1
|
Sarasqueta C, Perales A, Escobar A, Baré M, Redondo M, Fernández de Larrea N, Briones E, Piera JM, Zunzunegui MV, Quintana JM. Impact of age on the use of adjuvant treatments in patients undergoing surgery for colorectal cancer: patients with stage III colon or stage II/III rectal cancer. BMC Cancer 2019; 19:735. [PMID: 31345187 PMCID: PMC6659283 DOI: 10.1186/s12885-019-5910-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 07/08/2019] [Indexed: 12/13/2022] Open
Abstract
Background Many older patients don’t receive appropriate oncological treatment. Our aim was to analyse whether there are age differences in the use of adjuvant chemotherapy and preoperative radiotherapy in patients with colorectal cancer. Methods A prospective cohort study was conducted in 22 hospitals including 1157 patients with stage III colon or stage II/III rectal cancer who underwent surgery. Primary outcomes were the use of adjuvant chemotherapy for stage III colon cancer and preoperative radiotherapy for stage II/III rectal cancer. Generalised estimating equations were used to adjust for education, living arrangements, area deprivation, comorbidity and clinical tumour characteristics. Results In colon cancer 92% of patients aged under 65 years, 77% of those aged 65 to 80 years and 27% of those aged over 80 years received adjuvant chemotherapy (χ2trends < 0.001). In rectal cancer preoperative radiotherapy was used in 68% of patients aged under 65 years, 60% of those aged 65 to 80 years, and 42% of those aged over 80 years (χ2trends < 0.001). Adjusting by comorbidity level, tumour characteristics and socioeconomic level, the odds ratio of use of chemotherapy compared with those under age 65, was 0.3 (0.1–0.6) and 0.04 (0.02–0.09) for those aged 65 to 80 and those aged over 80, respectively; similarly, the odds ratio of use of preoperative radiotherapy was 0.9 (0.6–1.4) and 0.5 (0.3–0.8) compared with those under 65 years of age. Conclusions The probability of older patients with colorectal cancer receiving adjuvant chemotherapy and preoperative radiotherapy is lower than that of younger patients; many of them are not receiving the treatments recommended by clinical practice guidelines. Differences in comorbidity, tumour characteristics, curative resection, and socioeconomic factors do not explain this lower probability of treatment. Research is needed to identify the role of physical and cognitive functional status, doctors’ attitudes, and preferences of patients and their relatives, in the use of adjuvant therapies. Electronic supplementary material The online version of this article (10.1186/s12885-019-5910-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- C Sarasqueta
- Biodonostia Health Research Institute - Donostia University Hospital / Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Paseo Dr. Beguiristain s/n, 20014, Donostia-San Sebastián, Gipuzkoa, Spain.
| | - A Perales
- Biodonostia Health Research Institute - Donostia University Hospital / Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Paseo Dr. Beguiristain s/n, 20014, Donostia-San Sebastián, Gipuzkoa, Spain
| | - A Escobar
- Research Unit, Hospital Basurto / Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Avda Montevideo, 18, 48013, Bilbao, Bizkaia, Spain
| | - M Baré
- Clinical Epidemiology and Cancer Screening, Corporació Sanitaria Parc Taulí / Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Parc Taulí 1, 08208, Sabadell, Barcelona, Spain
| | - M Redondo
- Research Unit, Costa del Sol Hospital / Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Autovía A-7, Km 187, 29603, Marbella, Málaga, Spain
| | - N Fernández de Larrea
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Instituto de Salud Carlos III / Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Avda de Monforte de Lemos, 5, 28029, Madrid, Spain
| | - E Briones
- Epidemiology Unit, Seville Health District, Andalusian Health Service / Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Avda de la Constitución, 18, 41071, Seville, Spain
| | - J M Piera
- Medical Oncology Unit, Donostia University Hospital, Paseo Dr. Beguiristain 109, 20014, Donostia-San Sebastián, Gipuzkoa, Spain
| | - M V Zunzunegui
- Departement de médecine sociale et préventive Institut de recherche en santé publique (IRSPUM), University of Montréal, Pavillon 7101, salle 3111 7101, Avenue du Parc Montréal, Montréal, Québec, H3N 1X9, Canada
| | - J M Quintana
- Research Unit, Galdakao-Usansolo Hospital / REDISSEC, Labeaga Auzoa, 48960, Galdakao, Bizkaia, Spain
| | | |
Collapse
|
2
|
Salvador J, Aparicio J, Baron FJ, García-Campelo R, Garcia-Carbonero R, Lianes P, Llombart A, Isla D, Piera JM, Muñoz M, Puente J, Rivera F, Rodríguez CA, Virizuela JA, Martín M, Garrido P. Erratum to: Equity, barriers and cancer disparities: study of the Spanish Society of Medical Oncology on the access to oncologic drugs in the Spanish Regions. Clin Transl Oncol 2017; 19:525. [DOI: 10.1007/s12094-017-1628-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
3
|
Rivera F, Andres R, Felip E, Garcia-Campelo R, Lianes P, Llombart A, Piera JM, Puente J, Rodriguez CA, Vera R, Virizuela JA, Martin M, Garrido P. Medical oncology future plan of the Spanish Society of Medical Oncology: challenges and future needs of the Spanish oncologists. Clin Transl Oncol 2017; 19:508-518. [PMID: 28005259 PMCID: PMC5346109 DOI: 10.1007/s12094-016-1595-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 09/23/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE The SEOM Future Plan is aimed at identifying the main challenges, trends and needs of the medical oncology speciality over the next years, including potential oncologist workforce shortages, and proposing recommendations to overcome them. METHODS The estimations of the required medical oncologists workforce are based on an updated Medical Oncologist Register in Spain, Medical Oncology Departments activity data, dedication times and projected cancer incidence. Challenges, needs and future recommendations were drawn from an opinion survey and an advisory board. RESULTS A shortage of 211 FTE medical oncologist specialists has been established. To maintain an optimal ratio of 158 new cases/FTE, medical oncology workforce should reach 1881 FTE by 2035. CONCLUSIONS Main recommendations to face the growing demand and complexity of oncology services include a yearly growth of 2.5% of medical oncologist's workforce until 2035, and development and application of more accurate quality indicators for cancer care and health outcomes measure.
Collapse
Affiliation(s)
- F Rivera
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
- Sociedad Española de Oncología Médica (SEOM), C/ Velázquez, 7-3º planta, 28001, Madrid, Spain.
- 2013-2015 SEOM Executive Board, C/ Velázquez, 7-3º planta, 28001, Madrid, Spain.
| | - R Andres
- Medical Oncology Department, Hospital Clínico Lozano Blesa, Zaragoza, Spain
- SEOM Future Plan Advisory Board, C/ Velázquez, 7-3º planta, 28001, Madrid, Spain
| | - E Felip
- Institut d'Oncologia, Vall d'Hebron University Hospital, Barcelona, Spain
- SEOM Future Plan Advisory Board, C/ Velázquez, 7-3º planta, 28001, Madrid, Spain
| | - R Garcia-Campelo
- Medical Oncology Department, Complejo Hospitalario Universitario A Coruña, Coruña, Spain
- 2015-2017 SEOM Executive Board, C/ Velázquez, 7-3º planta, 28001, Madrid, Spain
| | - P Lianes
- Medical Oncology Department, Hospital de Mataró, Mataró, Barcelona, Spain
- 2013-2015 SEOM Executive Board, C/ Velázquez, 7-3º planta, 28001, Madrid, Spain
| | - A Llombart
- Medical Oncology Department, Hospital Universitàri Arnau de Vilanova, Lleida, Spain
- 2013-2015 SEOM Executive Board, C/ Velázquez, 7-3º planta, 28001, Madrid, Spain
| | - J M Piera
- Medical Oncology Department, University Hospital Donostia, Donostia/San Sebastián, Spain
- SEOM Future Plan Advisory Board, C/ Velázquez, 7-3º planta, 28001, Madrid, Spain
| | - J Puente
- Medical Oncology Department, Hospital Clínico Universitario San Carlos, Madrid, Spain
- SEOM Future Plan Advisory Board, C/ Velázquez, 7-3º planta, 28001, Madrid, Spain
| | - C A Rodriguez
- Medical Oncology Department, Hospital Clínico Universitario, Salamanca, Spain
- 2015-2017 SEOM Executive Board, C/ Velázquez, 7-3º planta, 28001, Madrid, Spain
| | - R Vera
- Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
- 2015-2017 SEOM Executive Board, C/ Velázquez, 7-3º planta, 28001, Madrid, Spain
| | - J A Virizuela
- Medical Oncology Department, Complejo Hospitalario Regional Virgen Macarena, Sevilla, Spain
- 2015-2017 SEOM Executive Board, C/ Velázquez, 7-3º planta, 28001, Madrid, Spain
| | - M Martin
- Department of Medical Oncology, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- 2015-2017 SEOM Executive Board, C/ Velázquez, 7-3º planta, 28001, Madrid, Spain
| | - P Garrido
- Department of Medical Oncology, IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain
- 2013-2015 SEOM Executive Board, C/ Velázquez, 7-3º planta, 28001, Madrid, Spain
| |
Collapse
|
4
|
Sánchez Parra M, Churruca C, Paredes A, Lacasta A, López de Argumedo G, Alvárez I, Abad T, Egana L, Guimón E, Piera JM. Phase II clinical trial of cisplatin, 5-fluorouracil, and ifosfamide as treatment for advanced locoregional head and neck carcinoma. Am J Clin Oncol 1999; 22:6-7. [PMID: 10025370 DOI: 10.1097/00000421-199902000-00002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The association of ifosfamide with cisplatin and 5-fluorouracil for the management of advanced squamous cell carcinoma of the head and neck was assessed in this trial. Ifosfamide was given initially to 12 patients in combination with standard fixed doses of cisplatin and 5-fluorouracil, at 1,000 mg/m2 daily on days 2, 3, and 4. Two patients died of neutropenia and severe infection, and the authors recruited seven more patients who were treated with a lower dose of ifosfamide, 800 mg/m2 daily on days 2, 3, and 4. One of the seven patients died of neutropenia and severe infection. Three complete remission were observed in 18 patients evaluable for efficacy. The study was closed early because of the severe toxicity profile demonstrated by this scheme and because of no clear advantage in efficacy versus cisplatin plus 5-fluorouracil combinations.
Collapse
Affiliation(s)
- M Sánchez Parra
- Medical Oncology Unit, Hospital Aránzazu, San Sebastian, Spain
| | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Solá C, Paredes A, Orube A, Piera JM. [Occult adenocarcinoma of the prostate and supraclavicular adenopathies]. Med Clin (Barc) 1989; 93:317-8. [PMID: 2607839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
6
|
Abstract
Fourteen patients with malignant ovarian germ cell tumors were treated postoperatively with a short-term, sequential regimen combining cisplatin, vincristine, methotrexate, bleomycin, dactinomycin, cyclophosphamide, etoposide, Adriamycin (Adria Laboratories, Columbus, OH), and vinblastine (POMB/ACE/PAV). Two patients had Stage I disease, Five had Stage II, five had Stage III, and two had Stage IV. The histologic diagnosis was immature teratoma in five cases (two cases were Grade 2 and three cases were Grade 3) endodermal sinus tumor in two cases, dysgerminoma in three cases, and mixed germ cell tumors in four cases. The chemotherapy regimen appeared to be highly effective against all histologic types, including advanced stages, with 12 of 14 (86%) overall sustained remissions. The median duration of treatment was 5 months. The toxicity of the regimen, which contained low total doses of cisplatin and bleomycin, was only moderate. After a median follow-up of 53+ months, 13 patients were alive without evidence of disease. The results and toxicity obtained were compared with those from other currently used regimens. Also, some comments on initial surgery and second-look surgery are given.
Collapse
Affiliation(s)
- J R Germá
- Department of Oncology, Hospital de la Santa Cruz y San Pablo, Universidad Autónoma de Barcelona, Spain
| | | | | | | |
Collapse
|
7
|
Ojeda MB, Alonso MC, Bastus R, Alba E, Piera JM, Lopez Lopez JJ. Follow-up of breast cancer stages I and II. An analysis of some common methods. Eur J Cancer Clin Oncol 1987; 23:419-23. [PMID: 3609106 DOI: 10.1016/0277-5379(87)90380-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A retrospective analysis of the follow-up methodology was done in 343 cases of breast cancer Stages I and II, in order to ascertain the effectiveness of the explorations performed and the usefulness of the follow-up program. The actuarial probability of relapse at 6 years was 35% for the 237 patients with negative axillary nodes and 46% for the 106 patients with nodal involvement. Fifty-eight per cent of the relapses were detected by the patients themselves, 24% of relapses were found by physical examination and 9% of relapses were discovered in chest radiographs, leading to 91% of relapses diagnosed by combination of these explorations. The authors conclude that follow-up methodology for these patients could be limited to the above-mentioned methods, without significant reduction of curability or survival possibilities after relapse.
Collapse
|
8
|
Piera JM, Alonso MC, Ojeda MB, Biete A. Locally advanced breast cancer with inflammatory component: a clinical entity with a poor prognosis. Radiother Oncol 1986; 7:199-204. [PMID: 3027763 DOI: 10.1016/s0167-8140(86)80030-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Locally advanced and inflammatory carcinomas of the breast are two distinct entities, with widely accepted differential clinical criteria. We describe a particular type of locally advanced cancer which acquires during its evolution inflammatory characteristics, although limited to a small area of skin and thus not accomplishing the common diagnostic criteria of inflammatory carcinoma. When comparing this type of tumors, named locally advanced cancer with inflammatory component, to other locally advanced cancers, some remarkable differences are found: there is a preponderance of younger patients, premenopausal or perimenopausal, with a greater percentage of poorly differentiated tumors and negative estrogen receptors. Their evolution and survival are similar to that of inflammatory carcinomas; thus, we conclude they should be considered and treated as inflammatory carcinomas. Finally, the prognostic limitations of the TNM classification are discussed and some adjustments for future classifications are suggested.
Collapse
|
9
|
Pallares C, Piera JM, Barnadas A, Izquierdo A, Lopez Lopez JJ. Phase II trial of chemotherapy with cisplatin and etoposide in non-small cell lung cancer. Cancer Treat Rep 1986; 70:677. [PMID: 3708618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
10
|
Tuneu A, Piera JM, Ravella A, Moreno A, de Moragas JM. [Basal cell nevoid carcinoma syndrome]. Med Clin (Barc) 1986; 86:641-3. [PMID: 3724277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|