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Abdelrahim M, Esmail A, Kasi A, Esnaola NF, Xiu J, Baca Y, Weinberg BA. Comparative molecular profiling of pancreatic ductal adenocarcinoma of the head versus body and tail. NPJ Precis Oncol 2024; 8:85. [PMID: 38582894 PMCID: PMC10998911 DOI: 10.1038/s41698-024-00571-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/29/2024] [Indexed: 04/08/2024] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) of the head (H) and body/tail (B/T) differ in embryonic origin, cell composition, blood supply, lymphatic and venous drainage, and innervation. We aimed to compare the molecular and tumor immune microenvironment (TIME) profiles of PDAC of the H vs. B/T. A total of 3499 PDAC samples were analyzed via next-generation sequencing (NGS) of RNA (whole transcriptome, NovaSeq), DNA (NextSeq, 592 genes or NovaSeq, whole exome sequencing), and immunohistochemistry (Caris Life Sciences, Phoenix, AZ). Significance was determined as p values adjusted for multiple corrections (q) of <0.05. Anatomic subsites of PDAC tumors were grouped by primary tumor sites into H (N = 2058) or B/T (N = 1384). There were significantly more metastatic tumors profiled from B/T vs. H (57% vs. 44%, p < 0.001). KRAS mutations (93.8% vs. 90.2%), genomic loss of heterozygosity (12.7% vs. 9.1%), and several copy number alterations (FGF3, FGF4, FGF19, CCND1, ZNF703, FLT4, MUTYH, TNFRS14) trended higher in B/T when compared to H (p < 0.05 but q > 0.05). Expression analysis of immuno-oncology (IO)-related genes showed significantly higher expression of CTLA4 and PDCD1 in H (q < 0.05, fold change 1.2 and 1.3) and IDO1 and PDCD1LG2 expression trended higher in B/T (p < 0.05, fold change 0.95). To our knowledge, this is one of the largest cohorts of PDAC tumors subjected to broad molecular profiling. Differences in IO-related gene expression and TIME cell distribution suggest that response to IO therapies may differ in PDAC arising from H vs. B/T. Subtle differences in the genomic profiles of H vs. B/T tumors were observed.
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Affiliation(s)
- Maen Abdelrahim
- Section of GI Oncology, Houston Methodist Neal Cancer Center and Cockrell Center for Advanced Therapeutics, Houston Methodist Hospital, Houston, TX, USA
| | - Abdullah Esmail
- Section of GI Oncology, Houston Methodist Neal Cancer Center and Cockrell Center for Advanced Therapeutics, Houston Methodist Hospital, Houston, TX, USA
| | - Anup Kasi
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Nestor F Esnaola
- Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
| | | | | | - Benjamin A Weinberg
- Ruesch Center for the Cure of Gastrointestinal Cancers, Lombardi Comprehensive Cancer, Georgetown University Medical Center, Washington, DC, USA.
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Satkunasivam R, Lim K, Teh BS, Guzman J, Zhang J, Farach A, Chen SH, Wallis CJ, Efstathiou E, Esnaola NF, Sonpavde GP. A phase II clinical trial of neoadjuvant sasanlimab and stereotactic body radiation therapy as an in situ vaccine for cisplatin-ineligible MIBC: the RAD VACCINE MIBC trial. Future Oncol 2022; 18:2771-2781. [PMID: 35703113 DOI: 10.2217/fon-2022-0380] [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] [Indexed: 11/21/2022] Open
Abstract
The utilization of neoadjuvant immune checkpoint inhibitor therapy, specifically anti-PD-1/L1 agents, prior to radical cystectomy is an emerging paradigm in muscle-invasive bladder cancer (MIBC). In situ vaccination represents a strategy to manipulate the tumor in order to augment the immune response toward improved local and distant cancer control. The authors describe the study rationale, design and objectives for RAD VACCINE MIBC, a single-arm, single-institution, phase II trial evaluating the efficacy and safety of combination neoadjuvant sasanlimab (humanized IgG monoclonal antibody that targets PD-1) with stereotactic body radiotherapy as an in situ vaccine in cisplatin-ineligible patients with MIBC. The results from this trial will establish the safety profile of this combination strategy and evaluate pathologic complete response rates.
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Affiliation(s)
- Raj Satkunasivam
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX 77030, USA
- Department of Urology, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Kelvin Lim
- Department of Urology, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Bin S Teh
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Jonathan Guzman
- Department of Urology, Houston Methodist Hospital, Houston, TX 77030, USA
- Department of Urology, Lenox Hill Hospital, New York, NY 10075, USA
| | - Jun Zhang
- Department of Medical Oncology, Houston Methodist Cancer Center, Houston, TX 77030, USA
| | - Andrew Farach
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Shu-Hsia Chen
- Center for Immunotherapy Research, Houston Methodist Research Institute, Houston, TX 77030, USA
| | - Christopher Jd Wallis
- Division of Urology, University of Toronto, Toronto, ON M5G 1E2, Canada
- Division of Urology, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Eleni Efstathiou
- Department of Medical Oncology, Houston Methodist Cancer Center, Houston, TX 77030, USA
| | - Nestor F Esnaola
- Department of Surgical Oncology, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Guru P Sonpavde
- Department of Genitourinary Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
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Gopalan A, Gallup TD, Wood S, Maldonado J, Margain C, Esnaola NF, Kim MP, Kopetz ES, Yun K. Abstract 694: E-slice: A novel 3D culture platform for precision medicine. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The need for personalized medicine in oncology is widely accepted but translating this important concept into clinical practice has been challenging. Currently, the dominant platform for precision medicine utilizes genomics/sequencing-based assays to measure the expression and/or mutational profiles and then infer patient responses to therapies based on previous knowledge; however, this approach benefits less than 10-15% of patients with profiled tumors. Recognizing the inherent limitations of these inference-based methods, functional assays (e.g., organoids and PDX models) have been developed; however, these approaches also have significant limitations including high cost and time required to establish the models, low “take rates”, and destruction of the native tumor microenvironment (TME). To overcome these challenges, EMPIRI uses a novel 3D ex vivo tumor slice culture method (E-slices) that enables rapid, personalized drug sensitivity testing in intact patient tumor tissues. Major differentiators of the E-slice platform from other ex vivo methods include the use of chemically defined, serum-free medium, longitudinal viability measurements from the same tissue, tracking of dynamic responses to treatment over 2-3 weeks, and retention of the native TME and tissue architecture, unlike other approaches. In addition, E-slices can be generated from any solid tumor tested thus far (breast, lung, colorectal, pancreas, brain, head 7 neck, and others) from patient tumors directly and PDX and genetically engineered mouse models. In addition, because E-slices retain tumor-infiltrating immune cells in their native microenvironment and spatial topography of all cell types in the endogenous configuration, it sustains immune cell survival and proliferation and measures immunotherapy responses ex vivo. The E-slice method is compatible with biopsies as well as surgical samples. Importantly, it has been shown to accurately predict individual patient treatment responses to chemotherapies and targeted therapies in 4-12 days, paving the way for evidence-based personalized treatment selections in a clinically actionable time frame. In summary, we present a novel ex vivo 3D human tumor tissue drug sensitivity platform that faithfully replicates the patient tumor tissues and provides personalized treatment responses in a clinically actionable time frame.
Citation Format: Archana Gopalan, Thomas D. Gallup, Stephanie Wood, Jose Maldonado, Corina Margain, Nestor F. Esnaola, Min P. Kim, E. Scott Kopetz, Kyuson Yun. E-slice: A novel 3D culture platform for precision medicine [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 694.
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Affiliation(s)
| | | | - Stephanie Wood
- 3Houston Methodist/Weill-Cornell Medical College, Houston, TX
| | - Jose Maldonado
- 3Houston Methodist/Weill-Cornell Medical College, Houston, TX
| | | | | | - Min P. Kim
- 3Houston Methodist/Weill-Cornell Medical College, Houston, TX
| | - E. Scott Kopetz
- 3Houston Methodist/Weill-Cornell Medical College, Houston, TX
| | - Kyuson Yun
- 3Houston Methodist/Weill-Cornell Medical College, Houston, TX
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Satkunasivam R, Lim K, Teh BS, Esnaola NF, Slawin J, Zhang J, Miles B, Brooks MA, Anis M, Muhammad T, Farach AM, Chen SH, Efstathiou E, Sonpavde GP. A phase II clinical trial of neoadjuvant sasanlimab and stereotactic body radiation therapy as an in situ vaccine for cisplatin-ineligible muscle invasive bladder cancer (RAD VACCINE MIBC). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps4611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS4611 Background: The utilization of neoadjuvant immune checkpoint inhibitor (ICI) therapy, including anti-PD1/L1 agents, prior to radical cystectomy (RC), is an emerging paradigm in muscle invasive bladder cancer (MIBC). Pathologic complete responses (pCR) have been observed in 25-40% of patients with neoadjuvant PD1/L1 inhibitor monotherapy for cisplatin-ineligible MIBC. In situ vaccination using stereotactic body radiation therapy (SBRT) may augment T-cell responses to tumor-specific antigens through immunogenic cell death. Sasanlimab (PF-06801591) is a humanized IgG monoclonal antibody that targets PD-1 selectively, for which there are both Phase 1 data and ongoing Phase 3 trials in early-stage urothelial carcinoma. There exists a strong rationale to evaluate a novel strategy of combination neoadjuvant ICI therapy with SBRT as an in situ vaccine to improve loco-regional control and decrease the risk of distant recurrence in cisplatin-ineligible patients with MIBC. Methods: This is a prospective, investigator-initiated, single-arm, single-institution, phase II trial that evaluates neoadjuvant sasanlimab in combination with SBRT as neoadjuvant therapy for patients with MIBC before RC. Eligibility requires patients to be cisplatin-ineligible (one of the following: ECOG-PS=2, creatinine clearance <60 ml/min, or comorbidities such as hearing loss or neuropathy) or those who refuse cisplatin-based chemotherapy. Sasanlimab (300 mg) will be administered subcutaneously on Day 1 of each 28-day cycle for a total of 2 cycles, in combination with SBRT to the primary tumor at a dose of 24Gy given in 3 fractions, starting on Day 1 of Cycle 2 with a 48-hour interval between fractions. The combination treatment will be assessed by using a Simon’s 2-Stage design, which the first 10 patients are enrolled as a safety lead-in to evaluate the safety and feasibility. Futility analysis will be performed after a total of 18 patients. The primary endpoint is pCR rate after neoadjuvant sasanlimab/SBRT, followed by RC. If pCR is observed in 4 or fewer patients, further enrollment of patients may be stopped with the conclusion that pT0 cannot be 40% or greater. Otherwise, an additional 15 patients will be accrued in stage II, resulting in a total of 33 patients. Secondary endpoints include adverse events, surgical complication rates, health related quality-of-life, overall survival, and recurrence free survival. Exploratory endpoints include analysis of and association with pCR of the tumor/germline genetic signatures, circulating tumor DNA, tumor PD-L1 expression, blood cytometry time-of-flight analysis to identify immune response. Enrollment opened on February 15, 2022. Clinical trial information: NCT05241340.
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Affiliation(s)
- Raj Satkunasivam
- Department of Urology and Center for Outcomes Research, Houston Methodist Hospital, Houston, TX
| | - Kelvin Lim
- Houston Methodist Hospital, Department of Urology, Houston, TX
| | - Bin S. Teh
- Houston Methodist Hospital, Department of Radiation Oncology, Houston, TX
| | - Nestor F. Esnaola
- Department of Surgical Oncology, Cancer Health Disparities and Community Engagement, Philadelphia, PA
| | - Jeremy Slawin
- Houston Methodist Hospital, Department of Urology, Houston, TX
| | - Jun Zhang
- Houston Methodist Cancer Center, Houston, TX
| | | | | | - Maryam Anis
- Houston Methodist Hospital, Department of Urology, Houston, TX
| | - Taliah Muhammad
- Houston Methodist Hospital, Department of Urology, Houston, TX
| | - Andrew M. Farach
- Houston Methodist Hospital, Department of Radiation Oncology, Houston, TX
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Wallis CJD, Jerath A, Coburn N, Klaassen Z, Luckenbaugh AN, Magee DE, Hird AE, Armstrong K, Ravi B, Esnaola NF, Guzman JCA, Bass B, Detsky AS, Satkunasivam R. Association of Surgeon-Patient Sex Concordance With Postoperative Outcomes. JAMA Surg 2021; 157:146-156. [PMID: 34878511 DOI: 10.1001/jamasurg.2021.6339] [Citation(s) in RCA: 127] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Surgeon sex is associated with differential postoperative outcomes, though the mechanism remains unclear. Sex concordance of surgeons and patients may represent a potential mechanism, given prior associations with physician-patient relationships. Objective To examine the association between surgeon-patient sex discordance and postoperative outcomes. Design, Setting, and Participants In this population-based, retrospective cohort study, adult patients 18 years and older undergoing one of 21 common elective or emergent surgical procedures in Ontario, Canada, from 2007 to 2019 were analyzed. Data were analyzed from November 2020 to March 2021. Exposures Surgeon-patient sex concordance (male surgeon with male patient, female surgeon with female patient) or discordance (male surgeon with female patient, female surgeon with male patient), operationalized as a binary (discordant vs concordant) and 4-level categorical variable. Main Outcomes and Measures Adverse postoperative outcome, defined as death, readmission, or complication within 30-day following surgery. Secondary outcomes assessed each of these metrics individually. Generalized estimating equations with clustering at the level of the surgical procedure were used to account for differences between procedures, and subgroup analyses were performed according to procedure, patient, surgeon, and hospital characteristics. Results Among 1 320 108 patients treated by 2937 surgeons, 602 560 patients were sex concordant with their surgeon (male surgeon with male patient, 509 634; female surgeon with female patient, 92 926) while 717 548 were sex discordant (male surgeon with female patient, 667 279; female surgeon with male patient, 50 269). A total of 189 390 patients (14.9%) experienced 1 or more adverse postoperative outcomes. Sex discordance between surgeon and patient was associated with a significant increased likelihood of composite adverse postoperative outcomes (adjusted odds ratio [aOR], 1.07; 95% CI, 1.04-1.09), as well as death (aOR, 1.07; 95% CI, 1.02-1.13), and complications (aOR, 1.09; 95% CI, 1.07-1.11) but not readmission (aOR, 1.02; 95% CI, 0.98-1.07). While associations were consistent across most subgroups, patient sex significantly modified this association, with worse outcomes for female patients treated by male surgeons (compared with female patients treated by female surgeons: aOR, 1.15; 95% CI, 1.10-1.20) but not male patients treated by female surgeons (compared with male patients treated by male surgeons: aOR, 0.99; 95% CI, 0.95-1.03) (P for interaction = .004). Conclusions and Relevance In this study, sex discordance between surgeons and patients negatively affected outcomes following common procedures. Subgroup analyses demonstrate that this is driven by worse outcomes among female patients treated by male surgeons. Further work should seek to understand the underlying mechanism.
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Affiliation(s)
- Christopher J D Wallis
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee.,Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Angela Jerath
- Department of Anesthesia, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Natalie Coburn
- Department of Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Zachary Klaassen
- Division of Urology, Medical College of Georgia, Augusta University, Augusta
| | - Amy N Luckenbaugh
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Diana E Magee
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Amanda E Hird
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kathleen Armstrong
- Division of Plastic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Bheeshma Ravi
- Division of Orthopedic Surgery, Department of Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada.,Division of Orthopedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Nestor F Esnaola
- Division of Surgical Oncology and Gastrointestinal Surgery, Department of Surgery, Houston Methodist Hospital, Houston, Texas
| | - Jonathan C A Guzman
- Department of Urology, Houston Methodist Hospital, Houston, Texas.,Center for Outcomes Research, Houston Methodist Hospital, Houston, Texas
| | - Barbara Bass
- School of Medicine and Health Sciences, George Washington University, Washington, DC
| | - Allan S Detsky
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada
| | - Raj Satkunasivam
- Department of Urology, Houston Methodist Hospital, Houston, Texas.,Center for Outcomes Research, Houston Methodist Hospital, Houston, Texas.,Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station
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Valero-Elizondo J, Chouairi F, Khera R, Grandhi GR, Saxena A, Warraich HJ, Virani SS, Desai NR, Sasangohar F, Krumholz HM, Esnaola NF, Nasir K. Atherosclerotic Cardiovascular Disease, Cancer, and Financial Toxicity Among Adults in the United States. JACC CardioOncol 2021; 3:236-246. [PMID: 34396329 PMCID: PMC8352280 DOI: 10.1016/j.jaccao.2021.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/12/2021] [Indexed: 12/30/2022]
Abstract
Background Financial toxicity (FT) is a well-established side-effect of the high costs associated with cancer care. In recent years, studies have suggested that a significant proportion of those with atherosclerotic cardiovascular disease (ASCVD) experience FT and its consequences. Objectives This study aimed to compare FT for individuals with neither ASCVD nor cancer, ASCVD only, cancer only, and both ASCVD and cancer. Methods From the National Health Interview Survey, we identified adults with self-reported ASCVD and/or cancer between 2013 and 2018, stratifying results by nonelderly (age <65 years) and elderly (age ≥65 years). We defined FT if any of the following were present: any difficulty paying medical bills, high financial distress, cost-related medication nonadherence, food insecurity, and/or foregone/delayed care due to cost. Results The prevalence of FT was higher among those with ASCVD when compared with cancer (54% vs. 41%; p < 0.001). When studying the individual components of FT, in adjusted analyses, those with ASCVD had higher odds of any difficulty paying medical bills (odds ratio [OR]: 1.22; 95% confidence interval [CI]: 1.09 to 1.36), inability to pay bills (OR: 1.25; 95% CI: 1.04 to 1.50), cost-related medication nonadherence (OR: 1.28; 95% CI: 1.08 to 1.51), food insecurity (OR: 1.39; 95% CI: 1.17 to 1.64), and foregone/delayed care due to cost (OR: 1.17; 95% CI: 1.01 to 1.36). The presence of ≥3 of these factors was significantly higher among those with ASCVD and those with both ASCVD and cancer when compared with those with cancer (23% vs. 30% vs. 13%, respectively; p < 0.001). These results remained similar in the elderly population. Conclusions Our study highlights that FT is greater among patients with ASCVD compared with those with cancer, with the highest burden among those with both conditions.
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Affiliation(s)
- Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.,Center for Outcomes Research, Houston Methodist, Houston, Texas, USA
| | - Fouad Chouairi
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Rohan Khera
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Gowtham R Grandhi
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
| | - Anshul Saxena
- Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, Florida, USA
| | - Haider J Warraich
- Department of Medicine, Cardiology Section, VA Boston Healthcare System, Boston, Massachusetts, USA.,Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Salim S Virani
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.,Section of Cardiovascular Research, Baylor College of Medicine, Houston, Texas, USA
| | - Nihar R Desai
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Farzan Sasangohar
- Center for Outcomes Research, Houston Methodist, Houston, Texas, USA.,Department of Industrial and Systems Engineering, Texas A&M College of Engineering, Texas A&M University, College Station, Texas, USA
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
| | - Nestor F Esnaola
- Cancer Center, Houston Methodist Research Institute, Houston, Texas, USA.,Department of Surgical Oncology, Fox Chase Cancer Center-Temple Health, Philadelphia, Pennsylvania, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.,Center for Outcomes Research, Houston Methodist, Houston, Texas, USA
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Ward WH, Hui J, Davis CH, Li T, Goel N, Handorf E, Ross EA, Curley SA, Karachristos A, Esnaola NF. Perioperative Outcomes Following Combined Versus Isolated Colorectal and Liver Resections: Insights From a Contemporary, National, Propensity Score-Based Analysis. Ann Surg Open 2021; 2:e050. [PMID: 36714392 PMCID: PMC9872861 DOI: 10.1097/as9.0000000000000050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 01/31/2021] [Indexed: 02/01/2023] Open
Abstract
Our objective was to compare outcomes following combined versus isolated resections for metastatic colorectal cancer and/or liver metastases using a large, contemporary national database. Background Controversy persists regarding optimal timing of resections in patients with synchronous colorectal liver metastases. Methods We analyzed 11,814 patients with disseminated colorectal cancer and/or liver metastases who underwent isolated colon, rectal, or liver resections (CRs, RRs, or LRs) or combined colon/liver or rectal/liver resections (CCLRs or CRLRs) in the National Surgical Quality Improvement Program Participant Use File (2011-2015). We examined associations between resection type and outcomes using univariate/multivariate analyses and used propensity adjustment to account for nonrandom receipt of isolated versus combined resections. Results Two thousand four hundred thirty-seven (20.6%); 2108 (17.8%); and 6243 (52.8%) patients underwent isolated CR, RR, or LR; 557 (4.7%) and 469 (4.0%) underwent CCLR or CRLR. Three thousand three hundred ninety-five patients (28.7%) had serious complications (SCs). One hundred forty patients (1.2%) died, of which 113 (80.7%) were failure to rescue (FTR). One thousand three hundred eighty-six (11.7%) patients experienced unplanned readmission. After propensity adjustment and controlling for procedural complexity, wound class, and operation year, CCLR/CRLR was independently associated with increased risk of SC, as well as readmission (compared with LR). CCLR was also independently associated with increased risk of FTR and death (compared with LR). Conclusions Combined resection uniformly confers increased risk of SC and increased risk of mortality after CCLR; addition of colorectal to LR increases risk of readmission. Combined resections are less safe, and potentially more costly, than isolated resections. Effective strategies to prevent SC after combined resections are warranted.
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Affiliation(s)
- William H. Ward
- From the Department of Surgery, Naval Medical Center, Portsmouth, VA
| | - Jane Hui
- Department of Surgery, University of Minnesota, Minneapolis, MN
| | - Catherine H. Davis
- Division of Surgical Oncology and Gastrointestinal Surgery, Department of Surgery, Houston Methodist Hospital, Houston, TX
| | - Tianyu Li
- Department of Data Sciences, Dana Farber Cancer Center, Boston, MA
| | - Neha Goel
- Department of Surgery, University of Miami, Miami, FL
| | - Elizabeth Handorf
- Biostatistics and Bioinformatics Facility, Fox Chase Cancer Center, Philadelphia, PA
| | - Eric A. Ross
- Biostatistics and Bioinformatics Facility, Fox Chase Cancer Center, Philadelphia, PA
| | | | | | - Nestor F. Esnaola
- Division of Surgical Oncology and Gastrointestinal Surgery, Department of Surgery, Houston Methodist Hospital, Houston, TX
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Zorbas KA, Velanovich V, Esnaola NF, Karachristos A. Modified frailty index predicts complications and death after non-bariatric gastrectomies. Transl Gastroenterol Hepatol 2021; 6:10. [PMID: 33409404 DOI: 10.21037/tgh.2020.01.07] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 01/18/2020] [Indexed: 12/21/2022] Open
Abstract
Background The modified frailty index (mFI) has been shown to predict mortality and morbidity after major operations. The aim of the present study was to assess the mFI as a preoperative predictor of short-term postoperative complications and 30-day mortality in patients undergoing gastrectomy for non-bariatric diseases. Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database was queried for patients who underwent total or partial gastrectomy from 2005 to 2011. A mFI was calculated based on 11 variables as previously described. The population divided into the following four categories based on the mFI score: the non-frail (mFI 0), the low frail (mFI 1), the intermediate frail (mFI 2) and frail (mFI ≥3). Thirty-day mortality and postoperative complications were evaluated. Results Overall, 5,711 patients underwent a gastrectomy for non-bariatric diseases. Higher mFI score was associated with higher rates of mortality (from 1.2% in the non-frail group to 10.7% in frail group, P<0.001), overall morbidity (26.7% vs. 51.1%, P<0.001), postoperative Clavien IV complication (6% vs. 24.6%, P<0.001), serious complications (19.3% vs. 42.6%, P<0.001), sepsis-related complications (8.4% vs. 16.4%, P<0.001), cardiopulmonary complications (5% vs. 20.7%, P<0.001) and failure to rescue (5.7% vs. 21.8%, P<0.001). Conclusions Higher mFI score in patients undergoing non-bariatric gastrectomy, is associated with a stepwise greater risk of postoperative morbidity and mortality. MFI Score can be easily calculated preoperatively, from the patient's history, and it can be used as an exceptionally useful criterion for treatment planning.
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Affiliation(s)
| | - Vic Velanovich
- Division of General Surgery, Department of Surgery, University of South Florida, Tampa, FL, USA
| | - Nestor F Esnaola
- Division of Surgical Oncology, Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Andreas Karachristos
- Division of Surgical Oncology, Department of Surgery, University of South Florida, Tampa, FL, USA
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Ford ME, Bryant DC, Cartmell KB, Sterba K, Burshell DR, Hill EG, Kim J, De Toma A, Knight KD, Reed T, Weaver K, Calhoun E, Esnaola NF. Abstract A085: Challenges and successes in recruiting African Americans with early-stage, non-small cell lung cancer to an NIMHD-funded, NCORP-based patient navigation trial. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp18-a085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: Enrollment of early-stage lung cancer patients to randomized trials has historically been challenging. The STARS Trial enrolled 36 of 1,030 intended patients from 28 sites, while the ROSEL Trial recruited 22 of 960 intended patients from 10 sites. Unfortunately, evidence shows African Americans with early-stage NSCLC are significantly less likely than their European American counterparts to undergo resection and may also be less likely to participate in lung cancer trials as well.
Purpose: The purpose of this research is to describe interim recruitment results from an NIMHD-funded, NCI NCORP-based patient navigation trial conducted with African Americans with early-stage, probable/proven non-small cell lung cancer (NSCLC).
Design: The protocol-driven, barriers-focused patient navigation intervention is being conducted in the context of a two-arm cluster-randomized trial testing the effectiveness of the intervention in increasing rates of lung-directed curative-intent therapy (surgery and SBRT) in African Americans with Stage I-II NSCLC. The 2 study arms consist of the protocol-driven, intensive navigation intervention vs. usual care. The trial includes 20 study sites in 11 US states. Specific activities to enhance recruitment in the present trial include reaching out to referring physicians (e.g., primary care, pulmonologists, radiologists) to increase referrals of African American patients to the participating NCORP sites, and partnering with the leaders of community engagement activities at the sites to raise community-level awareness of the trial.
Results/Conclusions: To date, 200 African American patients have been recruited and the trial is now on target to meet its expected accrual goal of 222 patients. The majority of potential participants were ineligible due to receipt of surgical resection or radiation therapy prior to enrollment (24%), not having been told that they had probable/proven NSCLC prior to study contact (22%), or a previous history of lung cancer (10%). The median age of the 200 participants is 65 years (range 40-86 years). Most are unmarried (70%) and have a high school diploma or less (71%). The number of enrolled-to-date African American participants in this ongoing trial exceeds the total number of participants recruited to the STARS Trial or to the ROSEL Trial.
Citation Format: Marvella E. Ford, Debbie C. Bryant, Kathleen B. Cartmell, Katherine Sterba, Dana R. Burshell, Elizabeth G. Hill, Joanne Kim, Allan De Toma, Kendrea D. Knight, Ta'Myiah Reed, Kathryn Weaver, Elizabeth Calhoun, Nestor F. Esnaola. Challenges and successes in recruiting African Americans with early-stage, non-small cell lung cancer to an NIMHD-funded, NCORP-based patient navigation trial [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A085.
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Affiliation(s)
| | | | | | | | | | | | - Joanne Kim
- 1Medical University of South Carolina, Charleston, SC,
| | | | | | - Ta'Myiah Reed
- 1Medical University of South Carolina, Charleston, SC,
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Butner JD, Elganainy D, Wang CX, Wang Z, Chen SH, Esnaola NF, Pasqualini R, Arap W, Hong DS, Welsh J, Koay EJ, Cristini V. Mathematical prediction of clinical outcomes in advanced cancer patients treated with checkpoint inhibitor immunotherapy. Sci Adv 2020; 6:eaay6298. [PMID: 32426472 PMCID: PMC7190324 DOI: 10.1126/sciadv.aay6298] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 01/21/2020] [Indexed: 05/20/2023]
Abstract
We present a mechanistic mathematical model of immune checkpoint inhibitor therapy to address the oncological need for early, broadly applicable readouts (biomarkers) of patient response to immunotherapy. The model is built upon the complex biological and physical interactions between the immune system and cancer, and is informed using only standard-of-care CT. We have retrospectively applied the model to 245 patients from multiple clinical trials treated with anti-CTLA-4 or anti-PD-1/PD-L1 antibodies. We found that model parameters distinctly identified patients with common (n = 18) and rare (n = 10) malignancy types who benefited and did not benefit from these monotherapies with accuracy as high as 88% at first restaging (median 53 days). Further, the parameters successfully differentiated pseudo-progression from true progression, providing previously unidentified insights into the unique biophysical characteristics of pseudo-progression. Our mathematical model offers a clinically relevant tool for personalized oncology and for engineering immunotherapy regimens.
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Affiliation(s)
- Joseph D. Butner
- Mathematics in Medicine Program, Houston Methodist Research Institute, Houston, TX, USA
| | - Dalia Elganainy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Charles X. Wang
- MD/PhD Program, Drexel University College of Medicine, Philadelphia, PA 19102, USA
| | - Zhihui Wang
- Mathematics in Medicine Program, Houston Methodist Research Institute, Houston, TX, USA
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shu-Hsia Chen
- Immunotherapy Research Center, Houston Methodist Research Institute, Houston, TX, USA
- Cancer Center, Houston Methodist Research Institute, Houston, TX, USA
| | - Nestor F. Esnaola
- Cancer Center, Houston Methodist Research Institute, Houston, TX, USA
- Department of Surgical Oncology, Fox Chase Cancer Center—Temple Health, Philadelphia, PA, USA
| | - Renata Pasqualini
- Rutgers Cancer Institute of New Jersey at University Hospital, Newark, NJ, USA
- Division of Cancer Biology, Department of Radiation Oncology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Wadih Arap
- Rutgers Cancer Institute of New Jersey at University Hospital, Newark, NJ, USA
- Division of Hematology/Oncology, Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - David S. Hong
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - James Welsh
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eugene J. Koay
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Corresponding author. (V.C.); (E.J.K.)
| | - Vittorio Cristini
- Mathematics in Medicine Program, Houston Methodist Research Institute, Houston, TX, USA
- MD/PhD Program, Drexel University College of Medicine, Philadelphia, PA 19102, USA
- Corresponding author. (V.C.); (E.J.K.)
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Ford ME, Esnaola NF, Salley JD. Preface. Adv Cancer Res 2020; 146:xv-xx. [DOI: 10.1016/s0065-230x(20)30030-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Goel N, Manstein SM, Ward WH, DeMora L, Smaldone MC, Farma JM, Uzzo RG, Esnaola NF. Does the Surgical Apgar Score predict serious complications after elective major cancer surgery? J Surg Res 2018; 231:242-247. [PMID: 30278936 DOI: 10.1016/j.jss.2018.05.037] [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: 03/02/2018] [Revised: 05/10/2018] [Accepted: 05/23/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Major cancer surgery is associated with significant risks of perioperative morbidity and mortality, resulting in delayed adjuvant therapy, higher recurrence rates, and worse overall survival. Previous retrospective studies have used the Surgical Apgar Score (SAS) for perioperative risk assessment. This study prospectively evaluated the predictive value of SAS to predict serious complication (SC) after elective major cancer surgery. METHODS Demographic, comorbidity, procedure, and intraoperative data were collected prospectively for 405 patients undergoing elective major cancer surgery between 2014-17. The SAS was calculated immediately postoperative and outcome data were collected prospectively. Rates of SC according to SAS risk category were compared using Cochran-Armitage trend test. Receiver operating characteristic curves and area under the receiver operating characteristic curves were generated and 95% confidence intervals were calculated. RESULTS Eighty percent, 17.3%, and 2.7% of patients were low (SAS 7-10), intermediate (SAS 5-6), and high risk (SAS 0-4), respectively, for SC based on their SAS. Forty-six (11.4%) had an SC within 30 days; 3.7% returned to the operating room, 3.7% experienced a urinary tract infection, 3.2% experienced a respiratory complication, 2.7% experienced a wound complication, and 1.2% experienced a cardiac complication. Overall, 9.3%, 18.6%, and 27.3% of patients with SAS 7-10, 5-6, and 0-4 experienced an SC, respectively (P = 0.005). The overall discriminatory ability of the SAS was modest (area under the receiver operating characteristic curves 0.661; 95% confidence intervals, 0.582-0.740). CONCLUSIONS Although there was an overall association between SAS and higher risk of subsequent postoperative SC in our cohort, the ability of the SAS to accurately predict risk of postoperative SC at the patient level was limited.
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Affiliation(s)
- Neha Goel
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Samuel M Manstein
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - William H Ward
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Lyudmila DeMora
- Biostatistics and Bioinformatics Facility, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Marc C Smaldone
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Jeffrey M Farma
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Robert G Uzzo
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Nestor F Esnaola
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
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Goel N, Li T, Ward WH, Manstein SM, Kutikov A, Chu CS, Ross E, Uzzo RG, Esnaola NF. Rapid Implementation of a Transdisciplinary Enhanced Recovery after Surgery Program at a National Cancer Institute Comprehensive Cancer Center: An Interim Analysis. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.07.342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ward WH, Goel N, Manstein SM, DeMora L, Smaldone MC, Farma JM, Ross E, Uzzo RG, Esnaola NF. Prospective Comparison of the American College of Surgeons-NSQIP Surgical Risk Calculator and Surgical Apgar Score to Predict Perioperative Outcomes after Major Cancer Surgery. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.08.591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Fareed MM, DeMora L, Esnaola NF, Denlinger CS, Karachristos A, Ross EE, Hoffman J, Meyer JE. Concurrent chemoradiation for resected gall bladder cancers and cholangiocarcinomas. J Gastrointest Oncol 2018; 9:762-768. [PMID: 30151273 DOI: 10.21037/jgo.2018.05.09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Gallbladder cancer (GBC) and cholangiocarcinoma (CCA) are rare entities with relatively poor prognoses. We compared treatment outcomes of definitive resection with or without neoadjuvant therapy in GBC and CCA patients. Methods All non-metastatic GBC and CCA patients at a single institution who underwent definitive resection from 1992-2016 were analyzed. We compared overall survival (OS), locoregional failure (LRF) and distant failure (DF) in patients who received neoadjuvant therapy (chemotherapy and/or radiation) versus those who did not receive neoadjuvant treatment. OS was analyzed using the Kaplan-Meier method and log rank tests. Cox proportional hazard models were used to analyze time to recurrence. Results Out of 128 patients, 90 had GBC and 38 had CCA, 25 patients (27%) among GBC and 8 patients (21%) with CCA were T3, T4 or node positive. Overall, 52 (40%) GBC and 25 (20%) CCA patients received neoadjuvant treatment, chemotherapy alone 60 patients (47%) or radiation with or without chemotherapy 17 patients (13%). Chemotherapy was single agent in 44 patients (34%) and multi-agent in 25 (20%). The median OS for GBC patients was 3.1 years with 2.6 years for no neoadjuvant group and 3.1 years for neoadjuvant group (P=0.6786). Median OS was 2.6 years for CCA patients, 3.6 years for no neoadjuvant therapy versus 2.0 years for neoadjuvant group (P=0.1613). There was a trend towards increased DF in patients with CCA and GBC receiving neoadjuvant therapy: HR 2.74, 95% CI, 0.73-10.3, P=0.14 and 0.92, 95% CI, 0.44-1.93, P=0.82 respectively. The hazard ratio for time to LRF in CCA patients receiving neoadjuvant treatment was 3.17, 95% CI, 0.62-16.31, P=0.16 whereas HR was 0.15, 95% CI, 0.10-1.76, P=0.23 for GBC patients. Among GBC patients, the pattern of first failure was locoregional in 8 (10%) having 3 LRF in neoadjuvant group (2 with chemotherapy, 1 with CRT, 0 with RT alone) as compared to 5 in adjuvant group. Among 28 (35%) patients with DF first, 15 patients received neoadjuvant therapy versus 13 patients in non-neoadjuvant group. In CCA patients, LRF occurred first in 6 patients receiving neoadjuvant treatment (3 with chemotherapy, 1 with CRT, 2 with RT alone) as compared to 2 patients who were treated with non-neoadjuvant CRT. DF was the first site of failure in 9 patients treated with neoadjuvant CRT (8 with chemotherapy, 0 with CRT and 1 with RT alone) as compared to 4 patients without neoadjuvant treatment. Conclusions In this retrospective data set, a trend towards better survival was seen in adjuvantly treated CCA patients, but not in GBC patients. Recurrence patterns also appear different among the two, which might be attributed to treatment modality used, patient selection or unmeasured factors. Keywords Gallbladder cancer (GBC); cholangiocarcinoma (CCA); neoadjuvant; resection; chemoradiation; chemotherapy.
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Affiliation(s)
- Muhammad M Fareed
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Lyudmila DeMora
- Department of Biostatistics, Fox Chase Cancer Center-Temple Health, Philadelphia, PA, USA
| | - Nestor F Esnaola
- Department of Surgical Oncology, Fox Chase Cancer Center-Temple Health, Philadelphia, PA, USA
| | - Crystal S Denlinger
- Department of Hematology/Oncology, Fox Chase Cancer Center-Temple Health, Philadelphia, PA, USA
| | - Andreas Karachristos
- Department of Surgical Oncology, Fox Chase Cancer Center-Temple Health, Philadelphia, PA, USA
| | - Eric E Ross
- Department of Biostatistics, Fox Chase Cancer Center-Temple Health, Philadelphia, PA, USA
| | - John Hoffman
- Department of Surgical Oncology, Fox Chase Cancer Center-Temple Health, Philadelphia, PA, USA
| | - Joshua E Meyer
- Department of Radiation Oncology, Fox Chase Cancer Center-Temple Health, Philadelphia, PA, USA
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Ford ME, Bryant DC, Cartmell KB, Sterba K, Burshell DR, Hill EG, Toma AD, Knight KD, Weaver K, Calhoun E, Esnaola NF. Abstract A23: Interim Recruitment Outcomes in an NCORP-Based Patient Navigation Trial for African Americans with Early Stage Lung Cancer. Cancer Epidemiol Biomarkers Prev 2018. [DOI: 10.1158/1538-7755.disp17-a23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: Enrollment of early-stage lung cancer patients to randomized trials has historically been challenging. The STARS Trial enrolled 36 of 1,030 intended patients from 28 sites, while the ROSEL Trial recruited 22 of 960 intended patients from 10 sites. Unfortunately, evidence shows African Americans with early-stage non-small cell lung cancer (NSCLC) are significantly less likely than their European American counterparts to undergo resection and may also be less likely to participate in lung cancer trials as well.
Purpose: The purpose of this research is to describe interim recruitment results from an NIMHD-funded, NCI NCORP-based patient navigation trial conducted with African Americans with early-stage, probable/proven NSCLC.
Design: The protocol-driven, barriers-focused patient navigation intervention is being conducted in the context of a two-arm cluster-randomized trial testing the effectiveness of the intervention in increasing rates of lung-directed curative-intent therapy (surgery and SBRT) in African Americans with Stage I-II NSCLC. The two study arms consist of the protocol-driven, intensive navigation intervention vs. usual care. The trial includes 24 study sites in 13 U.S. states. Specific activities to enhance recruitment in the present trial include reaching out to referring physicians (e.g., primary care, pulmonologists, radiologists) to increase referrals of African American patients to the participating NCORP sites, and partnering with the leaders of community-engagement activities at the sites to raise community-level awareness of the trial.
Results/Conclusions: To date, 90 African American patients have been recruited and the trial is now on target to meet its expected accrual goal of 200 patients. The majority of potential participants were ineligible due to receipt of surgical resection or radiation therapy prior to enrollment (27%), not having been told that they had probable/proven NSCLC prior to study contact (32%), or a previous history of lung cancer (10%). Only 13 potential participants have refused trial participation. The median age of the 90 participants is 66 years (range 51-86 years). Most are unmarried (64%) and have a high school diploma or less (73%). Only 10 of the participants (24%) have no comorbidities. The number of enrolled-to-date African American participants in this ongoing trial exceeds the total number of participants recruited to the STARS Trial or to the ROSEL Trial.
Citation Format: Marvella E. Ford, Debbie C. Bryant. Kathleen B. Cartmell, Katherine Sterba, Dana R. Burshell, Elizabeth G. Hill, Allan De Toma, Kendrea D. Knight, Kathryn Weaver Elizabeth Calhoun, Nestor F. Esnaola. Interim Recruitment Outcomes in an NCORP-Based Patient Navigation Trial for African Americans with Early Stage Lung Cancer [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A23.
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Affiliation(s)
- Marvella E. Ford
- 1Medical University of South Carolina (MUSC), Charleston, SC,
- 2MUSC Hollings Cancer Center, Charleston, SC,
| | - Debbie C. Bryant
- 1Medical University of South Carolina (MUSC), Charleston, SC,
- 2MUSC Hollings Cancer Center, Charleston, SC,
- 3MUSC College of Nursing, Charleston, SC,
| | - Kathleen B. Cartmell
- 1Medical University of South Carolina (MUSC), Charleston, SC,
- 2MUSC Hollings Cancer Center, Charleston, SC,
- 3MUSC College of Nursing, Charleston, SC,
| | - Katherine Sterba
- 1Medical University of South Carolina (MUSC), Charleston, SC,
- 2MUSC Hollings Cancer Center, Charleston, SC,
| | - Dana R. Burshell
- 1Medical University of South Carolina (MUSC), Charleston, SC,
- 2MUSC Hollings Cancer Center, Charleston, SC,
- 3MUSC College of Nursing, Charleston, SC,
| | - Elizabeth G. Hill
- 1Medical University of South Carolina (MUSC), Charleston, SC,
- 2MUSC Hollings Cancer Center, Charleston, SC,
| | - Allan De Toma
- 1Medical University of South Carolina (MUSC), Charleston, SC,
- 2MUSC Hollings Cancer Center, Charleston, SC,
| | - Kendrea D. Knight
- 1Medical University of South Carolina (MUSC), Charleston, SC,
- 2MUSC Hollings Cancer Center, Charleston, SC,
- 3MUSC College of Nursing, Charleston, SC,
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Ford ME, Brown ET, Turner DP, Findlay VJ, Esnaola NF, Alberg AJ, Bolick S, Hurley D, Kramer R, Salley JD, Cunningham JE. Abstract A24: Triple-negative breast Cancer risk: Ancestry and immune response. Cancer Epidemiol Biomarkers Prev 2018. [DOI: 10.1158/1538-7755.disp17-a24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: Blacks in the U.S. have the worst breast cancer survival outcomes of any racial/ethnic group in the nation. However, blacks are not a monolithic group but are comprised of several ethnic groups. One such group in particular is the Sea Island or Gullah population of coastal South Carolina, North Carolina, Georgia, and Florida, whose ancestors came from coastal rice-growing areas of Africa. Sea Islanders (SI) have the lowest rates of European (non-Hispanic white) genetic admixture of any U.S. blacks, and are thus a special population who provide a rare opportunity to investigate genetic contributions to the profound ancestrally linked disparities in BC.
Purpose: The purpose of this study was to identify, for the first time, frequencies of selected single nucleotide polymorphisms (SNPs) associated with triple-negative breast cancer (TNBC) in these three non-Hispanic population groups: whites, African Americans without Sea Island ancestry (AA), and African Americans with Sea Island ancestry (SI).
Methods: Saliva samples were obtained using a mailed kit from a sample of 90 women in SC who had been diagnosed with TNBC in the past 1.5 years, recruited from the three population groups (30 women per group). Four SNPs on the 19p13 locus of BRCA 1 (rs8170, rs4808611, rs2363956, and rs3745185) were evaluated.
Results: The percentage of TNBC cases was 6.7% among whites, 4.2% among SI blacks, and 22% among non-SI blacks. After controlling for TNBC status, similar allele frequencies for each SNP were seen in whites and SI blacks, compared to non-SI blacks (p<0.01). The less genetically admixed groups (SI and whites) had a lower percentage of triple-negative breast cancer (AA vs. whites, p=0.02; AA vs. SI, p=0.03; whites vs SI: p=0.99)
Discussion: The prevalence of triple-negative breast cancer is significantly higher in African American women, and at younger ages, than in white women. Findings by Mukhtar et al. (2011) implicate immune function in the development of this aggressive breast cancer, as higher proliferating cellular nuclear antigen counts and tumor-associated macrophages were associated with hormone receptor-negative tumors and non-white ethnicity. Human populations differ in their transcriptional responses to immune challenges, and immune-responsive regulatory variants have participated in human adaptation by positive selection. Regulatory variants affecting steady-state gene expression and transcriptional responsiveness to immune challenges, particularly those that were viral related, may have been preferentially introduced into African genomes through admixture with Europeans, which may have conferred a natural selection disadvantage to modern blacks without SI ancestry. Such a natural selection disadvantage may mean that different immunologic therapeutic approaches are required for blacks with cancer than for whites with cancer, particularly for more aggressive disease.
Citation Format: Marvella E. Ford, Erika T. Brown, David P. Turner, Victoria J. Findlay, Nestor F. Esnaola, Anthony J. Alberg, Susan Bolick, Deborah Hurley, Rita Kramer, Judith D. Salley, Joan E. Cunningham. Triple-negative breast Cancer risk: Ancestry and immune response [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A24.
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Affiliation(s)
- Marvella E. Ford
- 1Medical University of South Carolina, Hollings Cancer Center, Charleston, SC,
| | | | - David P. Turner
- 1Medical University of South Carolina, Hollings Cancer Center, Charleston, SC,
| | - Victoria J. Findlay
- 1Medical University of South Carolina, Hollings Cancer Center, Charleston, SC,
| | | | - Anthony J. Alberg
- 1Medical University of South Carolina, Hollings Cancer Center, Charleston, SC,
| | - Susan Bolick
- 4South Carolina (SC) Department of Health and Environmental Control, SC Central Cancer Registry, Columbia, SC,
| | - Deborah Hurley
- 4South Carolina (SC) Department of Health and Environmental Control, SC Central Cancer Registry, Columbia, SC,
| | - Rita Kramer
- 1Medical University of South Carolina, Hollings Cancer Center, Charleston, SC,
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Gonzalez ET, Washington A, Esnaola NF. Abstract A22: Improving the community's understanding of research through lay ambassadors. Cancer Epidemiol Biomarkers Prev 2018. [DOI: 10.1158/1538-7755.disp17-a22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Clinical trials are pathways to the discovery of effective new methods of prevention, treatment and rehabilitation for many diseases, including cancer. In addition, the collection of biospecimens is a critical element in emerging genetic and biologic studies. However, evidence has shown that despite the increasing advances in newly developed novel and targeted biologic therapies and the compelling scientific and social justice arguments for participation by all populations, ethnic and racial minorities continue to be under-represented. One key reason noted is the lack of awareness minority populations have regarding research options. Through our Community Ambassador Training program, we established a connection with African American audiences by educating trusted community stakeholders and representatives about the importance of research participation and how the research process works. Working through community partners and building on prior research efforts, Community Health Educators (CHE) funded by NCI's Center to Reduce Cancer Health Disparities recruited 21 African American lay educators (cancer and noncancer survivors) to participate in the study. Results from the training include changes in knowledge, attitudes, and intent to participate in research; dissemination reach; lessons learned; and next steps in our efforts to enhance and expand the program to address this gap in research participation.
Citation Format: Evelyn T. Gonzalez, Armenta Washington, Nestor F. Esnaola. Improving the community's understanding of research through lay ambassadors [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A22.
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Moten AS, Movva S, von Mehren M, Wu H, Esnaola NF, Reddy SS, Farma JM. Granular cell tumor experience at a comprehensive cancer center. J Surg Res 2018; 226:1-7. [DOI: 10.1016/j.jss.2018.01.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 12/10/2017] [Accepted: 01/17/2018] [Indexed: 12/20/2022]
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Regnante J, Richie N, Fashoyin-Aje L, Hall LL, Clark L, Dang J, Esnaola NF, Ford ME, Gonzalez E, Highsmith Q, Hoover SC, Larkins G, Lee SC, Louis J, McNeill LH, Petereit D, Vichnin M, Williams EF, Obasaju CK. Strategies associated with enhanced inclusion of racial and ethnic minorities in clinical cancer research: US Centers of Excellence current practices. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e18643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Lola Fashoyin-Aje
- Office of Hematology and Oncology Products, Office of New Drugs, Silver Spring, MD
| | | | | | - Julie Dang
- University of California, Davis Comprehensive Cancer Center, Sacramento, CA
| | - Nestor F. Esnaola
- Department of Surgical Oncology, Cancer Health Disparities and Community Engagement, Philadelphia, PA
| | | | | | | | | | | | - Simon Craddock Lee
- Department of Clinical Sciences UT Southwestern Medical Center and Harold C. Simmons Comprehensive Cancer Center, Dallas, TX
| | | | - Lorna H McNeill
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Daniel Petereit
- Avera Cancer Care Institute Sioux Falls and Rapid City Regional Cancer Care Institute, Rapid City, SD
| | | | - Erin Fenske Williams
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
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Cartmell KB, Sterba KR, Pickett K, Zapka J, Alberg AJ, Sood AJ, Esnaola NF. Availability of patient-centered cancer support services: A statewide survey of cancer centers. PLoS One 2018; 13:e0194649. [PMID: 29584744 PMCID: PMC5870953 DOI: 10.1371/journal.pone.0194649] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 03/07/2018] [Indexed: 12/05/2022] Open
Abstract
The Institute of Medicine recommended in their landmark report “From Cancer Patient to Cancer Survivor: Lost in Transition” that services to meet the needs of cancer patients should extend beyond physical health issues to include functional and psychosocial consequences of cancer. However, no systems exist in the US to support state-level data collection on availability of support services for cancer patients. Developing a mechanism to systematically collect these data and document service availability is essential for guiding comprehensive cancer control planning efforts. This study was carried out to develop a protocol for implementing a statewide survey of all Commission on Cancer (CoC) accredited cancer centers in South Carolina and to implement the survey to examine availability of patient support services within the state. We conducted a cross-sectional survey of CoC-certified cancer centers in South Carolina. An administrator at each center completed a survey on availability of five services: 1) patient navigation; 2) distress screening; 3) genetic risk assessment and counseling, 4) survivorship care planning; and 5) palliative care. Completed surveys were received from 16 of 17 eligible centers (94%). Of the 16 centers, 44% reported providing patient navigation; 31% reported conducting distress screening; and 44% reported providing genetic risk assessment and counseling. Over 85% of centers reported having an active palliative care program, palliative care providers and a hospice program, but fewer had palliative outpatient services (27%), palliative inpatient beds (50%) or inpatient consultation teams (31%). This was a small, yet systematic survey in one state. This study demonstrated a practical method for successfully monitoring statewide availability of cancer patient support services, including identifying service gaps.
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Affiliation(s)
- Kathleen B. Cartmell
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States of America
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States of America
- * E-mail:
| | - Katherine R. Sterba
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States of America
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States of America
| | - Kim Pickett
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States of America
| | - Jane Zapka
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States of America
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States of America
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States of America
| | - Anthony J. Alberg
- Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
| | - Amit J. Sood
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States of America
| | - Nestor F. Esnaola
- Department of Surgery, Fox Chase Cancer Center, Philadelphia, PA, United States of America
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Shaikh T, Handorf EA, Meyer JE, Hall MJ, Esnaola NF. Mismatch Repair Deficiency Testing in Patients With Colorectal Cancer and Nonadherence to Testing Guidelines in Young Adults. JAMA Oncol 2018; 4:e173580. [PMID: 29121143 DOI: 10.1001/jamaoncol.2017.3580] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Importance Mismatch repair (MMR) deficiency of DNA has been observed in up to 15% of sporadic colorectal cancers (CRCs) and is a characteristic feature of Lynch syndrome, which has a higher incidence in young adults (age, <50 years) with CRC. Mismatch repair deficiency can be due to germline mutations or epigenetic inactivation, affects prognosis and response to systemic therapy, and results in unrepaired repetitive DNA sequences, which increases the risk of multiple malignant tumors. Objective To evaluate the utilization of MMR deficiency testing in adults with CRC and analyze nonadherence to long-standing testing guidelines in younger adults using a contemporary national data set to help identify potential risk factors for nonadherence to newly implemented universal testing guidelines. Design, Setting, and Participants Adult (age, <30 to ≥70 years) and, of these, younger adult (<30 to 49 years) patients with invasive colorectal adenocarcinoma diagnosed between 2010 and 2012 and known MMR deficiency testing status were identified using the National Cancer Database. The study was conducted from March 16, 2016, to March 1, 2017. Exposures Patient sociodemographic, facility, tumor, and treatment characteristics. Main Outcomes and Measures The primary outcome of interest was receipt of MMR deficiency testing. Multivariable logistic regression was used to identify independent predictors of testing in adult and/or young adult patients. Results A total of 152 993 adults with CRC were included in the study (78 579 [51.4%] men; mean [SD] age, 66.9 [13.9] years). Of these patients, only 43 143 (28.2%) underwent MMR deficiency testing; the proportion of patients tested increased between 2010 and 2012 (22.3% vs 33.1%; P<.001). Among 17 218 younger adult patients with CRC, only 7422 (43.1%) underwent MMR deficiency testing; the proportion tested increased between 2010 and 2012 (36.1% vs 48.0%; P < .001). Irrespective of age, higher educational level (OR, 1.38; 95% CI, 1.15-1.66), later diagnosis year (OR, 1.81; 95% CI, 1.65-1.98), early stage disease (OR, 1.24; 95% CI, 1.18-1.30), and number of regional lymph nodes examined (≥12) (OR, 1.44; 95% CI, 1.34-1.55) were independently associated with MMR deficiency testing, whereas older age (OR, 0.31; 95% CI, 0.26-0.37); Medicare (OR, 0.89; 95% CI, 0.84-0.95), Medicaid (OR, 0.83; 95% CI, 0.73-0.93), or uninsured (OR, 0.78; 95% CI, 0.66-0.92) status; nonacademic vs academic/research facility type (OR, 0.44; 95% CI, 0.34-0.56); rectosigmoid or rectal tumor location (OR, 0.76; 95% CI, 0.68-0.86); unknown grade (OR, 0.61; 95% CI, 0.53-0.69); and nonreceipt of definitive surgery (OR, 0.33; 95% CI, 0.30-0.37) were associated with underuse of MMR deficiency testing. Conclusions and Relevance Despite recent endorsement of universal use of MMR deficiency testing in patients with CRC and well-established guidelines aimed at high-risk populations, overall utilization of testing is poor and significant underuse of testing among young adults persists. Interventions tailored to groups at risk for nonadherence to guidelines may be warranted in the current era of universal testing.
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Affiliation(s)
- Talha Shaikh
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Elizabeth A Handorf
- Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Joshua E Meyer
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Michael J Hall
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Nestor F Esnaola
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
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Goel N, Ward WH, DeMora L, Manstein S, Smaldone MC, Farma JM, Chu C, Kutikov A, Chen D, Lango M, Viterbo R, Ridge JA, Ross EA, Uzzo R, Esnaola NF. Outcomes after major cancer surgery: Can we predict them using parsimonious models? J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
811 Background: Major cancer surgery is associated with significant risks of morbidity/mortality. Retrospective studies have demonstrated an association between Surgical Apgar Score (SAS) and postoperative risk of serious complications (SC). This study prospectively evaluated the predictive value of SAS to predict SC, as well as other adverse postoperative outcomes and length of stay (LOS), both singly and in combination with parsimonious measures of “fitness for surgery” (American Society of Anesthesiology [ASA] classification) and surgical complexity (work relative value units [wRVU]). Methods: Demographic, comorbidity, procedure, intraoperative, and outcome data was collected prospectively for 442 cancer patients undergoing elective major surgery between 2014-17. ASA and wRVU were assigned preoperatively; SAS was calculated postoperatively. Logistic regression was used to analyze association of ASA versus (vs) wRVU vs SAS vs ASA/wRVU/SAS (combined) with perioperative outcomes, including SC, return to the operating room (ROR), not being discharged to home, and unplanned readmission; areas under receiver operator characteristic curves were calculated to assess predictive accuracy. Accelerated failure time models were used to analyze associations with LOS and compared using Harrell’s concordance index. Results: Predictive accuracy of SAS for SC was modest (AUC0.655) and not improved when controlling for ASA and wRVU (both of which had poor predictive accuracy for SC). Both wRVU (AUC 0.634) and SAS (AUC 0.663) had modest predictive accuracies for ROR, whereas the predictive accuracy of ASA (AUC 0.749) surpassed that of wRVU (AUC 0.630) for not being discharged to home. All 3 measures were poor at predicting readmission. In contrast, the predictive accuracy of ASA, wRVU, and SAS for LOS was highest when combined (AUC 0.699). Conclusions: Commonly used, simple measures of comorbidity/functional status and surgical complexity can help predict risk of ROR and not being discharged to home (respectively), whereas only SAS has sufficient (albeit modest) discriminatory ability to predict risk of SC. All three measures are too coarse to predict unplanned readmission, but when used in combination, can help predict LOS.
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Affiliation(s)
- Neha Goel
- Fox Chase Cancer Center, Philadelphia, PA
| | | | | | | | | | | | | | | | - David Chen
- Fox Chase Cancer Center, Philadelphia, PA
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24
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Shulman RM, Avkshtol V, DeMora L, Esnaola NF, Hall MJ, Handorf E, Meyer JE. Microsatellite instability as a predictive marker for response to neoadjuvant chemoradiation in locally advanced rectal cancer. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
806 Background: Microsatellite instability (MSI) is a marker for hypermutability due to impaired DNA mismatch repair and has been shown to be a favorable prognostic marker in colon cancer. We examined the role of MSI in locally advanced rectal cancer (LARC) as a predictive marker for response to neoadjuvant chemoradiation (CRT). Methods: We identified T3-T4 or ≥ N1 rectal cancer with reported MSI status in the National Cancer Data Base from 2007 – 2012. Patients were eligible if they were treated with CRT followed by surgical resection. Squamous cell and carcinoid histologies were excluded. The primary outcome was neoadjuvant rectal (NAR) score, categorized as low ( < 8), intermediate (8-16), and high ( > 16), representing a good, intermediate, and poor response to CRT, respectively. The secondary outcomes were complete pathologic response (ypCR) rate and overall survival (OS). Chi-square, Fisher’s exact, and independent sample t-tests were used to compare MSI status. Multivariable logistic regression models were used to examine factors associated with increasing level of NAR score and ypCR. OS was examined using multivariable Cox proportional hazards models. Results: A total of 1849 patients were eligible for the study and were classified as MSI-high (n = 52) or MSI-low/stable (n = 1797). Patients in the MSI-high group were younger (median age 50.5 vs 57.0, p = 0.005) and had higher rates of mucinous and signet ring histology (p < 0.001), clinical T4 disease (p = 0.001), and clinically positive lymph nodes (p = 0.049). The two groups did not differ in gender, race, grade, or resection margin status. While clinical T and N stage, histology, LVI, tumor grade, and PNI were correlated with the NAR score groups, MSI-high status was not significantly associated with a higher NAR score group on multivariable analysis (OR 1.168, 95% CI 0.673 – 2.028). The MSI-high group also did not differ significantly from MSI-low/stable group in ypCR rate (OR 0.748, 95% CI 0.179 – 3.115) or OS (HR 1.727, 95% CI 0.864 – 3.453) on multivariable analysis. Conclusions: MSI status in LARC was not associated with NAR score, ypCR rate, or OS. Our results do not support the use of MSI status as a predictive marker for response to CRT in LARC.
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25
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Waingankar N, Esnaola NF, Uzzo RG. A structured framework for optimizing surgical quality through process-of-care trials. Urol Oncol 2017; 35:177-179. [PMID: 29037530 DOI: 10.1016/j.urolonc.2017.03.017] [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: 11/24/2016] [Revised: 03/08/2017] [Accepted: 03/15/2017] [Indexed: 11/30/2022]
Abstract
Increased national focus has been placed on care delivery processes and their effect on health care quality. At the institutional level, investigators are increasingly engaged in surgical process-of-care trials that, compared to traditional randomized treatment trials, more explicitly control and mitigate provider- and system-based risk. Process-of-care trials have the potential to improve patient care while also improving the culture of a surgical department, hospital, and system.
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Affiliation(s)
- Nikhil Waingankar
- Department of UrologyDepartment of Population Health Science and Policy Icahn School of MedicineThe Mount Sinai HospitalNew York, NY; Department of Surgical Oncology Fox Chase Cancer Center - Temple Health Philadelphia, PA.
| | - Nestor F Esnaola
- Department of Surgical Oncology, Fox Chase Cancer Center-Temple Health, Philadelphia, PA
| | - Robert G Uzzo
- Department of Surgical Oncology, Fox Chase Cancer Center-Temple Health, Philadelphia, PA
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26
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Zaorsky NG, Williams GR, Barta SK, Esnaola NF, Kropf PL, Hayes SB, Meyer JE. (P088) Splenic Irradiation for Splenomegaly: A Meta-Analysis. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.02.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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27
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Smith JK, Esnaola NF. Utilization of minimally invasive versus open colectomy for colon cancer and perioperative/short-term oncologic outcomes: Are we there yet? J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
733 Background: Randomized controlled trials (RCTs) in highly-selected patient populations demonstrated equivalent outcomes following minimally invasive colectomy (MIC) versus (vs) open colectomy (OC) for colon cancer. The purpose of this study was to evaluate utilization of MIC and compare perioperative/short-term oncologic outcomes after MIC vs OC in a large, generalizable, national sample. Methods: We identified adult patients with invasive colon adenocarcinoma who underwent elective surgical resection between 2010 and 2012 using the National Cancer Data Base. Univariate associations between patient/tumor/facility/treatment characteristics and surgical approach were analyzed using chi-square tests. Multivariable logistic regression was used to identify independent predictors of receipt of MIC, as well as to evaluate independent associations between surgical approach and outcomes. Results: Among 111,372 patients identified, 48,393 (43.5%) underwent MIC; the proportion who underwent MIC increased between 2010 (37.8%) and 2012 (49%; p < 0.001). High education level (adjusted odds ratio [aOR] 1.13) and increasing income level (aOR 1.09-1.36) were independently associated with receipt of MIC, whereas black race (aOR 0.85), Medicare (aOR 0.86)/Medicaid (aOR 0.67)/uninsured status (aOR 0.57), non-metropolitan residence (aOR 0.92), and community (aOR 0.63) or other (aOR 0.58) cancer programs were independently associated with potential underuse. Mean length of stay was shorter following MIC vs OC (6.07 vs 7.68 days; p < 0.001). Use of MIC was independently associated with reduced 30-day (aOR 0.6) and 90-day (aOR 0.62) mortality, as well as lower rate of positive surgical margins (aOR 0.69) and higher rate of regional lymph nodes examined > = 12 (aOR 1.14). Conclusions: This study confirms that MIC is associated with favorable perioperative/short-term oncologic outcomes (compared to OC), as demonstrated in RCTs. Although utilization of MIC for colon cancer continues to rise, implementation studies are warranted to enhance access to optimal surgical care and eradicate persistent disparities in receipt of MIC among historically underserved populations.
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Ford ME, Bryant DC, Cartmell KB, Sterba K, Burshell DR, Hill EG, Toma AD, Knight KD, Weaver K, Calhoun E, Esnaola NF. Abstract A72: Interim Recruitment Outcomes in an NCORP-Based Patient Navigation Trial for African Americans with Early Stage Lung Cancer. Cancer Epidemiol Biomarkers Prev 2017. [DOI: 10.1158/1538-7755.disp16-a72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
BACKGROUND: Enrollment of early stage lung cancer patients to randomized trials has historically been challenging. The STARS Trial enrolled 36 of 1,030 intended patients from 28 sites, while the ROSEL Trial recruited 22 of 960 intended patients from 10 sites. Unfortunately, evidence shows African Americans with early stage, NSCLC are significantly less likely than their European American counterparts to undergo resection and may also be less likely to participate in lung cancer trials as well.
PURPOSE: The purpose of this research is to describe interim recruitment results from an NIMHD-funded, NCI NCORP-based patient navigation trial conducted with African Americans with early stage, probable/proven non-small cell lung cancer (NSCLC).
DESIGN: The protocol-driven, barriers-focused patient navigation intervention is being conducted in the context of a two-arm cluster-randomized trial testing the effectiveness of the intervention in increasing rates of lung-directed curative-intent therapy (surgery and SBRT) in African Americans with Stage I-II NSCLC. The 2 study arms consist of the protocol-driven, intensive navigation intervention vs. usual care. The trial includes 24 study sites in 13 US states. Specific activities to enhance recruitment in the present trial include reaching out to referring physicians (e.g., primary care, pulmonologists, radiologists) to increase referrals of African American patients to the participating NCORP sites, and partnering with the leaders of community engagement activities at the sites to raise community-level awareness of the trial.
RESULTS/CONCLUSIONS: To date, 64 African American patients have been recruited and the trial is now on target to meet its expected accrual goal of 200 patients. The majority of potential participants were ineligible due to receipt of surgical resection or radiation therapy prior to enrollment (32%), not having been told that they had probable/proven NSCLC prior to study contact (13%) or a previous history of lung cancer (13%). Only 9 potential participants have refused trial participation. The median age of the 64 participants is 64 years (range 37-86 years). Most are unmarried (64%) and have a high school diploma or less (72%). Only 13 of the participants (20%) have no comorbidities. The number of enrolled-to-date African American participants in this ongoing trial exceeds the total number of participants recruited to the STARS Trial or to the ROSEL Trial.
Citation Format: Marvella E. Ford, Debbie C. Bryant, Kathleen B. Cartmell, Katherine Sterba, Dana R. Burshell, Elizabeth G. Hill, Allan De Toma, Kendrea D. Knight, Kathryn Weaver, Elizabeth Calhoun, Nestor F. Esnaola. Interim Recruitment Outcomes in an NCORP-Based Patient Navigation Trial for African Americans with Early Stage Lung Cancer. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A72.
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Affiliation(s)
- Marvella E. Ford
- 1Medical University of South Carolina (MUSC) Hollings Cancer Center, Charleston, SC,
| | - Debbie C. Bryant
- 2Medical University of South Carolina (MUSC) College of Nursing, Charleston, SC,
| | - Kathleen B. Cartmell
- 2Medical University of South Carolina (MUSC) College of Nursing, Charleston, SC,
| | - Katherine Sterba
- 1Medical University of South Carolina (MUSC) Hollings Cancer Center, Charleston, SC,
| | - Dana R. Burshell
- 2Medical University of South Carolina (MUSC) College of Nursing, Charleston, SC,
| | - Elizabeth G. Hill
- 1Medical University of South Carolina (MUSC) Hollings Cancer Center, Charleston, SC,
| | - Allan De Toma
- 1Medical University of South Carolina (MUSC) Hollings Cancer Center, Charleston, SC,
| | - Kendrea D. Knight
- 1Medical University of South Carolina (MUSC) Hollings Cancer Center, Charleston, SC,
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Zaorsky NG, Williams GR, Barta SK, Esnaola NF, Kropf PL, Hayes SB, Meyer JE. Splenic irradiation for splenomegaly: A systematic review. Cancer Treat Rev 2017; 53:47-52. [PMID: 28063304 PMCID: PMC7537354 DOI: 10.1016/j.ctrv.2016.11.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 10/10/2016] [Revised: 11/19/2016] [Accepted: 11/29/2016] [Indexed: 10/20/2022]
Abstract
Splenic irradiation (SI) is a palliative treatment option for symptomatic splenomegaly (i.e. for pain, early satiety, pancytopenia from sequestration) secondary to hematologic malignancies and disorders. The purpose of the current article is to review the literature on SI for hematologic malignancies and disorders, including: (1) patient selection and optimal technique; (2) efficacy of SI; and (3) toxicities of SI. PICOS/PRISMA methods are used to select 27 articles including 766 courses of SI for 486 patients from 1960 to 2016. The most common cancers treated included chronic lymphocytic leukemia and myeloproliferative disorders; the most common regimen was 10Gy in 1Gy fractions over two weeks, and 27% of patients received retreatment. A partial or complete response (for symptoms, lab abnormalities) was obtained in 85-90% of treated patients, and 30% were retreated within 6-12months. There was no correlation between biologically equivalent dose of radiation therapy and response duration, pain relief, spleen reduction, or cytopenia improvement (r2 all <0.4); therefore, lower doses (e.g. 5Gy in 5 fractions) may be as effective as higher doses. Grade 3-4 toxicity (typically leukopenia, infection) was noted in 22% of courses, with grade 5 toxicity in 0.7% of courses. All grade 5 toxicities were due to either thrombocytopenia with hemorrhage or leukopenia with sepsis (or a combination of both); they were sequelae of cancer and not directly caused by SI. In summary, SI is generally a safe and efficacious method for treating patients with symptomatic splenomegaly.
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Affiliation(s)
- Nicholas G Zaorsky
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
| | - Graeme R Williams
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Stefan K Barta
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Nestor F Esnaola
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Patricia L Kropf
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Shelly B Hayes
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Joshua E Meyer
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
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Shaikh T, Handorf E, Meyer JE, Hall MJ, Esnaola NF. Underuse of microsatellite instability testing and predictors of high microsatellite instability disease among young colorectal cancer patients. J Clin Oncol 2017; 35:534-534. [DOI: 10.1200/jco.2017.35.4_suppl.534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
534 Background: The purpose was to identify predictors of non-adherence to MSI testing in young CRC patients and identify factors associated with an increased risk of high microsatellite instability (MSI-H) disease. Methods: Patients 18-49 years old diagnosed with invasive colorectal adenocarcinoma between 2010-2012 and known MSI testing status were identified using the National Cancer Data Base. Multivariable logistic regression was used to identify independent predictors of receipt of MSI testing, as well as MSI-H status among those tested. Results: Among 17,218 patients identified, only 7,422 (43%) underwent MSI testing; the proportion of patients tested increased between 2010 (36%) and 2012 (48%; p < 0.001). Higher educational level, early stage disease, and number of regional lymph nodes examined > 12 were independently associated with MSI testing, whereas older age (40-49), Hispanic ethnicity, non-private insurance status, non-academic/research facility, facility location, rectosigmoid/rectal tumor location, non-mucinous histology, unknown grade, non-receipt of definitive surgery were associated with underuse. Among 6,358 tested patients with known MSI status, 531 (8%) patients had MSI-H disease. Lower income, previous cancer history, and stage II disease were independently associated with MSI-H status, whereas older age (40-49), female sex, advanced comorbidity, non-metropolitan facility status, facility location, distal tumor location, non-mucinous histology, unknown/lower tumor grade, and non-receipt of chemotherapy were inversely associated with MSI-H status. Conclusions: Despite national guidelines, significant underuse of routine MSI testing in young patients diagnosed with colorectal cancer persists. Interventions are warranted to improve adherence to guideline-based care in these patients, particularly among those at increased risk of MSI-H disease. [Table: see text]
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Mohanty S, Rosenthal RA, Russell MM, Neuman MD, Ko CY, Esnaola NF. Optimal Perioperative Management of the Geriatric Patient: A Best Practices Guideline from the American College of Surgeons NSQIP and the American Geriatrics Society. J Am Coll Surg 2016; 222:930-47. [DOI: 10.1016/j.jamcollsurg.2015.12.026] [Citation(s) in RCA: 336] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 12/14/2015] [Indexed: 12/21/2022]
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Esnaola NF, Bryant DC, Cartmell KB, Calhoun E, Sterba K, Burshell DR, Hill EG, Wahlquist AE, Knight KD, Ford ME. Abstract C45: A patient navigation model to increase rates of lung-directed therapy with curative intent (LDTCI) in African Americans with early stage non-small cell lung cancer (NSCLC). Cancer Epidemiol Biomarkers Prev 2016. [DOI: 10.1158/1538-7755.disp15-c45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: LDTCI (i.e., surgical resection or stereotactic body radiation therapy [SBRT] in patients who are not surgical candidates]) is the standard of care for patients with early stage NSCLC. Unfortunately, African Americans with early stage, NSCLC are significantly less likely than their European American counterparts to undergo resection.
Purpose: This presentation will describe the design of an NIH/NIMHD-funded, NCORP-sponsored, cluster-randomized trial testing the effectiveness of a barriers-focused, protocol-driven patient navigation intervention on increasing rates of LDTCI in African Americans with early stage, probable/proven NSCLC.
Design: The trial is currently being conducted at 13 study sites across the United States. The investigators developed an electronic, web-based version of the NIH/NCI Patient Navigation Barrier Checklist. Patient navigators at each intervention site use the electronic Checklist to identify patient barriers to care and guide their interactions with patients. The navigators then enter the data from these interactions into a secure, web-based electronic data management system.
Results/Conclusions: Most of the African American patients at the study sites are ineligible for study participation due to advanced stage at diagnosis. Of the 2,529 patients who have been pre-screened for study eligibility to date, only 43 (1.7%) were determined to be African American with likely/proven stage I-II NSCLC. Of this number, 34 (79.1%) were consented for the study, and 29 are currently enrolled. During this presentation, the investigators will present de-identified case examples of barriers experienced by patients and the strategies used by the navigators to overcome these barriers. Plans are underway to add study sites to increase the denominator of potentially eligible participants.
Citation Format: Nestor F. Esnaola, Debbie C. Bryant, Kathleen B. Cartmell, Elizabeth Calhoun, Katherine Sterba, Dana R. Burshell, Elizabeth G. Hill, Amy E. Wahlquist, Kendrea D. Knight, Marvella E. Ford. A patient navigation model to increase rates of lung-directed therapy with curative intent (LDTCI) in African Americans with early stage non-small cell lung cancer (NSCLC). [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C45.
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Affiliation(s)
| | - Debbie C. Bryant
- 2Medical University of South Carolina (MUSC) Hollings Cancer Center, Charleston, SC,
| | - Kathleen B. Cartmell
- 3Medical University of South Carolina (MUSC) College of Nursing, Charleston, SC,
| | | | - Katherine Sterba
- 2Medical University of South Carolina (MUSC) Hollings Cancer Center, Charleston, SC,
| | - Dana R. Burshell
- 3Medical University of South Carolina (MUSC) College of Nursing, Charleston, SC,
| | - Elizabeth G. Hill
- 2Medical University of South Carolina (MUSC) Hollings Cancer Center, Charleston, SC,
| | - Amy E. Wahlquist
- 2Medical University of South Carolina (MUSC) Hollings Cancer Center, Charleston, SC,
| | - Kendrea D. Knight
- 2Medical University of South Carolina (MUSC) Hollings Cancer Center, Charleston, SC,
| | - Marvella E. Ford
- 2Medical University of South Carolina (MUSC) Hollings Cancer Center, Charleston, SC,
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Hui JYC, Li T, Ross EA, Esnaola NF. Perioperative outcomes following composite resections for colorectal cancer with liver metastases: Can we do better? J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.4_suppl.412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
412 Background: Curative resection for synchronous colorectal cancer and liver metastases (CRC/LM) can be performed simultaneously as composite resections or in isolation as staged resections. Composite resections expedite care and may be more cost-effective, but there is persistent controversy regarding their safety. This study aimed to identify potentially modifiable differences in adverse perioperative outcomes after composite versus (vs) isolated resection for CRC/LM. Methods: All patients (pts) with CRC/LM in the American College of Surgeons-National Surgical Quality Improvement Program Participant Use File who underwent elective colon, rectal, and/or liver resections from 2005 to 2013 were identified. Patient/procedure characteristics and perioperative outcomes were compared in pts who had isolated colon or rectal resection (CR or RR), isolated liver resection (LR), or composite colon/liver or rectal/liver resection (CLR or RLR) using chi square or Wilcoxon tests. Multiple logistic regression models were used to determine the independent effect of resection type on outcomes. Results: 13,523 pts underwent CR (3,601; 26.6%), RR (2,018; 14.9%), LR (7,002; 51.8%), CLR (513; 3.8%), or RLR (389; 2.9%). In colon cancer pts, the 30-day (30-d) rate of death/serious complication (DSC) was significantly higher after CLR (33.7%) than after CR (22.0%; adjusted odds ratio [aOR] 0.41, 95% confidence interval [95% CI], 0.33 to 0.52) or LR (13.9%; aOR 0.33; 95% CI, 0.27 to 0.41). Similarly, in rectal cancer pts, the 30-d rate of DSC was significantly higher after RLR (24.7%) than after RR (21.5%; aOR 0.66; 95% CI, 0.50 to 0.88) or LR (13.9%; aOR 0.47; 95% CI, 0.36 to 0.62). Differences in adverse outcomes following composite resections were not due to mortality, but to higher rates of pulmonary/infectious complications and returns to the operating room. Conclusions: Composite resections for CRC/LM are associated with higher rates of DSC, particularly in colon cancer pts. Aggressive targeted strategies to prevent pulmonary and infectious complications could significantly improve outcomes in pts undergoing composite resections for synchronous CRC/LM.
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Affiliation(s)
| | - Tianyu Li
- Fox Chase Cancer Center, Philadelphia, PA
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Esnaola NF, Meyer JE, Karachristos A, Maranki JL, Camp ER, Denlinger CS. Evaluation and management of intrahepatic and extrahepatic cholangiocarcinoma. Cancer 2016; 122:1349-69. [PMID: 26799932 DOI: 10.1002/cncr.29692] [Citation(s) in RCA: 175] [Impact Index Per Article: 21.9] [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: 06/19/2015] [Revised: 08/18/2015] [Accepted: 08/19/2015] [Indexed: 12/13/2022]
Abstract
Cholangiocarcinomas are rare biliary tract tumors that are often challenging to diagnose and treat. Cholangiocarcinomas are generally categorized as intrahepatic or extrahepatic depending on their anatomic location. The majority of patients with cholangiocarcinoma do not have any of the known or suspected risk factors and present with advanced disease. The optimal evaluation and management of patients with cholangiocarcinoma requires thoughtful integration of clinical information, imaging studies, cytology and/or histology, as well as prompt multidisciplinary evaluation. The current review focuses on recent advances in the diagnosis and treatment of patients with cholangiocarcinoma and, in particular, on the role of endoscopy, surgery, transplantation, radiotherapy, systemic therapy, and liver-directed therapies in the curative or palliative treatment of these individuals. Cancer 2016;122:1349-1369. © 2016 American Cancer Society.
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Affiliation(s)
- Nestor F Esnaola
- Department of Surgery, Fox Chase Cancer Center-Temple Health, Philadelphia, Pennsylvania
| | - Joshua E Meyer
- Department of Radiation Oncology, Fox Chase Cancer Center-Temple Health, Philadelphia, Pennsylvania
| | - Andreas Karachristos
- Department of Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Jennifer L Maranki
- Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - E Ramsay Camp
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Crystal S Denlinger
- Department of Hematology/Oncology, Fox Chase Cancer Center-Temple Health, Philadelphia, Pennsylvania
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Cunningham JE, Bauza CE, Brown ET, Anthony AJ, Kistner-Griffin E, Spruill IJ, Bryant DC, Esnaola NF, Jefferson MS, Whitfield K, Kramer RM, Bolick S, Hurley D, Mosley C, Hazelton TR, Bea VJ, Burshell DR, Knight KD, Ford ME. Abstract B27: Overweight/obesity and physical activity rates in an ethnically diverse sample of breast cancer survivors. Cancer Epidemiol Biomarkers Prev 2015. [DOI: 10.1158/1538-7755.disp14-b27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: High body mass index (BMI) is linked to poorer survival after breast cancer diagnosis. Physical activity (PA) could moderate this association.
Objectives/Hypothesis: Prevalence of high BMI (overweight/obesity) and level of PA were evaluated in a statewide sample of women within 18 months of breast cancer diagnosis.
Methods: In an ongoing study, 73 women (35 EA and 38 AA) were identified through the SC Central Cancer Registry, and were interviewed to obtain their self-reported body weight, height, PA and other data.
Results: Age: Age ranged from 26 to 90 years (mean 61 years, SD 13.0), with AAs 2.1 years younger than EAs (p=0.49). Education: 62% had more than a high school (HS) diploma (58% of AAs and 66% of EAs, p=0.49). BMI: 77% were overweight/obese; 42% of AAs and 31% of EAs were overweight, 45% of AAs and 34% of EAs were obese (p=0.03). PA: 23% reported no PA (29% of AAs and 17% of EAs, p=0.23). Only 38% met CDC PA guidelines of at least 150 min/week of moderate PA (29% of AAs and 47% of EAs; p=0.11). PA and BMI: PA <90 min/week was associated with 4-fold higher risk of overweight/ obesity (p=0.023). No significant associations were seen by race. PA and Education: No significant association was observed between >HS education and meeting PA guidelines (p=0.15), or between >HS education and greater PA per week (p=0.57). Education and BMI: No significant association was seen (p=0.77).
Conclusions: Prevalence of overweight/obesity was high, especially among AAs.
Future Recommendations: It is imperative to identify strategies to reduce obesity/overweight in BRCA survivors.
Citation Format: Joan E. Cunningham, Colleen E. Bauza, Erika T. Brown, Alberg J. Anthony, Emily Kistner-Griffin, Ida J. Spruill, Debbie C. Bryant, Nestor F. Esnaola, Melanie S. Jefferson, Keith Whitfield, Rita M. Kramer, Susan Bolick, Deborah Hurley, Catishia Mosley, Tonya R. Hazelton, Vivian J. Bea, Dana R. Burshell, Kendrea D. Knight, Marvella E. Ford. Overweight/obesity and physical activity rates in an ethnically diverse sample of breast cancer survivors. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B27.
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Affiliation(s)
| | - Colleen E. Bauza
- 2Medical University of South Carolina (MUSC) Hollings Cancer Center, Charleston, SC,
| | | | - Alberg J. Anthony
- 2Medical University of South Carolina (MUSC) Hollings Cancer Center, Charleston, SC,
| | - Emily Kistner-Griffin
- 2Medical University of South Carolina (MUSC) Hollings Cancer Center, Charleston, SC,
| | - Ida J. Spruill
- 4Medical University of South Carolina (MUSC), Charleston, SC,
| | - Debbie C. Bryant
- 2Medical University of South Carolina (MUSC) Hollings Cancer Center, Charleston, SC,
| | | | - Melanie S. Jefferson
- 2Medical University of South Carolina (MUSC) Hollings Cancer Center, Charleston, SC,
| | | | - Rita M. Kramer
- 2Medical University of South Carolina (MUSC) Hollings Cancer Center, Charleston, SC,
| | - Susan Bolick
- 7South Carolina of Health and Environmental Control, South Carolina Central Cancer Registry, Columbia, SC
| | - Deborah Hurley
- 7South Carolina of Health and Environmental Control, South Carolina Central Cancer Registry, Columbia, SC
| | - Catishia Mosley
- 7South Carolina of Health and Environmental Control, South Carolina Central Cancer Registry, Columbia, SC
| | - Tonya R. Hazelton
- 2Medical University of South Carolina (MUSC) Hollings Cancer Center, Charleston, SC,
| | - Vivian J. Bea
- 2Medical University of South Carolina (MUSC) Hollings Cancer Center, Charleston, SC,
| | | | - Kendrea D. Knight
- 2Medical University of South Carolina (MUSC) Hollings Cancer Center, Charleston, SC,
| | - Marvella E. Ford
- 2Medical University of South Carolina (MUSC) Hollings Cancer Center, Charleston, SC,
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Abstract
Pancreatic cancer is the fourth leading cause of cancer deaths in the USA. Although some patients will present with premalignant pancreatic lesions (i.e., intraductal papillary mucinous neoplasms) or localized tumors amenable to curative resection, the majority of patients will unfortunately present with technically unresectable or metastatic disease. This review of the recent medical literature will discuss the optimal work-up and management of premalignant pancreatic lesions and the surgical management of localized, borderline resectable, and locally advanced (i.e., unresectable) pancreatic tumors. It will focus on new criteria used to define surgical "resectability," the significance and clinical impact of surgical margins, the role of multimodality therapy in the management of patients with borderline resectable or locally advanced tumors, the role of surgery for local or distant recurrence, and minimally invasive surgical approaches.
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Affiliation(s)
- Andreas Karachristos
- Division of Surgical Oncology, Department of Surgery, Temple University School of Medicine, 3401 N. Broad Street, Suite 330 (NFE) and 640 (AK), Philadelphia, PA, 19140, USA,
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Esnaola NF, Chaudhary UB, O'Brien P, Garrett-Mayer E, Camp ER, Thomas MB, Cole DJ, Montero AJ, Hoffman BJ, Romagnuolo J, Orwat KP, Marshall DT. Phase 2 trial of induction gemcitabine, oxaliplatin, and cetuximab followed by selective capecitabine-based chemoradiation in patients with borderline resectable or unresectable locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 2014; 88:837-44. [PMID: 24606850 DOI: 10.1016/j.ijrobp.2013.12.030] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 12/17/2013] [Accepted: 12/18/2013] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate, in a phase 2 study, the safety and efficacy of induction gemcitabine, oxaliplatin, and cetuximab followed by selective capecitabine-based chemoradiation in patients with borderline resectable or unresectable locally advanced pancreatic cancer (BRPC or LAPC, respectively). METHODS AND MATERIALS Patients received gemcitabine and oxaliplatin chemotherapy repeated every 14 days for 6 cycles, combined with weekly cetuximab. Patients were then restaged; "downstaged" patients with resectable disease underwent attempted resection. Remaining patients were treated with chemoradiation consisting of intensity modulated radiation therapy (54 Gy) and concurrent capecitabine; patients with borderline resectable disease or better at restaging underwent attempted resection. RESULTS A total of 39 patients were enrolled, of whom 37 were evaluable. Protocol treatment was generally well tolerated. Median follow-up for all patients was 11.9 months. Overall, 29.7% of patients underwent R0 surgical resection (69.2% of patients with BRPC; 8.3% of patients with LAPC). Overall 6-month progression-free survival (PFS) was 62%, and median PFS was 10.4 months. Median overall survival (OS) was 11.8 months. In patients with LAPC, median OS was 9.3 months; in patients with BRPC, median OS was 24.1 months. In the group of patients who underwent R0 resection (all of which were R0 resections), median survival had not yet been reached at the time of analysis. CONCLUSIONS This regimen was well tolerated in patients with BRPC or LAPC, and almost one-third of patients underwent R0 resection. Although OS for the entire cohort was comparable to that in historical controls, PFS and OS in patients with BRPC and/or who underwent R0 resection was markedly improved.
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Affiliation(s)
- Nestor F Esnaola
- Department of Surgery, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
| | - Uzair B Chaudhary
- Division of Hematology and Oncology, Department of Internal Medicine, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
| | - Paul O'Brien
- Division of Hematology and Oncology, Department of Internal Medicine, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
| | - Elizabeth Garrett-Mayer
- Division of Biostatistics and Epidemiology, Department of Internal Medicine, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
| | - E Ramsay Camp
- Department of Surgery, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
| | - Melanie B Thomas
- Division of Hematology and Oncology, Department of Internal Medicine, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
| | - David J Cole
- Department of Surgery, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
| | - Alberto J Montero
- Division of Hematology and Oncology, Department of Internal Medicine, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
| | - Brenda J Hoffman
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
| | - Joseph Romagnuolo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
| | - Kelly P Orwat
- Department of Radiation Oncology, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
| | - David T Marshall
- Department of Radiation Oncology, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina.
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Cunningham JE, Bauza CE, Brown ET, Alberg AJ, Kistner-Griffin E, Spruill IJ, Bryant DC, Charles KD, Esnaola NF, Jefferson MS, Whitfield KE, Kramer RM, Bolick S, Hurley D, Mosley C, Hazelton TR, Bea VJ, Burshell DR, Ford ME. Abstract P5-12-11: Evaluating overweight/obesity and physical activity rates in an ethnically diverse sample of breast cancer survivors. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p5-12-11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Overweight/obesity are associated with higher risk of recurrence and poorer survival after a breast cancer diagnosis. According to The Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS) data for 2011, in South Carolina, 74.6% of African American (AA) and 62.5% of European American (EA) adult women are overweight/obese.
Methods: Prevalence of overweight/obesity and level of physical activity (PA) are evaluated in an ongoing, ethnically-diverse statewide study of adult women with recently-diagnosed invasive breast cancer. Participants are identified within 18 months post-diagnosis through the South Carolina Central Cancer Registry (SCCCR). Participants who opt in to the study are interviewed via telephone and self-report their body weight, height and physical activities. Published CDC body mass index (BMI) categories and 2008 PA guidelines are used to characterize BMI and PA guideline adherence.
Results: During the first 10 months of the study, 98 women (56 AA, 42 EA) were interviewed and results analyzed. Age: Participants ranged in age from 26 to 90 years (mean 60.2 years, SD 12.8), with AAs 3.7 years younger than EAs (p = 0.16). Education: Almost two-thirds of participants (61%) had more than a high school diploma (55% of AAs and 69% of EAs, p = 0.29). BMI: The BMI mean was 30.1 (SD 6.6, median 26.6) which was significantly higher in AAs (31.3 compared to 28.6 in EAs, p = 0.04). Among all women combined, 79% were overweight/obese, with no statistically significant difference by race (p = 0.15). Overweight was equally frequent among AAs (34%) and EAs (33%). However, obesity was more frequent among AAs (50%) than EAs (38%). Physical Activity (PA): CDC guideline adherence of ≥150 minutes/week of moderate PA was reported by only 32% of participants (25% of AAs, 41% of EAs; p = 0.10). A total of 28% reported no physical activity (30% of AAs and 24% of EAs, p = 0.47). Meeting CDC PA guidelines was associated with lower risk of being overweight/obese (OR = 0.41, p = 0.080), but this was statistically significant only among EAs (OR = 0.21, p = 0.035).
Conclusions: Prevalence of overweight/obesity is high, regardless of ethnicity, and physical activity is low in this group of breast cancer survivors. It is imperative to identify effective strategies to reduce overweight and obesity, and to increase PA, in order to reduce the risk of recurrence and improve survival. In this regard, the study team is developing an National Institutes of Health R01 grant application to evaluate the effectiveness of an intervention, which combines a reduced-energy diet with increased PA, in reducing levels of cancer-related inflammatory biomarkers linked to breast cancer recurrence. Updated results of our on-going study, including associations of BMI and PA with breast cancer stage and phenotype, will be presented.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-12-11.
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Affiliation(s)
- JE Cunningham
- Medical University of South Carolina (MUSC), Charleston, SC; MUSC Hollings Cancer Center, Charleston, SC; Morehouse School of Medicine, Atlanta, GA; Temple University School of Medicine, Philadelphia, PA; Duke University, Durham, NC; South Carolina Department of Health and Environmental Control, South Carolina Central Cancer Registry, Columbia, SC
| | - CE Bauza
- Medical University of South Carolina (MUSC), Charleston, SC; MUSC Hollings Cancer Center, Charleston, SC; Morehouse School of Medicine, Atlanta, GA; Temple University School of Medicine, Philadelphia, PA; Duke University, Durham, NC; South Carolina Department of Health and Environmental Control, South Carolina Central Cancer Registry, Columbia, SC
| | - ET Brown
- Medical University of South Carolina (MUSC), Charleston, SC; MUSC Hollings Cancer Center, Charleston, SC; Morehouse School of Medicine, Atlanta, GA; Temple University School of Medicine, Philadelphia, PA; Duke University, Durham, NC; South Carolina Department of Health and Environmental Control, South Carolina Central Cancer Registry, Columbia, SC
| | - AJ Alberg
- Medical University of South Carolina (MUSC), Charleston, SC; MUSC Hollings Cancer Center, Charleston, SC; Morehouse School of Medicine, Atlanta, GA; Temple University School of Medicine, Philadelphia, PA; Duke University, Durham, NC; South Carolina Department of Health and Environmental Control, South Carolina Central Cancer Registry, Columbia, SC
| | - E Kistner-Griffin
- Medical University of South Carolina (MUSC), Charleston, SC; MUSC Hollings Cancer Center, Charleston, SC; Morehouse School of Medicine, Atlanta, GA; Temple University School of Medicine, Philadelphia, PA; Duke University, Durham, NC; South Carolina Department of Health and Environmental Control, South Carolina Central Cancer Registry, Columbia, SC
| | - IJ Spruill
- Medical University of South Carolina (MUSC), Charleston, SC; MUSC Hollings Cancer Center, Charleston, SC; Morehouse School of Medicine, Atlanta, GA; Temple University School of Medicine, Philadelphia, PA; Duke University, Durham, NC; South Carolina Department of Health and Environmental Control, South Carolina Central Cancer Registry, Columbia, SC
| | - DC Bryant
- Medical University of South Carolina (MUSC), Charleston, SC; MUSC Hollings Cancer Center, Charleston, SC; Morehouse School of Medicine, Atlanta, GA; Temple University School of Medicine, Philadelphia, PA; Duke University, Durham, NC; South Carolina Department of Health and Environmental Control, South Carolina Central Cancer Registry, Columbia, SC
| | - KD Charles
- Medical University of South Carolina (MUSC), Charleston, SC; MUSC Hollings Cancer Center, Charleston, SC; Morehouse School of Medicine, Atlanta, GA; Temple University School of Medicine, Philadelphia, PA; Duke University, Durham, NC; South Carolina Department of Health and Environmental Control, South Carolina Central Cancer Registry, Columbia, SC
| | - NF Esnaola
- Medical University of South Carolina (MUSC), Charleston, SC; MUSC Hollings Cancer Center, Charleston, SC; Morehouse School of Medicine, Atlanta, GA; Temple University School of Medicine, Philadelphia, PA; Duke University, Durham, NC; South Carolina Department of Health and Environmental Control, South Carolina Central Cancer Registry, Columbia, SC
| | - MS Jefferson
- Medical University of South Carolina (MUSC), Charleston, SC; MUSC Hollings Cancer Center, Charleston, SC; Morehouse School of Medicine, Atlanta, GA; Temple University School of Medicine, Philadelphia, PA; Duke University, Durham, NC; South Carolina Department of Health and Environmental Control, South Carolina Central Cancer Registry, Columbia, SC
| | - KE Whitfield
- Medical University of South Carolina (MUSC), Charleston, SC; MUSC Hollings Cancer Center, Charleston, SC; Morehouse School of Medicine, Atlanta, GA; Temple University School of Medicine, Philadelphia, PA; Duke University, Durham, NC; South Carolina Department of Health and Environmental Control, South Carolina Central Cancer Registry, Columbia, SC
| | - RM Kramer
- Medical University of South Carolina (MUSC), Charleston, SC; MUSC Hollings Cancer Center, Charleston, SC; Morehouse School of Medicine, Atlanta, GA; Temple University School of Medicine, Philadelphia, PA; Duke University, Durham, NC; South Carolina Department of Health and Environmental Control, South Carolina Central Cancer Registry, Columbia, SC
| | - S Bolick
- Medical University of South Carolina (MUSC), Charleston, SC; MUSC Hollings Cancer Center, Charleston, SC; Morehouse School of Medicine, Atlanta, GA; Temple University School of Medicine, Philadelphia, PA; Duke University, Durham, NC; South Carolina Department of Health and Environmental Control, South Carolina Central Cancer Registry, Columbia, SC
| | - D Hurley
- Medical University of South Carolina (MUSC), Charleston, SC; MUSC Hollings Cancer Center, Charleston, SC; Morehouse School of Medicine, Atlanta, GA; Temple University School of Medicine, Philadelphia, PA; Duke University, Durham, NC; South Carolina Department of Health and Environmental Control, South Carolina Central Cancer Registry, Columbia, SC
| | - C Mosley
- Medical University of South Carolina (MUSC), Charleston, SC; MUSC Hollings Cancer Center, Charleston, SC; Morehouse School of Medicine, Atlanta, GA; Temple University School of Medicine, Philadelphia, PA; Duke University, Durham, NC; South Carolina Department of Health and Environmental Control, South Carolina Central Cancer Registry, Columbia, SC
| | - TR Hazelton
- Medical University of South Carolina (MUSC), Charleston, SC; MUSC Hollings Cancer Center, Charleston, SC; Morehouse School of Medicine, Atlanta, GA; Temple University School of Medicine, Philadelphia, PA; Duke University, Durham, NC; South Carolina Department of Health and Environmental Control, South Carolina Central Cancer Registry, Columbia, SC
| | - VJ Bea
- Medical University of South Carolina (MUSC), Charleston, SC; MUSC Hollings Cancer Center, Charleston, SC; Morehouse School of Medicine, Atlanta, GA; Temple University School of Medicine, Philadelphia, PA; Duke University, Durham, NC; South Carolina Department of Health and Environmental Control, South Carolina Central Cancer Registry, Columbia, SC
| | - DR Burshell
- Medical University of South Carolina (MUSC), Charleston, SC; MUSC Hollings Cancer Center, Charleston, SC; Morehouse School of Medicine, Atlanta, GA; Temple University School of Medicine, Philadelphia, PA; Duke University, Durham, NC; South Carolina Department of Health and Environmental Control, South Carolina Central Cancer Registry, Columbia, SC
| | - ME Ford
- Medical University of South Carolina (MUSC), Charleston, SC; MUSC Hollings Cancer Center, Charleston, SC; Morehouse School of Medicine, Atlanta, GA; Temple University School of Medicine, Philadelphia, PA; Duke University, Durham, NC; South Carolina Department of Health and Environmental Control, South Carolina Central Cancer Registry, Columbia, SC
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Yang Y, Mauldin PD, Ebeling M, Hulsey TC, Liu B, Thomas MB, Camp ER, Esnaola NF. Effect of metabolic syndrome and its components on recurrence and survival in colon cancer patients. Cancer 2012; 119:1512-20. [PMID: 23280333 DOI: 10.1002/cncr.27923] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 10/20/2012] [Accepted: 11/05/2012] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although epidemiologic studies suggest that metabolic syndrome (MetS) increases the risk of colorectal cancer, its effect on cancer mortality remains controversial. METHODS The authors used the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database (1998-2006) to conduct a retrospective cohort study of 36,079 patients with colon cancer to determine the independent effect of MetS and its components on overall survival (OS) and recurrence-free rates (RFRs). Data on MetS and its components were ascertained from Medicare claims. OS and RFRs in patients with and without MetS and its components were compared using multivariate Cox models. RESULTS MetS had no apparent effect on OS or RFR. Both elevated glucose/diabetes mellitus (DM) and elevated hypertension were associated with worse OS (adjusted hazard ratio [aHR], 1.17 [95% confidence interval, 1.13-1.21] and 1.08 [95% confidence interval, 1.03-1.12], respectively) and worse RFRs (aHR, 1.25 [95% confidence interval, 1.16-1.34] and 1.22 [95% confidence interval, 1.12-1.33], respectively). In contrast, dyslipidemia was associated with improved survival (aHR, 0.77; 95% confidence interval, 0.75-0.80) and reduced recurrence (aHR, 0.71; 95% confidence interval, 0.66-0.75). These effects were consistent for both men and women and were more pronounced in patients with early stage disease. CONCLUSIONS MetS had no apparent effect on colon cancer outcomes, probably because of the combined adverse effects of elevated glucose/DM and hypertension and the protective effect of dyslipidemia in patients with nonmetastatic disease. The authors concluded that patients who have early stage colon cancer with elevated glucose/DM and/or hypertension may benefit from more intensive surveillance and/or broader use of adjuvant therapy and that trials to define the benefits of low-fat diets, insulin-lowering agents, and statins on recurrence/survival in patients with nonmetastatic colon cancer are warranted.
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Affiliation(s)
- Yang Yang
- The Comprehensive Cancer Center of Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
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Ford ME, Cunningham JE, Brown ET, Spruill IJ, Alberg AJ, Bryant DC, Charles KD, Esnaola NF, Jefferson MS, Whitfield K, Kramer RM, Bolick S, Hurley D, Mosley C, Hazelton TR, Bea VJ, Burshell DR, Singh S, Kistner-Griffin E. Abstract B48: Design of a feasibility study of breast cancer candidate genes in three ethnic groups. Cancer Epidemiol Biomarkers Prev 2012. [DOI: 10.1158/1055-9965.disp12-b48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
The purpose of this presentation is to highlight the design and preliminary recruitment outcomes of a translational feasibility study to investigate the impacts of selected genetic single nucleotide polymorphisms (SNPs) on ethnic disparities in breast cancer subtypes, defined by ER, PR, and Her2 expression, associated with higher breast cancer mortality rates. The study will investigate the frequencies of five SNPs in the 19p13 locus of BRCA1 and two SNPs on chr 5p12 in three ethnic groups: African Americans with Sea Island ancestry (SI; all four grandparents were born in SI geographic regions), African Americans without known Sea Island ancestry (AA; 0 grandparents were born in SI geographic regions), and European Americans (EA). The SI population is an AA subpopulation indigenous to the coastal southeast that has the lowest rates of European genetic admixture of AA tested.(1,2) Comparing risk alleles across these three ethnic groups provides a novel paradigm to assess the extent to which SI ancestry and social processes such as acculturation may be linked to breast cancer subtypes associated with poor prognosis.
A protocol has been developed to identify, contact and recruit women recently diagnosed with breast cancer within each ethnic group. Breast cancer cases are initially ascertained through the South Carolina Central Cancer Registry (SCCCR). Recruitment methods encompass steps taken at the SCCCR that include passive consent from the physician of record to contact identified patients, followed by active consent from the identified patients prior to contact by study staff. An investigator-developed algorithm developed to determine SI ancestry of patients, based on geographic ancestry, is administered and eligible participants are asked to complete a telephone-administered survey and to provide a saliva sample for genetic analysis. Recruitment began in June 2012. To date, 23 participants have been recruited, of whom 6 are AA (26%) and 17 are EA (74%), with a mean age of 57.5 years (range =39-77 years). Recruitment will continue until 30 women in each ethnic group are enrolled (total 90 participants). The recruitment process is monitored using a CONSORT diagram. This work will ultimately identify loci for further investigation of breast cancer disparities in other groups and for future development of targeted clinical therapies.
References:
1. Divers, J, Sale MM, Lu L, et al. The genetic architecture of lipoprotein subclasses in Gullah-speaking African American families enriched for Type 2 diabetes: the Sea Islands Genetic African American Registry (Project SuGAR). Journal of Lipid Research 2009;51:586-597. PubMed PMID: 9783527; PubMed Central PMCID: PMC2817588.
2. McLean DC, Jr., Spruill I, Argyropoulos G, et al. Mitochondrial DNA (mtDNA haplotypes reveal maternal population genetic affinities of Sea Island Gullah-speaking African Americans. American Journal of Physical Anthropology 2005;127:427-438.
Citation Format: Marvella E. Ford, Joan E. Cunningham, Erika T. Brown, Ida J. Spruill, Anthony J. Alberg, Debbie C. Bryant, Karen D. Charles, Nestor F. Esnaola, Melanie S. Jefferson, Keith Whitfield, Rita M. Kramer, Susan Bolick, Deborah Hurley, Catishia Mosley, Tonya R. Hazelton, Vivian J. Bea, Dana R. Burshell, Shweta Singh, Emily Kistner-Griffin. Design of a feasibility study of breast cancer candidate genes in three ethnic groups. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B48.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Susan Bolick
- 3South Carolina Department of Health and Environmental Control, Columbia, SC
| | - Deborah Hurley
- 3South Carolina Department of Health and Environmental Control, Columbia, SC
| | - Catishia Mosley
- 3South Carolina Department of Health and Environmental Control, Columbia, SC
| | | | - Vivian J. Bea
- 1Medical University of South Carolina, Charleston, SC,
| | | | - Shweta Singh
- 1Medical University of South Carolina, Charleston, SC,
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Chow WB, Rosenthal RA, Merkow RP, Ko CY, Esnaola NF. Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society. J Am Coll Surg 2012; 215:453-66. [PMID: 22917646 DOI: 10.1016/j.jamcollsurg.2012.06.017] [Citation(s) in RCA: 507] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 05/29/2012] [Accepted: 06/11/2012] [Indexed: 01/10/2023]
Affiliation(s)
- Warren B Chow
- American College of Surgeons National Surgical Quality Improvement Program, Chicago, IL 60611-3211, USA.
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Abstract
Despite a profusion of studies over the past several years documenting racial differences in cancer outcomes, there is a paucity of data as to the root causes underlying these observations. This article reviews work to date focusing on black-white differences in cancer outcomes, explores potential mechanisms underlying these differences, and identifies patient, physician, and health care system factors that may account for persistent racial disparities in cancer care. Research strategies to elucidate the relative influence of these various factors and policy recommendations to reduce persistent disparities are also discussed.
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Affiliation(s)
- Nestor F Esnaola
- Division of Surgical Oncology, Department of Surgery, Medical University of South Carolina, 25 Courtenay Drive, Suite 7018, Charleston, SC 29425, USA.
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Lawson EH, Hall BL, Esnaola NF, Ko CY. Identifying worsening surgical site infection performance: control charts versus risk-adjusted rate outlier status. Am J Med Qual 2012; 27:391-7. [PMID: 22326982 DOI: 10.1177/1062860611428760] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Control charts are used in industry to monitor performance and are being used increasingly in hospitals as a quality improvement tool. The authors' objective was to determine if control charts using surgical site infection (SSI) rates predict changes in outlier status for risk-adjusted SSI rates using data from a surgical registry, the American College of Surgeons National Surgical Quality Improvement Program. Control charts of monthly SSI rates for 100 hospitals were analyzed for indicators of a performance change in 2009 (vs 2008) using standard rules. Hospitals also were classified as having better, worse, or no change in outlier status for risk-adjusted SSI rates in 2009 (vs 2008). There was moderate agreement between these methods (weighted κ = 0.401). Control charts predicted nonworsening performance well (specificity = 92.9%) and identified changes in SSI performance sooner; however, they failed to identify 31.2% of hospitals with worsened outlier status. This study demonstrates that these quality measurement tools have unique strengths and weaknesses and are complementary uses of the same clinical data source.
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Abstract
PH caused by anesthesia-induced thermoregulatory inhibition and exposure to cold operating room environments still occurs in a significant proportion of patients undergoing major surgery. Although the association between specific perioperative temperatures (in and of themselves) and postoperative morbidity remains unclear, there is fair evidence to suggest that perioperative active warming may reduce the risk of postoperative cardiac events, bleeding, and SSIs. As such, proactive efforts by surgical teams to prevent PH are warranted and have become the standard of care at many institutions. Continued intraoperative monitoring of core temperature (ideally using esophageal probes) is recommended in all cases lasting more than 30 minutes, both to detect malignant hyperthermia and to maintain normothermia. Preoperative and/or intraoperative use of warmed forced-air devices is an effective way to minimize redistribution hypothermia following induction, whereas intraoperative use of warmed i.v. fluids helps reduce the potential for fluid-induced hypothermia and, in turn, optimizes rates of perioperative normothermia.
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Affiliation(s)
- Nestor F Esnaola
- Division of Surgical Oncology, Department of Surgery, Medical University of South Carolina, 25 Courtenay Drive Suite 7018, Charleston, SC 29425, USA.
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Ford ME, Esnaola NF, Finney C, Sterba KR, Jefferson MS, Armeson K, Zapka J. Abstract B14: Racial differences in colorectal cancer surveillance in South Carolina. Cancer Prev Res (Phila) 2011. [DOI: 10.1158/1940-6207.prev-11-b14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background and Study Rationale: More than one million people in the U.S. are living as colorectal cancer (CRC) survivors. Post-treatment risk of recurrence is a significant clinical problem and is compounded by evidence of low prevalence of surveillance, notably among African Americans (AA). In national samples (Rolnick et al. 2005; Lafata et al. 2008), AA are significantly less likely than European Americans (EA) to receive surveillance colonoscopy at guideline-recommended intervals, which likely contributes to disparities in CRC mortality rates. In 2007, U.S. age-adjusted CRC mortality rates were 19.5 for EA males, 29.1 for AA males, 13.7 for EA females, and 19.7 for AA females.
The efficacy of surveillance colonoscopy has been well documented and it is the first-choice procedure for clinical surveillance after curative-intent CRC resection. CRC surveillance adherence is particularly important for AA, who tend to present at initial diagnosis with larger tumor size than EA, and who may be at greater risk of CRC recurrence. The purpose of this study was to examine whether the disparities in CRC surveillance seen nationally are present in South Carolina (SC).
Methods: Statewide, population-based data from the SC Hospital Billing Data database for calendar year 2007 were used to examine whether racial differences were present in surveillance colonoscopy receipt after CRC resection. Unique IDs were used to track patients over time. ICD-9 diagnosis and procedure codes, race, and gender and were used to identify and categorize patients who received resection surgery and colonoscopy following resection at 1 year, 2 years, and 3 years post-resection. The Chi-square test was used to test for differences in receipt of surveillance colonoscopy based on race and gender by follow-up year.
Results: Data from 1,273 (914 EA and 359 AA) patients diagnosed with Stage I–II CRC who received CRC resection in 2007 were evaluated. Significant racial differences in receipt of surveillance colonoscopy were seen. At 1 year post-resection, 25.6% of EA (n=234) and 18.1% of AA (n=65) had surveillance colonoscopy (p=0.005); at 2 years post-resection, 46.8% of EA (n=428) and 39.6% of AA (n=142) received surveillance colonoscopy (p=0.019); and at 3 years post-resection, 50.2% of EA (n=459) and 44.8% of AA (n=161) underwent surveillance (p=0.084).
Among females, 25.0% of EA (n=114) compared with 18.2% of AA (n=37) received CRC surveillance at 1 year post-resection (p=0.056); at 2 years post-resection, 45.8% of EA (n=209) and 37.9% of AA (n=77) had surveillance colonoscopy (p=0.058); and at 3 years post-resection, 49.1% of EA females (n=224) compared with 43.3% of AA (n=88) underwent surveillance (p=0.171).
Among males, the only statistically significant finding was at 1 year post-resection; 26.2% of EA (n=120) compared with 17.9% of AA (n=28) received CRC surveillance at 1 year post-resection (p=0.037); at 2 years post-resection, 47.8% of EA (n=219) and 41.7% of AA (n=65) had surveillance colonoscopy (p=0.183); and at 3 years post-resection, 51.3% of EA (n=235) compared with 46.8% of AA (n=73) underwent surveillance (p=0.330).
Conclusions: Reflecting national data, surveillance colonoscopy rates are low in SC. Rates are substantially lower among AA than among EA and are lower for AA men than for EA men at 1 year post-resection, emphasizing the need for culturally appropriate surveillance plans. While a study limitation is that some patients may have received colonoscopies at sites that did not report their data to the registry, it is clear that not only are there racial and gender disparities in CRC surveillance colonoscopy but rates are sub-optimal for both EA and AA. These results will guide the development of targeted multi-level intervention strategies and messages to improve CRC surveillance adherence to optimize survivorship and improve quality of life.
Citation Information: Cancer Prev Res 2011;4(10 Suppl):B14.
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Affiliation(s)
| | | | - Chris Finney
- 2South Carolina Department of Health and Environmental Control, Columbia, SC
| | | | | | - Kent Armeson
- 1Medical University of South Carolina, Charleston, SC
| | - Jane Zapka
- 1Medical University of South Carolina, Charleston, SC
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Ford ME, Esnaola NF, Finney C, Streba KR, Jefferson MS, Armeson K, Zapka JG. Abstract A55: Racial differences in colorectal cancer surveillance in South Carolina. Cancer Epidemiol Biomarkers Prev 2011. [DOI: 10.1158/1055-9965.disp-11-a55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background and Study Rationale: More than one million people in the U.S. are living as colorectal cancer (CRC) survivors. Post-treatment risk of recurrence is a significant clinical problem and is compounded by evidence of low prevalence of surveillance, notably among African Americans (AA). In national samples (Rolnick et al. 2005; Lafata et al. 2008), AA are significantly less likely than European Americans (EA) to receive surveillance colonoscopy at guideline-recommended intervals, which likely contributes to disparities in CRC mortality rates. In 2007, U.S. age-adjusted CRC mortality rates were 19.5 for EA males, 29.1 for AA males, 13.7 for EA females, and 19.7 for AA females.
The efficacy of surveillance colonoscopy has been well documented and it is the first-choice procedure for clinical surveillance after curative-intent CRC resection. CRC surveillance adherence is particularly important for AA, who tend to present at initial diagnosis with larger tumor size than EA, and who may be at greater risk of CRC recurrence. The purpose of this study was to examine whether the disparities in CRC surveillance seen nationally are present in South Carolina (SC).
Methods: Statewide, population-based data from the SC Hospital Billing Data database for calendar year 2007 were used to examine whether racial differences were present in surveillance colonoscopy receipt after CRC resection. Unique IDs were used to track patients over time. ICD-9 diagnosis and procedure codes, race, and gender and were used to identify and categorize patients who received resection surgery and colonoscopy following resection at 1 year, 2 years, and 3 years post-resection. The Chi-square test was used to test for differences in receipt of surveillance colonoscopy based on race and gender by follow-up year.
Results: Data from 1,273 (914 EA and 359 AA) patients diagnosed with Stage I–II CRC who received CRC resection in 2007 were evaluated. Significant racial differences in receipt of surveillance colonoscopy were seen. At 1 year post-resection, 25.6% of EA (n=234) and 18.1% of AA (n=65) had surveillance colonoscopy (p=0.005); at 2 years post-resection, 46.8% of EA (n=428) and 39.6% of AA (n=142) received surveillance colonoscopy (p=0.019); and at 3 years post-resection, 50.2% of EA (n=459) and 44.8% of AA (n=161) underwent surveillance (p=0.084).
Among females, 25.0% of EA (n=114) compared with 18.2% of AA (n=37) received CRC surveillance at 1 year post-resection (p=0.056); at 2 years post-resection, 45.8% of EA (n=209) and 37.9% of AA (n=77) had surveillance colonoscopy (p=0.058); and at 3 years post-resection, 49.1% of EA females (n=224) compared with 43.3% of AA (n=88) underwent surveillance (p=0.171).
Among males, the only statistically significant finding was at 1 year post-resection; 26.2% of EA (n=120) compared with 17.9% of AA (n=28) received CRC surveillance at 1 year post-resection (p=0.037); at 2 years post-resection, 47.8% of EA (n=219) and 41.7% of AA (n=65) had surveillance colonoscopy (p=0.183); and at 3 years post-resection, 51.3% of EA (n=235) compared with 46.8% of AA (n=73) underwent surveillance (p=0.330).
Conclusions: Reflecting national data, surveillance colonoscopy rates are low in SC. Rates are substantially lower among AA than among EA and are lower for AA men than for EA men at 1 year post-resection, emphasizing the need for culturally appropriate surveillance plans. While a study limitation is that some patients may have received colonoscopies at sites that did not report their data to the registry, it is clear that not only are there racial and gender disparities in CRC surveillance colonoscopy but rates are suboptimal for both EA and AA. These results will guide the development of targeted multi-level intervention strategies and messages to improve CRC surveillance adherence to optimize survivorship and improve quality of life.
Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A55.
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Affiliation(s)
| | | | - Chris Finney
- 2South Carolina Central Cancer Registry, Columbia, SC
| | | | | | - Kent Armeson
- 1Medical University of South Carolina, Charleston, SC,
| | - Jane G. Zapka
- 1Medical University of South Carolina, Charleston, SC,
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Wilson JA, Lewin DN, Esnaola NF, Romagnuolo J. Adenocarcinoma arising from a gastric submucosal intraductal papillary mucinous neoplasm. Gastrointest Endosc 2010; 71:1298-9. [PMID: 20598257 DOI: 10.1016/j.gie.2010.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 01/14/2010] [Indexed: 02/08/2023]
Affiliation(s)
- Jason A Wilson
- Digestive Disease Center, Medical University of South Carolina, Charleston, South Carolina, USA
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Esnaola NF, Stewart AK, Feig BW, Skibber JM, Rodriguez-Bigas MA. Age-, Race-, and Ethnicity-Related Differences in the Treatment of Nonmetastatic Rectal Cancer: A Patterns of Care Study From the National Cancer Data Base. Ann Surg Oncol 2008; 15:3036-47. [DOI: 10.1245/s10434-008-0106-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2005] [Revised: 06/26/2008] [Accepted: 06/28/2008] [Indexed: 01/13/2023]
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Esnaola NF, Gebregziabher M, Knott K, Finney C, Silvestri GA, Reed CE, Ford ME. Underuse of surgical resection for localized, non-small cell lung cancer among whites and African Americans in South Carolina. Ann Thorac Surg 2008; 86:220-6; discussion 227. [PMID: 18573427 DOI: 10.1016/j.athoracsur.2008.02.072] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2007] [Revised: 02/20/2008] [Accepted: 02/21/2008] [Indexed: 11/26/2022]
Abstract
BACKGROUND Early studies using Medicare data reported racial disparities in surgical treatment of localized, non-small cell lung cancer. We analyzed the independent effect of race on use of surgical resection in a recent, population-based sample of patients with localized non-small cell lung cancer, controlling for comorbidity and socioeconomic status. METHODS All cases of localized non-small cell lung cancer reported to our state Cancer Registry between 1996 and 2002 were identified and linked to the Inpatient/Outpatient Surgery Files and 2000 Census. Comorbidity (Romano-Charlson index) was calculated using administrative data codes. Educational level and income were estimated using census data. Characteristics of white and African American patients were compared using chi(2) tests. Odds ratios of resection and 95% confidence intervals were calculated using logistic regression. RESULTS We identified 2,506 white and 550 African American patients. African Americans were more likely to be younger, male, not married, less educated, poor, and uninsured or covered by Medicaid (all p < 0.0001), and to reside in rural communities (p = 0.0005). Use of surgical resection across races was lower than previously reported, and African Americans were significantly less likely to undergo surgery compared with whites (44.7% versus 63.4%; p < 0.0001). Even after controlling for sociodemographics, comorbidity, and tumor factors, the adjusted odds ratio for resection for African Americans was 0.43 (95% confidence interval, 0.34 to 0.55). CONCLUSIONS Underuse of surgical resection for localized, non-small cell lung cancer is a persistent problem, particularly among African Americans. Further studies are urgently needed to identify the patient-, physician-, and health system-related factors underlying these observations and optimize resection rates for non-small cell lung cancer.
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Affiliation(s)
- Nestor F Esnaola
- Department of Surgery, Medical University of South Carolina, Charleston, SC 29425, USA.
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Esnaola NF, Knott K, Finney C, Gebregziabher M, Ford ME. Urban/rural residence moderates effect of race on receipt of surgery in patients with nonmetastatic breast cancer: a report from the South Carolina central cancer registry. Ann Surg Oncol 2008; 15:1828-36. [PMID: 18398659 DOI: 10.1245/s10434-008-9898-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2007] [Revised: 02/14/2008] [Accepted: 02/17/2008] [Indexed: 11/18/2022]
Abstract
BACKGROUND Surgical resection is the cornerstone of therapy in patients with nonmetastatic breast cancer. Previous studies have reported underuse of adjuvant therapy among African Americans (AA). This study explores the independent effect of race on surgical resection in a recent, population-based sample of breast cancer patients. METHODS All cases of nonmetastatic breast cancer reported to the our state Cancer Registry between 1996 and 2002 were identified and linked to the state Inpatient/Outpatient Surgery Files and the 2000 Census. Characteristics between Caucasian and AA patients were compared using Student's t and chi-square tests. Odds ratios (OR) of resection and 95% confidence intervals (CI) were calculated using logistic regression. RESULTS We identified 12,404 Caucasian and 3,411 AA women. AA patients were more likely to be younger, non-married, have greater comorbidity, reside in rural communities, be less educated, live in poverty, and be uninsured or covered by Medicaid (all P < 0.0001). AA patients were slightly less likely to undergo resection compared to Caucasian patients (94.9% versus 96.4%, P < 0.0001). An interaction effect between race and urban/rural patient residence was observed (P = 0.003). After controlling for other factors, the adjusted OR for resection for urban AA patients was 0.58 (95% CI 0.41-0.82). In contrast, race had no effect on resection among rural patients (OR = 1.02; 95% CI 0.70-1.47). CONCLUSIONS AA race is an independent predictor of underuse of surgery among urban patients with breast cancer, while rural residence is associated with underuse of surgery, irrespective of race. Interventions designed to optimize surgical cancer care should target these vulnerable populations.
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Affiliation(s)
- N F Esnaola
- Department of Surgery, Medical University of South Carolina (MUSC), 25 Courtenay Drive - Suite 7018 (MSC 295), Charleston, SC 29425, USA.
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