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Choradia N, Mitchell A, Nipp R. Health Care Lobbying and Oncology. J Natl Compr Canc Netw 2024:1-5. [PMID: 38648846 DOI: 10.6004/jnccn.2023.7120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/29/2023] [Indexed: 04/25/2024]
Abstract
BACKGROUND The health care industry spends more on lobbying than any other industry, with more than $700 million spent in 2022. However, health care lobbying related to cancer has not been characterized. In this study, we sought to describe overall health sector lobbying spending and oncology-related lobbying spending across patient and clinician organizations. METHODS We obtained lobbying data from OpenSecrets.org and the Federal Election Commission. Overall health sector lobbying spending was categorized by OpenSecrets into 4 groups: pharmaceuticals/health products, health services/health maintenance organizations (HMOs), hospitals/nursing homes, and health professionals. We then identified and categorized 4 oncology-related lobbying groups: oncology physician professional organizations (OPPOs), prospective payment system (PPS)-exempt cancer hospitals, patient advocacy organizations, and provider networks (eg, US Oncology Network). We described temporal trends in lobbying spending from 2014 to 2022, in both overall dollar value (inflation-adjusted 2023 dollars) and in per-physician spending (using American Association of Medical Colleges [AAMC] data for number of hematologists/oncologists) using a Mann-Kendall trend test. RESULTS Among the overall health sector lobbying, pharmaceuticals/health products had the greatest increase in lobbying spending, with an increase from $294 million in 2014 to >$376 million in 2022 (P=.0006). In contrast, lobbying spending by health professionals did not change, remaining at $96 million (P=.35). Regarding oncology-related lobbying, OPPOs and PPS-exempt cancer hospitals had a significant increase of 170% (P=.016) and 62% (P=.009), respectively. Per-physician spending also demonstrated an increase from $60 to $134 for OPPOs and from $168 to $226 for PPS-exempt cancer hospitals. Overall, OPPO lobbying increased as a percentage of overall physician lobbying from 1.16% in 2014 to 3.76% in 2022. CONCLUSIONS Although overall health sector lobbying has increased, physician/health professional lobbying has remained relatively stable in recent years, spending for lobbying by OPPOs has increased. Continued efforts to understand the utility and value of lobbying in health care and across oncology are needed as the costs of care continue to increase.
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Affiliation(s)
- Nirmal Choradia
- 1Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | - Ryan Nipp
- 3University of Oklahoma Stephenson Cancer Center, Oklahoma City, OK
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Choradia N, Karzai F, Nipp R, Naqash AR, Gulley JL, Floudas CS. Increasing diversity in clinical trials: Demographic trends at the national cancer institute, 2005-2020. J Natl Cancer Inst 2024:djae018. [PMID: 38374401 DOI: 10.1093/jnci/djae018] [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] [Received: 07/28/2023] [Revised: 12/14/2023] [Accepted: 01/18/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND We described participant demographics for National Cancer Institute (NCI) clinical trials at the Clinical Center (CC) of the National Institutes of Health (NIH) (NCI-CC participants) to identify enrollment disparities. METHODS We analyzed NCI-CC data from 2005-2020, calculated enrollment fractions (EF), compared with the U.S. cancer population represented by the Surveillance, Epidemiology, and End Results (SEER) cancer incidence data (2018) and the Cancer in North American (CiNA) database (2018), and with clinical trial disparities data from NCI's Community Oncology Research Program (NCORP) and National Clinical Trials Network (NCTN) (2005-2019), and from ClinicalTrials.gov (2003-2016). RESULTS NCI-CC (38,531 participants) had higher EF for older adults (OA) (8.5%), male (5.6%), Non-Hispanic (5.1%), Black/African American (AA) (5.3%) participants; lower women proportion across race and ethnicity; fewer female-sex-specific-cancer (6.8%) than male-sex-specific cancer (11.7%) participants. NCI-CC had lower median age than SEER (54.0 vs 65.4), more AA participants (12.0% vs 11.1%), fewer women (41.7% vs 49.5%), White (76.1% vs 80.5%), Asian/Pacific Islander (AP) (4.6% vs 6.0%), American Indian/Alaska Native (AI) (0.3% vs 0.5%) and Hispanic participants (7.1% vs 13%). NCI-CC had more AA, AP participants, fewer Hispanic participants than the NCORP and NCTN; more AA, Hispanic participants, fewer AP participants than ClinicalTrials.gov data. Improvement was noted for NCI-CC (OA, AA, AP, Hispanic participants). CONCLUSION We found lower representation of OA, women, AP, AI, Hispanic vs the U.S. cancer population, higher representation of AA vs U.S. cancer population and oncology clinical trials. Multifaceted efforts are underway to reduce disparities in cancer clinical trials at the NCI-CC.
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Affiliation(s)
- Nirmal Choradia
- Affiliations of authors: Medical Oncology Service, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Fatima Karzai
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ryan Nipp
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Abdul Rafeh Naqash
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - James L Gulley
- Center for Immuno-Oncology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Charalampos S Floudas
- Center for Immuno-Oncology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Ufere NN, Serper M, Kaplan A, Horick N, Indriolo T, Li L, Satapathy N, Donlan J, Castano Jimenez JC, Lago-Hernandez C, Lieber S, Gonzalez C, Keegan E, Schoener K, Bethea E, Dageforde LA, Yeh H, El-Jawahri A, Park ER, Vodkin I, Schonfeld E, Nipp R, Desai A, Lai JC. Financial burden following adult liver transplantation is common and associated with adverse recipient outcomes. Liver Transpl 2024:01445473-990000000-00333. [PMID: 38353602 DOI: 10.1097/lvt.0000000000000348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/31/2024] [Indexed: 03/09/2024]
Abstract
The financial impact of liver transplantation has been underexplored. We aimed to identify associations between high financial burden (≥10% annual income spent on out-of-pocket medical costs) and work productivity, financial distress (coping behaviors in response to the financial burden), and financial toxicity (health-related quality of life, HRQOL) among adult recipients of liver transplant. Between June 2021 and May 2022, we surveyed 207 adult recipients of liver transplant across 5 US transplant centers. Financial burden and distress were measured by 25 items adapted from national surveys of cancer survivors. Participants also completed the Work Productivity and Activity Impairment and EQ-5D-5L HRQOL questionnaires. In total, 23% of recipients reported high financial burden which was significantly associated with higher daily activity impairment (32.9% vs. 23.3%, p =0.048). In adjusted analyses, the high financial burden was significantly and independently associated with delayed or foregone medical care (adjusted odds ratio, 3.95; 95% CI, 1.85-8.42) and being unable to afford basic necessities (adjusted odds ratio, 5.12; 95% CI: 1.61-16.37). Recipients experiencing high financial burden had significantly lower self-reported HRQOL as measured by the EQ-5D-5L compared to recipients with low financial burden (67.8 vs. 76.1, p =0.008) and an age-matched and sex-matched US general population (67.8 vs. 79.1, p <0.001). In this multicenter cohort study, nearly 1 in 4 adult recipients of liver transplant experienced a high financial burden, which was significantly associated with delayed or foregone medical care and lower self-reported HRQOL. These findings underscore the need to evaluate and address the financial burden in this population before and after transplantation.
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Affiliation(s)
- Nneka N Ufere
- Department of Medicine, Gastrointestinal Division, Liver Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marina Serper
- Department of Medicine, Division of Gastroenterology & Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Alyson Kaplan
- Department of Medicine, Tufts Abdominal Transplant Institute, Tufts University Medical Center, Boston, Massachusetts, USA
| | - Nora Horick
- Department of Statistics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Teresa Indriolo
- Department of Medicine, Gastrointestinal Division, Liver Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lucinda Li
- Department of Medicine, Gastrointestinal Division, Liver Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nishant Satapathy
- University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
| | - John Donlan
- Harvard Medical School, Boston, Massachusetts, USA
| | - Janeth C Castano Jimenez
- Department of Medicine, Division of Gastroenterology & Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Carlos Lago-Hernandez
- Department of Medicine, Division of Hospital Medicine, University of California San Diego, La Jolla, California, USA
| | - Sarah Lieber
- Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Carolina Gonzalez
- Department of Social Service, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Eileen Keegan
- Department of Social Service, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kimberly Schoener
- Department of Social Service, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Emily Bethea
- Department of Medicine, Gastrointestinal Division, Liver Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Leigh-Anne Dageforde
- Department of Surgery, Division of Transplantation, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Heidi Yeh
- Department of Surgery, Division of Transplantation, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Areej El-Jawahri
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Elyse R Park
- Department of Psychiatry, Mongan Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Irine Vodkin
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California, San Diego, California, USA
| | - Emily Schonfeld
- Department of Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, USA
| | - Ryan Nipp
- Department of Medicine, University of Oklahoma Health Sciences Center, Stephenson Cancer Center, Oklahoma City, Oklahoma, USA
| | - Archita Desai
- Department of Medicine, Division of Gastroenterology & Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jennifer C Lai
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California, USA
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Narra LR, Verdini N, Lapen K, Nipp R, Gillespie EF. Patient-Reported Outcomes in Clinical Trials: From an Endpoint to an Intervention in Cancer Care. Semin Radiat Oncol 2023; 33:358-366. [PMID: 37684065 DOI: 10.1016/j.semradonc.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/10/2023]
Abstract
Underreporting of patient symptoms by clinicians is a common and well-documented phenomenon that has led to integrating patient-reported outcomes (PROs) as endpoints into clinical trials. While PROs are often used to measure disease symptoms, cancer therapy toxicities, and quality of life, they can also assess patients' general experiences and preferences. With the increasing use of electronic medical records and the digital health revolution in oncology, conversion from paper to electronic PROs (ePROs) has also facilitated the integration of PROs into routine care. Evidence from clinical trials is rapidly emerging to support ePROs as a care delivery innovation, given the potential for ePROs to improve patient outcomes through timely evaluation and response to patient needs. Meanwhile, work is ongoing to understand and address ePRO use and challenges to equitable integration, including technical and language barriers for patients, clinicians, and health systems. Nonetheless, the health system and regulatory bodies continue to develop stipulations to promote the use of ePROs. Herein, we review the evolution of PROs from an endpoint to an intervention in prospective clinical trials in oncology.
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Affiliation(s)
| | - Nicholas Verdini
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kaitlyn Lapen
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ryan Nipp
- Division of Hematology-Oncology, University of Oklahoma, Oklahoma City, OK
| | - Erin F Gillespie
- Department of Radiation Oncology, University of Washington, Seattle, WA; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY.
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Krishan S, Munir MB, Khan MZ, Al-Juhaishi T, Nipp R, DeSimone CV, Deshmukh A, Stavrakis S, Barac A, Asad ZUA. Association of atrial fibrillation and outcomes in patients undergoing bone marrow transplantation. Europace 2023; 25:euad129. [PMID: 37208304 PMCID: PMC10198774 DOI: 10.1093/europace/euad129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 04/14/2023] [Indexed: 05/21/2023] Open
Abstract
AIMS Haematopoietic stem cell transplantation (HSCT) is a potentially curative therapy for several malignant and non-malignant haematologic conditions. Patients undergoing HSCT are at an increased risk of developing atrial fibrillation (AF). We hypothesized that a diagnosis of AF would be associated with poor outcomes in patients undergoing HSCT. METHODS AND RESULTS The National Inpatient Sample (2016-19) was queried with ICD-10 codes to identify patients aged >50 years undergoing HSCT. Clinical outcomes were compared between patients with and without AF. A multivariable regression model adjusting for demographics and comorbidities was used to calculate the adjusted odds ratio (aOR) and regression coefficients with corresponding 95% confidence intervals and P-values. A total of 50 570 weighted hospitalizations for HSCT were identified, out of which 5820 (11.5%) had AF. Atrial fibrillation was found to be independently associated with higher inpatient mortality (aOR 2.75; 1.9-3.98; P < 0.001), cardiac arrest (aOR 2.86; 1.55-5.26; P = 0.001), acute kidney injury (aOR 1.89; 1.6-2.23; P < 0.001), acute heart failure exacerbation (aOR 5.01; 3.54-7.1; P < 0.001), cardiogenic shock (aOR 7.73; 3.17-18.8; P < 0.001), and acute respiratory failure (aOR 3.24; 2.56-4.1; P < 0.001) as well as higher mean length of stay (LOS) (+2.67; 1.79-3.55; P < 0.001) and cost of care (+67 529; 36 630-98 427; P < 0.001). CONCLUSION Among patients undergoing HSCT, AF was independently associated with poor in-hospital outcomes, higher LOS, and cost of care.
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Affiliation(s)
- Satyam Krishan
- Department of Medicine, University of Oklahoma Health Sciences Center, 800 Stanton L. Young Blvd, AAT 5400, Oklahoma City, OK, 73104, USA
| | - Muhammad Bilal Munir
- Department of Cardiovascular Medicine, Electrophysiology Section, University of California Davis, Davis, CA, USA
| | - Muhammad Zia Khan
- Department of Medicine, West Virginia University, Morgantown, WV, USA
| | - Taha Al-Juhaishi
- Department of Medicine, University of Oklahoma Health Sciences Center, 800 Stanton L. Young Blvd, AAT 5400, Oklahoma City, OK, 73104, USA
| | - Ryan Nipp
- Department of Medicine, University of Oklahoma Health Sciences Center, 800 Stanton L. Young Blvd, AAT 5400, Oklahoma City, OK, 73104, USA
| | | | - Abhishek Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Stavros Stavrakis
- Department of Medicine, University of Oklahoma Health Sciences Center, 800 Stanton L. Young Blvd, AAT 5400, Oklahoma City, OK, 73104, USA
| | - Ana Barac
- Cardio Oncology Program, MedStar Heart and Vascular Institute, Georgetown University, Washington, DC, USA
| | - Zain Ul Abideen Asad
- Department of Medicine, University of Oklahoma Health Sciences Center, 800 Stanton L. Young Blvd, AAT 5400, Oklahoma City, OK, 73104, USA
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6
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MacDougall K, Day S, Hall S, Zhao D, Pandey M, Ibrahimi S, Khawandanah M, Chakrabarty JH, Asch A, Nipp R, Al-Juhaishi T. Impact of Race and Age and their Interaction on Survival Outcomes in Patients With Diffuse Large B-Cell Lymphoma. Clin Lymphoma Myeloma Leuk 2023; 23:379-384. [PMID: 36813625 DOI: 10.1016/j.clml.2023.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/25/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Advances in treatment for patients with Diffuse Large B-Cell Lymphoma (DLBCL) have led to improved patient outcomes but the magnitude of these disparities remains understudied with regards to improved survival outcomes. We sought to describe changes in DLBCL survival trends over time and explore potential differential survival patterns by patients' race/ethnicity and age. METHODS We utilized the Surveillance, Epidemiology, and End Results (SEER) database to identify patients diagnosed with DLBCL from 1980 to 009 and determined 5-year survival outcomes for all patients, categorizing patients by year of diagnosis. We used descriptive statistics and logistic regression, adjusting for stage and year of diagnosis, to describe changes in 5-year survival rates over time by race/ethnicity and age. RESULTS We identified 43,564 patients with DLBCL eligible for this study. Median age was 67 years (ages: 18-64 = 44.2%, 65-79 = 37.1%, 80 + = 18.7%). Most patients were male (53.4%) and had advanced stage III/IV disease (40.0%). Most patients were White race (81.4%), followed by Asian/Pacific Islander (API) (6.3%), Black (6.3%), Hispanic (5.4%), and American Indian/Alaska Native (AIAN) (0.05%). Overall, the 5-year survival rate improved from 35.1% in 1980 to 52.4% in 2009 across all races and age groups (odds ratio [OR] for 5-year survival with increasing year of diagnosis = 1.05, P < .001). Patients in racial/ethnic minority groups (API: OR = 0.86, P < .0001; Black: OR = 0.57, P < .0001; AIAN: OR = 0.51, P = .008; Hispanic: 0.76, P = 0.291) and older adults (ages 65-79: OR = 0.43, P < .0001; ages 80+: OR = 0.13, P < .0001) had lower 5-year survival rates after adjusting for race, age, stage, and diagnosis year. We found consistent improvement in the odds of 5-year survival for year of diagnosis across all race and ethnicity groups (White: OR = 1.05, P < .001; API: OR = 1.04, P < .001; Black: OR = 1.06, p<.001; AIAN: OR = 1.05, P < .001; Hispanic: OR = 1.05, P < .005) and age groups (ages 18-64: OR = 1.06, P < .001; ages 65-79: OR = 1.04, P < .001; ages 80+: OR = 1.04, P < .001). CONCLUSION Patients with DLBCL experienced improvements in 5-year survival rates from 1980 to 2009, despite persistently lower survival among patients in racial/ethnic minority groups and older adults.
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Affiliation(s)
- Kira MacDougall
- Department of Medicine, University of Oklahoma Health Sciences Center, Stephenson Cancer Center, Oklahoma, OK
| | - Silas Day
- Department of Medicine, University of Oklahoma Health Sciences Center, Stephenson Cancer Center, Oklahoma, OK
| | - Spencer Hall
- Department of Medicine, University of Oklahoma Health Sciences Center, Stephenson Cancer Center, Oklahoma, OK; Stephenson Cancer Center Biostatistics Research and Design Core, Oklahoma, OK
| | - Daniel Zhao
- Department of Medicine, University of Oklahoma Health Sciences Center, Stephenson Cancer Center, Oklahoma, OK; Stephenson Cancer Center Biostatistics Research and Design Core, Oklahoma, OK
| | - Manu Pandey
- Department of Medicine, University of Oklahoma Health Sciences Center, Stephenson Cancer Center, Oklahoma, OK
| | - Sami Ibrahimi
- Department of Medicine, University of Oklahoma Health Sciences Center, Stephenson Cancer Center, Oklahoma, OK
| | - Mohamad Khawandanah
- Department of Medicine, University of Oklahoma Health Sciences Center, Stephenson Cancer Center, Oklahoma, OK
| | - Jennifer H Chakrabarty
- Department of Medicine, University of Oklahoma Health Sciences Center, Stephenson Cancer Center, Oklahoma, OK
| | - Adam Asch
- Department of Medicine, University of Oklahoma Health Sciences Center, Stephenson Cancer Center, Oklahoma, OK
| | - Ryan Nipp
- Department of Medicine, University of Oklahoma Health Sciences Center, Stephenson Cancer Center, Oklahoma, OK
| | - Taha Al-Juhaishi
- Department of Medicine, University of Oklahoma Health Sciences Center, Stephenson Cancer Center, Oklahoma, OK.
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Lamba N, Saraf A, Koenig J, Balboni T, Haas-Kogan D, Nipp R, Aizer A. Association of Baseline Symptom Burden and Survival among Patients with Brain Metastases at a Tertiary Cancer Center. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.798] [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]
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Kaslow-Zieve E, Ly L, Parikh A, Klempner S, Wo J, Drapek L, Weekes C, Franses J, Hong T, Nipp R, Perni S. Knowledge and Understanding of Treatment Options among Patients with Gastrointestinal (GI) Cancer in an Academic Cancer Center. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1411] [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: 11/25/2022]
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Choucair K, Naqash AR, Nebhan CA, Nipp R, Johnson DB, Saeed A. Immune Checkpoint Inhibitors: The Unexplored Landscape of Geriatric Oncology. Oncologist 2022; 27:778-789. [PMID: 35781739 PMCID: PMC9438919 DOI: 10.1093/oncolo/oyac119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 02/14/2022] [Accepted: 05/11/2022] [Indexed: 12/12/2022] Open
Abstract
Cancer is classically considered a disease of aging, with over half of all new cancer diagnoses occurring in patients over the age of 65 years. Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment, yet the participation of older adults with cancer in ICI trials has been suboptimal, particularly at the extremes of age. Despite significant improvement in treatment response and an improved toxicity profile when compared with conventional cytotoxic chemotherapies, many cancers develop resistance to ICIs, and these drugs are not free of toxicities. This becomes particularly important in the setting of older adults with cancer, who are generally frailer and harbor more comorbidities than do their younger counterparts. Immunosenescence, a concept involving age-related changes in immune function, may also play a role in differential responses to ICI treatment in older patients. Data on ICI treatment response in older adult with cancers remains inconclusive, with multiple studies revealing conflicting results. The molecular mechanisms underlying response to ICIs in older cancer patients are poorly understood, and predictors of response that can delineate responders from non-responders remain to be elucidated. In this review, we explore the unique geriatric oncology population by analyzing existing retrospective datasets, and we also sought to highlight potential cellular, inflammatory, and molecular changes associated with aging as potential biomarkers for response to ICIs.
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Affiliation(s)
- Khalil Choucair
- University of Kansas School of Medicine-Wichita, Department of Internal Medicine, Wichita, KS, USA
| | - Abdul Rafeh Naqash
- The University of Oklahoma College of Medicine, Department of Internal Medicine, Division of Hematology/Oncology; Stephenson Cancer Center, Oklahoma City, OK, USA
| | - Caroline A Nebhan
- Vanderbilt University Medical Center, Department of Medicine, Division of Hematology/Oncology, Nashville, TN, USA
| | - Ryan Nipp
- The University of Oklahoma College of Medicine, Department of Internal Medicine, Division of Hematology/Oncology; Stephenson Cancer Center, Oklahoma City, Oklahoma, USA
| | - Douglas B Johnson
- Vanderbilt University Medical Center, Department of Medicine, Division of Hematology/Oncology, Nashville, Tennessee, USA
| | - Anwaar Saeed
- Kansas University Cancer Center, Department of Medicine, Division of Medical Oncology, Kansas City, KS, USA
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Zafar A, Drobni ZD, Lei M, Gongora CA, Quinaglia T, Lou UY, Mosarla R, Murphy SP, Jones-O’Connor M, Mahmood A, Hartmann S, Gilman HK, Weekes CD, Nipp R, Clark JR, Clark JW, Blaszkowsky LS, Tavares E, Neilan TG. The efficacy and safety of cardio-protective therapy in patients with 5-FU (Fluorouracil)-associated coronary vasospasm. PLoS One 2022; 17:e0265767. [PMID: 35390017 PMCID: PMC8989300 DOI: 10.1371/journal.pone.0265767] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 03/08/2022] [Indexed: 11/18/2022] Open
Abstract
Background Coronary vasospasm is a known side effect of 5-FU (fluorouracil) therapy. Beyond switching to non-5FU-based chemotherapy, there are no established treatments for 5-FU associated coronary vasospam. Our objective was to assess the safety and efficacy of re-challenge with 5-FU after pre-treatment with calcium channel blockers (CCBs) and long-acting nitrates among patients 5-FU associated coronary vasospasm. Methods We conducted a retrospective study of patients with 5-FU coronary vasospasm at a single academic center. By protocol, those referred to cardio-oncology received pre-treatment with either combination [nitrates and CCBs] or single-agent therapy [nitrates or CCBs]) prior to re-challenge with 5-FU. Our primary outcome was overall survival. Other important outcomes included progression-free survival and safety. Results Among 6,606 patients who received 5-FU from January 2001 to Dec 2020, 115 (1.74%) developed coronary vasospasm. Of these 115 patients, 81 patients continued 5-FU therapy, while 34 stopped. Of the 81 who continued, 78 were referred to cardio-oncology and prescribed CCBs and/or nitrates prior to subsequent 5-FU, while the remaining 3 continued 5-FU without cardiac pre-treatment. Of the 78, 56.4% (44/78) received both nitrates and CCBs, 19.2% (15/78) received CCBs alone, and 24.4% (19/78) received nitrates alone. When compared to patients who stopped 5-FU, those who continued 5-FU after pre-treatment (single or combination therapy) had a decreased risk of death (HR 0.42, P = 0.005 [95% CI 0.23–0.77]) and a trend towards decreased cancer progression (HR 0.60, P = 0.08 [95% CI 0.34–1.06]). No patient in the pre-treatment group had a myocardial infarct after re-challenge; however, chest pain (without myocardial infarction) recurred in 19.2% (15/78) among those who received cardiac pre-treatment vs. 66.7% (2/3) among those who did not (P = 0.048). There was no difference in efficacy or the recurrence of vasospasm among patients who received pre-treatment with a single agent (nitrates or CCBs) or combination therapy (14.7% (5/34) vs. 25.0% (11/44), P = 0.26). Conclusion Re-challenge after pre-treatment with CCBs and nitrates guided by a cardio-oncology service was safe and allowed continued 5-FU therapy.
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Affiliation(s)
- Amna Zafar
- Department of Radiology and Division of Cardiology, Cardiovascular Imaging Research Center (CIRC), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Cardiovascular Diseases and Hypertension, Department of Medicine, Robert Wood Johnson University Hospital, Rutgers Medical School, New Brunswick, New Jersey, United States of America
| | - Zsofia D. Drobni
- Department of Radiology and Division of Cardiology, Cardiovascular Imaging Research Center (CIRC), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Matthew Lei
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Carlos A. Gongora
- Department of Radiology and Division of Cardiology, Cardiovascular Imaging Research Center (CIRC), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Thiago Quinaglia
- Department of Radiology and Division of Cardiology, Cardiovascular Imaging Research Center (CIRC), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Uvette Y. Lou
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ramya Mosarla
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Sean P. Murphy
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Maeve Jones-O’Connor
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ali Mahmood
- Division of Cardiology, Department of Medicine, Morristown Medical Center, Morristown, New Jersey, United States of America
| | - Sarah Hartmann
- Department of Radiology and Division of Cardiology, Cardiovascular Imaging Research Center (CIRC), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Hannah K. Gilman
- Department of Radiology and Division of Cardiology, Cardiovascular Imaging Research Center (CIRC), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Colin D. Weekes
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ryan Nipp
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - John R. Clark
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jeffrey W. Clark
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Lawrence S. Blaszkowsky
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Erica Tavares
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Tomas G. Neilan
- Department of Radiology and Division of Cardiology, Cardiovascular Imaging Research Center (CIRC), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Cardiology, Department of Medicine, Cardio-Oncology Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
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11
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Vidula N, Kaslow-Zieve E, Qian C, Neckermann I, Gaufberg E, Vyas C, Newcomb R, Johnson PC, Lage D, Shin J, Nipp R. Abstract P4-12-04: Healthcare utilization and symptoms among hospitalized patients with breast cancer. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p4-12-04] [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: 11/16/2022]
Abstract
Abstract
Background: Patients with breast cancer generally receive most of their care in an outpatient setting, but unplanned hospitalizations may occur to help manage uncontrolled symptoms. We sought to investigate healthcare utilization and symptoms among patients with breast cancer experiencing an unplanned hospitalization. Methods: We enrolled patients with cancer and unplanned hospitalizations from 9/2014 to 2/2017. The current study focuses on the patients with breast cancer in this cohort. Following hospital admission, we assessed patient-reported symptoms using the Edmonton Symptom Assessment System (ESAS). We reviewed the electronic health record to obtain information about patient demographics, clinical characteristics, healthcare utilization, and reasons for hospital admission (elicited from primary and secondary diagnoses listed on the hospitalization discharge summary). We examined the associations among patients’ symptoms, healthcare utilization (i.e., hospital length of stay and 90-day readmissions), and survival using regression models. Results: We identified 101 patients with breast cancer (median age=60 years [range 22-86]. In this cohort, 74% had metastatic breast cancer. Primary/secondary reasons for hospitalization included fever/infection (34%), pain (18%), dyspnea (12%), gastrointestinal diagnoses (constipation, diarrhea, bowel obstruction, biliary obstruction, ascites, 10%), nausea/vomiting (7%), failure to thrive (6%), pleural effusion (5%), renal failure (4%), blood clot (3%), cardiac diagnoses (atrial fibrillation, cardiomyopathy, 3%), lightheadedness/hypotension (3%), neurologic diagnoses (altered mental status, seizure, subdural hematoma, 3%), fracture (2%), lower extremity swelling (2%), and other (i.e., rash, ptosis, SVC syndrome, fall, 1% each). Table 1 describes the baseline ESAS symptoms collected upon hospital admission. The mean length of hospital stay was 6.2 days and 90-day readmission rates were 28%. Patient disposition post hospitalization included discharge to home (76%), post-acute care facility (12%), hospice (5%), and death in the hospital (6%). We found that patients’ ESAS-physical symptoms were associated with longer hospital length of stay (B=0.08, p=0.029), greater risk of death or readmission within 90-days (OR=1.07, p<0.001), and worse overall survival (HR=1.04, p=0.001). Similarly, patients’ ESAS-total symptoms were associated with longer hospital length of stay (B=0.07, p=0.013), greater risk of death or readmission within 90-days (OR=1.05, p=0.001), and worse overall survival (HR=1.02, p=0.003). Conclusions: In this cohort of hospitalized patients with breast cancer, the majority had metastatic disease and presented with a high symptom burden. Unplanned admissions in these patients with breast cancer commonly occurred for fever/infection, pain, dyspnea, and gastrointestinal reasons. We identified novel associations among patients’ symptoms upon admission with their hospital length of stay, risk of readmissions/death, and overall survival. These findings highlight the need for timely outpatient interventions that address patient symptoms when seeking to enhance health care utilization and survival outcomes in this population.
Table 1.Baseline symptom% of patients with moderate or severe symptomsMedian ESAS scoreTiredness*90%8 (Severe)Pain*78%7 (Severe)Well-being76%5 (Moderate)Drowsiness*71%6 (Moderate)Lack of appetite*68%5 (Moderate)Anxiety61%5 (Moderate)Depression52%4 (Moderate)Nausea*45%2 (Mild)Shortness of breath*45%2 (Mild)Constipation*44%0 (None)Total ESAS scoreMedian score 47 Total ESAS_physical score. . Median score 34*components included in ESAS_physical score
Citation Format: Neelima Vidula, Emilia Kaslow-Zieve, Carolyn Qian, Isabel Neckermann, Eva Gaufberg, Charu Vyas, Richard Newcomb, Patrick C Johnson, Daniel Lage, Jennifer Shin, Ryan Nipp. Healthcare utilization and symptoms among hospitalized patients with breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-12-04.
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Affiliation(s)
| | | | | | | | | | - Charu Vyas
- Massachusetts General Hospital, Boston, MA
| | | | | | | | | | - Ryan Nipp
- Massachusetts General Hospital, Boston, MA
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12
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Johnson A, Healy M, Lundquist D, Nipp R, Jimenez R. The Impact of Early Palliative Radiation Among Patients Enrolled on Early Phase Clinical Trials. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1349] [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: 10/20/2022]
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13
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Deshields TL, Wells-Di Gregorio S, Flowers SR, Irwin KE, Nipp R, Padgett L, Zebrack B. Addressing distress management challenges: Recommendations from the consensus panel of the American Psychosocial Oncology Society and the Association of Oncology Social Work. CA Cancer J Clin 2021; 71:407-436. [PMID: 34028809 DOI: 10.3322/caac.21672] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 03/17/2021] [Accepted: 03/22/2021] [Indexed: 12/11/2022] Open
Abstract
Distress management (DM) (screening and response) is an essential component of cancer care across the treatment trajectory. Effective DM has many benefits, including improving patients' quality of life; reducing distress, anxiety, and depression; contributing to medical cost offsets; and reducing emergency department visits and hospitalizations. Unfortunately, many distressed patients do not receive needed services. There are several multilevel barriers that represent key challenges to DM and affect its implementation. The Consolidated Framework for Implementation Research was used as an organizational structure to outline the barriers and facilitators to implementation of DM, including: 1) individual characteristics (individual patient characteristics with a focus on groups who may face unique barriers to distress screening and linkage to services), 2) intervention (unique aspects of DM intervention, including specific challenges in screening and psychosocial intervention, with recommendations for resolving these challenges), 3) processes for implementation of DM (modality and timing of screening, the challenge of triage for urgent needs, and incorporation of patient-reported outcomes and quality measures), 4) organization-inner setting (the context of the clinic, hospital, or health care system); and 5) organization-outer setting (including reimbursement strategies and health-care policy). Specific recommendations for evidence-based strategies and interventions for each of the domains of the Consolidated Framework for Implementation Research are also included to address barriers and challenges.
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Affiliation(s)
- Teresa L Deshields
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
| | - Sharla Wells-Di Gregorio
- Department of Internal Medicine, Division of Palliative Medicine, The Ohio State University Wexner Medical Center, James Cancer Hospital, Columbus, Ohio
| | - Stacy R Flowers
- Department of Family Medicine, Boonshoft School of Medicine, Wright State University, Dayton, Ohio
| | - Kelly E Irwin
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ryan Nipp
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lynne Padgett
- Department of Psychology, Veterans Affairs Medical Center, Washington, District of Columbia
| | - Brad Zebrack
- School of Social Work, University of Michigan, Ann Arbor, Michigan
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14
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Affiliation(s)
- Ryan Nipp
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston
| | - Areej El-Jawahri
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston
| | - Jennifer Temel
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston
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15
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Navari RM, Ruddy KJ, LeBlanc TW, Nipp R, Clark-Snow R, Schwartzberg L, Binder G, Bailey WL, Potluri R, Schmerold LM, Papademetriou E, Roeland EJ. Avoidable Acute Care Use Associated with Nausea and Vomiting Among Patients Receiving Highly Emetogenic Chemotherapy or Oxaliplatin. Oncologist 2020; 26:325-331. [PMID: 33289268 DOI: 10.1002/onco.13620] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 05/19/2020] [Accepted: 11/20/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Chemotherapy-induced nausea and vomiting (CINV) contributes to avoidable acute care, a metric now tracked in Medicare's oncology outcome measure. CINV is preventable, yet guidelines are often not followed. We sought to quantify acute care involving CINV and other avoidable toxicities after highly emetogenic chemotherapy (HEC) to identify excess risk and assess clinician adherence to antiemesis guidelines for HEC. MATERIALS AND METHODS We retrospectively evaluated U.S. electronic health records (2012-2018) using Medicare's OP-35 outcome measure to identify avoidable acute care involving any of 10 toxicities, including CINV, after HEC regimens relative to non-HEC. Antiemetic guideline adherence was defined as use ofneurokinin-1 (NKl) receptor antagonists Q5 (RAs) plus 5-hydroxytryptamine type 3 RA+ dexamethasone at HEC initiation. RESULTS Among 17,609 patients receiving HEC, acute care rates associated with HEC chemotherapy included 32% cisplatin, 31% carboplatin, and 21% anthracycline/cyclosphospharnide (AC), with 76% meeting the criteria as avoidable events. Oxaliplatin rates were 29%. Avoidable acute care occurred 1.83 times (95% confidence interval, 1.76-1.91, p < .0001) as often after HEC versus non-HEC excluding oxaliplatin; CINV-related acute care occurred 2.29 times as often. Nonadherence to antiemesis guidelines occurred in 34% and 24% of cisplatin and AC courses, respectively, because of omission of a NKl RA. CONCLUSIONS Patients treated with HEC regimens experienced high avoidable acute care use, 1.8 times the risk seen for other chemotherapy. Nonadherence to guideline-directed antiemetic prophylaxis highlights the need to ensure adherence to antiemetic guidelines, including the use of NKl RA in HEC. IMPLICATIONS FOR PRACTICE After survival, perhaps the most important goal in oncology is limiting avoidable acute care, a goal now used by Medicare to impact cancer reimbursement. This study found that patients treated with highly emetogenic chemotherapy (HEC) regimens had high rates of avoidable acute care use, 1.8 times the risk seen for other chemotherapy. A substantial proportion of the avoidable acute care involved chemotherapy-induced nausea and vomiting. Results showed that incomplete adherence to national antiemetic guidelines for HEC regimens primarily driven by omission of upfront neurokinin-1 receptor antagonist use, suggesting that improved adherence can meaningfully resolve this gap in quality and cost of care.
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Affiliation(s)
| | | | - Thomas W LeBlanc
- Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Ryan Nipp
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | | | - Lee Schwartzberg
- Division of Hematology/Oncology, University of Tennessee Health Sciences Center and West Cancer Center, Germantown, Tennessee, USA
| | - Gary Binder
- Helsinn Therapeutics (U.S.), Iselin, New Jersey, USA
| | | | | | | | | | - Eric J Roeland
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
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16
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Roberts H, Grassberger C, Van Seventer E, Fernandez-Del Casti C, Ferrone C, Qadan M, Ryan D, Clark J, Parikh A, Allen J, Weekes C, Nipp R, Eyler C, Wo J, Hong T. Dose Escalation Radiation with IORT for Unresectable Pancreatic Cancer in the Era of FOLFIRINOX. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1805] [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: 10/23/2022]
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17
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Kim S, DiPeri TP, Guan M, Placencio-Hickok VR, Kim H, Liu JY, Hendifar A, Klempner SJ, Nipp R, Gangi A, Burch M, Waters K, Cho M, Chao J, Atkins K, Kamrava M, Tuli R, Gong J. Impact of palliative therapies in metastatic esophageal cancer patients not receiving chemotherapy. World J Gastrointest Surg 2020; 12:377-389. [PMID: 33024512 PMCID: PMC7520571 DOI: 10.4240/wjgs.v12.i9.377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/02/2020] [Accepted: 09/08/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Palliative therapy has been associated with improved overall survival (OS) in several tumor types. Not all patients with metastatic esophageal cancer receive palliative chemotherapy, and the roles of other palliative therapies in these patients are limited.
AIM To investigate the impact of other palliative therapies in patients with metastatic esophageal cancer not receiving chemotherapy.
METHODS The National Cancer Database was used to identify patients between 2004-2015. Patients with M1 disease who declined chemotherapy and had known palliative therapy status [palliative therapies were defined as surgery, radiotherapy (RT), pain management, or any combination thereof] were included. Cases with unknown chemotherapy, RT, or nonprimary surgery status were excluded. Kaplan-Meier estimates of OS were calculated. Cox proportional hazards regression models were employed to examine factors influencing survival.
RESULTS Among 140234 esophageal cancer cases, we identified 1493 patients who did not receive chemotherapy and had complete data. Median age was 70 years, most (66.3%) had a Charlson Comorbidity Index (CCI) of 0, and 37.1% were treated at an academic center. The majority (72.7%) did not receive other palliative therapies. On both univariate and multivariable analyses, there was no difference in OS between those receiving other palliative therapy (median 2.83 mo, 95%CI: 2.53-3.12) vs no palliative therapy (2.37 no, 95%CI: 2.2-2.56; multivariable P = 0.290). On univariate, but not multivariable analysis, treatment at an academic center was predictive of improved OS [Hazard ratio (HR) 0.90, 95%CI: 0.80-1.00; P = 0.047]. On multivariable analysis, female sex (HR 0.81, 95%CI: 0.71-0.92) and non-black, other race compared to white race (HR 0.72, 95%CI: 0.56-0.93) were associated with reduced mortality, while South geographic region relative to West region (HR 1.23, 95%CI: 1.04-1.46) and CCI of 1 relative to CCI of 0 (HR 1.17, 95%CI: 1.03-1.32) were associated with increased mortality. Higher histologic grade and T-stage were also associated with worse OS (P < 0.05).
CONCLUSION Palliative therapies other than chemotherapy conferred a numerically higher, but not statistically significant difference in OS among patients with metastatic esophageal cancer not receiving chemotherapy. Quality of life metrics, inpatient status, and subgroup analyses are important for examining the role of palliative therapies other than chemotherapy in metastatic esophageal cancer and future studies are warranted.
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Affiliation(s)
- Sungjin Kim
- Biostatistics and Bioinformatics Research Center, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
| | - Timothy P DiPeri
- Division of Surgical Oncology, Department of Surgery, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
| | - Michelle Guan
- Department of Medicine, Division of Hematology and Oncology, Samuel Oschin Comprehensive Cancer Institute, Cedars Sinai Medical Center, Los Angeles, CA 90048, United States
| | - Veronica R Placencio-Hickok
- Department of Medicine, Division of Hematology and Oncology, Samuel Oschin Comprehensive Cancer Institute, Cedars Sinai Medical Center, Los Angeles, CA 90048, United States
| | - Haesoo Kim
- Department of Medicine, Division of Hematology and Oncology, Samuel Oschin Comprehensive Cancer Institute, Cedars Sinai Medical Center, Los Angeles, CA 90048, United States
| | - Jar-Yee Liu
- Department of Medicine, Division of Hematology and Oncology, Samuel Oschin Comprehensive Cancer Institute, Cedars Sinai Medical Center, Los Angeles, CA 90048, United States
| | - Andrew Hendifar
- Department of Medicine, Division of Hematology and Oncology, Samuel Oschin Comprehensive Cancer Institute, Cedars Sinai Medical Center, Los Angeles, CA 90048, United States
| | - Samuel J Klempner
- Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA 02114, United States
| | - Ryan Nipp
- Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA 02114, United States
| | - Alexandra Gangi
- Division of Surgical Oncology, Department of Surgery, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
| | - Miguel Burch
- Division of Surgical Oncology, Department of Surgery, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
| | - Kevin Waters
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
| | - May Cho
- Division of Hematology and Oncology, Department of Medicine, University of California, Davis, Sacramento, CA 95817, United States
| | - Joseph Chao
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, United States
| | - Katelyn Atkins
- Department of Radiation Oncology, Cedars Sinai Medical Center, Los Angeles, CA 90048, United States
| | - Mitchell Kamrava
- Department of Radiation Oncology, Cedars Sinai Medical Center, Los Angeles, CA 90048, United States
| | - Richard Tuli
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Jun Gong
- Department of Medicine, Division of Hematology and Oncology, Samuel Oschin Comprehensive Cancer Institute, Cedars Sinai Medical Center, Los Angeles, CA 90048, United States
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18
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El-Jawahri A, Forst D, Fenech A, Brenner KO, Jankowski AL, Waldman L, Sereno I, Nipp R, Greer JA, Traeger L, Jackson V, Temel J. Relationship Between Perceptions of Treatment Goals and Psychological Distress in Patients With Advanced Cancer. J Natl Compr Canc Netw 2020; 18:849-855. [PMID: 32634779 DOI: 10.6004/jnccn.2019.7525] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 12/16/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Studies have shown gaps in prognostic understanding among patients with cancer. However, few studies have explored patients' perceptions of their treatment goals versus how they perceive their oncologist's goals, and the association of these views with their psychological distress. METHODS We conducted a cross-sectional study of 559 patients with incurable lung, gastrointestinal, breast, and brain cancers. The Prognosis and Treatment Perception Questionnaire was used to assess patients' reports of their treatment goal and their oncologist's treatment goal, and the Hospital Anxiety and Depression Scale was used to assess patients' psychological symptoms. RESULTS We found that 61.7% of patients reported that both their treatment goal and their oncologist's treatment goal were noncurative, whereas 19.3% reported that both their goal and their oncologist's goal were to cure their cancer, 13.9% reported that their goal was to cure their cancer whereas their oncologist's goal was noncurative, and 5% reported that their goal was noncurative whereas their oncologist's goal was curative. Patients who reported both their goal and their oncologist's goal as noncurative had higher levels of depression (B=0.99; P=.021) and anxiety symptoms (B=1.01; P=.015) compared with those who reported that both their goal and their oncologist's goal was curative. Patients with discordant perceptions of their goal and their oncologist's goal reported higher anxiety symptoms (B=1.47; P=.004) compared with those who reported that both their goal and their oncologist's goal were curative. CONCLUSIONS One-fifth of patients with incurable cancer reported that both their treatment goal and their oncologist's goal were to cure their cancer. Patients who acknowledged the noncurative intent of their treatment and those who perceived that their treatment goal was discordant from that of their oncologist reported greater psychological distress.
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Affiliation(s)
- Areej El-Jawahri
- 1Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center.,2Harvard Medical School, and
| | - Deborah Forst
- 1Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center.,2Harvard Medical School, and
| | - Alyssa Fenech
- 1Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center.,2Harvard Medical School, and
| | - Keri O Brenner
- 2Harvard Medical School, and.,3Department of Medicine, Division of Palliative Care, Massachusetts General Hospital, Boston, Massachusetts; and.,4Department of Medicine, Section of Palliative Care, Stanford University, Stanford, California
| | - Amanda L Jankowski
- 1Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center.,2Harvard Medical School, and
| | - Lauren Waldman
- 1Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center.,2Harvard Medical School, and
| | - Isabella Sereno
- 1Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center.,2Harvard Medical School, and
| | - Ryan Nipp
- 1Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center.,2Harvard Medical School, and
| | - Joseph A Greer
- 1Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center.,2Harvard Medical School, and
| | - Lara Traeger
- 1Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center.,2Harvard Medical School, and
| | - Vicki Jackson
- 2Harvard Medical School, and.,3Department of Medicine, Division of Palliative Care, Massachusetts General Hospital, Boston, Massachusetts; and
| | - Jennifer Temel
- 1Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center.,2Harvard Medical School, and
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19
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Ufere NN, Donlan J, Waldman L, Dienstag JL, Friedman LS, Corey KE, Hashemi N, Carolan P, Mullen AC, Thiim M, Bhan I, Nipp R, Greer JA, Temel JS, Chung RT, El-Jawahri A. Barriers to Use of Palliative Care and Advance Care Planning Discussions for Patients With End-Stage Liver Disease. Clin Gastroenterol Hepatol 2019; 17:2592-2599. [PMID: 30885884 PMCID: PMC6745282 DOI: 10.1016/j.cgh.2019.03.022] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 02/28/2019] [Accepted: 03/10/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Despite evidence for the benefits of palliative care (PC) referrals and early advance care planning (ACP) discussions for patients with chronic diseases, patients with end-stage liver disease (ESLD) often do not receive such care. We sought to examine physicians' perceptions of the barriers to PC and timely ACP discussions for patients with ESLD. METHODS We conducted a cross-sectional survey of hepatologists and gastroenterologists who provide care to adult patients with ESLD, recruited from the American Association for the Study of Liver Diseases 2018 membership registry. Using a questionnaire adapted from prior studies, we assessed physicians' perceptions of barriers to PC use and timely ACP discussions; 396 of 1236 eligible physicians (32%) completed the questionnaire. RESULTS The most commonly cited barriers to PC use were cultural factors that affect perception of PC (by 95% of respondents), unrealistic expectations from patients about their prognosis (by 93% of respondents), and competing demands for clinicians' time (by 91% of respondents). Most respondents (81%) thought that ACP discussions with patients who have ESLD typically occur too late in the course of illness. The most commonly cited barriers to timely ACP discussions were insufficient communication between clinicians and families about goals of care (by 84% of respondents) and insufficient cultural competency training about end-of-life care (81%). CONCLUSION There are substantial barriers to use of PC and timely discussions about ACP-most hepatologists and gastroenterologists believe that ACP occurs too late for patients with ESLD. Strategies are needed to overcome barriers and increase delivery of high-quality palliative and end-of-life care to patients with ESLD.
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Affiliation(s)
- Nneka N. Ufere
- Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | - John Donlan
- Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | - Lauren Waldman
- Division of Hematology-Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Jules L. Dienstag
- Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | | | - Kathleen E. Corey
- Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | - Nikroo Hashemi
- Division of Gastroenterology, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston MA, USA
| | - Peter Carolan
- Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | - Alan C. Mullen
- Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | - Michael Thiim
- Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | - Irun Bhan
- Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | - Ryan Nipp
- Division of Hematology-Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Joseph A. Greer
- Division of Hematology-Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Jennifer S. Temel
- Division of Hematology-Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Raymond T. Chung
- Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | - Areej El-Jawahri
- Division of Hematology-Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
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Kirchhoff AC, Nipp R, Warner EL, Kuhlthau K, Leisenring WM, Donelan K, Rabin J, Perez GK, Oeffinger KC, Nathan PC, Robison LL, Armstrong GT, Park ER. "Job Lock" Among Long-term Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study. JAMA Oncol 2019; 4:707-711. [PMID: 29049517 DOI: 10.1001/jamaoncol.2017.3372] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Importance Childhood cancer survivors may be reluctant to make changes in their employment because of access to health insurance. Objective To examine the prevalence of "job lock" (staying at a job to keep work-related health insurance) in a sample drawn from an established, multi-institutional cohort of full-time employed childhood cancer survivors compared with a random sample of siblings and to explore factors associated with job lock among cancer survivors. Design, Setting, and Participants Cross-sectional survey of full-time employed adult survivors of childhood cancer and a random sample of siblings derived from a cohort of 25 US pediatric oncology centers. Exposures Data collection included sociodemographic factors, insurance coverage, chronic medical conditions, and treatment. Main Outcomes and Measures Self-report of job lock and factors associated with job lock. Results Among the 522 participants, 394 were cancer survivors (54.5% male) and 128 were siblings (51.5% male). Job lock was reported by 23.2% (95% CI, 18.9%-28.1%) of survivors, compared with 16.9% (95% CI, 11.1%-25.0%) of siblings (P = .16). Job lock was more common among survivors reporting previous health insurance denial (relative risk [RR], 1.60; 95% CI, 1.03-2.52) and problems paying medical bills (RR, 2.43; 95% CI, 1.56-3.80). Among survivors, being female (RR, 1.70; 95% CI, 1.11-2.59; P = .01) and having a severe, disabling, or life-threatening health condition (RR, 1.72; 95% CI, 1.09-2.69; P = .02) were associated with job lock. Conclusions and Relevance Job lock is common among long-term childhood cancer survivors who are employed full-time. A survivor's decision to remain employed at a job in order to maintain health insurance coverage may affect career trajectory, diminish potential earning power, and ultimately impact quality of life.
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Affiliation(s)
- Anne C Kirchhoff
- Huntsman Cancer Institute, University of Utah, Salt Lake City.,Department of Pediatrics, University of Utah, Salt Lake City
| | - Ryan Nipp
- Department of Medicine, Massachusetts General Hospital Cancer Center, Boston.,Harvard Medical School, Boston
| | - Echo L Warner
- Huntsman Cancer Institute, University of Utah, Salt Lake City
| | - Karen Kuhlthau
- Department of Pediatrics, Massachusetts General Hospital, Boston.,Department of Pediatrics, Harvard Medical School, Boston
| | - Wendy M Leisenring
- Clinical Research Division and Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Karen Donelan
- Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston
| | - Julia Rabin
- Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston.,Massachusetts General Hospital Cancer Survivorship Program, Massachusetts General Hospital Cancer Center, Boston
| | - Giselle K Perez
- Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston.,Massachusetts General Hospital Cancer Survivorship Program, Massachusetts General Hospital Cancer Center, Boston
| | - Kevin C Oeffinger
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Paul C Nathan
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Elyse R Park
- Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston.,Massachusetts General Hospital Cancer Survivorship Program, Massachusetts General Hospital Cancer Center, Boston
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Perni S, Hong T, Noe B, Casti CFD, Ferrone C, Lillemoe K, Allen J, Parikh A, Nipp R, Ryan D, Qadan M, Clark J, Weekes C, Wo J. Local Therapy for a Systemic Disease: Indications and Impact of Radiation Therapy to the Pancreatic Primary in Metastatic Pancreatic Cancer. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1922] [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: 11/26/2022]
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22
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Mauri G, Kanter K, Fish M, Horick N, Allen J, Blaszkowsky L, Clark J, Ryan D, Nipp R, Giantonio B, Goyal L, Dubois J, Murphy J, Roeland E, Weekes C, Wo J, Hong T, Zhu A, Van Seventer E, Corcoran R, Parikh A. PARP-ness in metastatic colorectal cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz156.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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23
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Parikh A, Kanter K, Mojtahed A, Schneider J, Van Seventer E, Fish M, Allen J, Blaszkowsky L, Wo J, Clark J, Giantonio B, Goyal L, Hong T, Nipp R, Roeland E, Weekes C, Zhu A, Ryan D, Fetter I, Horick N, Corcoran R. Serial circulating tumor DNA (ctDNA) monitoring to predict response to treatment in metastatic gastrointestinal cancers. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz156.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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24
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Ufere NN, Donlan J, Waldman L, Patel A, Dienstag JL, Friedman LS, Corey KE, Hashemi N, Carolan P, Mullen AC, Thiim M, Bhan I, Nipp R, Greer J, Temel J, Chung RT, El-Jawahri A. Physicians' Perspectives on Palliative Care for Patients With End-Stage Liver Disease: A National Survey Study. Liver Transpl 2019; 25:859-869. [PMID: 30963669 PMCID: PMC6529275 DOI: 10.1002/lt.25469] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/24/2019] [Indexed: 12/12/2022]
Abstract
Specialty palliative care (PC) is underused for patients with end-stage liver disease (ESLD). We sought to examine attitudes of hepatologists and gastroenterologists about PC for patients with ESLD. We conducted a cross-sectional survey of these specialists who provide care to patients with ESLD. Participants were recruited from the American Association for the Study of Liver Diseases membership directory. Using a questionnaire adapted from prior studies, we examined physicians' attitudes about PC and whether these attitudes varied based on patients' candidacy for liver transplantation. We identified predictors of physicians' attitudes about PC using linear regression. Approximately one-third of eligible physicians (396/1236, 32%) completed the survey. Most (95%) believed that centers providing care to patients with ESLD should have PC services, and 86% trusted PC clinicians to care for their patients. Only a minority reported collaborating frequently with inpatient (32%) or outpatient (11%) PC services. Most believed that when patients hear the term PC, they feel scared (94%) and anxious (87%). Most (83%) believed that patients would think nothing more could be done for their underlying disease if a PC referral was suggested. Physicians who believed that ESLD is a terminal condition (B = 1.09; P = 0.006) reported more positive attitudes about PC. Conversely, physicians with negative perceptions of PC for transplant candidates (B = -0.22; standard error = 0.05; P < 0.001) reported more negative attitudes toward PC. In conclusion, although most hepatologists and gastroenterologists believe that patients with ESLD should have access to PC, they reported rarely collaborating with PC teams and had substantial concerns about patients' perceptions of PC. Interventions are needed to overcome misperceptions of PC and to promote collaboration with PC clinicians for patients with ESLD.
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Affiliation(s)
- Nneka N. Ufere
- Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | - John Donlan
- Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | - Lauren Waldman
- Division of Hematology-Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Arpan Patel
- Division of Digestive Diseases, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Jules L. Dienstag
- Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | | | - Kathleen E. Corey
- Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | - Nikroo Hashemi
- Division of Gastroenterology, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston MA, USA
| | - Peter Carolan
- Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | - Alan C. Mullen
- Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | - Michael Thiim
- Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | - Irun Bhan
- Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | - Ryan Nipp
- Division of Hematology-Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Joseph Greer
- Division of Hematology-Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Jennifer Temel
- Division of Hematology-Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Raymond T. Chung
- Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | - Areej El-Jawahri
- Division of Hematology-Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
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Wo JY, Niemierko A, Ryan DP, Blaszkowsky LS, Clark JW, Kwak EL, Lillemoe KD, Drapek LN, Zhu AX, Allen JN, Faris JE, Murphy JE, Nipp R, Fernandez-Del Castillo C, Ferrone CR, Hong TS. Tolerability and Long-term Outcomes of Dose-Painted Neoadjuvant Chemoradiation to Regions of Vessel Involvement in Borderline or Locally Advanced Pancreatic Cancer. Am J Clin Oncol 2019; 41:656-661. [PMID: 28134673 DOI: 10.1097/coc.0000000000000349] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE We reviewed our experience involving patients with borderline resectable or locally advanced pancreatic cancer, treated with the dose-painted (DP) boost technique to regions of vessel involvement which preclude upfront surgical resection. We evaluated patient outcomes with respect to tolerability and treatment outcomes. MATERIALS AND METHODS We retrospectively reviewed 99 patients with borderline resectable (n=25) or locally advanced pancreatic cancer (n=74) treated with DP-neoadjuvant chemoradiation from 2010 to 2015. Tumor and regional lymph nodes were prescribed 50.4 Gy and the region around the involved blood vessel was boosted to 58.8 Gy in 28 fractions. The primary outcome was acute toxicity and late duodenal toxicity. Secondary outcomes included conversion to surgical resectability, local failure, disease-free survival, and overall survival (OS). Cox proportional hazards models were performed to evaluate for predictors of survival. RESULTS All but 1 patient completed chemoradiation. The rates of grade 2+ and 3+ nausea were 40% and 12%, respectively. With regards to late toxicity, 5 patients developed potential RT-related grade 3+ duodenal complications including duodenal ulceration/bleeding (n=3) and duodenal stricture (n=2). With a median follow-up of 15 months, the median OS was 18.1 months. Among 99 patients in our study, 37 patients underwent surgical resection. For patients who underwent surgical resection (n=37), the median OS was 30.9 months. On multivariate analysis, only normalization of CA 19-9 post-RT was associated with improved OS. CONCLUSIONS We found that DP-neoadjuvant chemoradiation to regions of vessel involvement is both feasible and well tolerated. In addition, we demonstrated that over one third of patients with initially deemed unresectable disease were able to undergo surgical resection after receiving neoadjuvant therapy including DP-chemoradiation.
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26
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Roeland EJ, LeBlanc TW, Ruddy KJ, Nipp R, Clark-Snow R, Wickham R, Binder G, Bailey WL, Potluri R, Schmerold LM, Papademetriou E, Navari RM. BPI19-019: Avoidable Acute Care Use Associated With Nausea and Vomiting Among Patients Receiving Highly Emetogenic Chemotherapy or Oxaliplatin. J Natl Compr Canc Netw 2019. [DOI: 10.6004/jnccn.2018.7192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Avoiding acute care services can improve cancer care and reduce cost. The US Centers for Medicare and Medicaid Services’ (CMS) new oncology outcome measure (OP-35) defines 30-day post-chemotherapy inpatient (IP) and/or emergency department (ED) events (IP/ED) as “potentially avoidable” if involving any of 10 toxicities, including nausea or vomiting (NV). Evidence demonstrates meaningful gaps in oncologists’ adherence to antiemetic prophylaxis guidelines for highly emetogenic chemotherapy (HEC), and that NV-related IP use costs >$10,000; yet the incidence of avoidable acute care events involving NV is not well studied. Methods: We assessed chemotherapy courses using IBM Explorys electronic health records (4Q 2012–1Q 2018). We identified rates of IP/ED ≤30 days post-chemotherapy, and OP-35 toxicities (NV, anemia, dehydration, diarrhea, fever, neutropenia, pain, pneumonia, or sepsis) by ICD-9, ICD-10, procedure codes, and CMS criteria. We evaluated cisplatin, anthracycline + cyclophosphamide (AC), carboplatin (>14 days apart, as a proxy for AUC ≥4), oxaliplatin (OX), and other non-HEC chemotherapy. We assessed guideline adherence, defined as triple prophylaxis (NK1 RA + 5HT3 RA +dexamethasone) rates at HEC initiation. Results: In 17,609 HEC and 56,624 non-HEC courses, we observed 30-day IP/ED utilization in 29% and 19% of courses, respectively (Table 1). For HEC, 76% of IP/ED use involved ≥1 of the 10 CMS toxicities, most often anemia (42%), pain (41%), dehydration (24%), and NV (24%). Rates of all-cause IP/ED, IP/ED with OP-35 toxicity, and NV-related IP/ED were consistent for HEC and OX. Gaps in triple prophylaxis were common in HEC. Conclusion: Roughly one-third of patients receiving HEC or OX experienced IP/ED events ≤30 days after chemotherapy. Three-quarters of IP/ED events involved ≥1 of 10 OP-35 toxicities linked by CMS to potentially avoidable acute care; of these, one-third involved NV. NV-associated acute care use is considerable, costly, and potentially avoidable with better adherence to antiemesis guidelines.
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Affiliation(s)
| | - Thomas W. LeBlanc
- bDuke University School of Medicine, Duke Cancer Institute, Durham, NC
| | | | - Ryan Nipp
- aMassachusetts General Hospital, Boston, MA
| | | | - Rita Wickham
- eRush University College of Nursing, Chicago, IL
| | | | | | | | | | | | - Rudolph M. Navari
- hUniversity of Alabama Birmingham School of Medicine, Birmingham, AL
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Quain K, Nipp R, Greer J, El-Jawahri A, Batchelor T, Temel J, Forst D. QOLP-21. THE RELATIONSHIP BETWEEN CAREGIVING BURDEN AND ANXIETY SYMPTOMS IN CAREGIVERS OF PATIENTS WITH MALIGNANT GLIOMAS. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Ryan Nipp
- Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Tracy Batchelor
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Bhatt S, El-Jawahri A, Nipp R, Batchelor T, Temel J, Forst D. QOLP-23. PALLIATIVE CARE AND END OF LIFE HEALTHCARE UTILIZATION IN PATIENTS WITH INCURABLE PRIMARY MALIGNANT BRAIN TUMORS. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sunil Bhatt
- Massachusetts General Hospital, Boston, MA, USA
| | | | - Ryan Nipp
- Massachusetts General Hospital, Boston, MA, USA
| | - Tracy Batchelor
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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29
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Tramontano AC, Nipp R, Mercaldo ND, Kong CY, Schrag D, Hur C. Survival Disparities by Race and Ethnicity in Early Esophageal Cancer. Dig Dis Sci 2018; 63:2880-2888. [PMID: 30109578 PMCID: PMC6738563 DOI: 10.1007/s10620-018-5238-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/01/2018] [Indexed: 12/09/2022]
Abstract
BACKGROUND Survival outcome disparities among esophageal cancer patients exist, but are not fully understood. AIMS We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database to determine whether survival differences among racial/ethnic patient populations persist after adjusting for demographic and clinical characteristics. METHODS Our study included T1-3N0M0 adenocarcinoma and squamous cell cancer patients diagnosed between 2003 and 2011. We compared survival among two racial/ethnic patient subgroups using Cox proportional hazards methods, adjusting for age, sex, histology, marital status, socioeconomics, SEER region, comorbidities, T stage, tumor location, diagnosis year, and treatment received. RESULTS Among 2025 patients, 87.9% were White and 12.1% were Nonwhite. Median survival was 18.7 months for Whites vs 13.8 months for Nonwhites (p = 0.01). In the unadjusted model, Nonwhite patients had higher risk of mortality (HR = 1.29, 95% CI 1.11-1.49, p < 0.0001) when compared to White patients; however, in the Cox regression adjusted model there was no significant difference (HR = 0.94, 95% CI 0.80-1.10, p = 0.44). Surgery, chemotherapy, younger age, lower T stage, and lower Charlson comorbidity score were significant predictors in the full adjusted model. CONCLUSIONS Differences in mortality risk by race/ethnicity appear to be largely explained by additional factors. In particular, associations were seen in surgery and T stage. Further research is needed to understand potential mechanisms underlying the differences and to better target patients who can benefit from treatment options.
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Affiliation(s)
- Angela C. Tramontano
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA, USA
| | - Ryan Nipp
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center, Boston, USA
| | - Nathaniel D. Mercaldo
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, USA,Department of Radiology, Massachusetts General Hospital Cancer Center, Boston, USA
| | - Chung Yin Kong
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, USA
| | - Deborah Schrag
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - Chin Hur
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, USA,Gastrointestinal Division, Harvard Medical School, Boston, USA
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Tramontano AC, Nipp R, Kong CY, Yerramilli D, Gainor JF, Hur C. Hospice use and end-of-life care among older patients with esophageal cancer. Health Sci Rep 2018; 1:e76. [PMID: 30623099 PMCID: PMC6266462 DOI: 10.1002/hsr2.76] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 06/07/2018] [Accepted: 06/18/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Hospice and end-of-life health care utilization among patients with esophageal cancer are understudied. We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database to analyze hospice use and end-of-life treatment patterns. METHODS We included patients diagnosed with esophageal adenocarcinoma or squamous cell carcinoma between 2000 and 2011 and who had died by December 31, 2013. We evaluated patterns of hospice enrollment, chemotherapy receipt, radiation receipt, acute care hospitalizations, and intensive care unit (ICU) admissions at end of life. We used multivariate logistic regression to evaluate possible associations with hospice use, late ICU admission, and late chemotherapy receipt. RESULTS Our study included 6449 patients; 3597 (55.8%) enrolled in hospice. Among hospice enrolled patients, 31.4% enrolled in the last 7 days of life. Hospice enrollment increased over time, from 43.2% in 2000 to 59.6% in 2013. Patients who were older, female, with stage IV disease, or those with higher socioeconomic status were more likely to enroll in hospice. Among all patients, 19.1% had an ICU admission within the last 30 days and 4.6% received chemotherapy within the last 14 days of life. Those who were Black or Asian (compared to White), married, or had a comorbidity score >1 were more likely to have a late ICU admission. Males and younger patients were more likely to receive chemotherapy at end of life. CONCLUSION Hospice enrollment rates among patients with esophageal cancer have increased over time; however, a significant percentage of patients enrolls near the end of life. Further research is needed to improve understanding of how end-of-life care decisions for these patients are made.
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Affiliation(s)
| | - Ryan Nipp
- Department of Medicine, Division of Hematology and OncologyMassachusetts General Hospital Cancer Center & Harvard Medical SchoolBostonMAUSA
| | - Chung Yin Kong
- Institute for Technology AssessmentMassachusetts General HospitalBostonMAUSA
- Harvard Medical SchoolBostonMAUSA
| | - Divya Yerramilli
- Department of Radiation OncologyMassachusetts General HospitalBostonMAUSA
| | - Justin F. Gainor
- Department of Medicine, Division of Hematology and OncologyMassachusetts General Hospital Cancer Center & Harvard Medical SchoolBostonMAUSA
| | - Chin Hur
- Institute for Technology AssessmentMassachusetts General HospitalBostonMAUSA
- Harvard Medical SchoolBostonMAUSA
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31
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Pirl WF, Saez-Flores E, Schlumbrecht M, Nipp R, Traeger LN, Kobetz E. Race and Ethnicity in the Evidence for Integrating Palliative Care Into Oncology. J Oncol Pract 2018; 14:e346-e356. [DOI: 10.1200/jop.17.00016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose: ASCO recommends early involvement of palliative care for patients with advanced cancers on the basis of evidence from 18 randomized trials. We examined racial and ethnic minority representation in these trials and the role of race and ethnicity in the statistical analyses. The goal was to identify specific gaps in the palliative care evidence base for these individuals and potential strategies to address them. Methods: We reviewed the 18 trials cited in the 2012 and 2017 ASCO clinical statements on integrating palliative care into oncology. We extracted data on the reporting and categorization of race and ethnicity, on the enrollment of specific racial and ethnic minority groups, and on how race and ethnicity were addressed in the analyses. Results: One third of patient trials reported representation of specific racial and ethnic minority groups, one third reported rates of “white” versus “other,” and one third did not report race or ethnicity data. Among the patient trials with race and ethnicity data, 9.9% of participants were Asian, 8.8% Hispanic/Latino, and 5.7% African American. Analyses that used race and ethnicity were primarily baseline comparisons among randomized groups. Conclusion: Race and ethnicity were inconsistently reported in the trials. Among those that provided race and ethnicity data, representation of specific racial and ethnic minority groups was low. In addition to more research in centers with large minority populations, consistent reporting of race and ethnicity and supplementary data collection from minority patients who participate in trials may be strategies for improvement.
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Affiliation(s)
- William F. Pirl
- University of Miami, Miami, FL; Massachusetts General Hospital; Dana-Farber Cancer Institute; and Harvard Medical School, Boston, MA
| | - Estefany Saez-Flores
- University of Miami, Miami, FL; Massachusetts General Hospital; Dana-Farber Cancer Institute; and Harvard Medical School, Boston, MA
| | - Matthew Schlumbrecht
- University of Miami, Miami, FL; Massachusetts General Hospital; Dana-Farber Cancer Institute; and Harvard Medical School, Boston, MA
| | - Ryan Nipp
- University of Miami, Miami, FL; Massachusetts General Hospital; Dana-Farber Cancer Institute; and Harvard Medical School, Boston, MA
| | - Lara N. Traeger
- University of Miami, Miami, FL; Massachusetts General Hospital; Dana-Farber Cancer Institute; and Harvard Medical School, Boston, MA
| | - Erin Kobetz
- University of Miami, Miami, FL; Massachusetts General Hospital; Dana-Farber Cancer Institute; and Harvard Medical School, Boston, MA
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Abstract
Background Despite recommendations from professional organizations supporting early hospice enrollment for patients with cancer, little research exists regarding end-of-life (EOL) practices for patients with malignant glioma (MG). We evaluated rates and correlates of hospice enrollment and hospice length of stay (LOS) among patients with MG. Methods Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database, we identified adult patients who were diagnosed with MG from January 1, 2002 to December 31, 2011 and who died before December 31, 2012. We extracted sociodemographic and clinical data and used univariate logistic regression analyses to compare characteristics of hospice recipients versus nonrecipients. We performed multivariable logistic regression analyses to examine predictors of hospice enrollment >3 or >7 days prior to death. Results We identified 12437 eligible patients (46% female), of whom 7849 (63%) were enrolled in hospice before death. On multivariable regression analysis, older age, female sex, higher level of education, white race, and lower median household income predicted hospice enrollment. Of those enrolled in hospice, 6996 (89%) were enrolled for >3 days, and 6047 (77%) were enrolled for >7 days. Older age, female sex, and urban residence were predictors of longer LOS (3- or 7-day minimum) on multivariable analysis. Median LOS on hospice for all enrolled patients was 21 days (interquartile range, 8-45 days). Conclusions We identified important disparities in hospice utilization among patients with MG, with differences by race, sex, age, level of education, and rural versus urban residence. Further investigation of these barriers to earlier and more widespread hospice utilization is needed.
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Affiliation(s)
- Deborah Forst
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Eric Adams
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Ryan Nipp
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Allison Martin
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Boston, Massachusetts
| | - Areej El-Jawahri
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Ayal Aizer
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Boston, Massachusetts
| | - Justin T Jordan
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
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Nipp R, Tramontano AC, Kong CY, Pandharipande P, Dowling EC, Schrag D, Hur C. Disparities in cancer outcomes across age, sex, and race/ethnicity among patients with pancreatic cancer. Cancer Med 2018; 7:525-535. [PMID: 29322643 PMCID: PMC5806100 DOI: 10.1002/cam4.1277] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [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: 06/02/2017] [Revised: 09/05/2017] [Accepted: 11/08/2017] [Indexed: 01/14/2023] Open
Abstract
Age, sex, and racial/ethnic disparities exist, but are understudied in pancreatic adenocarcinoma (PDAC). We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database to determine whether survival and treatment disparities persist after adjusting for demographic and clinical characteristics. Our study included PDAC patients diagnosed between 1992 and 2011. We used Cox regression to compare survival across age, sex, and race/ethnicity within early-stage and late-stage cancer subgroups, adjusting for marital status, urban location, socioeconomics, SEER region, comorbidities, stage, lymph node status, tumor location, tumor grade, diagnosis year, and treatment received. We used logistic regression to compare differences in treatment received across age, sex, and race/ethnicity. Among 20,896 patients, 84% were White, 9% Black, 5% Asian, and 2% Hispanic. Median age was 75; 56% were female and 53% had late-stage cancer. Among early-stage patients in the adjusted Cox model, older patient subgroups had worse survival compared with ages 66-69 (HR > 1.1, P < 0.01 for groups >69); no survival differences existed between sexes. Black (HR = 1.1, P = 0.01) and Hispanic (HR = 1.2, P < 0.01) patients had worse survival compared with White. Among late-stage cancer patients, patients over age 84 had worse survival than those aged 66-69 (HR = 1.1, P < 0.01), and males (HR = 1.08, P < 0.01) had worse survival than females; there were no racial/ethnic differences. Older age and minority race/ethnicity were associated with lower likelihood of receiving chemotherapy, radiation, and/or surgery. Age and racial/ethnic disparities in survival outcomes and treatment received exist for PDAC patients; these disparities persist after adjusting for differences in demographic and clinical characteristics.
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Affiliation(s)
- Ryan Nipp
- Department of MedicineDivision of Hematology and OncologyMassachusetts General Hospital Cancer CenterBostonMassachusetts
- Harvard Medical SchoolBostonMassachusetts
| | - Angela C. Tramontano
- Institute for Technology AssessmentMassachusetts General HospitalBostonMassachusetts
| | - Chung Yin Kong
- Harvard Medical SchoolBostonMassachusetts
- Institute for Technology AssessmentMassachusetts General HospitalBostonMassachusetts
| | - Pari Pandharipande
- Harvard Medical SchoolBostonMassachusetts
- Institute for Technology AssessmentMassachusetts General HospitalBostonMassachusetts
| | - Emily C. Dowling
- Institute for Technology AssessmentMassachusetts General HospitalBostonMassachusetts
| | - Deborah Schrag
- Dana‐Farber Cancer InstituteHarvard Medical SchoolBostonMassachusetts
| | - Chin Hur
- Harvard Medical SchoolBostonMassachusetts
- Institute for Technology AssessmentMassachusetts General HospitalBostonMassachusetts
- Gastrointestinal DivisionHarvard Medical SchoolBostonMassachusetts
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Wu J, Goyal L, Nipp R, Wo J, Qadan M, Uppot RN. The Tipping Point: Key Oncologic Imaging Findings Resulting in Critical Changes in the Management of Malignant Tumors of the Gastrointestinal Tract. Curr Probl Diagn Radiol 2018; 48:61-74. [PMID: 29674013 DOI: 10.1067/j.cpradiol.2017.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 12/12/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The purpose of this article is to review tumor staging systems for gastrointestinal tumors including pancreatic adenocarcinoma, hepatocellular carcinoma, cholangiocarcinoma, gastric adenocarcinoma, small bowel adenocarcinoma, rectal carcinoma, and anal carcinoma and identify the key imaging findings ("tipping points"), which change patient management based on changes in tumor staging. CONCLUSION For all malignant gastrointestinal tumors, there are key imaging findings ("tipping points") including tumor size, tumor extension, lymphadenopathy, vascular invasion, and distant metastasis that dictate patient management and prognosis, based on changes in tumor stage. In interpreting these imaging studies, radiologists should be cognizant of these "tipping points" to guide patient management.
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Affiliation(s)
- Jonathan Wu
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Lipika Goyal
- Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Ryan Nipp
- Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Jennifer Wo
- Department of Radiation Oncology, MGH Cancer Center, Massachusetts General Hospital, Boston, MA
| | - Motaz Qadan
- Division of Surgical Oncology, MGH Cancer Center, Massachusetts General Hospital, Boston, MA
| | - Raul N Uppot
- Division of Interventional Radiology, Massachusetts General Hospital, Boston, MA.
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Forst D, Adams E, Nipp R, Martin A, Aizer A, Jordan J. PALL-08. HOSPICE USE AMONG PATIENTS WITH HIGH GRADE GLIOMAS. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.689] [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: 11/13/2022] Open
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Reyes S, Horick N, Clark J, Murphy J, Blaszkowsky L, Allen J, Ryan DP, Hong T, Wo J, Nipp R, Parikh A, Faris J, Kwak E, Galway A, Knowles M, Oklu R, John IA, Lennerz J, Finkelstein D, Borger D, Zhu A, Goyal L. Frequency and impact of tumor genotyping in clinical practice of patients with advanced biliary tract cancers (ABTCs). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx262.020] [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: 11/12/2022] Open
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Nipp R, Temel J. Editorial: The Patient Knows Best: Incorporating Patient-Reported Outcomes Into Routine Clinical Care. J Natl Cancer Inst 2017; 109:3573363. [DOI: 10.1093/jnci/djx044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 02/24/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ryan Nipp
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA
| | - Jennifer Temel
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA
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Nipp R, Goyal L. Bridging the Gap Between Sorafinib Efficacy and Effectiveness in Advanced Hepatocellular Carcinoma. Oncologist 2016; 21:1283-1285. [PMID: 27807300 PMCID: PMC5189629 DOI: 10.1634/theoncologist.2016-0349] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 10/06/2016] [Indexed: 11/28/2022] Open
Abstract
In this editorial, the generalizability of trial results to the geriatric population is discussed. Specifically, the results from a recent observational study are compared with results from the SHARP trial, and recommendations are made for bridging the gap between efficacy and effectiveness in clinical research, particularly with regard to older patients.
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Affiliation(s)
- Ryan Nipp
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lipika Goyal
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Nipp R, Sloane R, Rao AV, Schmader KE, Cohen HJ. Role of pain medications, consultants, and other services in improved pain control of elderly adults with cancer in geriatric evaluation and management units. J Am Geriatr Soc 2012; 60:1912-7. [PMID: 23036028 DOI: 10.1111/j.1532-5415.2012.04143.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To determine whether pain medication use and inpatient consultations and services were associated with significantly better pain control. DESIGN Secondary data analysis from a randomized two-by-two factorial trial. Hospitalized, frail individuals aged 65 and older were randomized to receive care in a geriatric inpatient unit, a geriatric outpatient clinic, both, or neither. SETTING Eleven Veterans Affairs Medical Centers. PARTICIPANTS Ninety-nine individuals with a diagnosis of cancer, excluding nonmelanoma skin cancer; 44 received geriatric evaluation and management unit (GEMU) care and 55 usual care. MEASUREMENTS Pain medications were measured at baseline and discharge; consultations and other services were quantified for the entire admission. RESULTS Participants receiving GEMU care had a significantly higher number of consultations than those in usual care. Participants in GEMU care received psychiatry, endocrinology, and psychology consultations 12.7% (P = .004), 9.1% (P = .04), and 21.8% (P = .05) times more, respectively, and occupational and physical therapy 27.3% (P = .004) and 18.2% (P = .04) more, respectively. There were no significant differences in pain medication use between intervention and usual care. CONCLUSION Significantly greater use of psychology, psychiatry, physical and occupational therapy in the GEMU participants may have improved the effectiveness of pain management in individuals in inpatient GEMUs. Although analgesic use was not significantly different between the GEMU and usual care groups, small sample size may have limited the ability to detect these differences.
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Affiliation(s)
- Ryan Nipp
- Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
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Nipp R, Bell T, Ruhl D, Lee C, Kirkland J. Pilot study to determine feasibility of development of an influenza clinical diagnostic tool. Int J Infect Dis 2010. [DOI: 10.1016/j.ijid.2010.02.555] [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: 11/29/2022] Open
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