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Miller RC, Simone BA, Lombardo JF, Taylor J, Nowak-Choi K, Ko K, Ferguson L, Donnelly A, Ali AS, Shi W, Dicker AP, Simone NL. A Pilot Trial Using Telemedicine in Radiation Oncology: The Future of Health Care Is Virtual. Telemed Rep 2021; 2:171-178. [PMID: 34250522 PMCID: PMC8259074 DOI: 10.1089/tmr.2021.0007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 06/13/2023]
Abstract
Background: Social determinants of health directly affect cancer survival. Driven by advances in technology and recent demands due to COVID-19, telemedicine has the ability to improve patient access to care, lower health care costs, and increase workflow efficiency. The role of telemedicine in radiation oncology is not established. Materials and Methods: We conducted an IRB-approved pilot trial using a telehealth platform for the first post-radiation visit in patients with any cancer diagnosis. The primary endpoint was feasibility of using telehealth defined by completion of five telehealth visits per month in a single department. Secondary endpoints included the ability to assess patients appropriately, patient and physician satisfaction. Physicians were surveyed again during the pandemic to determine whether viewpoints changed. Results: Between May 27, 2016 and August 1, 2018, 37 patients were enrolled in the Telehealth in Post-operative Radiation Therapy (TelePORT) trial, with 24 evaluable patients who completed their scheduled telehealth visit. On average, 1.4 patients were accrued per month. All patients were satisfied with their care, had enough time with their physician and 85.7% believed the telehealth communication was excellent. All physicians were able to accurately assess the patient's symptoms via telehealth, whereas 82.3% felt they could accurately assess treatment-related toxicity. Physicians assessing skin toxicity from breast radiation were those who did not feel they were able to assess toxicity. Discussion and Conclusions: Both health care providers and patients have identified telemedicine as a suitable platform for radiation oncology visits. Although there are limitations, telemedicine has significant potential for increasing access of cancer care delivery in radiation oncology.
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Affiliation(s)
- Ryan C. Miller
- Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Brittany A. Simone
- Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Department of Radiation Oncology, Upstate Cancer Center, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Joseph F. Lombardo
- Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - James Taylor
- Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kamila Nowak-Choi
- Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kevin Ko
- Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Linda Ferguson
- Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ann Donnelly
- Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ayesha S. Ali
- Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Wenyin Shi
- Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Adam P. Dicker
- Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nicole L. Simone
- Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Nowak-Choi K, Palmer JD, Casey J, Chitale A, Kalchman I, Buss E, Keith SW, Hegarty SE, Curtis M, Solomides C, Shi W, Judy K, Andrews DW, Farrell C, Werner-Wasik M. Resected WHO grade I meningioma and predictors of local control. J Neurooncol 2021; 152:145-151. [PMID: 33420897 DOI: 10.1007/s11060-020-03688-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 12/26/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Despite optimal surgical resection, meningiomas may recur, with increasing grade and the degree of resection being predictive of risk. We hypothesize that an increasing Ki67 correlates with a higher risk of recurrence of resected WHO grade I meningiomas. METHODS The study population consisted of patients with resected WHO grade 1 meningiomas in locations outside of the base of skull. Digitally scanned slides stained for Ki67 were analyzed using automatic image analysis software in a standardized fashion. RESULTS Recurrence was observed in 53 (17.7%) of cases with a median follow up time of 25.8 months. Ki67 ranged from 0 to 30%. Median Ki67 was 5.1% for patients with recurrence and 3.5% for patients without recurrence. In unadjusted analyses, high Ki-67 (≥ 5 vs. < 5) vs. ≥ 5) was associated with over a twofold increased risk of recurrence (13.1% vs. 27% respectively; HR 2.1731; 95% CI [1.2534, 3.764]; p = 0.006). After Adjusting for patient or tumor characteristics, elevated Ki-67 remained significantly correlated with recurrence. Grade 4 Simpson resection was noted in 71 (23.7%) of patients and it was associated with a significantly increased risk of recurrence (HR 2.56; 95% CI [1.41, 4.6364]; p = 0.002). CONCLUSIONS WHO grade 1 meningiomas exhibit a significant rate of recurrence following resection. While Ki-67 is not part of the WHO grading criteria of meningiomas, a value greater than 5% is an independent predictor for increased risk of local recurrence following surgical resection.
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Affiliation(s)
- Kamila Nowak-Choi
- Department of Radiation Oncology, Medstar Franklin Square Hospital, Baltimore, MD, USA
| | - Joshua D Palmer
- Department of Radiation Oncology and Department of Neurosurgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210, USA.
| | - James Casey
- Department of Neurosurgery, Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Ameet Chitale
- Department of Neurosurgery, Sidney Kimmel Medical College, Philadelphia, PA, USA
| | | | | | - Scott W Keith
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Sarah E Hegarty
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Mark Curtis
- Department of Pathology, Anatomy and Cell Biology, Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Charalambos Solomides
- Department of Pathology, Anatomy and Cell Biology, Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Wenyin Shi
- Department of Radiation Oncology, Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Kevin Judy
- Department of Neurosurgery, Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - David W Andrews
- Department of Neurosurgery, Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Christopher Farrell
- Department of Neurosurgery, Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Maria Werner-Wasik
- Department of Radiation Oncology, Sidney Kimmel Medical College, Philadelphia, PA, USA
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Williams NL, Nowak-Choi K, Skowronski J, Dan T, Eldredge HB, Hoffman-Censits JH, Lin J, Kelly WK, Gomella LG, Lallas CD, Trabulsi EJ, Hurwitz M, Dicker A, Leiby BE, Dabbish N, Den RB. Evaluating the effect of therapy duration on survival in patients with metastatic castration-resistant prostate cancer receiving radium-223. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.e593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e593 Background: The use of radium-223 in patients with metastatic castration-resistant prostate cancer (mCRPC) improves overall survival (OS) and quality of life. Combination of radium-223 with second-generation anti-androgens has further improved OS; however, the optimal length of radium-223 treatment for maximal effect remains unknown. Methods: We reviewed 35 consecutive patients with mCRPC who received radium-223 from December 2012 to August 2015 at Thomas Jefferson University. Patients were divided into two groups: those who received full treatment of 6 injections (n = 18) versus those who received less than 6 injections (n = 17). Kaplan-Meier analysis of OS were tested for difference by treatment group using Log Rank test. Univariable association with survival outcomes was calculated with univariable Cox regression and Log Rank tests. Results: Mean age was 73 ± 10 years and Karnofsky performance status (KPS) ranged from 50-90 (median, 80). Median follow-up was 13.9 months. Eighteen patients were receiving concurrent second generation anti-androgens at the start of treatment. Median OS was 12 months for patients who received 6 injections and 6.48 months for patients who received less than 6 injections (p = 0.0045). The results of univariate Cox regression analysis revealed full treatment was associated with increased OS (p = 0.0013). On multivariate analysis accounting for KPS, full treatment was significantly associated with improved OS (p = 0.0028). Conclusions: In this retrospective, single-institution analysis, we demonstrated that full course completion of radium-223 was associated with improved OS in patients with mCRPC. These patients should be optimally supported during treatment to allow for therapy completion.
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Affiliation(s)
| | | | | | - Tu Dan
- UT Southwestern, Dallas, TX
| | | | | | - Jianqing Lin
- The Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA
| | - William Kevin Kelly
- The Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA
| | - Leonard G. Gomella
- The Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA
| | - Costas D. Lallas
- The Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA
| | | | - Mark Hurwitz
- Thomas Jefferson University Hospital, Philadelphia, PA
| | - Adam Dicker
- Sidney Kimmel Cancer Center, Philadelphia, PA
| | - Benjamin E. Leiby
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA
| | | | - Robert B. Den
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
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