - Amy Y X Yu
- Department of Medicine (Neurology), University of Toronto, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Nancy N Baxter
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- ICES, Toronto, ON M4N 3M5, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON M5B 1T8, Canada
- Melbourne School of Global and Population Health, 207 Bouverie St. Level 5, University of Melbourne, Melbourne, VIC 3010, Australia
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De Leo AN, Giap F, Culbert MM, Drescher N, Brisson RJ, Cassidy V, Augustin EM, Casper A, Horowitz DH, Cheng SK, Yu JB. Nationwide changes in radiation oncology travel and location of care before and during the COVID-19 pandemic. Radiat Oncol J 2023; 41:108-119. [PMID: 37403353 PMCID: PMC10326508 DOI: 10.3857/roj.2023.00164] [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: 02/28/2023] [Revised: 05/12/2023] [Accepted: 05/22/2023] [Indexed: 07/06/2023] Open
Abstract
PURPOSE Patients with cancer are particularly vulnerable to coronavirus disease (COVID). Transportation barriers made travel to obtain medical care more difficult during the pandemic. Whether these factors led to changes in the distance traveled for radiotherapy and the coordinated location of radiation treatment is unknown. MATERIALS AND METHODS We analyzed patients across 60 cancer sites in the National Cancer Database from 2018 to 2020. Demographic and clinical variables were analyzed for changes in distance traveled for radiotherapy. We designated the facilities in the 99th percentile or above in terms of the proportion of patients who traveled more than 200 miles as "destination facilities." We defined "coordinated care" as undergoing radiotherapy at the same facility where the cancer was diagnosed. RESULTS We evaluated 1,151,954 patients. There was a greater than 1% decrease in the proportion of patients treated in the Mid-Atlantic States. Mean distance traveled from place of residence to radiation treatment decreased from 28.6 to 25.9 miles, and the proportion traveling greater than 50 miles decreased from 7.7% to 7.1%. At "destination facilities," the proportion traveling more than 200 miles decreased from 29.3% in 2018 to 24% in 2020. In comparison, at the other hospitals, the proportion traveling more than 200 miles decreased from 1.07% to 0.97%. In 2020, residing in a rural area resulted in a lower odds of having coordinated care (multivariable odds ratio = 0.89; 95% confidence interval, 0.83-0.95). CONCLUSION The first year of the COVID pandemic measurably impacted the location of U.S. radiation therapy treatment.
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Affiliation(s)
- Alexandra N. De Leo
- Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
| | - Fantine Giap
- Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
| | - Matthew M. Culbert
- Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
| | - Nicolette Drescher
- Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
| | - Ryan J. Brisson
- Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
| | - Vincent Cassidy
- Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
| | | | - Anthony Casper
- Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
| | - David H. Horowitz
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, USA
| | - Simon K. Cheng
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, USA
| | - James B. Yu
- Department of Radiation Oncology, St. Francis Hospital and Trinity Health of New England, Hartford, CT, USA
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Christ SM, Ahmadsei M, Seiler A, Vlaskou Badra E, Willmann J, Hertler C, Guckenberger M. Continuity and coordination of care in highly selected chronic cancer patients treated with multiple repeat radiation therapy. Radiat Oncol 2021; 16:227. [PMID: 34819112 PMCID: PMC8611895 DOI: 10.1186/s13014-021-01949-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/04/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction and background As cancer is developing into a chronic disease due to longer survival, continuity and coordination of oncological care are becoming more important for patients. As radiation oncology departments are an integral part of cancer care and as repeat irradiation becomes more commonplace, the relevance of continuity and coordination of care in operating procedures is increasing. This study aims to perform a single-institution analysis of cancer patients in which continuity and coordination of care matters most, namely the highly selected group with multiple repeat course radiotherapy throughout their chronic disease. Materials and methods All patients who received at least five courses of radiotherapy at the Department of Radiation Oncology at the University Hospital Zurich from 2011 to 2019 and who were alive at the time of the initiation of this project were included into this study. Patient and treatment characteristics were extracted from the hospital information and treatment planning systems. All patients completed two questionnaires on continuity of care, one of which was designed in-house and one of which was taken from the literature. Results Of the 33 patients identified at baseline, 20 (60.6%) participated in this study. A median of 6 years (range 3–13) elapsed between the first and the last visit at the cancer center. The median number of involved primary oncologists at the radiation oncology department was two (range 1–5). Fifty-seven percent of radiation therapy courses were preceded by a tumor board discussion. Both questionnaires showed high levels of experienced continuity of care. No statistically significant differences in experienced continuity of care between groups with more or less than two primary oncologists was found. Discussion and conclusion Patients treated with multiple repeat radiation therapy at our department over the past decade experienced high levels of continuity of care, yet further efforts should be undertaken to coordinate care among oncological disciplines in large cancer centers through better and increased use of interdisciplinary tumor boards. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-021-01949-5.
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Affiliation(s)
- Sebastian M Christ
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
| | - Maiwand Ahmadsei
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Annina Seiler
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.,Competence Center for Palliative Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Eugenia Vlaskou Badra
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Jonas Willmann
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Caroline Hertler
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.,Competence Center for Palliative Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
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Mostarac I, Barbera L, Sussman J, Dainty K, Wu L, Ratcliffe J, Atzema CL. I'm here because I was told to come: a study of cancer patients' reasons for attending the emergency department. Support Care Cancer 2021; 29:6565-6578. [PMID: 33913007 DOI: 10.1007/s00520-021-06215-8] [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: 12/19/2020] [Accepted: 04/09/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Patients with cancer are seen frequently in emergency departments (EDs). It has been proposed that many of these visits are preventable, but the patient perspective has not been well-studied. METHODS We conducted structured interviews with a convenience sample of patients who presented to a single ED with a cancer-related complaint. We asked standardized questions regarding patient predisposing characteristics, enabling factors (e.g., access to support), and perceived need for care. We compared the reported perceived need with the evaluated need by ED healthcare providers. Themes were identified using descriptive content analysis. RESULTS Forty-five patients completed interviews, of whom 30 (67%) were admitted to hospital. The most frequent reasons for seeking ED care were pain (includes abdominal) (33%), fever (11%), and weakness (11%). The majority (77%) did not make the decision to go to the ED alone: healthcare providers (40%, most commonly oncologists) and caregivers (36%) were the reported decision-makers in these cases. The majority (73%) felt their ED visit was not preventable. Themes of an alternative oncological setting for tests, improved community services, and both earlier medication management and referral to specialist care were identified from patients who reported their visit was avoidable. Congruence between (patient) perceived need and evaluated need was high (96%). CONCLUSIONS The minority of patients made the decision to seek ED care by themselves. While the majority did not believe emergency care was avoidable, those who did had cogent suggestions to that end. Patient's assessments of their own need had high agreement with ED providers' evaluations.
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Affiliation(s)
- Ivona Mostarac
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
| | - Lisa Barbera
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,ICES, Toronto, ON, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.,Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan Sussman
- Department of Oncology, McMaster University, Juravinski Cancer Centre, Hamilton, ON, Canada
| | - Katie Dainty
- The Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,North York General Hospital, Toronto, ON, Canada
| | - Libo Wu
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Jenna Ratcliffe
- Department of Oncology, McMaster University, Juravinski Cancer Centre, Hamilton, ON, Canada
| | - Clare L Atzema
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,ICES, Toronto, ON, Canada.,The Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada
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