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Behrens S, Potter K, Patel RK, Schwantes IR, Sutton TL, Johnson AJ, Pommier RF, Sheppard BC. High-volume centers are associated with higher receipt of combined therapy in stage III pancreatic cancer. Am J Surg 2023; 225:887-890. [PMID: 36858864 DOI: 10.1016/j.amjsurg.2023.02.012] [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: 11/15/2022] [Revised: 01/22/2023] [Accepted: 02/17/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Pancreatic ductal adenocarcinoma (PDAC) is often diagnosed at a locally advanced stage with vascular involvement which was previously viewed as a contraindication to resection. However, high-volume centers are increasingly capable of resecting complex tumors. We aimed to explore patterns of treatment that are uncharacterized on a population level. METHODS A statewide registry was queried from 2003 to 2018 for stage III PDAC. Stepwise logistic regression and Kaplan-Meier were used for statistical analysis. RESULTS We identified 424 eligible patients. 348 (82%) received chemotherapy, 17 (4.0%) received resection, and 59 (13.9%) received both; median survival was 10.7, 8.7, and 22.7 months, respectively (P < 0.001). High-volume centers (≥20 cases per year; OR 5.40 [95% CI: 2.76, 10.58], P < 0.001) and later year of diagnosis (OR 1.12/year [95% CI: 1.04, 1.20], P = 0.004) were associated with higher odds of receiving combined therapy. CONCLUSION PDAC patients with vascular involvement who receive both systemic chemotherapy and surgical resection have improved overall survival. High-volume centers are independently associated with higher odds of receiving combined systemic therapy and surgical resection.
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Affiliation(s)
- Shay Behrens
- Department of Surgery, Oregon Heath & Science University, Portland, OR, 97239, USA
| | - Kristin Potter
- School of Medicine, Oregon Heath & Science University, Portland, OR, 97239, USA
| | - Ranish K Patel
- Department of Surgery, Oregon Heath & Science University, Portland, OR, 97239, USA
| | - Issac R Schwantes
- Department of Surgery, Oregon Heath & Science University, Portland, OR, 97239, USA
| | - Thomas L Sutton
- Department of Surgery, Oregon Heath & Science University, Portland, OR, 97239, USA
| | - Alicia J Johnson
- Department of Surgery, Oregon Heath & Science University, Portland, OR, 97239, USA
| | - Rodney F Pommier
- Division of Surgical Oncology, Department of Surgery, Oregon Heath & Science University, Portland, OR, 97239, USA
| | - Brett C Sheppard
- Department of Surgery, Oregon Heath & Science University, Portland, OR, 97239, USA; Division of Gastrointestinal and General Surgery, Department of Surgery, Oregon Heath & Science University, Portland, OR, 97239, USA.
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2
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Boyne DJ, Brenner DR, Gupta A, Mackay E, Arora P, Wasiak R, Cheung WY, Hernán MA. Head-to-head comparison of FOLFIRINOX versus gemcitabine plus nab-paclitaxel in advanced pancreatic cancer: a target trial emulation using real-world data. Ann Epidemiol 2023; 78:28-34. [PMID: 36563766 DOI: 10.1016/j.annepidem.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/29/2022] [Accepted: 12/15/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE To emulate a hypothetical target trial assessing the effect of initiating 5-fluorouracil, folinic acid, irinotecan, and oxaliplatin (FOLFIRINOX) versus gemcitabine plus nab-paclitaxel (GN) within 8 weeks of diagnosis on overall survival. METHODS An observational cohort study was conducted using population-level data from Alberta, Canada. Individuals diagnosed with advanced pancreatic cancer between April 2015 and December 2019 were identified through the provincial cancer registry and followed until March 2021. Records were linked to other administrative databases containing information on relevant variables. Individuals were excluded if they did not have adequate hemoglobin, platelet, white blood cell, and serum creatinine measures or if they received prior therapy. The observational analog of the per-protocol effect was estimated using inverse probability weighted Kaplan-Meier curves with bootstrapped 95% confidence intervals. RESULTS Four hundred seven individuals were eligible. The weighted median overall survival was 8.3 months (95% CI, 5.7-11.9) for FOLFIRINOX and 5.1 months (95% CI: 4.3 to 5.8) for GN. The adjusted difference in median overall survival was 3.2 months (95% CI, 1.1-7.4) and the mortality hazard ratio was 0.78 (95% CI, 0.61-0.97). CONCLUSIONS Our estimates favored the initiation of FOLFIRINOX over GN with respect to overall survival.
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3
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Kang MJ, Lim J, Han SS, Park HM, Park SJ, Won YJ, Kim SW. First Course of treatment and Prognosis of Exocrine Pancreatic Cancer in Korea from 2006 to 2017. Cancer Res Treat 2022; 54:208-217. [PMID: 34030432 PMCID: PMC8756130 DOI: 10.4143/crt.2021.421] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 05/20/2021] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Hospital-based clinical studies have limitations in holistic assessment of cancer treatment and prognosis, as they omit out-of-hospital patients including elderly individuals. This study aimed to investigate trends in initial treatment and corresponding prognosis of patients with exocrine pancreatic cancer (EPC) in Korea. MATERIALS AND METHODS The Korea Central Cancer Registry data of patients with EPC from 2006 to 2017 were retrospectively reviewed. We defined the first course of treatment (FT) as the cancer-directed treatment administered within four months after cancer diagnosis according to the Surveillance, Epidemiology, and End Results (SEER) program. RESULTS Among 62,209 patients with EPC, localized and regional (LR) SEER stage; patients over 70 years old; and ductal adenocarcinoma excluding cystic or mucinous (DAC) accounted for 40.6%, 50.1%, and 95.9%, respectively. "No active treatment" (NT, 46.5%) was the most frequent, followed by non-surgical FT (28.7%) and surgical FT (22.0%). Among 25,198 patients with LR EPC, surgical FT increased (35.9% to 46.3%) and NT decreased (45.0% to 29.5%) from 2006 to 2017. The rate of surgical FT was inversely related to age (55.1% [< 70 years], 37.3% [70-79 years], 10.9% [≥ 80 years]). Five-year relative survival rates of LR DAC were higher after surgical FT than after NT in localized (46.1% vs. 12.9%) and regional stage (23.6% vs. 4.9%) from 2012 to 2017. CONCLUSION Less than half of overall patients with LR EPC underwent surgical FT, and this proportion decreased significantly in elderly individuals. Clinicians should focus attention on elderly patients with EPC to provide appropriate medical advice.
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Affiliation(s)
- Mee Joo Kang
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang,
Korea
- Division of Cancer Registration and Surveillance, National Cancer Center, Goyang,
Korea
| | - Jiwon Lim
- Division of Cancer Registration and Surveillance, National Cancer Center, Goyang,
Korea
| | - Sung-Sik Han
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang,
Korea
| | - Hyeong Min Park
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang,
Korea
| | - Sang-Jae Park
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang,
Korea
| | - Young-Joo Won
- Division of Cancer Registration and Surveillance, National Cancer Center, Goyang,
Korea
- Department of Cancer Control & Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang,
Korea
| | - Sun-Whe Kim
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang,
Korea
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4
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O'Kane GM, Ladak F, Gallinger S. Avancées dans la prise en charge de l’adénocarcinome canalaire pancréatique. CMAJ 2021; 193:E1362-E1370. [PMID: 34462299 PMCID: PMC8432315 DOI: 10.1503/cmaj.201450-f] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Grainne M O'Kane
- Centre d'oncologie Princess Margaret (O'Kane, Gallinger), Réseau universitaire de santé de Toronto, Toronto, Ont.; Université de l'Alberta (Ladak), Edmonton, Alb. Grainne.O'
| | - Farah Ladak
- Centre d'oncologie Princess Margaret (O'Kane, Gallinger), Réseau universitaire de santé de Toronto, Toronto, Ont.; Université de l'Alberta (Ladak), Edmonton, Alb
| | - Steven Gallinger
- Centre d'oncologie Princess Margaret (O'Kane, Gallinger), Réseau universitaire de santé de Toronto, Toronto, Ont.; Université de l'Alberta (Ladak), Edmonton, Alb
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Affiliation(s)
- Grainne M O'Kane
- Princess Margaret Cancer Centre (O'Kane, Gallinger), University Health Network, Toronto, Toronto, Ont.; University of Alberta (Ladak), Edmonton, Alta. Grainne.O'
| | - Farah Ladak
- Princess Margaret Cancer Centre (O'Kane, Gallinger), University Health Network, Toronto, Toronto, Ont.; University of Alberta (Ladak), Edmonton, Alta
| | - Steven Gallinger
- Princess Margaret Cancer Centre (O'Kane, Gallinger), University Health Network, Toronto, Toronto, Ont.; University of Alberta (Ladak), Edmonton, Alta
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Partelli S, Sclafani F, Barbu ST, Beishon M, Bonomo P, Braz G, de Braud F, Brunner T, Cavestro GM, Crul M, Trill MD, Ferollà P, Herrmann K, Karamitopoulou E, Neuzillet C, Orsi F, Seppänen H, Torchio M, Valenti D, Zamboni G, Zins M, Costa A, Poortmans P. European Cancer Organisation Essential Requirements for Quality Cancer Care (ERQCC): Pancreatic Cancer. Cancer Treat Rev 2021; 99:102208. [PMID: 34238640 DOI: 10.1016/j.ctrv.2021.102208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 12/14/2022]
Abstract
European Cancer Organisation Essential Requirements for Quality Cancer Care (ERQCC) are written by experts representing all disciplines involved in cancer care in Europe. They give patients, health professionals, managers and policymakers a guide to essential care throughout the patient journey. Pancreatic cancer is an increasing cause of cancer mortality and has wide variation in treatment and care in Europe. It is a major healthcare burden and has complex diagnosis and treatment challenges. Care must be carried out only in pancreatic cancer units or centres that have a core multidisciplinary team (MDT) and an extended team of health professionals detailed here. Such units are far from universal in European countries. To meet European aspirations for comprehensive cancer control, healthcare organisations must consider the requirements in this paper, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship.
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Affiliation(s)
- Stefano Partelli
- European Society of Surgical Oncology (ESSO); IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Sclafani
- European Organisation for Research and Treatment of Cancer (EORTC); Institut Jules Bordet, Brussels, Belgium
| | - Sorin Traian Barbu
- Pancreatic Cancer Europe (PCE); Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Marc Beishon
- Cancer World, European School of Oncology (ESO), Milan, Italy
| | - Pierluigi Bonomo
- Flims Alumni Club (FAC); Careggi University Hospital, Florence, Italy
| | - Graça Braz
- European Oncology Nursing Society (EONS); Portuguese Oncology Institute, Porto, Portugal
| | - Filippo de Braud
- Organisation of European Cancer Institutes (OECI); IRCCS Foundation National Cancer Institute of Milan, Milan, Italy
| | - Thomas Brunner
- European Society for Radiotherapy and Oncology (ESTRO); Otto von Guericke University, Magdeburg, Germany
| | - Giulia Martina Cavestro
- European Hereditary Tumour Group (EHTG); IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mirjam Crul
- European Society of Oncology Pharmacy (ESOP); Amsterdam University Medical Centre, Netherlands
| | - Maria Die Trill
- International Psycho-Oncology Society (IPOS); ATRIUM: Psycho-Oncology & Clinical Psychology, Madrid, Spain
| | - Piero Ferollà
- International Neuroendocrine Cancer Alliance (INCA); Umbria Regional Cancer Network, Perugia, Italy
| | - Ken Herrmann
- European Association of Nuclear Medicine (EANM); University Hospital Essen, Essen, Germany
| | - Eva Karamitopoulou
- European Society of Pathology (ESP); Institute of Pathology, University of Bern, Bern, Switzerland
| | - Cindy Neuzillet
- International Society of Geriatric Oncology (SIOG), Institut Curie, Saint-Cloud, France
| | - Franco Orsi
- Cardiovascular and Interventional Radiological Society of Europe (CIRSE); European Institute of Oncology, Milan, Italy
| | - Hanna Seppänen
- Association of European Cancer Leagues (ECL); Helsinki University Hospital, Helsinki, Finland
| | - Martina Torchio
- Organisation of European Cancer Institutes (OECI); IRCCS Foundation National Cancer Institute of Milan, Milan, Italy
| | - Danila Valenti
- European Association for Palliative Care (EAPC); Palliative Care Network, AUSL Bologna, Bologna, Italy
| | - Giulia Zamboni
- European Society of Oncologic Imaging (ESOI); University Hospital Verona, Verona, Italy
| | - Marc Zins
- European Society of Radiology (ESR); Groupe hospitalier Paris Saint-Joseph, Paris, France
| | | | - Philip Poortmans
- European Cancer Organisation (ECCO); Iridium Kankernetwerk and University of Antwerp, Wilrijk-Antwerp, Belgium
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Abdel-Rahman O, Koski S, Mulder K. Real-world patterns of chemotherapy administration and attrition among patients with metastatic colorectal cancer. Int J Colorectal Dis 2021; 36:493-499. [PMID: 33068162 DOI: 10.1007/s00384-020-03778-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To assess the real-world patterns of systemic treatment attrition rates among patients with metastatic colorectal cancer. METHODS Databases based from the provincial cancer registry and electronic medical records in Alberta were accessed, and cases with a de novo diagnosis of metastatic colorectal cancer with no history of other primary cancers (2004-2017) were reviewed. Rates of chemotherapy administration in first and subsequent lines of treatment were assessed. Multivariable logistic regression analysis for factors associated with non-administration of chemotherapy was evaluated. The impact of administration of all three chemotherapy agents (fluoropyrimidines, oxaliplatin, and irinotecan) across the course of treatment was assessed through multivariable Cox regression analysis with time-dependent covariates. RESULTS A total of 4179 patients with metastatic colorectal cancer were included in the current study. This includes 1988 patients receiving at least one cycle of chemotherapy and 2191 patients who did not receive any chemotherapy. The following factors were associated with a higher probability of no chemotherapy use: older age (OR 1.064; 95% CI 1.057-1.070), higher Charlson comorbidity index (OR 1.444; 95% CI 1.342-1.554), female sex (OR for male sex versus female sex 0.763; 95% CI 0.660-0.881), rural residence (OR for residence in zone 2 (Calgary) versus zone 5 (North zone) 0.346; 95% CI 0.272-0.440), proximal tumor location (OR 1.255; 95% CI 1.083-1.454), and earlier year at diagnosis (OR (continuous) 0.895; 95% CI 0.879-0.911). Within the cohort of patients who received at least one cycle of chemotherapy, 42.5% received one line of chemotherapy only, and 30.5% received two lines of chemotherapy. The use of all three chemotherapy drugs was associated with better overall survival (HR 3.305; 95% CI 2.755-3.965) and colorectal cancer-specific survival (HR 3.367; 95% CI 2.753-4.117). CONCLUSIONS A considerable proportion of metastatic colorectal cancer patients who received active chemotherapy in this population-based study received only one line of therapy. This highlights the significance of choosing effective treatments in the first-line treatment as the attrition rate is high. Furthermore, the use of all three chemotherapy agents across the course of treatment was associated with better outcomes.
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Affiliation(s)
- Omar Abdel-Rahman
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB, T6G 1Z2, Canada.
| | - Sheryl Koski
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB, T6G 1Z2, Canada
| | - Karen Mulder
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB, T6G 1Z2, Canada
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8
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Yee EK, Coburn NG, Davis LE, Mahar AL, Zuk V, Gupta V, Liu Y, Earle CC, Hallet J. Impact of Geography on Care Delivery and Survival for Noncurable Pancreatic Adenocarcinoma: A Population-Based Analysis. J Natl Compr Canc Netw 2020; 18:1642-1650. [PMID: 33285520 DOI: 10.6004/jnccn.2020.7605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/18/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Little is known about how the geographic distribution of cancer services may influence disparities in outcomes for noncurable pancreatic adenocarcinoma. We therefore examined the geographic distribution of outcomes for this disease in relation to distance to cancer centers. METHODS We conducted a retrospective population-based analysis of adults in Ontario, Canada, diagnosed with noncurable pancreatic adenocarcinoma from 2004 through 2017 using linked administrative healthcare datasets. The exposure was distance from place of residence to the nearest cancer center providing medical oncology assessment and systemic therapy. Outcomes were medical oncology consultation, receipt of cancer-directed therapy, and overall survival. We examined the relationship between distance and outcomes using adjusted multivariable regression models. RESULTS Of 15,970 patients surviving a median of 3.3 months, 65.6% consulted medical oncology and 38.5% received systemic therapy. Regions with comparable outcomes were clustered throughout Ontario. Mapping revealed regional discordances between outcomes. Increasing distance (reference, ≤10 km) was independently associated with lower likelihood of medical oncology consultation (relative risks [95% CI] for 11-50, 51-100, and ≥101 km were 0.90 [0.83-0.98], 0.78 [0.62-0.99], and 0.77 [0.55-1.08], respectively) and worse survival (hazard ratios [95% CI] for 11-50, 51-100, and ≥101 km were 1.08 [1.04-1.12], 1.17 [1.10-1.25], and 1.10 [1.02-1.18], respectively), but not with likelihood of receiving therapy. Receipt of therapy seems less sensitive to distance, suggesting that distance limits entry into the cancer care system via oncology consultation. Regional outcome discordances suggest inefficiencies within and protective factors outside of the cancer care system. CONCLUSIONS These findings provide a basis for clinicians to optimize their practices for patients with noncurable pancreatic adenocarcinoma, for future studies investigating geographic barriers to care, and for regional interventions to improve access.
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Affiliation(s)
- Elliott K Yee
- 1Faculty of Medicine, University of Toronto, Toronto, Ontario.,2Cancer Program - Evaluative Clinical Sciences, and
| | - Natalie G Coburn
- 2Cancer Program - Evaluative Clinical Sciences, and.,3Department of Surgery, Odette Cancer Centre - Sunnybrook Health Sciences Centre, Toronto, Ontario.,4Department of Surgery, University of Toronto, Toronto, Ontario.,5ICES, Toronto, Ontario
| | - Laura E Davis
- 6Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec
| | - Alyson L Mahar
- 7Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba; and
| | - Victoria Zuk
- 2Cancer Program - Evaluative Clinical Sciences, and
| | - Vaibhav Gupta
- 2Cancer Program - Evaluative Clinical Sciences, and.,4Department of Surgery, University of Toronto, Toronto, Ontario
| | - Ying Liu
- 4Department of Surgery, University of Toronto, Toronto, Ontario
| | - Craig C Earle
- 2Cancer Program - Evaluative Clinical Sciences, and.,5ICES, Toronto, Ontario.,8Division of Medical Oncology, Odette Cancer Centre - Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Julie Hallet
- 2Cancer Program - Evaluative Clinical Sciences, and.,3Department of Surgery, Odette Cancer Centre - Sunnybrook Health Sciences Centre, Toronto, Ontario.,4Department of Surgery, University of Toronto, Toronto, Ontario.,5ICES, Toronto, Ontario
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Boyne DJ, Brenner DR, Sajobi TT, Hilsden RJ, Yusuf D, Xu Y, Friedenreich CM, Cheung WY. Development of a Model for Predicting Early Discontinuation of Adjuvant Chemotherapy in Stage III Colon Cancer. JCO Clin Cancer Inform 2020; 4:972-984. [PMID: 33125264 DOI: 10.1200/cci.20.00065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To develop a tool that can be used to predict early discontinuation of adjuvant chemotherapy among patients with stage III colon cancer. PATIENTS AND METHODS Through record linkage of Alberta administrative and tumor registry databases, we identified a cohort of individuals age ≥ 18 years who were diagnosed with stage III colon cancer and who received adjuvant chemotherapy in Alberta between 2004 and 2015. Early discontinuation was defined as receipt of < 5 months of a planned 6-month course of chemotherapy. By a systematic review of the literature and a survey of medical oncologists, the following candidate variables were identified: age (years), number of comorbidities (0, 1, ≥ 2), cancer stage (IIIC v IIIA-B), type of chemotherapy (fluorouracil, leucovorin, and oxaliplatin; capecitabine and oxaliplatin; or monotherapy), time from surgery to chemotherapy initiation (weeks), type of treatment facility (academic or community), and distance from home to treatment center (kilometers). Models developed using penalized logistic regression and the random forest algorithm were compared. Model performance was assessed using the C-statistic, Brier score, and a calibration plot. Internal validation was performed using the bootstrap method. RESULTS From an initial 3,115 patients identified, 1,378 were deemed eligible for inclusion. Of these patients, 474 patients (34.4%) failed to complete at least 5 months of chemotherapy. Although well calibrated, the penalized logistic regression model had poor discrimination (optimism-adjusted C-statistic, 0.63; 95% CI, 0.60 to 0.67). In contrast, the random forest model achieved adequate discrimination (optimism-adjusted C-statistic, 0.80; 95% CI, 0.79 to 0.82). Although the degree of calibration of the random forest was acceptable, it was slightly worse than that of the penalized logistic regression model. CONCLUSION Internal validation of our random forest model suggests that it may have clinical utility. Additional research regarding its external validation and clinical impact is needed.
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Affiliation(s)
- Devon J Boyne
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Alberta, Canada
| | - Darren R Brenner
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Alberta, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Tolulope T Sajobi
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Robert J Hilsden
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Dimas Yusuf
- Delta Research Institute, Delta, British Columbia, Canada
| | - Yuan Xu
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Surgery, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Christine M Friedenreich
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Alberta, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Winson Y Cheung
- Department of Oncology, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
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Bond EG, Abrahamyan L, Khan MKA, Gershon A, Krahn M, Li P, Mian R, Mitsakakis N, Sadatsafavi M, To T, Pechlivanoglou P. Understanding resource utilization and mortality in COPD to support policy making: A microsimulation study. PLoS One 2020; 15:e0236559. [PMID: 32817636 PMCID: PMC7444558 DOI: 10.1371/journal.pone.0236559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 07/08/2020] [Indexed: 11/19/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) poses a significant but heterogeneous burden to individuals and healthcare systems. Policymakers develop targeted policies to minimize this burden but need personalized tools to evaluate novel interventions and target them to subpopulations most likely to benefit. We developed a platform to identify subgroups that are at increased risk of emergency department visits, hospitalizations and mortality and to provide stratified patient input in economic evaluations of COPD interventions. We relied on administrative and survey data from Ontario, Canada and applied a combination of microsimulation and multi-state modeling methods. We illustrated the functionality of the platform by quantifying outcomes across smoking status (current, former, never smokers) and by estimating the effect of smoking cessation on resource use and survival, by comparing outcomes of hypothetical cohorts of smokers who quit at diagnosis and smokers that continued to smoke post diagnosis. The cumulative incidence of all-cause mortality was 37.9% (95% CI: 34.9, 41.4) for never smokers, 34.7% (95% CI: 32.1, 36.9) for current smokers, and 46.4% (95% CI: 43.6, 49.0) for former smokers, at 14 years. Over 14 years, smokers who did not quit at diagnosis had 16.3% (95% CI: 9.6, 38.4%) more COPD-related emergency department visits than smokers who quit at diagnosis. In summary, we combined methods from clinical and economic modeling to create a novel tool that policymakers and health economists can use to inform future COPD policy decisions and quantify the effect of modifying COPD risk factors on resource utilization and morality.
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Affiliation(s)
- Elizabeth G. Bond
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | - Lusine Abrahamyan
- Toronto General Hospital Research Institute, Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mohammad K. A. Khan
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Andrea Gershon
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
| | - Murray Krahn
- Toronto General Hospital Research Institute, Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | | | | | - Nicholas Mitsakakis
- Toronto General Hospital Research Institute, Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mohsen Sadatsafavi
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Teresa To
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
| | - Petros Pechlivanoglou
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- * E-mail:
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Mavros MN, Coburn NG, Davis LE, Mahar AL, Liu Y, Beyfuss K, Myrehaug S, Earle CC, Hallet J. Low rates of specialized cancer consultation and cancer-directed therapy for noncurable pancreatic adenocarcinoma: a population-based analysis. CMAJ 2020; 191:E574-E580. [PMID: 31133604 DOI: 10.1503/cmaj.190211] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Although advancements in systemic therapy have improved the outlook for pancreatic adenocarcinoma, it is not known if patients get access to these therapies. We aimed to examine the patterns and factors associated with access to specialized cancer consultations and subsequent receipt of cancer-directed therapy for patients with non-curative pancreatic adenocarcinoma. METHODS We conducted a population-based analysis of noncurative pancreatic adenocarcinoma diagnosed over 2005-2016 in Ontario by linking administrative health care data sets. Our primary outcomes were specialized cancer consultation and receipt of cancer-directed therapy (chemotherapy or a combination of chemo- and radiation therapy [chemoradiation therapy]). We examined specialized cancer consultation with hepato-pancreatico-biliary surgery, medical and radiation oncology. We used multivariable logistic regression to identify factors associated with medical oncology consultation and cancer-directed therapy. RESULTS Of 10 881 patients, 64.9% had a consultation with specialists in medical oncology, 35.1% with hepatopancreatico-biliary surgery and 24.7% with radiation oncology. Sociodemographic characteristics were not associated with the likelihood of medical oncology consultation. Of these patients, 4144 received cancer-directed therapy, representing 38.1% of all patients and 58.6% of those who consulted with medical oncology. Of 6737 patients not receiving cancer-directed therapy, 2988 (44.4%) had a consultation with medical oncology. Older age and lowest income quintile were independently associated with lower likelihood of cancer-directed therapy. If the first specialized cancer consultation was with medical or radiation oncology, the likelihood of cancer-directed therapy was significantly higher compared with surgery. INTERPRETATION A considerable proportion of patients with noncurable pancreatic adenocarcinoma in Ontario did not have a specialized cancer consultation and most did not receive cancer-directed therapy. We identified disparities in specialized cancer consultation and receipt of systemic cancer-directed therapy that indicate potential gaps in assessment.
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Affiliation(s)
- Michail N Mavros
- Department of Surgery (Mavros, Coburn, Hallet), University of Toronto; Divisions of General Surgery (Coburn, Hallet), Radiation Oncology (Myrehaug) and Medical Oncology (Earle), Odette Cancer Centre - Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Coburn, Davis, Beyfuss, Earle, Hallet); ICES (Coburn, Liu, Earle, Hallet), Toronto, Ont.; Department of Community Health Sciences (Mahar), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man
| | - Natalie G Coburn
- Department of Surgery (Mavros, Coburn, Hallet), University of Toronto; Divisions of General Surgery (Coburn, Hallet), Radiation Oncology (Myrehaug) and Medical Oncology (Earle), Odette Cancer Centre - Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Coburn, Davis, Beyfuss, Earle, Hallet); ICES (Coburn, Liu, Earle, Hallet), Toronto, Ont.; Department of Community Health Sciences (Mahar), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man
| | - Laura E Davis
- Department of Surgery (Mavros, Coburn, Hallet), University of Toronto; Divisions of General Surgery (Coburn, Hallet), Radiation Oncology (Myrehaug) and Medical Oncology (Earle), Odette Cancer Centre - Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Coburn, Davis, Beyfuss, Earle, Hallet); ICES (Coburn, Liu, Earle, Hallet), Toronto, Ont.; Department of Community Health Sciences (Mahar), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man
| | - Alyson L Mahar
- Department of Surgery (Mavros, Coburn, Hallet), University of Toronto; Divisions of General Surgery (Coburn, Hallet), Radiation Oncology (Myrehaug) and Medical Oncology (Earle), Odette Cancer Centre - Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Coburn, Davis, Beyfuss, Earle, Hallet); ICES (Coburn, Liu, Earle, Hallet), Toronto, Ont.; Department of Community Health Sciences (Mahar), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man
| | - Ying Liu
- Department of Surgery (Mavros, Coburn, Hallet), University of Toronto; Divisions of General Surgery (Coburn, Hallet), Radiation Oncology (Myrehaug) and Medical Oncology (Earle), Odette Cancer Centre - Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Coburn, Davis, Beyfuss, Earle, Hallet); ICES (Coburn, Liu, Earle, Hallet), Toronto, Ont.; Department of Community Health Sciences (Mahar), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man
| | - Kaitlyn Beyfuss
- Department of Surgery (Mavros, Coburn, Hallet), University of Toronto; Divisions of General Surgery (Coburn, Hallet), Radiation Oncology (Myrehaug) and Medical Oncology (Earle), Odette Cancer Centre - Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Coburn, Davis, Beyfuss, Earle, Hallet); ICES (Coburn, Liu, Earle, Hallet), Toronto, Ont.; Department of Community Health Sciences (Mahar), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man
| | - Sten Myrehaug
- Department of Surgery (Mavros, Coburn, Hallet), University of Toronto; Divisions of General Surgery (Coburn, Hallet), Radiation Oncology (Myrehaug) and Medical Oncology (Earle), Odette Cancer Centre - Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Coburn, Davis, Beyfuss, Earle, Hallet); ICES (Coburn, Liu, Earle, Hallet), Toronto, Ont.; Department of Community Health Sciences (Mahar), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man
| | - Craig C Earle
- Department of Surgery (Mavros, Coburn, Hallet), University of Toronto; Divisions of General Surgery (Coburn, Hallet), Radiation Oncology (Myrehaug) and Medical Oncology (Earle), Odette Cancer Centre - Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Coburn, Davis, Beyfuss, Earle, Hallet); ICES (Coburn, Liu, Earle, Hallet), Toronto, Ont.; Department of Community Health Sciences (Mahar), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man
| | - Julie Hallet
- Department of Surgery (Mavros, Coburn, Hallet), University of Toronto; Divisions of General Surgery (Coburn, Hallet), Radiation Oncology (Myrehaug) and Medical Oncology (Earle), Odette Cancer Centre - Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Coburn, Davis, Beyfuss, Earle, Hallet); ICES (Coburn, Liu, Earle, Hallet), Toronto, Ont.; Department of Community Health Sciences (Mahar), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.
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Kruger S, Schirle K, Haas M, Crispin A, Schirra J, Mayerle J, D'Haese JG, Kunz WG, Ricke J, Ormanns S, Kirchner T, Kobold S, Ilmer M, Gebauer L, Westphalen CB, von Bergwelt-Baildon M, Werner J, Heinemann V, Boeck S. Prolonged time to treatment initiation in advanced pancreatic cancer patients has no major effect on treatment outcome: a retrospective cohort study controlled for lead time bias and waiting time paradox. J Cancer Res Clin Oncol 2019; 146:391-399. [PMID: 31642961 DOI: 10.1007/s00432-019-03061-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 10/16/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE A prolonged time to treatment initiation (TTI) correlates with an adverse prognosis in different cancer types including resectable pancreatic cancer (PC). Only limited evidence on the correlation between TTI and prognosis in advanced PC exists. METHODS Consecutive PC patients (n = 368) who were diagnosed or treated at our high-volume comprehensive cancer center were included in a prospectively maintained database. We retrospectively analyzed time from first imaging showing advanced PC to initiation of palliative first-line chemotherapy. Lead time bias and waiting time paradox were addressed by landmark analysis and correlation of tumor burden with TTI. RESULTS Two hundred and ninety-seven patients met the pre-specified in- and exclusion criteria of our study. Median TTI was 29 days (range: 1-124 days). Most common reasons for prolonged TTI (> 21 days) were referral from an external treatment center (39%) and a second biopsy (31%). A TTI above the median-, 75th or 90th percentile (43 or 60 days, respectively) had no impact on overall survival. Furthermore, no correlation between levels of carbohydrate antigen 19-9 (CA 19-9) at time of treatment initiation and TTI was observed. CONCLUSION While a timely work-up of advanced PC patients remains important, delays in treatment initiation due to repeated biopsies, inclusion in a clinical study or transfer to a specialized cancer center appear to be justified in light of the absence of a strong adverse effect of prolonged TTI on prognosis in advanced PC patients.
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Affiliation(s)
- Stephan Kruger
- Department of Medicine III, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany. .,Division of Clinical Pharmacology and Center for Integrated Protein Science Munich (CIPSM), University Hospital, LMU Munich, Munich, Germany.
| | - Karoline Schirle
- Department of Medicine III, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Michael Haas
- Department of Medicine III, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Alexander Crispin
- Institute of Medical Informatics, Biometry and Epidemiology, LMU Munich, Munich, Germany
| | - Jörg Schirra
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Julia Mayerle
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Jan G D'Haese
- Department of General, Visceral, and Transplantation Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Wolfgang G Kunz
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | | | | | - Sebastian Kobold
- Division of Clinical Pharmacology and Center for Integrated Protein Science Munich (CIPSM), University Hospital, LMU Munich, Munich, Germany
| | - Matthias Ilmer
- Department of General, Visceral, and Transplantation Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Leonie Gebauer
- Department of Medicine III, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Christoph B Westphalen
- Department of Medicine III, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | | | - Jens Werner
- Department of General, Visceral, and Transplantation Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Volker Heinemann
- Department of Medicine III, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Stefan Boeck
- Department of Medicine III, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
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Abdel-Rahman O, Xu Y, Tang PA, Lee-Ying RM, Cheung WY. A real-world, population-based study of patterns of referral, treatment, and outcomes for advanced pancreatic cancer. Cancer Med 2018; 7:6385-6392. [PMID: 30378285 PMCID: PMC6308068 DOI: 10.1002/cam4.1841] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/26/2018] [Accepted: 10/03/2018] [Indexed: 12/12/2022] Open
Abstract
Background To describe patterns of referral, consultation, and treatment of advanced pancreatic cancer patients in a population‐based health care system and to evaluate the impact of these factors on outcomes. Methods This is a retrospective analysis of population‐based cancer data from the province of Alberta, Canada. We analyzed patients diagnosed with either locally advanced or metastatic pancreatic adenocarcinoma from 2009 to 2016 and evaluated their patterns of referral to a cancer center, consultation with oncology, and treatment with active anticancer therapies. Logistic regression models were constructed to determine the factors associated with referral, late oncology assessment, and late receipt of treatment. Results We identified 1621 pancreatic cancer patients. Median age was 70 years, 50% were men, and 51% had a Charlson index of 2+. Within this cohort, only 884 (54%) patients were referred to one of the provincial cancer centers. Adjusting for confounders in logistic regression models, older age and worse comorbidity scores were associated with nonreferral (both P < 0.01). In multivariable analysis among treated patients, the following factors were associated with improved overall survival, including younger age, earlier stage, and better comorbidity scores (all P < 0.01). Neither referral to consultation times nor consultation to treatment times correlated with outcomes. Importantly, nonreferred patients were more likely to use acute care services, including longer total duration of hospitalizations and more frequent visits with physician specialists. Conclusion A significant proportion of patients with advanced pancreatic cancer were never referred to a cancer center. Nonreferred patients were more likely to utilize specific health care resources.
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Affiliation(s)
- Omar Abdel-Rahman
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.,Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Yuan Xu
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Patricia A Tang
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | | | - Winson Y Cheung
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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