1
|
Santos P, Chakraborty N, Salz T, Curry M, Vicioso NL, Mathis NJ, Caron M, Ostroff J, Guttman D, Salner AL, Panoff JE, McIntosh AF, Pfister DG, Yang JT, Snyderman AL, Gillespie EF. Implementation Outcomes of Strategies to Promote Short-Course Radiation for Nonspine Bone Metastases in an Academic-Community Partnership: Survey Results from the ALIGNMENT Trial. Int J Radiat Oncol Biol Phys 2023; 117:S124-S125. [PMID: 37784321 DOI: 10.1016/j.ijrobp.2023.06.466] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Local treatment of nonspine bone metastases has become increasingly complex, resulting in physician practice variability nationwide. The purpose of this study was to assess physician perceptions of 3 implementation strategies to promote adoption of short course radiotherapy (RT) for nonspine bone metastases. MATERIALS/METHODS ALIGNMENT ("Alliance Group for Bone Metastasis") was a multi-institutional stepped wedge cluster randomized implementation trial testing strategies to increase use of ≤5 fractions for nonspine bone metastases conducted across 3 clinical sites in an academic-community partnership. Strategies included a) multidisciplinary consensus guidelines, b) e-Consults, an email-based consultation platform, and c) personalized audit and feedback (A&F) reports with peer comparison. Using the Proctor et al. framework and validated questions from Weiner et al., physician surveys were used to assess each strategy's usefulness, acceptability (i.e., "I welcome [strategy]"), appropriateness (i.e., "[strategy] seems like a good match"), and feasibility (i.e., "[strategy] seems implementable" or "easy to use"). Survey responses were anonymized, so Fisher's Exact test was used to compare proportions with significance set at p<0.05. RESULTS Overall, 29 of 38 and 30 of 38 physicians participated in the pre- and post-implementation surveys, respectively, with 80% completing both. Pre-implementation, guidelines was most often ranked 1st in terms of usefulness (61%), followed by eConsults (38%) and A&F (3%). Post-implementation, guidelines and eConsults had the most and least favorable acceptability, appropriateness, and feasibility scores, respectively (Table), with 77% of physicians being likely to recommend the guidelines to other oncologists. In contrast, while 43% of physicians reported having at least 1 difficult clinical question regarding bone metastases during the study, only 33% of physicians preferred eConsults, while 50% preferred reaching out to a friend/colleague. Lastly, although A&F had the lowest perceived usefulness pre-implementation, A&F had the greatest increase in acceptability (72%→90%; p = 0.10), appropriateness (66%→90%; p = 0.03) feasibility ("implementable": 59%→93%, p = 0.002; "easy to use": 45%→93%, p<0.001). CONCLUSION In this multicenter trial, all strategies were acceptable, appropriate, and feasible, with guidelines and A&F showing the most favorable outcomes post-implementation. While guidelines were assessed as the most useful, A&F had significant increases in appropriateness and feasibility.
Collapse
Affiliation(s)
- P Santos
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; Harvard T.H. Chan School of Public Health, Boston, MA
| | - N Chakraborty
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - T Salz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - M Curry
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - N Ledesma Vicioso
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - N J Mathis
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - M Caron
- Strategic Partnerships, Memorial Sloan Kettering Cancer Center, New York, NY
| | - J Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - D Guttman
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - A L Salner
- Hartford HealthCare Cancer Institute, Hartford, CT
| | - J E Panoff
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - A F McIntosh
- Allentown Radiation Oncology Associates, Allentown, PA, United States
| | - D G Pfister
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - J T Yang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Radiation Oncology, University of Washington, Seattle, WA
| | - A Lipitz Snyderman
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - E F Gillespie
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Radiation Oncology, University of Washington, Seattle, WA
| |
Collapse
|
2
|
Hong BY, Hoare A, Cardenas A, Dupuy AK, Choquette L, Salner AL, Schauer PK, Hegde U, Peterson DE, Dongari-Bagtzoglou A, Strausbaugh LD, Diaz PI. The Salivary Mycobiome Contains 2 Ecologically Distinct Mycotypes. J Dent Res 2020; 99:730-738. [PMID: 32315566 DOI: 10.1177/0022034520915879] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
A broad range of fungi has been detected in molecular surveys of the oral mycobiome. However, knowledge is still lacking on interindividual variability of these communities and the ecologic and clinical significance of oral fungal commensals. In this cross-sectional study, we use internal transcribed spacer 1 amplicon sequencing to evaluate the salivary mycobiome in 59 subjects, 36 of whom were scheduled to receive cancer chemotherapy. Analysis of the broad population structure of fungal communities in the whole cohort identified 2 well-demarcated genus-level community types (mycotypes), with Candida and Malassezia as the main taxa driving cluster partitioning. The Candida mycotype had lower diversity than the Malassezia mycotype and was positively correlated with cancer and steroid use in these subjects, smoking, caries, utilizing a removable prosthesis, and plaque index. Mycotypes were also associated with metabolically distinct bacteria indicative of divergent oral environments, with aciduric species enriched in the Candida mycotype and inflammophilic bacteria increased in the Malassezia mycotype. Similar to their fungal counterparts, coexisting bacterial communities associated with the Candida mycotype showed lower diversity than those associated with the Malassezia mycotype, suggesting that common environmental pressures affected bacteria and fungi. Mycotypes were also seen in an independent cohort of 24 subjects, in which cultivation revealed Malassezia as viable oral mycobiome members, although the low-abundance Malassezia sympodialis was the only Malassezia species recovered. There was a high degree of concordance between the molecular detection and cultivability of Candida, while cultivation showed low sensitivity for detection of the Malassezia mycotype. Overall, our work provides insights into the oral mycobiome landscape, revealing 2 community classes with apparently distinct ecologic constraints and specific associations with coexisting bacteria and clinical parameters. The utility of mycotypes as biomarkers for oral diseases warrants further study.
Collapse
Affiliation(s)
- B Y Hong
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, UConn Health, Farmington, CT, USA.,The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - A Hoare
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, UConn Health, Farmington, CT, USA.,Laboratorio de Microbiología Oral, Facultad de Odontología, Universidad de Chile, Santiago, Chile
| | - A Cardenas
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, UConn Health, Farmington, CT, USA
| | - A K Dupuy
- Department of Molecular and Cell Biology, University of Connecticut, Storrs, CT, USA
| | - L Choquette
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, UConn Health, Farmington, CT, USA.,The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - A L Salner
- Hartford Healthcare Cancer Institute at Hartford Hospital, Hartford, CT, USA
| | - P K Schauer
- Hartford Healthcare Cancer Institute at Hartford Hospital, Hartford, CT, USA
| | - U Hegde
- Department of Medicine, UConn Health, Farmington, CT, USA
| | - D E Peterson
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, UConn Health, Farmington, CT, USA
| | - A Dongari-Bagtzoglou
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, UConn Health, Farmington, CT, USA
| | - L D Strausbaugh
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - P I Diaz
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, UConn Health, Farmington, CT, USA
| |
Collapse
|
3
|
Salner AL, Staff I. Racial and ethnic disparities in presenting stage and overall survival in women treated for breast cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.27_suppl.187] [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
187 Background: Over the past 20 years, we have recognized racial/ethnic disparities in breast cancer outcomes, and have attempted to develop outreach, screening, and care strategies to address these. This study explored changes in these disparities over twenty years in presenting stage and overall survival at a single large urban teaching and community hospital with an active cancer outreach program, a member of the NCI Community Cancer Centers Program. Methods: Between 1990 and 2009, 9733 women were diagnosed and treated with breast cancer at our institution. 8918 women with complete race/ethnicity and clinical data were analyzed. The women were grouped into four five-year cohorts, and 3 subgroups-Caucasian, African American, and Latina. All four cohorts were compared for stage migration, while only the initial three cohorts were compared for 5 year overall survival to allow follow-up. Chi-Square tests of proportions were utilized to compare subgroups. Results: Of the 8918 women analyzed, 91.5% are Caucasian, 4.5% African American, and 4% Latina. Over the 20 years of the study, significant stage migration occurred; the total number of women diagnosed with early stage disease(in-situ and localized) increased from 71.7% to 78.7%. Significant stage migration was found for all subgroups of women. Stronger trends were found focusing only on in-situ disease—an overall increase from 14.4% to 30.8%. Five year overall survival of the entire group improved from 78.7% to 85.4%, and also improved for each of the subgroups. Caucasian women were significantly older (60 vs. 54) but the cohort and ethnic findings remained in multivariate analysis. Significant disparities between Caucasians and Latinas for stage and between Caucasians and African American for 5 year survival gradually diminished. Conclusions: Significant improvements are seen in earlier stage presentation and five year overall survival amongst women treated for breast cancer between 1990 and 2009, as well as in subgroups of Caucasian, African American and Latina women. Differences between subgroups diminish and in many cases disappear by the end of the study period, suggesting that strategies may have helped reduce breast cancer disparities.
Collapse
|
4
|
Krasna M, Freeman RK, Petrelli NJ, Salner AL, Young JA, Zaren HA, Bearden J, Harness JK, Purcell T, Asfeldt T. Improvement in multidisciplinary cancer care: The National Cancer Institute Community Cancer Centers Program (NCCCP) Multidisciplinary Lung Cancer Conference and Clinics. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e16539] [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: 11/20/2022] Open
|
5
|
Distasio SA, Salner AL, Brant JM, Fischberg D, Manfredi P. Brachial plexopathy after treatment for breast cancer. Cancer Pract 2000; 8:110-3. [PMID: 11898134 DOI: 10.1046/j.1523-5394.2000.83003.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Affiliation(s)
- S A Distasio
- Northwest CT Oncology-Hematology Assoc. Litchfield County, Connecticut, USA
| | | | | | | | | |
Collapse
|
6
|
Saleh J, Silberstein HJ, Salner AL, Uphoff DF. Meningioma: the role of a foreign body and irradiation in tumor formation. Neurosurgery 1991; 29:113-8; discussion 118-9. [PMID: 1870671] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
A case of meningioma is reported. At the age of 18 years, the patient had undergone insertion of a Torkildsen shunt through a posteroparietal burr hole for obstructive hydrocephalus secondary to a tumor of the pineal region, of which no biopsy had been made. After the hydrocephalus was relieved, he underwent irradiation of the tumor. Thirty years later, he was treated for an intracranial meningioma wrapped around the shunt. The tumor followed the shunt in all of its intracranial course. Microscopy disclosed pieces of the shunt tube within the meningioma. The role of a foreign body and irradiation in the induction of meningiomas is discussed, and a comprehensive review of the literature is presented.
Collapse
Affiliation(s)
- J Saleh
- Department of Neurosurgery, Hartford Hospital, Connecticut
| | | | | | | |
Collapse
|
7
|
Salner AL, Obbagy JE, Hellman S. Differing stem cell self-renewal of lectin-separated murine bone marrow fractions. J Natl Cancer Inst 1982; 68:639-41. [PMID: 7040767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The success of bone marrow transplantation depends not only on the engraftment of adequate numbers of hematopoietic stem cells but also on their self-renewal capacity, which must be sufficient to provide lifetime hematopoiesis. The lectin peanut agglutinin (PNA), when exposed to bone marrow, causes separation into two distinct fractions. The agglutinated fraction not only is enriched with colony-forming units--spleen but also is devoid of graft-versus-host (GVH) activity when injected into allogeneic lethally irradiated recipients, and therefore, it is considered to be an ideal source for bone marrow transplantation. The absence of GVH activity is presumably due to the separation of mature thymocytes into the nonagglutinated fraction and functionally immature thymocytes into the agglutinated fraction. Although there has been speculation that immature hematopoietic stem cells also selectively bind to PNA, other evidence suggests that the relationship of lectin binding specificity to level of maturity varies in different tissues. This study was performed to assess the self-renewal capacity of lectin-separated bone marrow stem cells. Results indicate that the self-renewal of the agglutinated fraction is significantly lower than that of the unfractionated bone marrow; such self-renewal of the nonagglutinated fraction is higher. This is further evidence for the heterogeneity of the stem cell pool. Stem cell enrichment should not be the goal in bone marrow transplantation; rather, the goal should be utilization of stem cells with the greatest self-renewal potential.
Collapse
|
8
|
Salner AL, Botnick LE, Herzog AG, Goldstein MA, Harris JR, Levene MB, Hellman S. Reversible brachial plexopathy following primary radiation therapy for breast cancer. Cancer Treat Rep 1981; 65:797-802. [PMID: 6791820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Reversible brachial plexopathy has occurred in very low incidence in patients with breast carcinoma treated definitively with radiation therapy. Of 565 patients treated between January 1968 and December 1979 with moderate doses of supervoltage radiation therapy (average axillary dose of 5000 rad in 5 weeks), eight patients (1.4%) developed the characteristic symptoms at a median time of 4.5 months after radiation therapy. This syndrome consists of paresthesias in all patients, with weakness and pain less commonly seen. The symptom complex differs from other previously described brachial plexus syndromes, including paralytic brachial neuritis, radiation-induced injury, and carcinoma. A possible relationship to adjuvant chemotherapy exists, though the etiology is not well-understood. The cases described demonstrate temporal clustering. Resolution is always seen.
Collapse
|
9
|
Salner AL, Mullany LD, Cole SR. Methysergide induced mitral valvular insufficiency. Conn Med 1980; 44:6-8. [PMID: 7353368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
|