1
|
Corral J, Borras JM, Lievens Y. Utilisation of radiotherapy in lung cancer: A scoping narrative literature review with a focus on the introduction of evidence-based therapeutic approaches in Europe. Clin Transl Radiat Oncol 2024; 45:100717. [PMID: 38226026 PMCID: PMC10788411 DOI: 10.1016/j.ctro.2023.100717] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/16/2023] [Indexed: 01/17/2024] Open
Abstract
Background and purpose The aim of this study was to review the published studies on the utilisation of radiotherapy in lung cancer (both small and non-small cell lung cancer, SCLC and NSCLC) patients in European countries with a population-based perspective. Material and methods A literature search since January 2000 until December 2022 was carried out. Only English-published papers were included, and only European data was considered. PRISMA guidelines were followed. A scoping narrative review was undertaken due to the hetereogeneity of the published papers. Results 38 papers were included in the analysis, with the majority from the Netherlands (52.6%) and the UK (18.4%). Large variability is observed in the reported radiotherapy utilisation, around 40% for NSCLC in general and between 26 and 42% in stage I NSCLC. Stereotactic body radiotherapy (SBRT) shows a wide range of utilisation across countries and over time, from 8 to 63%. Similary, in stage III lung cancer, chemoradiotherapy (CRT) utilisation varied considerably (11-70%). Eleven studies compared radiotherapy utilisation between older and younger age-groups, showing that younger patients receive more CRT, while the opposite applies for SBRT. An widespreadlack of data on relevant covariates such as comorbidty and health-services related variables is observed. Conclusion The actual utilisation of radiotherapy for lung cancer reported in patterns-of-care studies (POCs) is notably lower than the evidence-based optimal utilisation. Important variability is observed by country, time period, stage at diagnosis and age. A wider use of POCs should be promoted to improve our knowledge on the actual application of evidence-based treatment recommendations.
Collapse
Affiliation(s)
- Julieta Corral
- Catalonian Cancer Plan, Department of Health, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet, Barcelona, Spain
| | - Josep M. Borras
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet, Barcelona, Spain
- Department of Clinical Sciences, University of Barcelona, Spain
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| |
Collapse
|
2
|
Waltenberger M, Vogel MME, Bernhardt D, Münch S, Dobiasch S, Redmond KJ, Lo SS, Acker G, Fehlings MG, Ringel F, Vajkoczy P, Meyer B, Combs SE. Radiotherapy concepts for spinal metastases-results from an online survey among radiation oncologists of the German Society for Radiation Oncology. Strahlenther Onkol 2024; 200:159-174. [PMID: 37272996 PMCID: PMC10805849 DOI: 10.1007/s00066-023-02082-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/31/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE Spinal metastases (SM) are a common radiotherapy (RT) indication. There is limited level I data to drive decision making regarding dose regimen (DR) and target volume definition (TVD). We aim to depict the patterns of care for RT of SM among German Society for Radiation Oncology (DEGRO) members. METHODS An online survey on conventional RT and Stereotactic Body Radiation Therapy (SBRT) for SM, distributed via e‑mail to all DEGRO members, was completed by 80 radiation oncologists between February 24 and April 29, 2022. Participation was voluntary and anonymous. RESULTS A variety of DR was frequently used for conventional RT (primary: n = 15, adjuvant: n = 14). 30 Gy/10 fractions was reported most frequently. TVD in adjuvant RT was heterogenous, with a trend towards larger volumes. SBRT was offered in 65% (primary) and 21% (adjuvant) of participants' institutions. A variety of DR was reported (primary: n = 40, adjuvant: n = 27), most commonly 27 Gy/3 fractions and 30 Gy/5 fractions. 59% followed International Consensus Guidelines (ICG) for TVD. CONCLUSION We provide a representative depiction of RT practice for SM among DEGRO members. DR and TVD are heterogeneous. SBRT is not comprehensively practiced, especially in the adjuvant setting. Further research is needed to provide a solid data basis for detailed recommendations.
Collapse
Affiliation(s)
- Maria Waltenberger
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany.
- German Cancer Consortium (DKTK), partner site Munich, Munich, Germany.
- German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Marco M E Vogel
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Denise Bernhardt
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Stefan Münch
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Sophie Dobiasch
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
- German Cancer Consortium (DKTK), partner site Munich, Munich, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Institute of Radiation Medicine (IRM), Helmholtz Zentrum, Munich, Germany
| | - Kristin J Redmond
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Simon S Lo
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, USA
| | - Güliz Acker
- Department of Neurosurgery, Charité Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Michael G Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Florian Ringel
- Department of Neurosurgery, University Hospital Mainz, Mainz, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
- German Cancer Consortium (DKTK), partner site Munich, Munich, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Institute of Radiation Medicine (IRM), Helmholtz Zentrum, Munich, Germany
| |
Collapse
|
3
|
Vanbraband J, Van Damme N, Silversmit G, De Geyndt A, Bouche G, Jacomen G, de Jonge E, Goffin F, Denys H, Amant F. Practice patterns, time trends and quality of care of uterine cancer in Belgium: An analysis of the EFFECT database. Gynecol Oncol 2024; 180:70-78. [PMID: 38086166 DOI: 10.1016/j.ygyno.2023.11.015] [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: 07/20/2023] [Revised: 11/07/2023] [Accepted: 11/13/2023] [Indexed: 02/18/2024]
Abstract
OBJECTIVES To investigate the practice patterns and quality of care for uterine cancer on a national level in Belgium, including trends in practice over the period 2012-2016. METHODS Quality indicators were measured using the EFFectiveness of Endometrial Cancer Treatment (EFFECT) database. Multivariable logistic mixed regression was used to test for associations between the quality indicators and year of diagnosis, adjusted for potential confounders and intra-cluster correlations. RESULTS The EFFECT database includes 4178 patients diagnosed with uterine cancer in the period 2012-2016. Minimally invasive surgery (laparoscopic or robotic-assisted) was applied in 61.6% of patients who had surgery for clinical stage I endometrial carcinoma (EC), increasing from 52.9% in 2012 to 66.4% in 2016. At least pelvic lymph node staging was performed in 69.0% of patients with clinical stage I, high-grade EC; and in 63.9% of patients with clinical stage I-II serous carcinoma, clear cell carcinoma or carcinosarcoma. The latter increased from 48.8% in 2012 to 77.2% in 2016. Adjuvant radiotherapy (external beam and/or brachytherapy) was offered to 33.5% of patients who had surgery without lymph node staging for pathological stage I EC at high-intermediate or high risk of recurrence. Adjuvant chemotherapy was administered to 64.4% of patients with pathological stage III-IVA EC. CONCLUSIONS Study results indicate an overall good quality of care for patients with uterine cancer in Belgium. Treatment areas with potential room for improvement include the use of minimally invasive surgery, comprehensive surgical staging and adjuvant therapy, which confirms the remaining controversies in uterine cancer treatment and the need for further research.
Collapse
Affiliation(s)
- Joren Vanbraband
- Unit of Gynecologic Oncology, Department of Oncology, KU Leuven, Campus Gasthuisberg, ON4 Herestraat 49, Box 1045, 3000 Leuven, Belgium.
| | - Nancy Van Damme
- Belgian Cancer Registry, Koningsstraat 215, Box 7, 1210 Brussels, Belgium.
| | - Geert Silversmit
- Belgian Cancer Registry, Koningsstraat 215, Box 7, 1210 Brussels, Belgium.
| | - Anke De Geyndt
- Belgian Cancer Registry, Koningsstraat 215, Box 7, 1210 Brussels, Belgium.
| | - Gauthier Bouche
- The Anticancer Fund, Brusselsesteenweg 11, 1860 Meise, Belgium.
| | - Gerd Jacomen
- Laboratory of Pathological Anatomy, AZ Sint-Maarten, Liersesteenweg 435, 2800 Mechelen, Belgium.
| | - Eric de Jonge
- Department of Obstetrics and Gynecology, Ziekenhuis Oost-Limburg, Campus Sint-Jan, Synaps Park 1, 3600 Genk, Belgium.
| | - Frédéric Goffin
- Department of Obstetrics and Gynecology, CHU de Liège et Hôpital de La Citadelle, Boulevard du 12e de Ligne 1, 4000 Liège, Belgium.
| | - Hannelore Denys
- Department of Medical Oncology, University Hospital Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Frédéric Amant
- Unit of Gynecologic Oncology, Department of Oncology, KU Leuven, Campus Gasthuisberg, ON4 Herestraat 49, Box 1045, 3000 Leuven, Belgium; Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX Amsterdam, The Netherlands; Department of Gynecologic Oncology, UZ Leuven, Campus Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium.
| |
Collapse
|
4
|
Rubatto Birri PN, Giannoni R, Furche M, Nahra M, Arce Gallardo M, Segui G, Ilutovich S, Olmos M, Birri P, Romano M, Ayala P, Petrochelli V, Huespe L, Banegas D, Gomez A, Zakalik G, Lipovestky F, Montefiore JP, Galletti C, Pendino C, Vera M, Mare S, Bergallo L, Fernandez G, Campassi ML, Ríos F, Saul P, Bonsignore P, Gallardo B, Gimenez M, Estenssoro E. Epidemiology, patterns of care and prognosis of acute kidney injury in critically ill patients: A multicenter study in Argentina (The EPIRA study). J Crit Care 2023; 78:154382. [PMID: 37516091 DOI: 10.1016/j.jcrc.2023.154382] [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: 06/07/2023] [Revised: 07/10/2023] [Accepted: 07/13/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) is associated with high morbidity and mortality rates in the intensive care unit (ICU). In low- and middle-income countries (LMICs), epidemiological information about this condition is still scarce. Our main objective was to characterize its epidemiology, prognosis, and its treatment. METHODS This multicenter prospective cohort study included 1466 patients from 35 ICUs during 6 months in Argentina in 2018. Risk factors and outcomes in patients with and without AKI, and between AKI on admission (AKIadm) and that developed during hospitalization (AKIhosp) were analyzed. RESULTS AKI occurred in 61.3% of patients (900/1466); 72.6% were AKIadm and 27.3% AKIhosp. Risk factors were age, BMI, arterial hypertension, cardiovascular diseases, diabetes, SOFA, APACHE II, dehydration, sepsis, vasopressor use, radiocontrast, diuresis/h and mechanical ventilation. Independent predictors for AKI were sepsis, diabetes, dehydration, vasopressors on admission, APACHE II and radiocontrast use. Renal replacement therapies (RRT) requirement in AKI patients was 14.8%. Hospital mortality in AKI vs. non-AKI was 38.7% and 23.3% (p < 0.001); and in AKIadm vs. AKIhosp, 41.2% and 37.8% (p = 0.53). CONCLUSIONS ICU-acquired AKI has high incidence, complications and mortality. Risk factors for AKI and RRT utilization were similar to those described in other epidemiological studies. AKIadm was more frequent than AKIhosp, but had equal prognosis.
Collapse
Affiliation(s)
| | - Roberto Giannoni
- Hospital Regional Ramon Carrillo, Santiago del Estero, Santiago del Estero, Argentina; Centro Integral de Salud, La Banda, Santiago del Estero, Argentina.
| | - Mariano Furche
- Sanatorio De los Arcos, Ciudad Autónoma de Buenos Aires, Argentina.
| | - M Nahra
- Hospital Español, Ciudad Autónoma de Buenos Aires, Argentina
| | - M Arce Gallardo
- Hospital Regional Ramon Carrillo, Santiago del Estero, Santiago del Estero, Argentina
| | - Gabriela Segui
- Hospital Dr. Luis Güemes, Haedo, Buenos Aires, Argentina
| | | | - Matias Olmos
- Hospital Universitario Fundación Favaloro, Ciudad Autónoma de Buenos Aires, Argentina
| | | | | | | | | | - Luis Huespe
- Hospital Escuela General San Martin, Corrientes, Argentina
| | - David Banegas
- Sanatorio Otamendi, Ciudad Autónoma de Buenos Aires, Argentina
| | - Alejandro Gomez
- Sanatorio De los Arcos, Ciudad Autónoma de Buenos Aires, Argentina
| | | | | | | | | | | | | | | | | | | | | | | | - Pablo Saul
- Policlínico UOM, Ciudad Autónoma Buenos Aires, Argentina
| | | | | | - Mirta Gimenez
- Hospital Centenario, Gualeguaychú, Entre Ríos, Argentina
| | - Elisa Estenssoro
- Escuela de Gobierno en Salud, Ministerio de Salud de la Provincia de Buenos Aires, Buenos Aires, Argentina.
| |
Collapse
|
5
|
Willmann J, Appelt AL, Balermpas P, Baumert BG, de Ruysscher D, Hoyer M, Hurkmans C, Kaidar-Person O, Meattini I, Niyazi M, Poortmans P, Reynaert N, Tandini-Lang S, van der Linden Y, Nieder C, Andratschke N. Re-irradiation in clinical practice: Results of an international patterns of care survey within the framework of the ESTRO-EORTC E 2-RADIatE platform. Radiother Oncol 2023; 189:109947. [PMID: 37806559 DOI: 10.1016/j.radonc.2023.109947] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/17/2023] [Accepted: 10/01/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Re-irradiation is an increasingly utilized treatment for recurrent, metastatic or new malignancies after previous radiotherapy. It is unclear how re-irradiation is applied in clinical practice. We aimed to investigate the patterns of care of re-irradiation internationally. MATERIAL/METHODS A cross-sectional survey conducted between March and September 2022. The survey was structured into six sections, each corresponding to a specific anatomical region. Participants were instructed to complete the sections of their clinical expertise. A total of 15 multiple-choice questions were included in each section, addressing various aspects of the re-irradiation process. The online survey targeted radiation and clinical oncologists and was endorsed by the European Society for Radiotherapy and Oncology (ESTRO) and the European Organisation for Research and Treatment of Cancer (EORTC). RESULTS 371 physicians from 55 countries across six continents participated. Participants had a median professional experience of 16 years, and the majority (60%) were affiliated with an academic hospital. The brain region was the most common site for re-irradiation (77%), followed by the pelvis (65%) and head and neck (63%). Prolonging local control was the most common goal (90-96% across anatomical regions). The most common minimum interval between previous radiotherapy and re-irradiation was 6-12 months (45-55%). Persistent grade 3 or greater radiation-induced toxicity (77-80%) was the leading contraindication. Variability in organs at risk dose constraints for re-irradiation was observed. Advanced imaging modalities and conformal radiotherapy techniques were predominantly used. A scarcity of institutional guidelines for re-irradiation was reported (16-19%). Participants from European centers more frequently applied thoracic and abdominal re-irradiation. Indications did not differ between academic and non-academic hospitals. CONCLUSION This study highlights the heterogeneity in re-irradiation practices across anatomical regions and emphasizes the need for high-quality evidence from prospective studies to guide treatment decisions and derive safe cumulative dose constraints.
Collapse
Affiliation(s)
- Jonas Willmann
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Ane L Appelt
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Panagiotis Balermpas
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Brigitta G Baumert
- Institute of Radiation-Oncology, Cantonal Hospital Graubünden, Chur, Switzerland
| | - Dirk de Ruysscher
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), School for Oncology and Developmental Biology (GROW), Maastricht and Department of Radiotherapy, Erasmus MC, Rotterdam, the Netherlands
| | - Morten Hoyer
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Coen Hurkmans
- Department of Radiation Oncology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - Orit Kaidar-Person
- Breast Cancer Radiation Therapy Unit, Sheba Medical Center, Ramat Gan, Israel And Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany; Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Philip Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Wilrijk-Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk-Antwerp, Belgium
| | - Nick Reynaert
- Department of Medical Physics, Institut Jules Bordet, Brussels, Belgium
| | - Stephanie Tandini-Lang
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Yvette van der Linden
- Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands
| | - Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital Trust, Bodø, Norway; Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| |
Collapse
|
6
|
Evers J, Hendriks LEL, De Jaeger K, Wijsman R, De Ruysscher D, Terhaard C, van der Sangen M, Siesling S, Struikmans H, Aarts MJ. Trends and variations in the treatment of stage I-III small cell lung cancer from 2008 to 2019: A nationwide population-based study from the Netherlands. Lung Cancer 2021; 162:61-70. [PMID: 34739855 DOI: 10.1016/j.lungcan.2021.10.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/15/2021] [Accepted: 10/21/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Recent treatment patterns for small cell lung cancer (SCLC) in the Netherlands were unknown. This nationwide population-based study describes trends and variations in the treatment of stage I-III SCLC in the Netherlands over the period 2008-2019. MATERIALS AND METHODS Patients were selected from the population-based Netherlands Cancer Registry. Treatments were studied stratified for clinical stage. In stage II-III, factors associated with the use of concurrent (cCRT) versus sequential chemoradiation (sCRT) and accelerated versus conventionally fractionated radiotherapy in the context of cCRT were identified. RESULTS In stage I (N = 535), 29% of the patients underwent surgery in 2008-2009 which increased to 44% in 2018-2019. Combined use of chemotherapy and radiotherapy decreased in stage I from 47% to 15%, remained constant (64%) in stage II (N = 472), and increased from 57% (2008) to 70% (2019) in stage III (N = 5,571). Use of cCRT versus sCRT in stage II-III increased over time (odds ratio (OR) 2008-2011 vs 2016-2019: 0.53 (95%-confidence interval (95%CI): 0.41-0.69)) and was strongly associated with lower age, WHO performance status 0, and diagnosis in a hospital with in-house radiotherapy. Forty-six percent of patients with stage III received cCRT in 2019. Until 2012, concurrent radiotherapy was mainly conventionally fractionated, thereafter a hyperfractionated accelerated scheme was administered more frequently (57%). Accelerated radiotherapy was strongly associated with geographic region (ORsouth vs north: 4.13 (95%CI: 3.00-5.70)), WHO performance (OR1 vs 0: 0.50 (95%CI: 0.35-0.71)), and radiotherapy facilities treating ≥ 16 vs < 16 SCLC patients annually (OR: 3.01 (95%CI: 2.38-3.79)). CONCLUSIONS The use of surgery increased in stage I. In stages II and III, the use of cCRT versus sCRT increased over time, and since 2012 most radiotherapy in cCRT was accelerated. Treatment regimens and radiotherapy fractionation schemes varied between patient groups, regions and hospitals. Possible unwarranted treatment variation should be countered.
Collapse
|
7
|
Shah A, Sumer BD, Schostag K, Balachandra S, Sher DJ, Gordin EA, Day AT. Institutional patterns of head and neck oncology care during the early phase of the COVID-19 pandemic: A retrospective, pooled cross-sectional analysis. Oral Oncol 2021; 122:105564. [PMID: 34634666 PMCID: PMC8495055 DOI: 10.1016/j.oraloncology.2021.105564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/03/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Avni Shah
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, United States.
| | - Baran D Sumer
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, United States
| | - Kelly Schostag
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, United States
| | - Sanjana Balachandra
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, United States
| | - David J Sher
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, United States
| | - Eli A Gordin
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, United States
| | - Andrew T Day
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, United States.
| |
Collapse
|
8
|
Durbin L, Murali B, Li S, Zhao L, Hawthorne S, Kanas G, Davis C, Clark O. Treatment patterns in non-small-cell lung cancer in China: Results from the CancerMPact survey 2020. Cancer Treat Res Commun 2021; 29:100462. [PMID: 34583209 DOI: 10.1016/j.ctarc.2021.100462] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the treatment patterns of non-small-cell lung cancer (NSCLC) patients in China based on a survey of physicians (CancerMPact). METHODS 117 Chinese physicians from 27 cities in mainland China were recruited for an online survey in October 2020, reporting on how they treat their patients across all disease stages, including histology and relevant biomarkers in advanced or metastatic NSCLC. RESULTS Surveyed physicians indicated that almost half of their stage I patients were treated with surgery only. For stage II patients, it is more common to treat with surgery in combination with radiation and/or systemic therapy (44.5%), whereas the use of surgery decreases for stage III patients and the overall use of systemic therapy increases (63.4%-68.8%). Physicians are more likely to use systemic therapy alone for stage IV patients (31.4%). Chosen treatment regimens for stage IV NSCLC varied by histology and biomarkers, and several observed treatment patterns differed from the USA. In China, platinum-based chemotherapy is standard of care for treating stage IV NSCLC patients, unlike the USA, where checkpoint inhibitors are the dominant choice in first-line. Further, Chinese physicians reported prescribing biomarker-targeted agents for one-third or less of their patients with EGFR, ALK, ROS-1, or BRAF driver mutations, compared to 60-95% in the USA. CONCLUSION As treatment options expand in NSCLC in China, physicians face complex decisions for the treatment of their patients. Treatment patterns often vary, including by disease histology and clinically relevant biomarkers. The standard of care for NSCLC in China also differs from the USA.
Collapse
Affiliation(s)
| | | | - Song Li
- Kantar Health, New York, NY, USA
| | | | | | | | | | | |
Collapse
|
9
|
Alencar de Pinho N, Capgras JB, Speyer É, Combe C, Fouque D, Frimat L, Massy Z, Ayav C, Liabeuf S, Lange C, Jacquelinet C, Stengel B, Pascal C, Laville M; au nom du groupe d’étude de la cohorte Chronic Kidney Disease-Renal Epidemiology Information Network (CKD-REIN). [CKD care in French nephrology practices]. Nephrol Ther 2021:S1769-7255(21)00146-2. [PMID: 34384728 DOI: 10.1016/j.nephro.2021.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/14/2021] [Accepted: 06/27/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND To be able to assess the impact of the bundled payment system on real-life management of patients with chronic kidney disease, an overview of patient-care management before its implementation is needed. PATIENTS AND METHODS We describe patterns of nephrology care over 3 years in 2835 patients with moderate to severe chronic kidney disease, who were followed-up from 2013 to 2019 in the CKD-REIN cohort study. Compliance with health authority guidelines during this period is also studied. RESULTS At baseline, patients' mean age was 67 years, 65% were men, and 43% had chronic kidney disease stage 4 or 5. The mean number of nephrology visits increased from 1.1 to 2.7 per year, from chronic kidney disease stage 3A to stage 5. The minimum number of nephrology visits as recommended by health authorities was achieved in 84%, 63%, and 33% of patients with chronic kidney disease stages 3B, 4, and 5, respectively. In chronic kidney disease stages 4 and 5, only 34% and 40% of patients had seen a dietitian, and 33% and 54% had received information about treatment options, respectively. The average waiting time for a first appointment with a nephrologist was longer, 60 days and its duration shorter, 30 vs 38 to 40 minutes, in university hospitals compared with non-university hospitals and private clinics. CONCLUSION The significant gap between received and recommended care reflects human resources and organizational limits in chronic kidney disease management in the nephrology setting. Improvements with bundled payment are expected.
Collapse
|
10
|
Ronden MI, Bahce I, Claessens NJ, Barlo N, Dahele MR, Daniels JM, Tissing-Tan C, Hekma E, Hashemi SM, van der Wel A, Spoelstra FO, Verbakel WFR, Tiemessen MA, van Laren M, Becker A, Tarasevych S, Haasbeek CJ, Maassen van den Brink K, Dickhoff C, Senan S. The Impact of the Availability of Immunotherapy on Patterns of Care in Stage III NSCLC: A Dutch Multicenter Analysis. JTO Clin Res Rep 2021; 2:100195. [PMID: 34590040 PMCID: PMC8474425 DOI: 10.1016/j.jtocrr.2021.100195] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/02/2021] [Accepted: 05/25/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Treatment patterns in stage III NSCLC can vary considerably between countries. The PACIFIC trial reported improvements in progression-free and overall survival with adjuvant durvalumab after concurrent chemoradiotherapy (CCRT). We studied treatment decision-making by three Dutch regional thoracic multidisciplinary tumor boards between 2015 and 2019, to identify changes in practice when adjuvant durvalumab became available. METHODS Details of patients presenting with stage III NSCLC were retrospectively collected. Both CCRT and multimodality schemes incorporating planned surgery were defined as being radical-intent treatment (RIT). RESULTS Of 855 eligible patients, most (95%) were discussed at a thoracic multidisciplinary tumor board, which recommended a RIT in 63% (n = 510). Only 52% (n = 424) of the patients finally received a RIT. Predictors for not recommending RIT were age greater than or equal to 70 years, WHO performance score greater than or equal to 2, Charlson comorbidity index greater than or equal to 2 (excluding age), forced expiratory volume in 1 second less than 80% of predicted value, N3 disease, and period of diagnosis. Between 2015 to 2017 and 2018 to 2019, the proportion of patients undergoing CCRT increased from 34% to 42% (p = 0.02) and use of sequential chemoradiotherapy declined (21%-16%, p = 0.05). Rates of early toxicity and 1-year mortality were comparable for both periods. After 2018, 57% of the patients who underwent CCRT (90 of 159) received adjuvant durvalumab. CONCLUSIONS After publication of the PACIFIC trial, a significant increase was observed in the use of CCRT for patients with stage III NSCLC with rates of early toxicity and mortality being unchanged. Since 2018, 57% of the patients undergoing CCRT went on to receive adjuvant durvalumab. Nevertheless, approximately half of the patients were still considered unfit for a RIT.
Collapse
Affiliation(s)
- Merle I. Ronden
- Department of Radiation Oncology, Amsterdam UMC, Amsterdam, the Netherlands
- Department of Pulmonology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Idris Bahce
- Department of Pulmonology, Amsterdam UMC, Amsterdam, the Netherlands
| | | | - Nicole Barlo
- Department of Pulmonology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | - Max R. Dahele
- Department of Radiation Oncology, Amsterdam UMC, Amsterdam, the Netherlands
| | | | | | - Edo Hekma
- Department of Surgery, Rijnstate Ziekenhuis, Arnhem, the Netherlands
| | | | | | | | | | - Marian A. Tiemessen
- Department of Pulmonology, Dijklander Ziekenhuis, Hoorn & Purmerend, the Netherlands
| | - Marjolein van Laren
- Department of Pulmonology, Dijklander Ziekenhuis, Hoorn & Purmerend, the Netherlands
| | - Annemarie Becker
- Department of Pulmonology, Amsterdam UMC, Amsterdam, the Netherlands
| | | | | | | | - Chris Dickhoff
- Department of Surgery, Amsterdam UMC, Amsterdam, the Netherlands
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam UMC, Amsterdam, the Netherlands
| |
Collapse
|
11
|
von der Grün J, Winkelmann R, Rödel F, Balster S, Neumayer T, Ghanaati S, Brandts C, Burck I, Martin D, Rödel C, Kesar N, Balermpas P. Patterns of care, toxicity and outcome in the treatment of salivary gland carcinomas: long-term experience from a tertiary cancer center. Eur Arch Otorhinolaryngol 2021. [PMID: 33760953 DOI: 10.1007/s00405-021-06652-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/27/2021] [Indexed: 11/25/2022]
Abstract
Background Salivary gland carcinomas (SGC) cover a heterogeneous group of malignancies with a lack of data of high-level evidence. Methods Clinical data of 127 patients treated for SGC at a university cancer center between 2002 and 2017 were analyzed retrospectively. The association of clinicopathological characteristics, treatment modalities, adverse events, and outcome was assessed. Results Patients received surgery (n = 65), surgery followed by (chemo-)radiotherapy (n = 56), or primary (chemo-)radiotherapy (n = 6). Injury to the cranial nerves or their branches was the most frequent surgical complication affecting 40 patients (33.1%). Ten year overall and progression-free survival rates were 73.2% and 65.4%, respectively. Parotid tumor site, advanced tumor, and positive nodal stage remained independent negative prognostic factors for overall survival, loco-regional and distant tumor control in multivariate analysis. Conclusions Optimizing treatment strategies for SGC, depending on distinct clinicopathological factors, remains challenging due to the low incidence rates of the disease. Supplementary Information The online version contains supplementary material available at 10.1007/s00405-021-06652-5.
Collapse
|
12
|
Evers J, de Jaeger K, Hendriks LEL, van der Sangen M, Terhaard C, Siesling S, De Ruysscher D, Struikmans H, Aarts MJ. Trends and variations in treatment of stage I-III non-small cell lung cancer from 2008 to 2018: A nationwide population-based study from the Netherlands. Lung Cancer 2021; 155:103-113. [PMID: 33774382 DOI: 10.1016/j.lungcan.2021.03.013] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION This Dutch population-based study describes nationwide treatment patterns and its variations for stage I-III non-small cell lung cancer (NSCLC). MATERIALS AND METHODS Patients diagnosed with clinical stage I-III NSCLC in the period 2008-2018 were selected from the Netherlands Cancer Registry. Treatment trends were studied over time and age groups. Use of radiotherapy versus surgery (stage I-II), and concurrent versus sequential chemoradiotherapy (stage III) were analyzed by logistic regression. RESULTS In stage I, the rate of surgery decreased from 58 % (2008) to 40 % (2018) while radiotherapy use increased over time (from 31 % to 52 %), which mostly concerned stereotactic body radiotherapy (74 %). In stage II, 54 % of patients received surgery, and use of radiotherapy alone increased from 18 % to 25 %. The strongest factors favoring radiotherapy over surgery were WHO performance status (OR ≥ 2 vs 0: 23.39 (95% CI: 18.93-28.90)), increasing age (OR ≥ 80 vs <60 years: 14.52 (95% CI: 13.02-16.18)) and stage (OR stage II vs I: 0.61 (95% CI: 0.57-0.65)). In stage III, the combined use of chemotherapy and radiotherapy increased from 35 % (2008) to 39 % (2018). In all years, 23 % received concurrent chemoradiotherapy, 9 % sequential chemoradiotherapy, 23 % radiotherapy or chemotherapy alone, and 25 % best supportive care. The strongest factors favoring concurrent over sequential chemoradiotherapy were age (OR ≥ 80 vs <60 years: 0.14 (95% CI: 0.10-0.19)), WHO Performance status (OR ≥ 2 vs 0: 0.33 (95% CI: 0.24-0.47)) and region (OR east vs north: 0.39 (95% CI: 0.30-0.50)). CONCLUSIONS The use of radiotherapy became more prominent over time in stage I NSCLC. Combined use of chemotherapy and radiotherapy marginally increased in stage III: only one third of patients received chemoradiotherapy, mainly concurrently. Treatment variation seen between patient groups suggests tailored treatment decision, while variation between hospitals and regions indicate differences in clinical practice.
Collapse
Affiliation(s)
- Jelle Evers
- Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research and Development, Godebaldkwartier 419, 3511 DT Utrecht, the Netherlands; University of Twente, Department of Health Technology and Services Research, Hallenweg 5, 7522 NH Enschede, the Netherlands.
| | - Katrien de Jaeger
- Catharina Hospital, Department of Radiation Oncology, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands.
| | - Lizza E L Hendriks
- Maastricht University Medical Center, GROW School for Oncology and Developmental Biology, Department of Pulmonary Diseases, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands.
| | - Maurice van der Sangen
- Catharina Hospital, Department of Radiation Oncology, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands.
| | - Chris Terhaard
- Utrecht University Medical Center, Department of Radiation Oncology, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | - Sabine Siesling
- Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research and Development, Godebaldkwartier 419, 3511 DT Utrecht, the Netherlands; University of Twente, Department of Health Technology and Services Research, Hallenweg 5, 7522 NH Enschede, the Netherlands.
| | - Dirk De Ruysscher
- Maastricht University Medical Center, GROW School for Oncology and Developmental Biology, Department of Radiation Oncology (MAASTRO Clinic), Doctor Tanslaan 12, 6229 ET Maastricht, the Netherlands.
| | - Henk Struikmans
- Leiden University Medical Centre, Department of Radiation Oncology, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
| | - Mieke J Aarts
- Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research and Development, Godebaldkwartier 419, 3511 DT Utrecht, the Netherlands.
| |
Collapse
|
13
|
Ribi K, Thürlimann B, Schär C, Dietrich D, Cathomas R, Zürrer-Härdi U, von Briel T, Anchisi S, Bohanes P, Blum V, von Burg P, Mannhart M, Caspar CB, von Moos R, Mark M. Quality of life and pain in patients with metastatic bone disease from solid tumors treated with bone-targeted agents- a real-world cross-sectional study from Switzerland (SAKK 95/16). BMC Cancer 2021; 21:182. [PMID: 33607966 PMCID: PMC7893880 DOI: 10.1186/s12885-021-07903-8] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 02/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background Bone-targeted agents (BTAs) are widely used in the management of patients with bone metastases from solid tumors. Knowledge of the impact of their routine care use on patient-reported pain and bone pain-related quality of life (QoL) is limited. Methods This real world, cross-sectional study enrolled patients over a 3-month period through oncologists across Switzerland. Patients were ≥ 18 years, had solid tumors and at least one bone metastasis, and received routine care for bone metastases. Physicians provided data on BTA-related practices, risk of bone complications and BTA regimen. Patients completed questionnaires about pain (BPI-SF), general and bone pain-related QoL (FACT-G, FACT-BP) and treatment satisfaction (FACIT-TS-G). Results Eighteen sites recruited 417 patients. Based on the FACT-BP, 42% of the patients indicated not having bone pain. According to the BPI-SF, 28% reported no, 43% mild, 14% moderate, and 15% severe pain, respectively. Patients not treated with a BTA had better overall QoL (FACT-G: p = 0.031) and bone pain-related QoL (FACT-BP, p = 0.007) than those treated with a BTA. All pain and other QoL scales did not differ between groups. Patients perceived at ‘low risk of bone complications’ by their physician not receiving a BTA reported less pain and better QoL than those considered at ‘low risk’ but receiving BTA treatment or those considered at ‘high risk’ regardless of BTA treatment. Overall satisfaction with the treatment was good; almost 50% of patients reporting that they were completely satisfied. Conclusions Overall, pain and QoL did not differ according to BTA treatment or physicians’ risk perception. Patient with low risks not receiving BTA treatment reported least pain and highest QoL scores. These results may suggest that treating physicians assess bone complication risk appropriately and treat patients accordingly, but they need to be confirmed by objective determination of longitudinal skeletal complication risk. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-07903-8.
Collapse
Affiliation(s)
- Karin Ribi
- International Breast Cancer Study Group (IBCSG), Bern, Switzerland.
| | | | - Corinne Schär
- Swiss Group for Clinical Cancer Research (SAKK) Coordinating Center, Bern, Switzerland
| | - Daniel Dietrich
- Swiss Group for Clinical Cancer Research (SAKK) Coordinating Center, Bern, Switzerland
| | | | | | | | | | - Pierre Bohanes
- Centre de Chimiothérapie Anti-Cancéreuse, Lausanne, Switzerland
| | | | | | | | | | | | | |
Collapse
|
14
|
Vera-Llonch M, Reddy SR, Chang E, Tarbox MH, Pollock M. The patient journey toward a diagnosis of hereditary transthyretin (ATTRv) amyloidosis. Orphanet J Rare Dis 2021; 16:25. [PMID: 33430941 PMCID: PMC7798313 DOI: 10.1186/s13023-020-01623-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/16/2020] [Indexed: 01/10/2023] Open
Abstract
Background Despite emerging treatments for hereditary transthyretin (ATTRv) amyloidosis, the disease is often misdiagnosed, with reported diagnostic delays of up to several years. Knowledge of the patient journey leading up to diagnosis may help to promote earlier intervention. The study’s objective was to examine patient clinical characteristics and healthcare utilization prior to ATTRv amyloidosis diagnosis. Methods Patients ≥ 18 years and newly diagnosed with ATTRv amyloidosis identified in IBM® MarketScan® Commercial and Medicare Supplemental data using a claims-based algorithm as follows: diagnosis required ≥ 1 medical claim with relevant amyloidosis diagnosis code (ICD-10-CM: E85.0-.4, E85.89, E85.9; excludes light chain and wild type) during identification (ID) period (1/1/2016–12/31/2017), and ≥ 1 occurrence of qualifying criteria during 2011–2017: ≥ 15 days diflunisal use without > 30-day gap, liver transplant, or claim with specific codes E85.1 or E85.2. The index date was defined as the date of first claim with amyloidosis diagnosis code in ID period. Patients had continuous enrollment ≥ 5 years pre-index date (look-back period). Occurrence of selected comorbid conditions and symptoms and healthcare utilization (testing, emergency department visits and hospitalization) measured during the look-back period; demographics, physician specialty, and Charlson comorbidity index (CCI) measured 1 year pre-index. Patients with an ICD-9/10 amyloidosis code during the look-back period were excluded. An ATTRv-free reference cohort was created from a random sample of enrollees who lacked any diagnosis of amyloidosis and matched 3:1 to ATTRv patients on age, gender, and region to provide reference values; same index and enrollment requirement as match. Results For the 141 qualifying patients with ATTRv and 423 matched controls, mean (standard deviation) age was 62.5 (14.2) years and 53.9% were female. Mean CCI for ATTRv cohort was 2.7 (3.0) versus 1.1 (1.9) among controls. Selected comorbidities, testing, visits, and hospitalization were common among patients with ATTRv during the look-back period with higher rates versus controls. Conclusions Patients with ATTRv amyloidosis experience multiple neurological, cardiovascular, and other clinical manifestations, testing, and hospitalization prior to diagnosis. Occurrence of potential markers of illness is most common in the year before diagnosis.
Collapse
Affiliation(s)
- Montserrat Vera-Llonch
- Global Health Economics and Outcomes, 22 Boston Wharf Road, 9th Floor, Boston, MA, 02210, USA.
| | - Sheila R Reddy
- Partnership for Health Analytic Research, LLC, 280 S. Beverly Dr., Ste 404, Beverly Hills, CA, 90212, USA
| | - Eunice Chang
- Partnership for Health Analytic Research, LLC, 280 S. Beverly Dr., Ste 404, Beverly Hills, CA, 90212, USA
| | - Marian H Tarbox
- Partnership for Health Analytic Research, LLC, 280 S. Beverly Dr., Ste 404, Beverly Hills, CA, 90212, USA
| | - Michael Pollock
- Global Health Economics and Outcomes, 22 Boston Wharf Road, 9th Floor, Boston, MA, 02210, USA
| |
Collapse
|
15
|
Steeb T, Wessely A, Alter M, Bayerl C, Bender A, Bruning G, Dabrowski E, Debus D, Devereux N, Dippel E, Drexler K, Dücker P, Dummer R, Emmert S, Elsner P, Enk A, Gebhardt C, Gesierich A, Goebeler M, Goerdt S, Goetze S, Gutzmer R, Haferkamp S, Hansel G, Hassel JC, Heinzerling L, Kähler KC, Kaume KM, Krapf W, Kreuzberg N, Lehmann P, Livingstone E, Löffler H, Loquai C, Mauch C, Mangana J, Meier F, Meissner M, Moritz RKC, Maul LV, Müller V, Mohr P, Navarini A, Van Nguyen A, Pfeiffer C, Pföhler C, Posch C, Richtig E, Rompel R, Sachse MM, Sauder S, Schadendorf D, Schatton K, Schulze HJ, Schultz E, Schilling B, Schmuth M, Simon JC, Streit M, Terheyden P, Thiem A, Tüting T, Welzel J, Weyandt G, Wesselmann U, Wollina U, Ziemer M, Zimmer L, Zutt M, Berking C, Schlaak M, Heppt MV. Patterns of care and follow-up care of patients with uveal melanoma in German-speaking countries: a multinational survey of the German Dermatologic Cooperative Oncology Group (DeCOG). J Cancer Res Clin Oncol 2020; 147:1763-1771. [PMID: 33219855 PMCID: PMC8076157 DOI: 10.1007/s00432-020-03450-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/31/2020] [Indexed: 12/22/2022]
Abstract
Purpose Uveal melanoma (UM) is an orphan cancer of high unmet medical need. Current patterns of care and surveillance remain unclear as they are situated in an interdisciplinary setting. Methods A questionnaire addressing the patterns of care and surveillance in the management of patients with uveal melanoma was distributed to 70 skin cancer centers in Austria, Germany and Switzerland. Frequency distributions of responses for each item of the questionnaire were calculated. Results 44 of 70 (62.9%) skin cancer centers completed the questionnaire. Thirty-nine hospitals were located in Germany (88.6%), three in Switzerland (6.8%) and two in Austria (4.5%). The majority (68.2%) represented university hospitals. Most patients with metastatic disease were treated in certified skin cancer centers (70.7%, 29/41). Besides, the majority of patients with UM were referred to the respective skin cancer center by ophthalmologists (87.2%, 34/39). Treatment and organization of follow-up of patients varied across the different centers. 35.1% (14/37) of the centers stated to not perform any screening measures. Conclusion Treatment patterns of patients with uveal melanoma in Germany, Austria and Switzerland remain extremely heterogeneous. A guideline for the treatment and surveillance is urgently needed.
Collapse
Affiliation(s)
- Theresa Steeb
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany.,Comprehensive Cancer Center Erlangen, European Metropolitan Region of Nuremberg, Erlangen, Germany
| | - Anja Wessely
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany.,Comprehensive Cancer Center Erlangen, European Metropolitan Region of Nuremberg, Erlangen, Germany
| | - Mareike Alter
- Department of Dermatology, University Medical Center, Magdeburg, Germany
| | - Christiane Bayerl
- Department of Dermatology and Allergology, Skin Cancer Center Wiesbaden, Helios Dr. Horst Schmidt Clinics, Wiesbaden, Germany
| | - Armin Bender
- Department of Dermatology and Allergology, Philipps University Marburg, Marburg, Germany
| | - Guido Bruning
- Center for Venous and Dermatosurgery, Tabea Krankenhaus Hamburg, Hamburg, Germany
| | - Evelyn Dabrowski
- Department of Dermatology, Ludwigshafen Medical Center, Ludwigshafen, Germany
| | - Dirk Debus
- Department of Dermatology, Paracelsus Medical University Nuremberg, City Hospital of Nuremberg, Nuremberg, Germany
| | - Nina Devereux
- Center for Venous and Dermatosurgery, Tabea Krankenhaus Hamburg, Hamburg, Germany
| | - Edgar Dippel
- Department of Dermatology, Ludwigshafen Medical Center, Ludwigshafen, Germany
| | - Konstantin Drexler
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Pia Dücker
- Department of Dermatology, Hospital of Dortmund, Dortmund, Germany
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, University Zurich, Zürich, Switzerland
| | - Steffen Emmert
- Department of Dermatology and Venereology, University Medical Center, Rostock, Germany
| | - Peter Elsner
- Department of Dermatology, University Hospital, Jena, Germany
| | - Alexander Enk
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Christoffer Gebhardt
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Gesierich
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Matthias Goebeler
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Sergij Goerdt
- Department of Dermatology, Venerology and Allergology, Medical Faculty Mannheim, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Steven Goetze
- Department of Dermatology, University Hospital, Jena, Germany
| | - Ralf Gutzmer
- Department of Dermatology and Allergy, Hannover Medical School, Skin Cancer Center Hannover, Hannover, Germany
| | - Sebastian Haferkamp
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Gesina Hansel
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany
| | - Jessica C Hassel
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Lucie Heinzerling
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany.,Comprehensive Cancer Center Erlangen, European Metropolitan Region of Nuremberg, Erlangen, Germany.,Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilians-University (LMU), Frauenlobstr. 9-11, 80337, Munich, Germany
| | - Katharina C Kähler
- Department of Dermatology, Venereology and Allergology, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Kjell M Kaume
- Department of Dermatology and Allergology, Klinikum Bremen-Mitte, Bremen, Germany
| | - Wolfgang Krapf
- Department of Dermatology, SLK Hospital Heilbronn, Heilbronn, Germany
| | - Nicole Kreuzberg
- Department of Dermatology and Venerology, University of Cologne, Cologne, Germany
| | - Percy Lehmann
- Department of Dermatology, Helios University Hospital Wuppertal, Wuppertal, Germany
| | - Elisabeth Livingstone
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Harald Löffler
- Department of Dermatology, SLK Hospital Heilbronn, Heilbronn, Germany
| | - Carmen Loquai
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Cornelia Mauch
- Department of Dermatology and Venerology, University of Cologne, Cologne, Germany
| | - Johanna Mangana
- Department of Dermatology, University Hospital Zurich, University Zurich, Zürich, Switzerland
| | - Friedegund Meier
- Department of Dermatology, University Hospital Dresden, Dresden, Germany
| | - Markus Meissner
- Department of Dermatology, Venereology and Allergology, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - Rose K C Moritz
- Department of Dermatology and Venereology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Lara Valeska Maul
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Verena Müller
- Department of Dermatology, Venerology and Allergology, Medical Faculty Mannheim, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Peter Mohr
- Department of Dermatology, Elbe-Kliniken, Buxtehude, Germany
| | - Alexander Navarini
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Ahn Van Nguyen
- Department of Dermatology, Venerology and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christiane Pfeiffer
- Department of Dermatology and Allergology, University Hospital Augsburg, Augsburg, Germany.,Department of Dermatology and Allergology, University Hospital Ulm, Ulm, Germany
| | - Claudia Pföhler
- Department of Dermatology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Christian Posch
- Department of Dermatology and Allergy, School of Medicine, German Cancer Consortium (DKTK), Technical University of Munich, Munich, Germany
| | - Erika Richtig
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Rainer Rompel
- Department of Dermatology, Klinikum Kassel, Kassel, Germany
| | - Michael M Sachse
- Skin Cancer Center, Department of Dermatology, Allergology and Phlebology, Bremerhaven Reinkenheide, Bremerhaven, Germany
| | | | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Kerstin Schatton
- Medical Faculty, Department of Dermatology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Hans-Joachim Schulze
- Department of Dermatology and Dermato-Histo-Pathology, Fachklinik Hornheide, Skin Cancer Centre, Münster, Germany
| | - Erwin Schultz
- Department of Dermatology, Paracelsus Medical University Nuremberg, City Hospital of Nuremberg, Nuremberg, Germany
| | - Bastian Schilling
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Matthias Schmuth
- Department of Dermatology, Venerology and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - Jan C Simon
- Department of Dermatology, Venereology and Allergology, University Medical Center Leipzig, Leipzig, Germany
| | - Markus Streit
- Department of Dermatology, Hospital Aarau, Aarau, Switzerland
| | | | - Alexander Thiem
- Department of Dermatology and Venereology, University Medical Center, Rostock, Germany
| | - Thomas Tüting
- Department of Dermatology, University Medical Center, Magdeburg, Germany
| | - Julia Welzel
- Department of Dermatology and Allergology, University Hospital Augsburg, Augsburg, Germany
| | - Gerhard Weyandt
- Department of Dermatology and Allergology, Hospital Bayreuth, Bayreuth, Germany
| | - Ulrich Wesselmann
- Department of Dermatology, Helios University Hospital Wuppertal, Wuppertal, Germany
| | - Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany
| | - Mirjana Ziemer
- Department of Dermatology, Venereology and Allergology, University Medical Center Leipzig, Leipzig, Germany
| | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Markus Zutt
- Department of Dermatology and Allergology, Klinikum Bremen-Mitte, Bremen, Germany
| | - Carola Berking
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany.,Comprehensive Cancer Center Erlangen, European Metropolitan Region of Nuremberg, Erlangen, Germany
| | - Max Schlaak
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilians-University (LMU), Frauenlobstr. 9-11, 80337, Munich, Germany.
| | - Markus V Heppt
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany.,Comprehensive Cancer Center Erlangen, European Metropolitan Region of Nuremberg, Erlangen, Germany
| | | |
Collapse
|
16
|
Chopra S, Mangaj A, Sharma A, Tan LT, Sturdza A, Jürgenliemk-Schulz I, Han K, Huang F, Schmid MP, Fokdal L, Chargari C, Diendorfer T, Tanderup K, Potter R, Nout RA. Management of oligo-metastatic and oligo-recurrent cervical cancer: A pattern of care survey within the EMBRACE research network. Radiother Oncol 2020; 155:151-159. [PMID: 33144247 DOI: 10.1016/j.radonc.2020.10.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 08/12/2020] [Revised: 10/24/2020] [Accepted: 10/26/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND In the metastatic or recurrent cervical cancer, systemic chemotherapy constitutes the main treatment. Though there is an increasing use of high dose external radiation and brachytherapy in the metastatic setting, no consensus exists. METHODS A 17-item survey was designed with additional case-based questions to explore present management of oligo-metastatic and oligo-recurrent cervix cancer within EMBRACE research group participating sites. The questions were designed to elicit prevailing practices in the management of de-novo oligo-metastasis and oligo-recurrent setting after completing the primary treatment of cervix cancer. The survey was sent electronically with two rounds of email reminders to respond over a 2-week survey period. The online survey was designed such that it was mandatory to complete all questions. The responses were recorded and results were summarized as proportions and summary statistics were generated. RESULTS Twenty-two centers responded to this survey. A majority (90%) of respondents reported a low incidence of de-novo oligo-metastatic cervical cancer in their practice (<5%), with a higher proportion of patients with oligo-recurrence after completing primary treatment (5-10%). All responding sites preferred to treat pelvic disease in the de-novo oligo-metastatic setting albeit with different fractionation regimens. While 68.2% of respondents recommended chemo-radiation and brachytherapy, 31.8% considered additional systemic therapy. Overall 77.3% centers recommended the use of stereotactic ablative radiation therapy to oligo-metastasis. For out-of-field nodal recurrences, 63.7% of respondents considered treating with curative intent, while 59% preferred treating in-field recurrence with palliative intent. A vast majority of the participating centers (90%) have stereotactic radiation therapy capacity and would consider a clinical trial addressing oligo-metastatic and oligo-recurrent cervical cancer. CONCLUSION Although contemporary practice is variable, a substantial proportion of EMBRACE centers consider high dose radiation in de-novo metastatic and oligo-recurrence settings. However, there is clear need for a joint clinical protocol and prospective studies to address the role of high dose radiation within oligo-recurrent and oligo-metastatic scenarios.
Collapse
Affiliation(s)
- Supriya Chopra
- Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India.
| | - Akshay Mangaj
- Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Alisha Sharma
- Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Li Tee Tan
- Cambridge University Addenbrooke's Hospital, United Kingdom
| | - Alina Sturdza
- Medical University/General Hospital of Vienna, Comprehensive Cancer Center, Austria
| | | | - Kathy Han
- University of Toronto Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Canada
| | - Fleur Huang
- Cross Cancer Institute and University of Alberta, Department of Oncology, Edmonton, Canada
| | - Maximilian P Schmid
- Medical University/General Hospital of Vienna, Comprehensive Cancer Center, Austria
| | - Lars Fokdal
- Aarhus University Hospital, Department of Oncology, Aarhus, Denmark
| | | | - Tamara Diendorfer
- Medical University/General Hospital of Vienna, Comprehensive Cancer Center, Austria
| | - Kari Tanderup
- Aarhus University Hospital, Department of Oncology, Aarhus, Denmark
| | - Richard Potter
- Medical University/General Hospital of Vienna, Comprehensive Cancer Center, Austria
| | - Remi A Nout
- Erasmus MC Cancer Institute, Erasmus University Medical Center Rotterdam, the Netherlands.
| |
Collapse
|
17
|
Mayinger M, Straube C, Habermehl D, Duma MN, Combs SE. Hypo- vs. normofractionated radiation therapy in breast cancer: A patterns of care analysis in German speaking countries. Rep Pract Oncol Radiother 2020; 25:775-779. [PMID: 32904392 DOI: 10.1016/j.rpor.2020.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 05/31/2020] [Accepted: 07/24/2020] [Indexed: 10/24/2022] Open
Abstract
Aim and background To assess the use of hypofractionated (HG-RT) versus normofractionated radiation therapy (NF-RT) in Breast Cancer in German speaking countries. Materials and methods Between July 2017 and August 2017, an email-based survey was sent to all 1408 physicians that are members of the German Society of Radiation Oncology (DEGRO). The survey was completed by 180 physicians including 10 private practice owners and 52 heads of departments. The majority (82.1%) of the participants had >15 years of experience in radiation therapy (RT). Results The majority (83.9%) of the heads of the departments agreed on using the normofractionated regimen of RT as standard treatment for breast cancer. Several physicians were skeptical about HF-RT with 6.5% of the heads refusing to use HF-RT. 40.3% of the departments had not seen the new German guidelines suggesting HF-RT as the standard treatment for all patients as positive or merely adopted a neutral position toward the guidelines (33.9%). The main points of criticism were increased side effects, an impaired toxicity profile and insufficient data. Most departments (46.8%) that perform HF-RT do so in an individual based manner. Conclusions HF-RT remains controversial in German speaking countries. Our data shows that NF-RT remains the predominant method of treatment. HF-RT is only used in a defined group of patients as most German physicians agree that particular patients, especially those at higher risk of RT late effects, may benefit from a less intense, extended fractionation schedule.
Collapse
Affiliation(s)
- M Mayinger
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany.,Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland
| | - C Straube
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany.,Institute of Innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Munich, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partnerstandort München, Munich, Germany
| | - D Habermehl
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany.,Institute of Innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Munich, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partnerstandort München, Munich, Germany
| | - M N Duma
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany.,Institute of Innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Munich, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partnerstandort München, Munich, Germany
| | - S E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany.,Institute of Innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Munich, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partnerstandort München, Munich, Germany
| |
Collapse
|
18
|
Martin D, von der Grün J, Rödel C, Fokas E. Management of anal cancer patients - a pattern of care analysis in German-speaking countries. Radiat Oncol 2020; 15:122. [PMID: 32450863 PMCID: PMC7249388 DOI: 10.1186/s13014-020-01539-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/14/2020] [Indexed: 01/20/2023] Open
Abstract
Background Radiotherapy dose and target volume prescriptions for anal squamous cell carcinoma (ASCC) vary considerably in daily practice and guidelines, including those from NCCN, UK, Australasian, and ESMO. We conducted a pattern-of-care survey to assess the patient management in German speaking countries. Methods We developed an anonymous questionnaire comprising 18 questions on diagnosis and treatment of ASCC. The survey was sent to 361 DEGRO-associated institutions, including 41 university hospitals, 118 non-university institutions, and 202 private practices. Results We received a total of 101 (28%) surveys, including 20 (19.8%) from university, 36 (35.6%) from non-university clinics, and 45 (44.6%) from private practices. A total of 28 (27.8%) institutions reported to treat more than 5 patients with early-stage ASCC and 42 (41.6%) institutions treat more than 5 patients with locoregionally-advanced ASCC per year. Biopsy of suspicious inguinal nodes was advocated in only 12 (11.8%) centers. Screening for human immunodeficiency virus (HIV) is done in 28 (27.7%). Intensity modulated radiotherapy or similar techniques are used in 97%. The elective lymph node dose ranged from 30.6 Gy to 52.8 Gy, whereas 87% prescribed 50.4–55. 8 Gy (range: 30.6 to 59.4 Gy) to the involved lymph nodes. The dose to gross disease of cT1 or cT2 ASCC ranged from 50 to ≥60 Gy. For cT3 or cT4 tumors the target dose ranged from 54 Gy to more than 60 Gy, with 76 (75.2%) institutions prescribing 59.4 Gy. The preferred concurrent chemotherapy regimen was 5-FU/Mitomycin C, whereas 6 (6%) prescribed Capecitabine/Mitomycin C. HIV-positive patients are treated with full-dose CRT in 87 (86.1%) institutions. First assessment for clinical response is reported to be performed at 4–6 weeks after completion of CRT in 2 (2%) institutions, at 6–8 weeks in 20 (19.8%), and 79 (78%) institutions wait up to 5 months. Conclusions We observed marked differences in radiotherapy doses and treatment technique in patients with ASCC, and also variable approaches for patients with HIV. These data underline the need for an consensus treatment guideline for ASCC.
Collapse
Affiliation(s)
- Daniel Martin
- Department of Radiotherapy and Oncology, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany. .,Frankfurt Cancer Institute (FCI), Frankfurt, Germany. .,German Cancer Research Center (DKFZ), Heidelberg, Germany. .,German Cancer Consortium (DKTK), partner site: Frankfurt a. M, Heidelberg, Germany.
| | - Jens von der Grün
- Department of Radiotherapy and Oncology, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), partner site: Frankfurt a. M, Heidelberg, Germany
| | - Claus Rödel
- Department of Radiotherapy and Oncology, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.,Frankfurt Cancer Institute (FCI), Frankfurt, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), partner site: Frankfurt a. M, Heidelberg, Germany
| | - Emmanouil Fokas
- Department of Radiotherapy and Oncology, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.,Frankfurt Cancer Institute (FCI), Frankfurt, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), partner site: Frankfurt a. M, Heidelberg, Germany
| |
Collapse
|
19
|
Barsky AR, Ahern CA, Venigalla S, Verma V, Anstadt EJ, Wright CM, Ludmir EB, Berlind CG, Lindsay WD, Grover S, Cengel KA, Simone CB 2nd. Gender-based Disparities in Receipt of Care and Survival in Malignant Pleural Mesothelioma. Clin Lung Cancer 2020; 21:e583-91. [PMID: 32611504 DOI: 10.1016/j.cllc.2020.05.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 04/26/2020] [Accepted: 05/14/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Despite accounting for a minority of malignant pleural mesothelioma (MPM) diagnoses, females may experience differential survival relative to males. It is unclear if there are gender-based differences in receipt of treatment or disease-related outcomes for patients with MPM. We therefore utilized the National Cancer Database (NCDB) to assess patterns-of-care and overall survival (OS) among patients with MPM by gender. MATERIALS AND METHODS Patients with histologically confirmed MPM treated from 2004 to 2013 were identified from the NCDB. The association between female gender and OS was assessed using multivariable Cox proportional hazards models with propensity score matching. Patterns-of-care were assessed using multivariable logistic regression. The overall treatment effect was tested in subsets of patients by treatment strategy, histology, and clinical stage. RESULTS A total of 18,799 patients were identified, of whom 14,728 (78%) were male and 4071 (22%) were female. Females were statistically more likely to present at a younger age, with fewer comorbidities, and with epithelioid histology. Despite these favorable prognostic features, women were less likely to receive surgery (P ≤ .001) or chemotherapy (P ≤ .001) compared with males. On multivariable analysis, female gender was associated with improved OS (hazard ratio, 0.83; 95% confidence interval, 0.80-0.86; P ≤ .001). Gender-based survival differences were seen across all stages, but only among patients with epithelioid (P ≤ .001) and not biphasic (P = .17) or sarcomatoid (P = 1.00) histology. CONCLUSIONS Surgery and chemotherapy are disproportionately underutilized in female patients with MPM. Despite this concerning disparity, female gender is independently associated with improved survival relative to males. Further research to understand factors that lead to gender disparities in MPM is warranted.
Collapse
|
20
|
Wells SM, Boothe D, Ager BJ, Tao R, Gilcrease GW, Lloyd S. Analysis of Nonsurgical Treatment Options for Metastatic Rectal Cancer. Clin Colorectal Cancer 2020; 19:91-99.e1. [PMID: 32173281 DOI: 10.1016/j.clcc.2019.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/17/2019] [Accepted: 11/19/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Using a large national registry, we investigated patterns of care and overall survival (OS) for metastatic rectal cancer patients treated with chemotherapy or radiotherapy (RT), or with a multimodal approach. PATIENTS AND METHODS Adult patients with metastatic rectal cancer who did not undergo resection diagnosed from 2004 to 2014 were included. Kaplan-Meier, log-rank, and Cox regression analyses were performed. RESULTS We identified 2385 patients. Of these, 1020 patients (43%) received chemotherapy alone, 228 (10%) received RT alone, 850 (36%) received chemotherapy and RT, and 287 (12%) received no treatment. Receipt of chemotherapy alone increased over the study period, and receipt of chemoradiotherapy decreased (P < .01). The only factor predictive of receiving any RT on multivariate analysis was clinical stage T3 disease. Factors predictive of OS on multivariate analysis included receipt of chemotherapy, Hispanic race, income greater than $46,000, and presence of lung metastasis. The OS for patients treated with chemotherapy and RT was not significantly different than chemotherapy alone. Five-year OS with chemotherapy alone, RT alone, chemoradiotherapy, and no treatment were, respectively, 84%, 56%, 79%, and 46%. CONCLUSION Metastatic rectal cancer patients with T3 tumors were more likely to receive RT. Local RT does not improve survival for patients with metastatic rectal cancer who do not also undergo surgery. The use of chemotherapy alone for metastatic rectal cancer is increasing, and chemotherapy is associated with higher OS compared to no treatment and RT alone. This remained true even in patients older than 80 years.
Collapse
Affiliation(s)
- Stacey M Wells
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT
| | | | - Bryan J Ager
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT
| | - Randa Tao
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT
| | - Glynn Weldon Gilcrease
- Division of Oncology, Department of Internal Medicine, Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT
| | - Shane Lloyd
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT.
| |
Collapse
|
21
|
Miglietta E, Lasalvia A, Bonetto C, Comacchio C, Cristofalo D, Tosato S, De Santi K, Petterlini S, Zanatta G, Cremonese C, Ramon L, Ruggeri M. Pathways to care, DUP, and types of interventions over 5 years following psychosis onset: findings from a naturalistic study conducted in routine generalist mental health services. Soc Psychiatry Psychiatr Epidemiol 2020; 55:175-186. [PMID: 31511926 DOI: 10.1007/s00127-019-01775-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 09/04/2019] [Indexed: 01/04/2023]
Abstract
PURPOSE To describe pathways to care, duration of untreated psychosis (DUP), and types of interventions provided to first-episode psychosis (FEP) patients by routine Italian mental health services over 5 years since the first service contact. METHODS Naturalistic study conducted in Veneto, within the context of the Psychosis Incident Cohort Outcome Study (PICOS). A comprehensive set of measures was used, including schedules designed to collect information on referrals to psychiatric services and on psychological and pharmacological treatments at 1, 2, and 5 years since first service contact. RESULTS Overall, 397 patients were assessed. Most engaged with services with the help of family members (47.4%) and through emergency routes (60.3%). Those referred by clinicians were more likely to access care in a non-emergency way. Mean DUP was 5.62 months (SD 11.8) and longer DUP was associated with poorer functioning at 2 and 5 years. Interventions provided over 5 years were mainly constituted by antipsychotic medications (95.4% at 1 year; 85.8% at 2 years; 80.6% at 5 years), whereas a lower percentage (69.1% at 1 year; 61.5% at 2 years; 44.9% at 5 years) also received some forms of psychological interventions, mainly consisting of unspecific support sessions. Other structured interventions, such as CBT or family interventions, were seldom provided at each time-point. CONCLUSIONS Mental health services in Veneto seem effective in engaging FEP patients within a short time since illness onset. However, type of care provided does not meet quality standards recommended by treatment guidelines, especially regarding psychological interventions.
Collapse
Affiliation(s)
- Elisabetta Miglietta
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Antonio Lasalvia
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy. .,Unit of Psychiatry, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Policlinico "GB Rossi", Verona, Italy.
| | - Chiara Bonetto
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Carla Comacchio
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Doriana Cristofalo
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Sarah Tosato
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy.,Unit of Psychiatry, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Policlinico "GB Rossi", Verona, Italy
| | - Katia De Santi
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy.,Unit of Psychiatry, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Policlinico "GB Rossi", Verona, Italy
| | - Sara Petterlini
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Gioia Zanatta
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Carla Cremonese
- Psychiatric Clinic, Department of Neuroscience, University of Padua, Padua, Italy
| | - Luana Ramon
- Department of Mental Health, NHS, Local Health Authority Portogruaro (VE), Portogruaro, Italy
| | - Mirella Ruggeri
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy.,Unit of Psychiatry, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Policlinico "GB Rossi", Verona, Italy
| | | |
Collapse
|
22
|
Morias S, Buckley E, Beckmann K, O'Callaghan M, Borg M, Short M. Variation in radiotherapy patterns of care in the radical treatment of South Australian men with non-metastatic prostate cancer between 2005-2015. Radiother Oncol 2020; 145:138-45. [PMID: 31978853 DOI: 10.1016/j.radonc.2019.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/16/2019] [Accepted: 12/22/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE To investigate associations between socio-demographic characteristics and radiotherapy patterns of care in non-metastatic prostate cancer [nmPCa] in South Australia [SA] between 2005-2015 and document practice patterns over time. MATERIALS AND METHODS Men with nmPCa receiving primary curative radiotherapy were identified from SA Prostate Cancer Clinical Outcomes Collaborative database. Adjuvant, salvage and palliative therapies were excluded. Associations between socio-demographic factors (age, residence, socio-economic status, diagnostic period) and radiotherapy mode (external beam radiotherapy [EBRT] vs. brachytherapy [BT]) and technique (low-dose-rate vs. high-dose-rate brachytherapy) were investigated using multivariable logistic regression with separate models for clinical risk categories. RESULTS Of the 1874 men who underwent primary RT, 80% received EBRT and 20% BT. For low and intermediate risk disease, likelihood of receiving EBRT was higher among older men (ORlow = 3.08; 95% CI 1.82-5.22 and ORintermediate = 3.48; 2.28-5.31 for 65-74 yrs vs. <65 yrs) and lower among regional/remote compared with metropolitan residents (ORlow = 0.34; 0.17-0.67 and ORintermediate = 0.57; 0.34-0.94). For intermediate and high risk disease, more recent diagnosis was associated with decreased likelihood of EBRT (ORintermediate = 0.22; 95% CI 0.15-0.33 and ORhigh = 0.50; 0.29-0.88, respectively). Among men receiving BT, low-dose-rate BT use decreased over time for low (OR = 0.19; 0.04-0.89) and intermediate risk disease (OR = 0.32; 0.12-0.84). Dose escalation and intensity modulation for EBRT increased after 2010. CONCLUSION Over the last decade substantial changes in RT for nmPCa were observed. Older age and more remote residence may be barriers to accessing specific types of RT. Further research to understand how these factors affect access is warranted to improve service provision.
Collapse
|
23
|
Mark M, Thürlimann B, Ribi K, Schär C, Dietrich D, Cathomas R, Zürrer-Härdi U, von Briel T, Anchisi S, Bohanes P, Blum V, von Burg P, Mannhart M, Caspar CB, von Moos R. Patterns of care for patients with metastatic bone disease in solid tumors: A cross-sectional study from Switzerland (SAKK 95/16). J Bone Oncol 2019; 21:100273. [PMID: 31970055 PMCID: PMC6965709 DOI: 10.1016/j.jbo.2019.100273] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/12/2019] [Accepted: 12/14/2019] [Indexed: 02/03/2023] Open
Abstract
Implementation of guideline-recommended BTA practice is high among Swiss physicians. Denosumab is the BTA of choice in Switzerland. BTAs were widely administered (94.2%) according to a 3–4-weekly dosing regimen. Bone pain and SRE incidence were low in patients with solid tumor bone metastases. Low SRE incidence may indicate BTA efficacy and judicious BTA prescribing.
Background Bone-targeted agents (BTAs) are widely used in the management of patients with bone metastases from solid tumors, but knowledge of their routine care use and the therapeutic implications remains limited. This non-interventional study aimed to characterize real-world BTA patterns of care in Switzerland. Materials and methods Non-interventional, cross-sectional study involving oncologists from across Switzerland who completed a Treating Physician questionnaire, providing data on their clinical setting and BTA-related practices, and a Patient Characteristics and Treatment questionnaire, providing data on their patients’ disease status, risk of bone complications, BTA regimen and related outcomes. Eligible patients were aged ≥ 18 years, with solid tumors and at least one bone metastasis and were receiving routine management at the participating physician's center over the 3-month study period. Results A total of 86 oncologists recruited 417 patients from across 18 centers in Switzerland (80% public hospitals; 20% private clinics). The majority of physicians (70.9%) reported prescribing BTAs in line with international guidelines; denosumab was the treatment of choice in 78.5% of patients. BTAs were widely administered (94.2%) according to a 3–4-weekly dosing regimen; 33.7% of physicians reported extending intervals to 12 weeks after an initial 2 years of treatment. Physicians appeared to use clinical judgement, as well as formal risk assessment, to guide treatment for symptomatic skeletal events. No association was seen between either BTA use, or risk of complications, and incidence of skeletal complications. Only 4.3% of patients were reported to be experiencing severe bone pain at the time of the study. Conclusions This cross-sectional, non-interventional study found high implementation of guideline-recommended BTA prescribing, good pain control and low incidence of skeletal-related events. Long-term BTA randomized controlled trials have the potential to further optimize routine care outcomes for patients.
Collapse
Key Words
- BP, bisphosphonate
- BTA, bone-targeted agent
- Bone metastases
- Bone-targeting agents
- HRQoL, health-related quality of life
- IBCSG, International Breast Cancer Study Group
- Non-interventional
- Patterns of care
- RANKL, receptor activator of nuclear factor kappa-B ligand
- RCT, randomized controlled trial
- SAKK, Swiss Group for Clinical Cancer Research
- SGMO, Schweizerische Gesellschaft für Medizinische Onkologie
- SRE, symptomatic skeletal-related event
- SSE, symptomatic skeletal event
- Skeletal-related event
- Symptomatic skeletal events
- mCRPC, metastatic castration-resistant prostate cancer
Collapse
Affiliation(s)
- Michael Mark
- Department of Hematology/Oncology, Kantonsspital Graubünden, Loestrasse 170, 7000 Chur, Switzerland
- Corresponding author.
| | | | - Karin Ribi
- International Breast Cancer Study Group IBCSG (IBCSG), Bern, Switzerland
| | - Corinne Schär
- Swiss Group for Clinical Cancer Research (SAKK) Coordinating Center, Bern, Switzerland
| | - Daniel Dietrich
- Swiss Group for Clinical Cancer Research (SAKK) Coordinating Center, Bern, Switzerland
| | - Richard Cathomas
- Department of Hematology/Oncology, Kantonsspital Graubünden, Loestrasse 170, 7000 Chur, Switzerland
| | | | | | | | - Pierre Bohanes
- Centre de Chimiothérapie Anti-Cancéreuse, Lausanne, Switzerland
| | | | | | | | | | - Roger von Moos
- Department of Hematology/Oncology, Kantonsspital Graubünden, Loestrasse 170, 7000 Chur, Switzerland
| |
Collapse
|
24
|
Gale SL, Trinh H, Mathew N, Jahreis A, Lin CJF, Sarsour K. Characterizing Disease Manifestations and Treatment Patterns Among Adults with Systemic Sclerosis: A Retrospective Analysis of a US Healthcare Claims Population. Rheumatol Ther 2020; 7:89-99. [PMID: 31734871 DOI: 10.1007/s40744-019-00181-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Indexed: 12/26/2022] Open
Abstract
Introduction Real-world use of immunomodulating therapy (IMT) in patients with systemic sclerosis (SSc) was investigated for the first time in a descriptive, retrospective cohort analysis of claims made in a healthcare insurance database to characterize treatment patterns and their alignment with SSc disease manifestations. Methods Treatment patterns and disease manifestations, symptoms, complications, and comorbidities were assessed in patients with SSc enrolled in a US healthcare claims database who received treatment between January 2006 and December 2013 and for whom data were available 6 months before and 12 months after SSc diagnosis. Results Among 7812 eligible patients, 6852 received treatments of interest for SSc and 2404 (30.8%) received IMT during the first year after SSc diagnosis. In the first year after diagnosis, the most common claims were for antibiotics (61.7%), opioids (50.6%), glucocorticoids (46.5%), and proton pump inhibitors (35.4%); the most common organs involved with complications among patients with SSc were lung (30.5%), heart (17.4%), and gastrointestinal tract (22.4%); the most common signs or symptoms were musculoskeletal (16.1%) and fatigue (10.5%); 1035 patients (15.1%) had infections and 14 (0.2%) had malignancies. Among patients who received IMT, 43.8% received at least hydroxychloroquine and 21.1% received at least methotrexate; 460 patients switched to a second IMT, 23.0% to at least methotrexate and 22.8% to at least mycophenolate mofetil. The most common comorbidities reported with first IMT were in lung (11.8%), overlap syndrome (8.4%), heart (5.3%), and gastrointestinal (6.8%) categories. Conclusion One-third of patients with SSc in the healthcare claims population received IMTs during the first year after diagnosis. However, patients who received IMTs had disease manifestations similar to those of the overall SSc healthcare claims population. Electronic Supplementary Material The online version of this article (10.1007/s40744-019-00181-8) contains supplementary material, which is available to authorized users.
Collapse
|
25
|
Borm KJ, Kessel K, Devecka M, Muench S, Straube C, Schiller K, Schüttrumpf L, Dapper H, Wöller B, Pigorsch S, Combs SE. Variability in lymph node irradiation in patients with breast cancer-results from a multi-center survey in German-speaking countries. Strahlenther Onkol 2020; 196:15-22. [PMID: 31722060 DOI: 10.1007/s00066-019-01537-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/23/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Lymph node irradiation in breast cancer has gained complexity due to recently published studies and technical innovations which then led to changes in international guidelines. We sought to determine real-time variability in lymph node irradiation in clinical practice in German-speaking countries. METHODS The Department of Radiation Oncology, Technical University of Munich (TUM), developed an online-based questionnaire focusing on the indication, target definition, and treatment technique of lymph node irradiation in patients with breast cancer. The invitation to participate in the survey was sent to members of the German Society of Radiation Oncology (DEGRO) by e‑mail. The results of the survey were exported from the online platform into SPSS for a detailed analysis. RESULTS In total, 100 physicians completed the questionnaire between 05/2019 and 06/2019. Despite the existence of several treatment and contouring guidelines, we observed large variability of lymph node irradiation: The guideline recommendation for internal mammary irradiation is not consistently implemented in clinical practice and irradiation of the axilla after positive SLNB (sentinel lymph node biopsy) or ALND (axillary lymph node dissection) is handled very differently. Furthermore, in most clinics, the ESTRO (European Society for Therapeutic Radiology and Oncology) contouring consensus is not used, and PTV (planning target volume) definitions and margins vary considerably. CONCLUSION Further clinical studies should be performed with a particular focus on radiotherapy for lymphatic drainage to support and amend the existing guidelines. These studies should establish a more standardized treatment of the lymph node regions in clinical practice. Quality assurance should enforce broad implementation of consensus recommendations.
Collapse
|
26
|
Irwin G, Bannon F, Coles C, Copson E, Cutress R, Dave R, Grayson M, Holcombe C, Irshad S, O'Brien C, O'Connell R, Palmieri C, Shaaban A, Sharma N, Singh J, Whitehead I, Potter S, McIntosh S. The NeST (neoadjuvant systemic therapy in breast cancer) study - Protocol for a prospective multi-centre cohort study to assess the current utilization and short-term outcomes of neoadjuvant systemic therapies in breast cancer. Int J Surg Protoc 2019; 18:5-11. [PMID: 31897446 PMCID: PMC6921204 DOI: 10.1016/j.isjp.2019.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/17/2019] [Accepted: 10/19/2019] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Neoadjuvant systemic therapy (NST) has several potential advantages in the treatment of breast cancer. However, there is currently considerable variation in NST use across the UK. The NeST study is a national, prospective, multicentre cohort study that will investigate current patterns of care with respect to NST in the UK. METHODS AND ANALYSIS Phase 1 - a national practice questionnaire (NPQ) to survey current practice.Phase 2 - a multi-centre prospective cohort study of breast cancer patients, undergoing NST.Women undergoing NST as their MDT recommended primary breast cancer treatment between December 2017 and May 2018 will be included. The breast surgery and oncological professional associations and the trainee research collaborative networks will encourage participation by all breast cancer centres.Patient demographics, radiological, oncological, surgical and pathological data will be collected, including complications and the need for further intervention/treatment. Data will be collated to establish current practice in the UK, regarding NST usage and variability of access and provision of these therapies. Prospective data on 600 patients from ~50 centres are anticipated.Trial registration: ISRCTN11160072. ETHICS AND DISSEMINATION Research ethics approval is not required for this study, as per the online Health Research Authority decision tool. The information obtained will provide valuable insights to help patients make informed decisions about their treatment. These data should establish current practice in the UK concerning NST, inform future service delivery as well as identifying further research questions.This protocol will be disseminated through the Mammary Fold Academic Research Collaborative (MFAC), the Reconstructive Surgery Trials Network and the Association of Breast Surgery. Participating units will have access to their own data and collective results will be presented at relevant conferences and published in appropriate peer-reviewed journals, as well as being made accessible to relevant patient groups.
Collapse
Affiliation(s)
- G.W. Irwin
- Belfast City Hospital, Belfast Health and Social Care Trust, 51 Lisburn Road, Belfast BT98 7AB, UK
| | - F. Bannon
- Centre for Public Health, Queen’s University, Belfast, UK
| | - C.E. Coles
- Oncology Centre, Box 193, University of Cambridge, Hills Road, Cambridge CB2 0QQ, UK
| | - E. Copson
- Cancer Sciences Academic Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
| | - R.I. Cutress
- Cancer Sciences Academic Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
| | - R.V. Dave
- Nightingale Breast Centre, Manchester University Foundation Trust, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK
| | - M. Grayson
- Northern Ireland Cancer Research Consumer Forum, Belfast, Northern Ireland, UK
| | - C. Holcombe
- North West Cancer Research Centre, University of Liverpool, 200 London Road, Liverpool L3 9TA, UK
| | - S. Irshad
- Research Oncology, Kings College London, SE1 9RT, UK
- Guys & St Thomas’ NHS Trust, London SE1 9RT, UK
| | - C. O'Brien
- The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 2BX, UK
| | - R.L. O'Connell
- Department of Breast Surgery, Royal Marsden NHS Foundation Trust. Downs Road, Sutton, Surrey SM2 5PT, UK
| | - C. Palmieri
- Institute of Translational Medicine, University of Liverpool, Liverpool L69 3BX, UK
| | - A.M. Shaaban
- Queen Elizabeth Hospital Birmingham and University of Birmingham, Birmingham B15 2GW, UK
| | - N. Sharma
- Breast Unit, Level 1 Chancellor Wing, St James Hospital, Beckett Street, Leeds LS97TF, UK
| | - J. Singh
- University Hospitals Birmingham, Edgbaston, Birmingham B15 2GW, UK
| | - I. Whitehead
- Burney Breast Unit, St Helens & Knowsley Teaching Hospitals NHS Trust, Marshalls Cross Road, St Helens WA9 3DA, UK
| | - S. Potter
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
- Bristol Breast Care Centre, North Bristol NHS Trust, Southmead Road, Bristol BS10 5NB, UK
| | - S.A. McIntosh
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7AE, UK
| |
Collapse
|
27
|
Ong WL, Evans SM, Evans M, Tacey M, Dodds L, Kearns P, Milne RL, Foroudi F, Millar J. Trends in Conservative Management for Low-risk Prostate Cancer in a Population-based Cohort of Australian Men Diagnosed Between 2009 and 2016. Eur Urol Oncol 2019; 4:319-322. [PMID: 31411964 DOI: 10.1016/j.euo.2019.04.006] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 04/12/2019] [Indexed: 10/26/2022]
Abstract
Conservative management, specifically with active surveillance (AS), has emerged as the preferred approach for low-risk prostate cancer (LRPC). We evaluated the trend for conservative management (ie, no active treatment within 12mo of diagnosis) for LRPC in an Australian population-based cohort of men captured in the Prostate Cancer Outcomes Registry Victoria (PCOR-Vic). Of the 3201 men diagnosed with LRPC between January 2009 and December 2016, 60% (1928/3201) had conservative management, and 52% (1664/3201) were documented to be on AS. There was an increase in conservative management from 52% in 2009 to 73% in 2016 (p<0.001), largely attributable to an increase in AS from 33% in 2009 to 67% in 2016 (p<0.001). When stratified by age group, the increase in conservative management was more pronounced among younger patients: from 37% to 66% for men aged <60yr versus from 72% to 86% for men aged ≥70yr. In multivariable analyses, increasing age, lower prostate-specific antigen and clinical category, lower socioeconomic status, and being diagnosed in public metropolitan institutions were all independently associated with a greater likelihood of conservative management. Identification of sociodemographic and institutional variations in practice allows for targeted strategies to improve management for men with LRPC. PATIENT SUMMARY: We looked at the uptake of conservative management (no active treatment within 12 mo of diagnosis) over time in an Australian population-based cohort of men with low-risk prostate cancer. The proportion of men with low-risk prostate cancer managed conservatively increased from 52% in 2009 to 73% in 2016. The increase in the uptake of conservative management for low-risk prostate cancer in Australia is concordant with international guidelines and other international population-based studies.
Collapse
Affiliation(s)
- Wee Loon Ong
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Australia; School of Clinical Medicine, University of Cambridge, Cambridge, UK; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Health and Biomedical Informatics Centre, University of Melbourne, Melbourne, Australia.
| | - Sue M Evans
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Melanie Evans
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mark Tacey
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Australia; Department of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Australia
| | | | | | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia; Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Australia; Precision Medicine, School of Clinical Sciences, Monash Health, Monash University, Melbourne, Australia
| | - Farshad Foroudi
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Australia
| | - Jeremy Millar
- Alfred Health Radiation Oncology Services, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia
| |
Collapse
|
28
|
Riedel F, Heil J, Golatta M, Schaefgen B, Hug S, Schott S, Rom J, Schuetz F, Sohn C, Hennigs A. Changes of breast and axillary surgery patterns in patients with primary breast cancer during the past decade. Arch Gynecol Obstet 2018; 299:1043-1053. [PMID: 30478667 DOI: 10.1007/s00404-018-4982-3] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 11/16/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE Breast-conserving therapy (BCT) is the standard procedure for most patients with primary breast cancer (BC). By contrast, axillary management is still under transition to find the right balance between avoiding of morbidity, maintaining oncological safety, and performing a staging procedure. The rising rate of primary systemic therapy creates further challenges for surgical management. METHODS Patients with primary, non-metastatic BC treated between 01.01.2003 and 31.12.2016 under guideline-adherent conditions were included in this study. For this prospectively followed cohort, breast and axillary surgery patterns are presented in a time-trend analysis as annual rate data (%) for several subgroups. RESULTS Overall, 6700 patients were included in the analysis. While BCT rates remained high (mean 2003-2016: 70.4%), the proportion of axillary lymph node dissection has declined considerably from 80.1% in 2003 to 16.0% in 2016, while the proportion for sentinel lymph node biopsy (SLND) has increased correspondingly from 10.3 to 76.4%. Among patients with cT1-2, cN0 breast cancer receiving BCT with positive SLND, the rate of axillary completion has decreased from 100% in 2008 to 24.4% in 2016. CONCLUSIONS In the past decade, SLNB has been established as the standard procedure for axillary staging of clinically node-negative patients. Surgical morbidity has been further reduced by the rapid implementation of new evidence from the ACOSOG Z0011 trial into clinical routine. The results reflect the transition towards more individually tailored, less invasive treatment for selected patient subgroups, especially in regards to axillary lymph node management.
Collapse
Affiliation(s)
- F Riedel
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - J Heil
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - M Golatta
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - B Schaefgen
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - S Hug
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - S Schott
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - J Rom
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - F Schuetz
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - C Sohn
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - A Hennigs
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
| |
Collapse
|
29
|
Miller ED, Fisher JL, Haglund KE, Grecula JC, Xu-Welliver M, Bertino EM, He K, Shields PG, Carbone DP, Williams TM, Otterson GA, Bazan JG. Identifying patterns of care for elderly patients with non-surgically treated stage III non-small cell lung cancer: an analysis of the national cancer database. Radiat Oncol 2018; 13:196. [PMID: 30290823 PMCID: PMC6173899 DOI: 10.1186/s13014-018-1142-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 09/26/2018] [Indexed: 12/21/2022] Open
Abstract
Background To compare patterns of care for elderly patients versus non-elderly patients with non-surgically treated stage III non-small cell lung cancer (NSCLC) using the National Cancer Database (NCDB). We hypothesize that elderly patients are less likely to receive curative treatments, including concurrent chemoradiation (CCRT), compared to non-elderly patients. Methods We identified patients from the NCDB between 2003 and 2014 with non-surgically treated stage III NSCLC. We defined elderly as ≥70 years old and non-elderly <70 years old. Treatment categories included: no treatment, palliative treatment (chemotherapy alone, radiation (RT) alone <59.4 Gy or chemoradiation (CRT) <59.4 Gy), or definitive treatment (RT alone ≥59.4 Gy or CRT ≥59.4 Gy). Differences in treatment between elderly and non-elderly were tested using the χ2 test. Results We identified 57,602 elderly and 55,928 non-elderly patients. More elderly patients received no treatment (24.5% vs. 13.2%, P < 0.0001) and the elderly were less likely to receive definitive treatment (48.5% vs. 56.3%, P < 0.0001). CCRT was delivered in a significantly smaller proportion of elderly vs. non-elderly patients (66.0% vs. 78.9%, P < 0.0001 in patients treated with definitive intent; 32.0% vs. 44.5%, P < 0.0001 in patients receiving any treatment; and 24.2% vs. 38.6%, P < 0.0001 amongst all patients). Conclusions In this large study of patients with non-surgically treated stage III NSCLC, elderly patients were less likely to receive any treatment or treatment with definitive intent compared to the non-elderly. The lack of use of concurrent or sequential chemotherapy in the elderly with stage III NSCLC suggests that the optimal treatment approach for this vulnerable population remains undefined. Electronic supplementary material The online version of this article (10.1186/s13014-018-1142-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Eric D Miller
- Department of Radiation Oncology, at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, 460 W. 10th Avenue, Columbus, OH, 43210, USA
| | - James L Fisher
- College of Public Health, at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Karl E Haglund
- Department of Radiation Oncology, at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, 460 W. 10th Avenue, Columbus, OH, 43210, USA
| | - John C Grecula
- Department of Radiation Oncology, at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, 460 W. 10th Avenue, Columbus, OH, 43210, USA
| | - Meng Xu-Welliver
- Department of Radiation Oncology, at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, 460 W. 10th Avenue, Columbus, OH, 43210, USA
| | - Erin M Bertino
- Department of Internal Medicine, Division of Medical Oncology, at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Kai He
- Department of Internal Medicine, Division of Medical Oncology, at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Peter G Shields
- Department of Internal Medicine, Division of Medical Oncology, at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - David P Carbone
- Department of Internal Medicine, Division of Medical Oncology, at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Terence M Williams
- Department of Radiation Oncology, at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, 460 W. 10th Avenue, Columbus, OH, 43210, USA
| | - Gregory A Otterson
- Department of Internal Medicine, Division of Medical Oncology, at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Jose G Bazan
- Department of Radiation Oncology, at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, 460 W. 10th Avenue, Columbus, OH, 43210, USA.
| |
Collapse
|
30
|
Eze C, Roengvoraphoj O, Dantes M, Abdo R, Käsmann L, Schmidt-Hegemann NS, Belka C, Manapov F. Prophylactic Cranial Irradiation for Patients with Small Cell Lung Cancer in Germany: Pattern of Care Survey. Anticancer Res 2018; 38:5261-5265. [PMID: 30194176 DOI: 10.21873/anticanres.12851] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 07/30/2018] [Revised: 08/12/2018] [Accepted: 08/16/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The general pattern of care regarding the application of prophylactic cranial irradiation (PCI) in small cell lung cancer (SCLC) patients in Germany has not been previously evaluated. This survey was conducted to assess patterns of care. PATIENTS AND METHODS Radiation oncology institutions in Germany were surveyed via an anonymous online questionnaire sent by e-mail to member institutions of the German Society for Radiation Oncology. RESULTS A total of 95 responses were received (29% response rate). Eighty-eight percent of all responders recommended a PCI total dose of 30Gy delivered in 15 daily fractions. Overall, 11 and 38% of the respondents applied PCI simultaneously with chemo- and radiotherapy, respectively. A quarter of respondents offered hippocampal-avoidance PCI and followed their patients with serial brain imaging. CONCLUSION PCI with a total dose of 30 Gy in 15 daily fractions, without neuropsychological testing and hippocampus-avoidance, delivered after completion of primary multimodal treatment remains standard in Germany.
Collapse
Affiliation(s)
- Chukwuka Eze
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Olarn Roengvoraphoj
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Maurice Dantes
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Reem Abdo
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Lukas Käsmann
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | | | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Farkhad Manapov
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| |
Collapse
|
31
|
Nene BM, Selmouni F, Lokhande M, Hingmire SJ, Muwonge R, Jayant K, Sankaranarayanan R. Patterns of Care of Breast Cancer Patients in a Rural Cancer Center in Western India. Indian J Surg Oncol 2018; 9:374-380. [PMID: 30288001 PMCID: PMC6154374 DOI: 10.1007/s13193-018-0748-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 11/22/2017] [Accepted: 04/03/2018] [Indexed: 01/13/2023] Open
Abstract
Breast cancer is an emerging public health problem in low- and middle-income countries. The main objective is to describe the clinical characteristics and patterns of care of breast cancer patients diagnosed and treated in a rural cancer hospital in Barshi, Western India. The results from a cross-sectional study of 99 consecutive breast cancer patients diagnosed and treated between February 2012 and November 2014 in Nargis Dutt Memorial Cancer Hospital is reported. The case records of the patients were scrutinized and reviewed to abstract data on their clinical characteristics, diagnostic, and treatment details. The mean age at diagnosis of the patients was 52.8 ± 11.6 years; 83.5% of women were married, and 60.6% were illiterate. Sixty percent of patients had tumors measuring 5 cm or less. Almost half of the patients (46.4%) had stage I or II A disease and a third (36.0%) had axillary lymph node metastasis. Estrogen, progesterone, and human epidermal growth factor receptor2 receptor status were investigated in 41 (41.4%) of patients only. The median interval between diagnosis and initiation of treatment was 11 days. Modified radical mastectomy was done in 91% of patients, and nearly a third of patients who were prescribed chemotherapy did not complete treatment. The rural-based tertiary cancer care center has made treatment more accessible to breast cancer patients and has reduced the interval between diagnosis and treatment initiation. However, there are still many challenges like non-compliance to and incomplete treatments and poor follow-up that need to be addressed.
Collapse
Affiliation(s)
| | - Farida Selmouni
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69008 Lyon, France
| | | | | | - Richard Muwonge
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69008 Lyon, France
| | | | | |
Collapse
|
32
|
Shaaban SG, Verma V, Choi JI, Shabason J, Sharma S, Glass E, Grover S, Badiyan SN, Simone CB. Utilization of Intensity-Modulated Radiation Therapy for Malignant Pleural Mesothelioma in the United States. Clin Lung Cancer 2018; 19:e685-e692. [PMID: 29803576 DOI: 10.1016/j.cllc.2018.04.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 01/28/2018] [Revised: 04/04/2018] [Accepted: 04/26/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Although postoperative radiotherapy (RT) for malignant pleural mesothelioma (MPM) has historically been delivered using 3-dimensional conformal RT (3DCRT) techniques, multiple reports show noteworthy safety and efficacy of the more advanced intensity-modulated RT (IMRT). To our knowledge, this is the only known study to evaluate national practice patterns of IMRT utilization for MPM. MATERIALS AND METHODS The National Cancer Data Base was queried for newly-diagnosed MPM patients who underwent definitive surgery (extrapleural pneumonectomy [EPP] or extended pleurectomy/decortication [P/D]) followed by adjuvant RT. Patients with metastatic disease, non-EPP or P/D surgical techniques, and lack of RT receipt (or without specified RT technique) were excluded. Statistics included multivariable logistic regression, Kaplan-Meier overall survival (OS) analysis, and Cox proportional hazards modeling. RESULTS Overall, 286 patients met criteria (181 [63%] IMRT and 105 [37%] 3DCRT). Temporal trends revealed that although 3DCRT was more common at initial time periods, IMRT utilization rose from 2004 to 2007 and stayed as a relatively constant majority thereafter. This was also present when substratifying the cohort according to EPP versus P/D approaches. IMRT was more often delivered at academic centers, along with institutions in the Southern United States, whereas 3DCRT was more frequently utilized in community facilities and in the Northeast (P ≤ .05 for all). RT technique did not affect OS (P > .05 for all comparisons). CONCLUSION In the United States, IMRT is now the most commonly utilized adjuvant RT technique for MPM. Facility and regional differences might associate with IMRT delivery. The findings of this investigation have implications for insurance coverage, clinical referral patterns, and ongoing and future prospective trial design.
Collapse
Affiliation(s)
- Sherif G Shaaban
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Vivek Verma
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE
| | - J Isabelle Choi
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD
| | - Jacob Shabason
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Sonam Sharma
- Department of Radiation Oncology, The Mount Sinai Hospital, New York, NY
| | - Erica Glass
- California Protons Cancer Therapy Center, San Diego, CA
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | | | | |
Collapse
|
33
|
Koo T, Lim DH, Seol HJ, Park CK, Kim IH, Chang JH, Lee J, Jung S, Gwak HS, Cho KH, Hong CK, Lee IJ, Kim E, Kim JH, Hong YK, Jang HS, Kim CY, Kim IA, Kim SH, Kim YI, Kim EY, Kim WC, Hong S. Multi-institutional study of treatment patterns in Korean patients with WHO grade II gliomas: KNOG 15-02 and KROG 16-04 intergroup study. J Neurooncol 2018; 138:667-677. [PMID: 29572674 DOI: 10.1007/s11060-018-2839-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/28/2017] [Accepted: 03/17/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION We performed this study to identify the treatment patterns of patients with low-grade gliomas (LGG) in Korea. METHODS A total of 555 patients diagnosed as WHO grade II gliomas between 2000 and 2010 at 14 Korean institutions were included. The patients were divided into four adjuvant treatment groups: adjuvant fractionated radiotherapy (RT, N = 204), adjuvant chemotherapy (N = 20), adjuvant fractionated RT and chemotherapy (N = 65), and non-adjuvant treatment (N = 266) groups. We examined differences among the groups and validated patient/tumor characteristics associated with the adjuvant treatments. RESULTS Astrocytoma was diagnosed in 210 patients (38%), oligoastrocytoma in 85 patients (15%), and oligodendroglioma in 260 patients (47%). Gross total resection was performed in 200 patients (36%), subtotal resection in 153 (28%), partial resection in 71 patients (13%), and biopsy in 131 patients (24%). RT was most commonly applied as an adjuvant treatment. The use of chemotherapy with or without RT decreased after 2008 (from 38 to 4%). The major chemotherapeutic regimen was procarbazine, lomustine, and vincristine (PCV); however, the proportion of temozolomide increased since 2005 (up to 69%). Patient/tumor characteristics related with RT were male gender, non-seizure, multiple lobes involvement, and non-gross total resection. Chemotherapy was associated with non-gross total resection and non-astrocytoma. CONCLUSIONS A preference for RT and increased use of temozolomide was evident in the treatment pattern of LGG. The extent of resection was associated with a decision to perform RT and chemotherapy. To establish a robust guideline for LGG, further studies including molecular information are needed.
Collapse
Affiliation(s)
- Taeryool Koo
- Department of Radiation Oncology, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Do Hoon Lim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-Gu, Seoul, 06351, South Korea.
| | - Ho Jun Seol
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Chul-Kee Park
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Il Han Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, South Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Jeongshim Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Shin Jung
- Department of Neurosurgery, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun, South Korea
| | - Ho-Shin Gwak
- Department of System Cancer Science, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea
| | - Kwan Ho Cho
- Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Chang-Ki Hong
- Department of Neurosurgery, Brain Tumor Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Ik Jae Lee
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - El Kim
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, South Korea
| | - Jin Hee Kim
- Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, South Korea
| | - Yong-Kil Hong
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hong Seok Jang
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Chae-Yong Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - In Ah Kim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Sung Hwan Kim
- Department of Radiation Oncology, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea
| | - Young Il Kim
- Department of Radiation Oncology, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Eun-Young Kim
- Department of Neurosurgery, Inha University Hospital, Inha University of Medicine, Inchon, South Korea
| | - Woo Chul Kim
- Department of Radiation Oncology, Inha University Hospital, Inha University of Medicine, Inchon, South Korea
| | - Semie Hong
- Department of Radiation Oncology, Konkuk University Medical Center, School of Medicine, Konkuk University, Seoul, South Korea
| |
Collapse
|
34
|
Park HJ, Cho S, Kim Y. Patterns of Rectal Cancer Radiotherapy Adopting Evidence-Based Medicine: An Analysis of the National Database from 2005 to 2016. Cancer Res Treat 2017; 50:975-983. [PMID: 29081217 PMCID: PMC6056965 DOI: 10.4143/crt.2017.459] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 10/25/2017] [Indexed: 12/20/2022] Open
Abstract
Purpose Not many studies have evaluated the adoption and dissemination of evidence-based medicine in rectal cancer radiotherapy (RT). We aimed to analyze the differences by institutional characteristics and geography in adopting evidence-based care for rectal cancer RT and factors affecting the adoption in Korea. Materials and Methods Korean National Health Insurance Service claims database was used. All rectal cancer patients treated with radical surgery and adjuvant RT at the same institution in 2005-2016 were included in this study. RT within 3 months before and after surgery was regarded as preoperative and postoperative RT, respectively. Results A total of 16,827 patients treated in 83 institutions were included in the analysis. The use of preoperative RT has substantially increased over time, from 40.6% in 2005 to 84.2% in 2016 all over the nation. The proportion of preoperative RT (54.8%) exceeded that of postoperative RT (45.2%) in 2006. However, a wide range of institutional and regional variation was observed. Compared to high-volume institutions, low-volume institutions showed late adoption and variable dissemination patterns of preoperative RT. Busan–Ulsan–Gyeongsangnam-do and Gangwon-do showed slower adoption and less use of preoperative RT than other region. Conclusion We demonstrated gradual and steady increase in adoption of preoperative RT in rectal cancer treatment nationally from 2005 to 2016. Institutional variations between high- and low-volume institutions were observed.
Collapse
Affiliation(s)
- Hae Jin Park
- Department of Radiation Oncology, Hanyang University Hospital, Seoul, Korea.,Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
| | - Sanghyun Cho
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
| | - Yoon Kim
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea.,Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, Korea
| |
Collapse
|
35
|
Barber EL, Dusetzina SB, Stitzenberg KB, Rossi EC, Gehrig PA, Boggess JF, Garrett JM. Variation in neoadjuvant chemotherapy utilization for epithelial ovarian cancer at high volume hospitals in the United States and associated survival. Gynecol Oncol 2017; 145:500-507. [PMID: 28366545 PMCID: PMC5503107 DOI: 10.1016/j.ygyno.2017.03.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/19/2017] [Accepted: 03/21/2017] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To estimate variation in the use of neoadjuvant chemotherapy by high volume hospitals and to determine the association between hospital utilization of neoadjuvant chemotherapy and survival. METHODS We identified incident cases of stage IIIC or IV epithelial ovarian cancer in the National Cancer Database from 2006 to 2012. Inclusion criteria were treatment at a high volume hospital (>20 cases/year) and treatment with both chemotherapy and surgery. A logistic regression model was used to predict receipt of neoadjuvant chemotherapy based on case-mix predictors (age, comorbidities, stage etc). Hospitals were categorized by the observed-to-expected ratio for neoadjuvant chemotherapy use as low, average, or high utilization hospitals. Survival analysis was performed. RESULTS We identified 11,574 patients treated at 55 high volume hospitals. Neoadjuvant chemotherapy was used for 21.6% (n=2494) of patients and use varied widely by hospital, from 5%-55%. High utilization hospitals (n=1910, 10 hospitals) had a median neoadjuvant chemotherapy rate of 39% (range 23-55%), while low utilization hospitals (n=2671, 14 hospitals) had a median rate of 10% (range 5-17%). For all ovarian cancer patients adjusting for clinical and socio-demographic factors, treatment at a hospital with average or high neoadjuvant chemotherapy utilization was associated with a decreased rate of death compared to treatment at a low utilization hospital (HR 0.90 95% CI 0.83-0.97 and HR 0.85 95% CI 0.75-0.95). CONCLUSIONS Wide variation exists in the utilization of neoadjuvant chemotherapy to treat stage IIIC and IV epithelial ovarian cancer even among high volume hospitals. Patients treated at hospitals with low rates of neoadjuvant chemotherapy utilization experience decreased survival.
Collapse
Affiliation(s)
- Emma L Barber
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, United States; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States.
| | - Stacie B Dusetzina
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States; Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Karyn B Stitzenberg
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States; Division of Surgical Oncology, Department of Surgery, University of North Carolina at Chapel Hill, NC, United States
| | - Emma C Rossi
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, United States; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States
| | - Paola A Gehrig
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, United States; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States
| | - John F Boggess
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, United States; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States
| | - Joanne M Garrett
- Division of Family Planning, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, United States
| |
Collapse
|
36
|
Glaser SM, Dohopolski MJ, Balasubramani GK, Flickinger JC, Beriwal S. Glioblastoma multiforme (GBM) in the elderly: initial treatment strategy and overall survival. J Neurooncol 2017; 134:107-18. [PMID: 28527010 DOI: 10.1007/s11060-017-2493-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 05/14/2017] [Indexed: 10/19/2022]
Abstract
The EORTC trial which solidified the role of external beam radiotherapy (EBRT) plus temozolomide (TMZ) in the management of GBM excluded patients over age 70. Randomized studies of elderly patients showed that hypofractionated EBRT (HFRT) alone or TMZ alone was at least equivalent to conventionally fractionated EBRT (CFRT) alone. We sought to investigate the practice patterns and survival in elderly patients with GBM. We identified patients age 65-90 in the National Cancer Data Base (NCDB) with histologically confirmed GBM from 1998 to 2012 and known chemotherapy and radiotherapy status. We analyzed factors predicting treatment with EBRT alone vs. EBRT plus concurrent single-agent chemotherapy (CRT) using multivariable logistic regression. Similarly, within the EBRT alone cohort we compared CFRT (54-65 Gy at 1.7-2.1 Gy/fraction) to HFRT (34-60 Gy at 2.5-5 Gy/fraction). Multivariable Cox proportional hazards model (MVA) with propensity score adjustment was used to compare survival. A total of 38,862 patients were included. Initial treatments for 1998 versus 2012 were: EBRT alone = 50 versus 10%; CRT = 6 versus 50%; chemo alone = 1.6% (70% single-agent) versus 3.2% (94% single-agent). Among EBRT alone patients, use of HFRT (compared to CFRT) increased from 13 to 41%. Numerous factors predictive for utilization of CRT over EBRT alone and for HFRT over CFRT were identified. Median survival and 1-year overall survival were higher in the CRT versus EBRT alone group at 8.6 months vs. 5.1 months and 36.0 versus 15.7% (p < 0.0005 by log-rank, multivariable HR 0.65 [95% CI = 0.61-0.68, p < 0.0005], multivariable HR with propensity adjustment 0.66 [95% CI = 0.63-0.70, p < 0.0005]). For elderly GBM patients in the United States, CRT is the most common initial treatment and appears to offer a survival advantage over EBRT alone. Adoption of hypofractionation has increased over time but continues to be low.
Collapse
|
37
|
de Boer P, Jürgenliemk-Schulz IM, Westerveld H, de Leeuw AAC, Dávila-Fajardo R, Rasch CRN, Pieters BR, Stalpers LJA. Patterns of care survey: Radiotherapy for women with locally advanced cervical cancer. Radiother Oncol 2017; 123:306-311. [PMID: 28434797 DOI: 10.1016/j.radonc.2017.04.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 03/31/2017] [Accepted: 04/03/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE Regarding latest developments, the need of a radiotherapy 'Patterns of Care' survey was expressed by the Dutch National Platform Radiotherapy for Gynaecological Cancer (LPRGT). Therefore, this study investigated current practice for cervical cancer in all 16 radiation oncology centres in the Netherlands specialised in gynaecological oncology. MATERIAL AND METHODS A structured 'patterns of care' questionnaire was completed and followed by an in-depth interview with radiation oncologists from all radiotherapy centres specialised in gynaecological oncology. Specific topics addressed were: definition of target volumes, treatment preparation, imaging for treatment planning, treatment planning, and image-guided adaptive radiotherapy for external beam radiotherapy and brachytherapy. RESULTS Current radiotherapy practice in the Netherlands for cervical cancer appears to be in accordance with international standards. However, at the time of the survey some differences were revealed that might have relevant clinical impact. For instance: 1) Half of the centres acquired positron emission tomography combined with CT (PET-CT) for staging and target delineation for every patient, 2) The definition of upper border of the para-aortal lymph node area and dose prescription for external beam radiotherapy varied between the centres, and 3) 12 centres used a single treatment plan for delivering EBRT, and four used a plan-of-the-day strategy with a library of 3-4 treatment plans. CONCLUSIONS Most differences were found at the cutting edge of clinical evidence. However, the majority of these uncertainties are topics being addressed in current and planned (inter)national studies.
Collapse
Affiliation(s)
- Peter de Boer
- Department of Radiation Oncology, Academic Medical Centre (AMC) - University of Amsterdam, The Netherlands.
| | | | - Henrike Westerveld
- Department of Radiation Oncology, Academic Medical Centre (AMC) - University of Amsterdam, The Netherlands
| | - Astrid A C de Leeuw
- Department of Radiation Oncology, University Medical Centre Utrecht, The Netherlands
| | - Raquel Dávila-Fajardo
- Department of Radiation Oncology, University Medical Centre Utrecht, The Netherlands
| | - Coen R N Rasch
- Department of Radiation Oncology, Academic Medical Centre (AMC) - University of Amsterdam, The Netherlands
| | - Bradley R Pieters
- Department of Radiation Oncology, Academic Medical Centre (AMC) - University of Amsterdam, The Netherlands
| | - Lukas J A Stalpers
- Department of Radiation Oncology, Academic Medical Centre (AMC) - University of Amsterdam, The Netherlands
| |
Collapse
|
38
|
Chang AR, Park W. Radiotherapy in prostate cancer treatment: results of the patterns of care study in Korea. Radiat Oncol J 2017; 35:25-31. [PMID: 28292006 PMCID: PMC5398354 DOI: 10.3857/roj.2016.01984] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 01/16/2017] [Accepted: 02/13/2017] [Indexed: 01/17/2023] Open
Abstract
Purpose The purpose of this study was to describe treatment patterns of radiotherapy (RT) for prostate cancer in Korea. Materials and Methods A questionnaire about radiation treatment technique and principles in 2013 was sent to 83 radiation oncologists and data from 57 hospitals were collected analyzed to find patterns of RT for prostate cancer patients in Korea. Results The number of patients with prostate cancer treated with definitive RT ranged from 1 to 72 per hospital in 2013. RT doses and target volumes increased according to risk groups but the range of radiation doses was wide (60 to 81.4 Gy) and the fraction size was diverse (1.8 to 5 Gy). Intensity-modulated radiation therapy was used for definitive treatment in 93.8% of hospitals. Hormonal therapy was integrated with radiation for intermediate (63.2%) and high risk patients (77.2%). Adjuvant RT after radical prostatectomy was performed in 46 hospitals (80.7%). Indications of adjuvant RT included positive resection margin, seminal vesicle invasion, and capsular invasion. The total dose for adjuvant RT ranged from 50 to 72 Gy in 24–39 fractions. Salvage RT was delivered with findings of consecutive elevations in prostate-specific antigen (PSA), PSA level over 0.2 ng/mL, or clinical recurrence. The total radiation doses ranged from 50 to 80 Gy with a range of 1.8 to 2.5 Gy per fraction for salvage RT. Conclusion This nationwide patterns of care study suggests that variable radiation techniques and a diverse range of dose fractionation schemes are applied for prostate cancer treatment in Korea. Standard guidelines for RT in prostate cancer need to be developed.
Collapse
Affiliation(s)
- Ah Ram Chang
- Department of Radiation Oncology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea.,Division for Urologic Cancer, Korean Radiation Oncology Group, Seoul, Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Division for Urologic Cancer, Korean Radiation Oncology Group, Seoul, Korea
| |
Collapse
|
39
|
Amini A, Raben D, Crawford ED, Flaig TW, Kessler ER, Lam ET, Maroni P, Pugh TJ. Patient characterization and usage trends of proton beam therapy for localized prostate cancer in the United States: A study of the National Cancer Database. Urol Oncol 2017; 35:438-446. [PMID: 28214281 DOI: 10.1016/j.urolonc.2017.01.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/10/2017] [Accepted: 01/16/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate usage trends and identify factors associated with proton beam therapy (PBT) compared to alternative forms of external beam radiation therapy (RT) (EBRT) for localized prostate cancer. PATIENTS AND METHODS The National Cancer Database was queried for men with localized (N0, M0) prostate cancer diagnosed between 2004 and 2013, treated with EBRT, with available data on EBRT modality (photon vs. PBT). Binary multiple logistic regression identified variables associated with EBRT modality. RESULTS In total, 143,702 patients were evaluated with relatively few men receiving PBT (5,709 [4.0%]). Significant differences in patient and clinical characteristics were identified between those men treated with PBT compared to those treated with photon (odds ratio [OR]; 95% CI). Patients treated with PBT were generally younger (OR = 0.73; CI: 0.67-0.82), National Comprehensive Cancer Network low-risk compared to intermediate (0.71; 0.65-0.78) or high (0.44; 0.38-0.5) risk, white vs. black race (0.66; 0.58-0.77), with less comorbidity (Charlson-Deyo 0 vs. 2+; 0.70; 0.50-0.98), live in higher income counties (1.55; 1.36-1.78), and live in metropolitan areas compared to urban (0.21; 0.18-0.23) or rural (0.14; 0.10-0.19) areas. Most patients treated with PBT travelled more than 100 miles to the treatment facility. Annual PBT utilization significantly increased in both total number and percentage of EBRT over time (2.7%-5.6%; P<0.001). PBT utilization increased mostly in men classified as National Comprehensive Cancer Network low-risk (4%-10.2%). CONCLUSION PBT for men with localized prostate cancer significantly increased in the United States from 2004 to 2013. Significant demographic and prognostic differences between those men treated with photons and protons were identified.
Collapse
Affiliation(s)
- Arya Amini
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO
| | - David Raben
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO
| | - E David Crawford
- Department of Internal Medicine, School of Medicine, University of Colorado, Aurora, CO
| | - Thomas W Flaig
- Department of Internal Medicine, School of Medicine, University of Colorado, Aurora, CO
| | - Elizabeth R Kessler
- Department of Internal Medicine, School of Medicine, University of Colorado, Aurora, CO
| | - Elaine T Lam
- Department of Internal Medicine, School of Medicine, University of Colorado, Aurora, CO
| | - Paul Maroni
- Department of Surgery, School of Medicine, University of Colorado, Aurora, CO
| | - Thomas J Pugh
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO.
| |
Collapse
|
40
|
Rao YJ, Hassanzadeh C, Fischer-Valuck B, Chicoine MR, Kim AH, Perkins SM, Huang J. Patterns of care and treatment outcomes of patients with Craniopharyngioma in the national cancer database. J Neurooncol 2017; 132:109-17. [PMID: 28012064 DOI: 10.1007/s11060-016-2342-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 12/11/2016] [Indexed: 10/20/2022]
Abstract
To investigate the patterns of care and outcomes in patients with craniopharyngioma in the National Cancer Data Base (NCDB). This study included 697 patients (166 pediatric and 531 adult cases) treated for craniopharyngioma between 2004 and 2012 in the NCDB. Adjuvant radiotherapy (RT) was defined if within 6 months of surgery. Limited surgery (LS) was defined as biopsy or subtotal resection. Proportional-hazards models were used to evaluate associations between covariates and overall survival (OS). A time-dependent analysis of RT was performed to account for early deaths after surgery. Median follow-up was 46 months. Overall, 21% of patients received adjuvant RT. Of patients with known surgical extent (n = 195), 71% had LS. Utilization of adjuvant RT increased from 18% in 2004-2007 to 24% in 2008-2012. Patterns of care regarding adjuvant RT or LS were not significantly different between adult and pediatric patients. Tumor size, low comorbidity, and LS were associated with increased utilization of adjuvant RT. The 5-year OS among patients treated with LS, LS+RT, and gross total resection were 75, 85, and 82% (p = 0.02). On multivariate analysis of the 195 patients with known surgical extent, LS+RT was associated with improved OS compared to LS (HR 0.22, 95% CI 0.05-0.99, p = 0.04), but was not significant when early deaths (<2 months from surgery) were removed to adjust for immortal-time bias. Medical practice regarding surgical approach and adjuvant RT are similar for pediatric and adult craniopharyngiomas. Immortal-time bias may confound assessment of OS for adjuvant RT. Prospective studies comparing adjuvant RT versus observation after LS are warranted.
Collapse
|
41
|
Julka PK, Sharma DN, Madan R, Mallick S, Benson R, Kunhi P H, Gupta S, Rath GK. Patterns of care and survival among small cell lung cancer patients: Experience from a tertiary center in India. J Egypt Natl Canc Inst 2016; 29:47-51. [PMID: 27856126 DOI: 10.1016/j.jnci.2016.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 04/08/2016] [Revised: 10/07/2016] [Accepted: 10/08/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND/PURPOSE Lung cancer is the commonest malignancy and the most common cause of cancer related mortality in males worldwide. Non-small cell lung cancer (NSCLC) is the commonest histology while small cell lung cancer (SCLC) contributes to only 15% of all cases of lung cancer. This report intended to present the patterns of care, survival outcomes and prognostic factors of SCLC treated in a tertiary care institute. RESULTS A total of 85 patients of SCLC were registered in radiotherapy unit I during the period January, 2005 to December, 2012. The median age of the cohort was 56.5years (95% CI 34-72). The majority of the patients were male with a male:female ratio of 6.7:1. Sixty eight percent of the patients were smokers. Sixty percent patients presented with extensive stage disease. Radiotherapy (RT) was used in 76% of the patients while chemotherapy was used in 75% of the patients. Platinum Etoposide was the most common regimen which was used in 70% of the patients who received chemotherapy. The median progression free survival (PFS) of the entire cohort was 11.4months (95% CI 9.11-13.58months). Stage, performance status, and use of chemotherapy were found to be significant factors affecting survival outcome in patients with SCLC. CONCLUSION The pattern of care and survival outcomes in the present study parallels that of the various published retrospective reviews. Basic research and development of targeted agents may be the way forward in improving the outcome of patients with SCLC.
Collapse
Affiliation(s)
- Pramod K Julka
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Daya Nand Sharma
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Renu Madan
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India.
| | - Supriya Mallick
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Rony Benson
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Haresh Kunhi P
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Subhash Gupta
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Goura K Rath
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
42
|
Banegas MP, Harlan LC, Mann B, Yabroff KR. Toward greater adoption of minimally invasive and nephron-sparing surgical techniques for renal cell cancer in the United States. Urol Oncol 2016; 34:433.e9-433.e17. [PMID: 27321355 PMCID: PMC5035195 DOI: 10.1016/j.urolonc.2016.05.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 03/22/2016] [Accepted: 05/16/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To examine national, population-based utilization trends of nephron-sparing and minimally invasive techniques for the surgical management of patients with adult renal cell cancer (RCC) in the United States. METHODS Linked data from the National Cancer Institute׳s Patterns of Care studies and the Area Health Resource File were used to evaluate trends of nephron-sparing and minimally invasive techniques in a sample of 1,110 patients newly diagnosed with American Joint Committee on Cancer stages I-II RCC, in 2004 and 2009, who underwent surgery. Descriptive statistics were used to assess patterns of surgery between 2004 and 2009. Multivariable logistic regression analyses were used to evaluate the associations between demographic, clinical, hospital, and area-level health care characteristics with surgery utilization, stratified by the subset of patients who were potentially eligible for partial nephrectomy (PN) vs. radical nephrectomy (RN) and laparoscopic RN (LRN) vs. open RN, respectively. RESULTS Between 2004 and 2009, PN use among stage I patients with tumors≤7cm increased from 29% to 41%, respectively (P = 0.22). Among patients with stage I tumors≤4cm, use of PN significantly increased from 43% in 2004 to 55% in 2009 (P≤0.05). Among patients with stage I tumors>4 to 7cm, laparoscopic partial nephrectomy increased from 8% to 15%, whereas LRN increased from 38% to 69%, between 2004 and 2009 (P = 0.07). Significant increases in LRN use were observed for both stage I (from 43% in 2004 to 58% in 2009; P≤0.05) and stage II patients (from 16% in 2004 to 47% in 2009; P≤0.01). Patients diagnosed at an older age, with larger tumors, non-clear cell RCC and who did not receive treatment in a hospital with residency training were significantly less likely to receive PN vs. RN; whereas, those diagnosed in 2009 with stage I disease were significantly more likely to receive LRN vs. open RN. CONCLUSIONS This study highlights a significant shift toward increased use of nephron-sparing and minimally invasive surgical techniques to treat patients with RCC in the United States. Our findings are among the first population-based reports in which most eligible patients with RCC received PN over RN. In light of the long-standing evidence on the improved patient outcomes, future investigation is warranted to identify the barriers to increased adoption of these nephron-sparing and minimally invasive approaches.
Collapse
Affiliation(s)
- Matthew P Banegas
- Kaiser Permanente Northwest, The Center for Health Research, Portland, OR.
| | - Linda C Harlan
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Bhupinder Mann
- Clinical Investigations Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - K Robin Yabroff
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| |
Collapse
|
43
|
Boothe D, Orton A, Thorpe C, Kokeny K, Hitchcock YJ. Postoperative Radiotherapy in Locally Invasive Malignancies of the Thymus: Patterns of Care and Survival. J Thorac Oncol 2016; 11:2218-26. [PMID: 27544056 DOI: 10.1016/j.jtho.2016.07.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 07/28/2016] [Accepted: 07/31/2016] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Our purpose was to determine the overall survival (OS) benefit of postoperative radiotherapy (PORT) in patients with advanced thymic malignancies and the associated predictors of PORT receipt. METHODS We queried the National Cancer Data Base for all stage II to III thymic malignancies. Trends in PORT use over time were analyzed using least squares linear regression. Factors predictive of PORT and OS were identified by using multivariate logistic and Cox regression analysis, respectively. RESULTS We identified 1156 patients between 2004 and 2012 who met the inclusion criteria. The utilization of PORT was found to increase over the study period by 41% (37% to 52% [p = 0.01]). On multivariate analysis, the factors found to be the most predictive of receipt of PORT were positive surgical margins (adjusted OR = 1.98 [p < 0.01]) and treatment at a nonacademic facility (adjusted OR = 1.44 [p = 0.01]). The 5-year OS was superior for patients receiving PORT compared with for those who did not (83% versus 79%, p = 0.03). Receipt of PORT was associated with a trend toward decreased risk for death on multivariate analysis (hazard ratio = 0.75 [p = 0.09]). In addition, a positive macroscopic margin was the most important predictor of survival (hazard ratio = 3.48 [p < 0.01]). On subgroup analysis, patients with thymic carcinoma and WHO histologic types A and AB were associated with an OS benefit with PORT, whereas types B1, B2, and B3 were not. Patients with positive margins were not associated with an OS benefit with PORT. CONCLUSIONS The use of PORT in patients with advanced thymic malignancies is increasing over time and is determined by both clinical and demographic factors. Receipt of PORT was associated with improved OS. The OS benefit with PORT was dependent on the WHO histologic type.
Collapse
|
44
|
Orton A, Boothe D, Gan M, Monroe MM, Hitchcock YJ, Lloyd S. The "decay" of brachytherapy use in tumors of the oral cavity: A population-based patterns of care and outcomes analysis from 1973 to 2012. Brachytherapy 2016; 15:851-858. [PMID: 27364872 DOI: 10.1016/j.brachy.2016.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 04/15/2016] [Accepted: 05/25/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE We aimed to evaluate if use of brachytherapy (BT) is associated with improved survival in patients with oral cavity cancer who do not receive surgery and to analyze patterns of care. METHODS AND MATERIALS We queried the Surveillance, Epidemiology, and End Results database for patients who received radiation therapy for squamous cell carcinoma of the oral cavity between 1973 and 2012. Patients were grouped by treatment modality: external beam radiotherapy alone vs. external beam radiotherapy + BT. Surgical patients were excluded. Trends in BT utilization over the study period and patterns of care were analyzed. Propensity scores were generated, and a nearest-neighbor matching algorithm was used to balance the 2 groups. Cox regression modeling was used to estimate the effect of BT on overall survival. Sensitivity analysis was conducted to estimate the effect of unmeasured confounders on the analysis. RESULTS Of 5,161 patients with squamous cell carcinoma of the oral cavity who received radiotherapy, 12% of patients received BT. The rate of BT use has decreased by 0.58% per year (p < 0.001). Factors that predicted for omission of radiation therapy included age ≥ 65 years (adjusted odds ratio [aOR], 0.56; p < 0.001), regional nodal disease (aOR, 0.57; p < 0.001), and black race (aOR, 0.45; p < 0.001). Use of BT was associated with a decreased risk of death (hazard ratio, 0.75; p < 0.001). CONCLUSIONS The use of BT is associated with improved survival in oral cavity tumors treated with definitive radiotherapy. Rates of BT utilization have declined by 0.58% per year and are currently very low.
Collapse
Affiliation(s)
- Andrew Orton
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT
| | - Dustin Boothe
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT
| | - Meng Gan
- University of Utah School of Medicine, Salt Lake City, UT
| | - Marcus M Monroe
- Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, UT
| | - Ying J Hitchcock
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT
| | - Shane Lloyd
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT.
| |
Collapse
|
45
|
Roumie CL, Greevy RA, Grijalva CG, Hung AM, Liu X, Griffin MR. Diabetes treatment intensification and associated changes in HbA1c and body mass index: a cohort study. BMC Endocr Disord 2016; 16:32. [PMID: 27255309 PMCID: PMC4890276 DOI: 10.1186/s12902-016-0101-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 04/29/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND To describe common type 2 diabetes treatment intensification regimens, patients' characteristics and changes in glycated hemoglobin (HbA1c) and body mass index (BMI). METHODS We constructed a national retrospective cohort of veterans initially treated for diabetes with either metformin or sulfonylurea from 2001 through 2008, using Veterans Health Administration (VHA) and Medicare data. Patients were followed through September, 2011 to identify common diabetes treatment intensification regimens. We evaluated changes in HbA1c and BMI post-intensification for metformin-based regimens. RESULTS We identified 323,857 veterans who initiated diabetes treatment. Of these, 55 % initiated metformin, 43 % sulfonylurea and 2 % other regimens. Fifty percent (N = 89,057) of metformin initiators remained on metformin monotherapy over a median follow-up 58 months (interquartile range [IQR] 35, 74). Among 80,725 patients who intensified metformin monotherapy, the four most common regimens were addition of sulfonylurea (79 %), thiazolidinedione [TZD] (6 %), or insulin (8 %), and switch to insulin monotherapy (2 %). Across these regimens, median HbA1c values declined from a range of 7.0-7.8 % (53-62 mmol/mol) at intensification to 6.6-7.0 % (49-53 mmol/mol) at 1 year, and remained stable up to 3 years afterwards. Median BMI ranged between 30.5 and 32 kg/m(2) at intensification and increased very modestly in those who intensified with oral regimens, but 1-2 kg/m(2) over 3 years among those who intensified with insulin-based regimens. CONCLUSIONS By 1 year post-intensification of metformin monotherapy, HbA1c declined in all four common intensification regimens, and remained close to 7 % in subsequent follow-up. BMI increased substantially for those on insulin-based regimens.
Collapse
Affiliation(s)
- Christianne L Roumie
- Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research Education Clinical Center (GRECC), HSR&D Center, Nashville, TN, USA.
- Department of Medicine, Vanderbilt University, Nashville, TN, USA.
- Nashville VA Medical Center, 1310 24th Ave South GRECC, Nashville, TN, 37212, USA.
| | - Robert A Greevy
- Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research Education Clinical Center (GRECC), HSR&D Center, Nashville, TN, USA
- Department of Biostatistics, Vanderbilt University, Nashville, TN, USA
| | - Carlos G Grijalva
- Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research Education Clinical Center (GRECC), HSR&D Center, Nashville, TN, USA
- Department of Health Policy, Vanderbilt University, Nashville, TN, USA
| | - Adriana M Hung
- Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research Education Clinical Center (GRECC), HSR&D Center, Nashville, TN, USA
- Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Xulei Liu
- Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research Education Clinical Center (GRECC), HSR&D Center, Nashville, TN, USA
- Department of Biostatistics, Vanderbilt University, Nashville, TN, USA
| | - Marie R Griffin
- Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research Education Clinical Center (GRECC), HSR&D Center, Nashville, TN, USA
- Department of Medicine, Vanderbilt University, Nashville, TN, USA
- Department of Health Policy, Vanderbilt University, Nashville, TN, USA
| |
Collapse
|
46
|
Gibberd A, Supramaniam R, Dillon A, Armstrong BK, O'Connell DL. Lung cancer treatment and mortality for Aboriginal people in New South Wales, Australia: results from a population-based record linkage study and medical record audit. BMC Cancer 2016; 16:289. [PMID: 27112140 PMCID: PMC4845365 DOI: 10.1186/s12885-016-2322-1] [Citation(s) in RCA: 16] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 04/15/2016] [Indexed: 12/12/2022] Open
Abstract
Background The aim of this study was to compare surgical treatment received by Aboriginal and non-Aboriginal people with non-small cell lung cancer (NSCLC) in New South Wales (NSW), Australia and to examine whether patient and disease characteristics are associated with any disparities found. An additional objective was to describe the adjuvant treatments received by Aboriginal people diagnosed with NSCLC in NSW. Finally, we compared the risk of death from NSCLC for Aboriginal and non-Aboriginal people. Methods We used logistic regression and competing risks regression to analyse population-based cancer registry records for people diagnosed with NSCLC in NSW, 2001–2007, linked to hospital inpatient episodes and deaths. We also analysed treatment patterns from a medical record audit for 170 Aboriginal people diagnosed with NSCLC in NSW, 2000–2010. Results Of 20,154 people diagnosed with primary lung cancer, 341 (1.7 %) were Aboriginal. Larger proportions of Aboriginal people were younger, female, living outside major cities or in areas of greater socioeconomic disadvantage, smoking at the time of diagnosis and had comorbidities. Although Aboriginal people were, on average, younger at diagnosis with non-metastatic NSCLC than non-Aboriginal people, only 30.8 % of Aboriginal people received surgery, compared with 39.5 % of non-Aboriginal people. Further, Aboriginal people who were not receiving surgery, at the time of diagnosis, were more likely to be younger, live in major cities and have no comorbidities. The observed risk of death from NSCLC 5 years after diagnosis was higher for 266 Aboriginal people (83.3 % 95 % CI 77.5–87.7) than for 15,491 non-Aboriginal people (77.6 % 95 % CI 76.9–78.3) and the adjusted subhazard ratio was 1.32 (95 % CI 1.14–1.52). From the medical record audit, 29 % of Aboriginal people with NSCLC had potentially curative treatment, 45 % had palliative radiotherapy/chemotherapy and 26 % had no active treatment. Conclusions There are disparities in NSCLC surgical treatment and mortality for Aboriginal people compared with non-Aboriginal people in NSW. It is imperative that Aboriginal people are offered active lung cancer treatment, particularly those who are younger and without comorbidities and are therefore most likely to benefit, and are provided with assistance to access it if required.
Collapse
Affiliation(s)
- Alison Gibberd
- School of Public Health, University of Sydney, Sydney, Australia
| | | | - Anthony Dillon
- Institute for Positive Psychology and Education, Australian Catholic University, Sydney, Australia
| | | | - Dianne L O'Connell
- School of Public Health, University of Sydney, Sydney, Australia. .,Cancer Research Division, Cancer Council NSW, Sydney, Australia. .,School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.
| |
Collapse
|
47
|
Vaz-Luis I, Hughes ME, Cronin A, Rugo HS, Edge SB, Moy B, Theriault RL, Hassett MJ, Winer EP, Lin NU. Trends in the use of mastectomy in women with small node-negative breast cancer treated at US academic centers. Breast Cancer Res Treat 2016; 155:569-78. [PMID: 26868124 DOI: 10.1007/s10549-016-3707-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 02/05/2016] [Indexed: 10/22/2022]
Abstract
Breast-conserving surgery (BCS) provides equivalent survival outcomes to unilateral mastectomy. There is no survival advantage to bilateral mastectomy in average risk breast cancer. Among a cohort of breast cancer patients expected to be candidates for BCS, we examined choice of surgery and factors associated with it. A prospective cohort study of unilateral clinical Stage I breast cancer patients treated at National Comprehensive Cancer Network centers from 2000 to 2009 was performed. The proportion of patients who initially underwent mastectomy versus BCS and time to definitive surgery and chemotherapy were examined. Of 10,249 patients, 23 % underwent mastectomy as an initial surgery. No decline in the use of mastectomy as initial surgery was found. There was significant institutional variation, with rates of initial mastectomy ranging from 14 to 30 % (adjusted odds ratio: 0.42-1.38). Tumor characteristics were associated with surgical option, but with small absolute differences. Of those who received initial mastectomy, 22 % had bilateral mastectomy, with an increase over time (2000:13 % vs. 2009:30 %) and substantial institutional variation (11-34 %). Women treated with initial mastectomy had longer median times from diagnosis to complete definitive surgery (6 vs. 4 weeks) and to start of adjuvant chemotherapy (12 vs. 11 weeks). Among Stage I breast cancer, the overall use of mastectomy did not change significantly over 10 years; however, an increasing proportion of women with unilateral cancer had bilateral mastectomy, and there was wide variation in type of surgery by institution. Further studies to assess reasons for the observed wide variation are warranted.
Collapse
|
48
|
Thompson SR, Delaney GP, Jacob S, Shafiq J, Wong K, Hanna TP, Gabriel GS, Barton MB. Estimation of the optimal utilisation rates of radical prostatectomy, external beam radiotherapy and brachytherapy in the treatment of prostate cancer by a review of clinical practice guidelines. Radiother Oncol 2016; 118:118-21. [PMID: 26776443 DOI: 10.1016/j.radonc.2015.12.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 12/24/2015] [Accepted: 12/27/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND PURPOSE We aimed to construct an evidence-based model of optimal treatment utilisation for prostate cancer, incorporating all local treatment modalities: radical prostatectomy (RP), external beam radiotherapy (EBRT), and brachytherapy (BT); and then to compare this optimal model with actual practice. MATERIALS AND METHODS Evidence-based guidelines were used to construct a prostate cancer treatment decision-tree. The proportion of patients who fulfilled treatment criteria was drawn from the epidemiological literature. These data were combined to calculate the overall proportion of patients that should optimally have RP, EBRT and/or BT at least once during the course of their disease. The model was peer reviewed and tested by sensitivity analyses and compared with actual practice. RESULTS Optimal utilisation rates, at some point during the disease course, were: RP, 24% (range 15-30%); EBRT, 58% (range 54-64%); BT, 9.6% (range 6.0-17.9%); and any RT, 60% (range 56-66%). Many patients had indications for more than one of these treatments, and at least one of these treatments was indicated in 76% of patients. The model was sensitive to patient preference estimates. Optimal rates were achievable in some health care jurisdictions. CONCLUSIONS Modelling optimal utilisation of all local treatment options for a particular cancer is possible. These optimal prostate cancer treatment rates can be used as a planning and quality assurance tool, providing an evidence-based benchmark against which can be measured patterns of practice.
Collapse
|
49
|
Gallego CJ, Perez ML, Burt A, Amendola LM, Shirts BH, Pritchard CC, Hisama FM, Bennett RL, Veenstra DL, Jarvik GP. Next Generation Sequencing in the Clinic: a Patterns of Care Study in a Retrospective Cohort of Subjects Referred to a Genetic Medicine Clinic for Suspected Lynch Syndrome. J Genet Couns 2015; 25:515-9. [PMID: 26637299 DOI: 10.1007/s10897-015-9902-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 10/15/2015] [Indexed: 01/09/2023]
Abstract
Next generation sequencing (NGS) gene panels are increasingly used in medical genetics clinics for the evaluation of common inherited cancer syndromes, but the clinical efficacy of these tests, and the factors driving clinical providers to order them are unclear. We conducted a patterns-of-care study to compare patients evaluated with NGS gene panels with a reference group. We abstracted demographic, socioeconomic, and clinical information in a retrospective cohort of patients referred to a large medical genetics clinic for evaluation of inherited colorectal cancer and polyposis syndromes. Patients tested with NGS gene panels were more likely to be insured compared to the reference group (85.3 % vs. 69.2 %, p = 0.0068),less likely to have prior tumor tissue testing (29.4 % vs. 54.3 %, p = 0.0004), and less likely to have an abnormal tumor tissue test result (46.7 % vs. 74.5 %, p = 0.01). No significant differences were found between groups in age, gender, race, employment status, personal history of colorectal cancer, or proportion of patients fulfilling Lynch syndrome clinical criteria. Patients with NGS testing were less likely to have a pathogenic/likely pathogenic variant detected (13.7 % vs. 31.9 %, p = 0.002). Patients referred for NGS testing to evaluate inherited colorectal cancer/polyposis risk appear to undergo tumor tissue testing less frequently than non-NGS testing patients. Further studies are needed to assess the most effective and cost-effective approach to genomic diagnosis in this patient population.
Collapse
Affiliation(s)
- Carlos J Gallego
- Department of Medicine, Division of Medical Genetics, University of Washington, 1705 NE Pacific Street, K228, UW Box 357720, Seattle, WA, 98195, USA.
- Department of Pharmacy, Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA, 98195, USA.
| | - Matthew L Perez
- Department of Medicine, Division of Medical Genetics, University of Washington, 1705 NE Pacific Street, K228, UW Box 357720, Seattle, WA, 98195, USA
| | - Amber Burt
- Department of Medicine, Division of Medical Genetics, University of Washington, 1705 NE Pacific Street, K228, UW Box 357720, Seattle, WA, 98195, USA
| | - Laura M Amendola
- Department of Medicine, Division of Medical Genetics, University of Washington, 1705 NE Pacific Street, K228, UW Box 357720, Seattle, WA, 98195, USA
| | - Brian H Shirts
- Department of Laboratory Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Colin C Pritchard
- Department of Laboratory Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Fuki M Hisama
- Department of Medicine, Division of Medical Genetics, University of Washington, 1705 NE Pacific Street, K228, UW Box 357720, Seattle, WA, 98195, USA
| | - Robin L Bennett
- Department of Medicine, Division of Medical Genetics, University of Washington, 1705 NE Pacific Street, K228, UW Box 357720, Seattle, WA, 98195, USA
| | - David L Veenstra
- Department of Pharmacy, Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA, 98195, USA
| | - Gail P Jarvik
- Department of Medicine, Division of Medical Genetics, University of Washington, 1705 NE Pacific Street, K228, UW Box 357720, Seattle, WA, 98195, USA
| |
Collapse
|
50
|
Sung SY, Kang MK, Kay CS, Keum KC, Kim SH, Kim YS, Kim WT, Kim JY, Kim JH, Moon SH, Ahn YC, Oh YT, Wu HG, Lee CG, Chung WK, Cho KH, Cho MJ, Choi JH. Patterns of care for patients with nasopharyngeal carcinoma (KROG 11-06) in South Korea. Radiat Oncol J 2015; 33:188-97. [PMID: 26484302 PMCID: PMC4607572 DOI: 10.3857/roj.2015.33.3.188] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 06/17/2015] [Accepted: 08/07/2015] [Indexed: 11/03/2022] Open
Abstract
PURPOSE To investigate the patterns of care for patients with nasopharyngeal carcinoma (NPC) in South Korea. MATERIALS AND METHODS A multi-institutional retrospective study was performed (Korean Radiation Oncology Group [KROG] 11-06) on a total of 1,445 patients from 15 institutions. RESULTS Of the 1,445 patients, more than half were stages III (39.9%) and IV (35.8%). In addition to patterns of care, we also investigated trends over time with the periods 1988-1993, 1994-2002, and 2003-2011. The frequencies of magnetic resonance imaging and positron emission tomography-computed tomography were markedly increased in the third period compared to previous 2 periods. Concurrent chemoradiation (CCRT) was performed on 894 patients (61.9%), neoadjuvant chemotherapy on 468 patients (32.4%), and adjuvant chemotherapy on 366 patients (25.3%). Of stage II-IV patients, CCRT performed on 78.8% in 2003-2011 compared to 15.0% in 1988-1993. For patients treated with CCRT, cisplatin was the most commonly used agent in 81.3% of patients. Over the periods of time, commonly used radiotherapy (RT) techniques were changed from 2-dimensional RT (1988-1993, 92.5%) to 3-dimensional RT (2003-2011, 35.5%) or intensity-modulated RT (IMRT; 2003-2011, 56.5%). Median RT doses given to primary tumors, high-risk lymphatics, and low-risk lymphatics were 70.0 Gy, 58.1 Gy, and 48.0 Gy, respectively. Adoption of IMRT increased the dose per fraction and escalated total radiation dose. CONCLUSION Assessment of the patterns of care for NPC patients in South Korea demonstrated that management for NPC including diagnostic imaging, treatment regimen, RT techniques and dose schedule, advanced in accordance with the international guidelines.
Collapse
Affiliation(s)
- Soo Yoon Sung
- Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Min Kyu Kang
- Department of Radiation Oncology, Yeungnam University College of Medicine, Daegu, Korea
| | - Chul Seung Kay
- Department of Radiation Oncology, Incheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Incheon, Korea
| | - Ki Chang Keum
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Hwan Kim
- Department of Radiation Oncology, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Yeon-Sil Kim
- Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Won Taek Kim
- Department of Radiation Oncology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Ji-Yoon Kim
- Department of Radiation Oncology, Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jin-Hee Kim
- Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Sung Ho Moon
- Department of Radiation Oncology, Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Taek Oh
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Chang-Geol Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Woong-Ki Chung
- Department of Radiation Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Kwan Ho Cho
- Department of Radiation Oncology, Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Moon-June Cho
- Department of Radiation Oncology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jin Hwa Choi
- Department of Radiation Oncology, Chung-Ang University Hospital, Seoul, Korea
| |
Collapse
|