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Byng D, Thomas SM, Rushing CN, Lynch T, McCarthy A, Francescatti AB, Frank ES, Partridge AH, Thompson AM, Retèl VP, van Harten WH, Grimm LJ, Hyslop T, Hwang ES, Ryser MD. Surveillance Imaging after Primary Diagnosis of Ductal Carcinoma in Situ. Radiology 2023; 307:e221210. [PMID: 36625746 PMCID: PMC10068891 DOI: 10.1148/radiol.221210] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 10/13/2022] [Accepted: 11/11/2022] [Indexed: 01/11/2023]
Abstract
Background Guidelines recommend annual surveillance imaging after diagnosis of ductal carcinoma in situ (DCIS). Guideline adherence has not been characterized in a contemporary cohort. Purpose To identify uptake and determinants of surveillance imaging in women who underwent treatment for DCIS. Materials and Methods A stratified random sample of women who underwent breast-conserving surgery for primary DCIS between 2008 and 2014 was retrospectively selected from 1330 facilities in the United States. Imaging examinations were recorded from date of diagnosis until first distant recurrence, death, loss to follow-up, or end of study (November 2018). Imaging after treatment was categorized into 10 12-month periods starting 6 months after diagnosis. Primary outcome was per-period receipt of asymptomatic surveillance imaging (mammography, MRI, or US). Secondary outcome was diagnosis of ipsilateral invasive breast cancer. Multivariable logistic regression with repeated measures and generalized estimating equations was used to model receipt of imaging. Rates of diagnosis with ipsilateral invasive breast cancer were compared between women who did and those who did not undergo imaging in the 6-18-month period after diagnosis using inverse probability-weighted Kaplan-Meier estimators. Results A total of 12 559 women (median age, 60 years; IQR, 52-69 years) were evaluated. Uptake of surveillance imaging was 75% in the first period and decreased over time (P < .001). Across the first 5 years after treatment, 52% of women participated in consistent annual surveillance. Surveillance was lower in Black (adjusted odds ratio [OR], 0.80; 95% CI: 0.74, 0.88; P < .001) and Hispanic (OR, 0.82; 95% CI: 0.72, 0.94; P = .004) women than in White women. Women who underwent surveillance in the first period had a higher 6-year rate of diagnosis of invasive cancer (1.6%; 95% CI: 1.3, 1.9) than those who did not (1.1%; 95% CI: 0.7, 1.4; difference: 0.5%; 95% CI: 0.1, 1.0; P = .03). Conclusion Half of women did not consistently adhere to imaging surveillance guidelines across the first 5 years after treatment, with racial disparities in adherence rates. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Rahbar and Dontchos in this issue.
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Affiliation(s)
- Danalyn Byng
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - Samantha M. Thomas
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - Christel N. Rushing
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - Thomas Lynch
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - Anne McCarthy
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - Amanda B. Francescatti
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - Elizabeth S. Frank
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - Ann H. Partridge
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - Alastair M. Thompson
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - Valesca P. Retèl
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - Wim H. van Harten
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - Lars J. Grimm
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - Terry Hyslop
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - E. Shelley Hwang
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - Marc D. Ryser
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
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Plichta JK, Rushing CN, Lewis HC, Rooney MM, Blazer DG, Thomas SM, Hwang ES, Greenup RA. Implications of missing data on reported breast cancer mortality. Breast Cancer Res Treat 2023; 197:177-187. [PMID: 36334190 PMCID: PMC9912364 DOI: 10.1007/s10549-022-06764-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 10/06/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND National cancer registries are valuable tools to analyze patterns of care and clinical outcomes; yet, missing data may impact the accuracy and generalizability of these data. We sought to evaluate the association between missing data and overall survival (OS). METHODS Using the NCDB (National Cancer Database) and SEER (Surveillance, Epidemiology, End Results Program), we assessed data missingness among patients diagnosed with invasive breast cancer from 2010 to 2014. Key variables included demographic (age, race, ethnicity, insurance, education, income), tumor (grade, ER, PR, HER2, TNM stages), and treatment (surgery in both databases; chemotherapy and radiation in NCDB). OS was compared between those with and without missing data using Cox proportional hazards models. RESULTS Overall, 775,996 patients in the NCDB and 263,016 in SEER were identified; missing at least 1 key variable occurred for 29% and 13%, respectively. Of those, the overwhelming majority (NCDB 80%; SEER 88%) were missing tumor variables. When compared to patients with complete data, missingness was associated with a greater risk of death: NCDB HR 1.23 (99% CI 1.21-1.25) and SEER HR 2.11 (99% CI 2.05-2.18). Patients with complete tumor data had higher unadjusted OS estimates than that of the entire sample: NCDB 82.7% vs 81.8% and SEER 83.5% vs 81.7% for 5-year OS. CONCLUSIONS Missingness of select variables is not uncommon within large national cancer registries and is associated with a worse OS. Exclusion of patients with missing variables may introduce unintended bias into analyses and result in findings that underestimate breast cancer mortality.
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Affiliation(s)
- Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC, DUMC 351327710, USA.
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, DUMC 351327710, USA.
- Duke Cancer Institute, Durham, NC, USA.
| | - Christel N Rushing
- Duke Cancer Institute, Durham, NC, USA
- Biostatistics Shared Resource, Duke Cancer Institute, Durham, NC, USA
| | - Holly C Lewis
- Department of Surgery, Duke University Medical Center, Durham, NC, DUMC 351327710, USA
| | - Marguerite M Rooney
- Department of Surgery, Duke University Medical Center, Durham, NC, DUMC 351327710, USA
| | - Dan G Blazer
- Department of Surgery, Duke University Medical Center, Durham, NC, DUMC 351327710, USA
- Duke Cancer Institute, Durham, NC, USA
| | - Samantha M Thomas
- Duke Cancer Institute, Durham, NC, USA
- Biostatistics Shared Resource, Duke Cancer Institute, Durham, NC, USA
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC, USA
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, NC, DUMC 351327710, USA
- Duke Cancer Institute, Durham, NC, USA
| | - Rachel A Greenup
- Department of Surgery, Duke University Medical Center, Durham, NC, DUMC 351327710, USA
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, DUMC 351327710, USA
- Duke Cancer Institute, Durham, NC, USA
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Byng D, Retel VP, van Harten W, Rushing CN, Thomas SM, Lynch T, McCarthy A, Francescatti AB, Frank ES, Partridge AH, Thompson AM, Grimm L, Hyslop T, Hwang ESS, Ryser MD. Disparities in surveillance imaging after breast conserving surgery for primary DCIS. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.6516] [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
6516 Background: Due to the elevated risk of ipsilateral invasive breast cancer (iIBC) after diagnosis with primary ductal carcinoma in situ (DCIS), professional guidelines recommend surveillance screening within 6-12 months (mo) after completion of initial local treatment and annually thereafter. To characterize adherence to these guidelines, we explored longitudinal patterns of utilization and factors associated with the use of surveillance imaging (mammography, MRI, ultrasound) for women with primary DCIS treated with breast conserving surgery (BCS) ± radiotherapy (RT) within 6 mo of diagnosis. Methods: A treatment-stratified random sample of patients diagnosed with screen-detected and biopsy-confirmed DCIS in 2008-15 was selected from 1,330 Commission on Cancer-accredited facilities (up to 20/site) in the US. All imaging exams coded as asymptomatic were collected from 6 mo up to 10 years (yr) post-diagnosis. Time was defined according to 12-mo long surveillance periods. To be included in a given surveillance period, women had to be alive and free of a new breast cancer diagnosis through the end of the period. Women were classified as “consistent” screeners if they had at least one surveillance screen during each period, for the first 5 yr post-treatment or until censoring, whichever occurred first. Repeated measures multivariable logistic regression with generalized estimating equations was used to model receipt of surveillance breast imaging over time. The model included clinical and socioeconomic features. Results: The final analytic cohort contained 12,559 women; 8,989 (71.6%) received RT after BCS. Median age was 60 yr (interquartile range: 52-69) and median follow-up was 5.6 yr (95% confidence interval [CI] 5.6-5.7). Among women who received BCS (instead of BCS+RT), 62.5% (79.7%) underwent surveillance imaging within 6-18 mo after diagnosis. 38.7% (54.0%) were categorized as “consistent” screeners. Compared to white women, Black women were less likely to receive surveillance screening after treatment for primary DCIS (odds ratio [OR] 0.85, 95% CI 0.77-0.94). Hispanic ethnicity had a similar association (OR 0.86, 95% CI 0.74-0.99) compared to non-Hispanic ethnicity. Women with private insurance, compared to government insurance, were more likely to receive screening (OR 1.20, 95% CI 1.11-1.30). Prognostic tumor features indicative of a higher risk of subsequent iIBC, including higher grade, presence of comedonecrosis, and hormone receptor-negative DCIS, were not associated with screening uptake. Conclusions: Despite guidelines recommending annual surveillance imaging, many women with primary DCIS do not undergo regular imaging after BCS. The findings from this US-based study suggest that disparities in screening uptake are associated with race/ethnicity and insurance status rather than prognostic tumor features.
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Affiliation(s)
- Danalyn Byng
- Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | | | | | - Samantha M. Thomas
- Duke University Medical Center, Department of Biostatistics and Bioinformatics, Durham, NC
| | | | | | | | | | | | | | - Lars Grimm
- Duke University Medical Center, Durham, NC
| | - Terry Hyslop
- Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Durham, NC
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Nussbaum DP, Rushing CN, Sun Z, Yerokun BA, Worni M, Saunders RS, McClellan MB, Niedzwiecki D, Greenup RA, Blazer DG. Hospital-level compliance with the commission on cancer's quality of care measures and the association with patient survival. Cancer Med 2021; 10:3533-3544. [PMID: 33943026 PMCID: PMC8178497 DOI: 10.1002/cam4.3875] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 03/08/2021] [Accepted: 03/13/2021] [Indexed: 11/23/2022] Open
Abstract
Background Quality measurement has become a priority for national healthcare reform, and valid measures are necessary to discriminate hospital performance and support value‐based healthcare delivery. The Commission on Cancer (CoC) is the largest cancer‐specific accreditor of hospital quality in the United States and has implemented Quality of Care Measures to evaluate cancer care delivery. However, none has been formally tested as a valid metric for assessing hospital performance based on actual patient outcomes. Methods Eligibility and compliance with the Quality of Care Measures are reported within the National Cancer Database, which also captures data for robust patient‐level risk adjustment. Hospital‐level compliance was calculated for the core measures, and the association with patient survival was tested using Cox regression. Results Seven hundred sixty‐eight thousand nine hundred sixty‐nine unique cancer cases were included from 1323 facilities. Increasing hospital‐level compliance was associated with improved survival for only two measures, including a 35% reduced risk of mortality for the gastric cancer measure G15RLN (HR 0.65, 95% CI 0.58–0.72) and a 19% reduced risk of mortality for the colon cancer measure 12RLN (HR 0.81, 95% CI 0.77–0.85). For the lung cancer measure LNoSurg, increasing compliance was paradoxically associated with an increased risk of mortality (HR 1.14, 95% CI 1.08–1.20). For the remaining measures, hospital‐level compliance demonstrated no consistent association with patient survival. Conclusion Hospital‐level compliance with the CoC’s Quality of Care Measures is not uniformly aligned with patient survival. In their current form, these measures do not reliably discriminate hospital performance and are limited as a tool for value‐based healthcare delivery.
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Affiliation(s)
| | - Christel N Rushing
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Zhifei Sun
- Department of Surgery, Duke University, Durham, NC, USA
| | | | - Mathias Worni
- Department of Visceral Surgery, Clarunis, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, Basel, Switzerland.,Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
| | - Robert S Saunders
- Duke University, Robert J. Margolis Center for Health Policy, Durham, NC, USA
| | - Mark B McClellan
- Duke University, Robert J. Margolis Center for Health Policy, Durham, NC, USA
| | - Donna Niedzwiecki
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Rachel A Greenup
- Department of Surgery and Population Health Sciences, Duke University, Duke Cancer Institute, Durham, NC, USA
| | - Dan G Blazer
- Department of Surgery, Duke University, Duke Cancer Institute, Durham, NC, USA
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5
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Salama AKS, Palta M, Rushing CN, Selim MA, Linney KN, Czito BG, Yoo DS, Hanks BA, Beasley GM, Mosca PJ, Dumbauld C, Steadman KN, Yi JS, Weinhold KJ, Tyler DS, Lee WT, Brizel DM. Ipilimumab and Radiation in Patients with High-risk Resected or Regionally Advanced Melanoma. Clin Cancer Res 2021; 27:1287-1295. [PMID: 33172894 PMCID: PMC8759408 DOI: 10.1158/1078-0432.ccr-20-2452] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/22/2020] [Accepted: 11/05/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE In this prospective trial, we sought to assess the feasibility of concurrent administration of ipilimumab and radiation as adjuvant, neoadjuvant, or definitive therapy in patients with regionally advanced melanoma. PATIENTS AND METHODS Twenty-four patients in two cohorts were enrolled and received ipilimumab at 3 mg/kg every 3 weeks for four doses in conjunction with radiation; median dose was 4,000 cGy (interquartile range, 3,550-4,800 cGy). Patients in cohort 1 were treated adjuvantly; patients in cohort 2 were treated either neoadjuvantly or as definitive therapy. RESULTS Adverse event profiles were consistent with those previously reported with checkpoint inhibition and radiation. For the neoadjuvant/definitive cohort, the objective response rate was 64% (80% confidence interval, 40%-83%), with 4 of 10 evaluable patients achieving a radiographic complete response. An additional 3 patients in this cohort had a partial response and went on to surgical resection. With 2 years of follow-up, the 6-, 12-, and 24-month relapse-free survival for the adjuvant cohort was 85%, 69%, and 62%, respectively. At 2 years, all patients in the neoadjuvant/definitive cohort and 10/13 patients in the adjuvant cohort were still alive. Correlative studies suggested that response in some patients were associated with specific CD4+ T-cell subsets. CONCLUSIONS Overall, concurrent administration of ipilimumab and radiation was feasible, and resulted in a high response rate, converting some patients with unresectable disease into surgical candidates. Additional studies to investigate the combination of radiation and checkpoint inhibitor therapy are warranted.
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Affiliation(s)
- April K S Salama
- Department of Medicine, Division of Medical Oncology, Duke University, Durham, North Carolina.
| | - Manisha Palta
- Department of Radiation Oncology, Duke University, Durham, North Carolina
| | | | - M Angelica Selim
- Department of Pathology, Duke University, Durham, North Carolina
| | | | - Brian G Czito
- Department of Radiation Oncology, Duke University, Durham, North Carolina
| | - David S Yoo
- Department of Radiation Oncology, Duke University, Durham, North Carolina
| | - Brent A Hanks
- Department of Medicine, Division of Medical Oncology, Duke University, Durham, North Carolina
- Department of Pharmacology and Cancer Biology, Durham, North Carolina
| | | | - Paul J Mosca
- Department of Surgery, Duke University, Durham, North Carolina
| | - Chelsae Dumbauld
- Department of Immunology, Mayo Clinic Scottsdale, Scottsdale, Arizona
| | | | - John S Yi
- Department of Surgery, Duke University, Durham, North Carolina
| | - Kent J Weinhold
- Department of Surgery, Duke University, Durham, North Carolina
| | - Douglas S Tyler
- Department of Surgery, The University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Walter T Lee
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina
| | - David M Brizel
- Department of Radiation Oncology, Duke University, Durham, North Carolina
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina
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Ryser MD, Rushing CN, Thomas SM, Lynch T, McCarthy A, Mohammed ZA, Francescatti AB, Frank ES, Partridge AH, Thompson AM, Hyslop T, Hwang ES. Abstract PD5-03: Ipsilateral invasive cancer risk after diagnosis with ductal carcinoma in situ in patients with and without index surgery: The effects of endocrine therapy and radiation treatment. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-pd5-03] [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. Ongoing clinical trials are evaluating active surveillance as a potential alternative to immediate surgery in patients diagnosed with low-risk ductal carcinoma in situ (DCIS). Among women undergoing lumpectomy, the risk of ipsilateral invasive breast cancer (iIBC) after a diagnosis of DCIS can be reduced with adjuvant therapy, including endocrine therapy (ET) and radiation treatment (RT). Here we characterize the effects of ET and RT on iIBC risk after diagnosis with DCIS in a national cohort, in patients who received breast conserving surgery (BCS) within 6 months of diagnosis (BCS group) compared to patients who did not receive any locoregional treatment within 6 months of diagnosis (surveillance [SV] group). Methods. A treatment-stratified random sample of patients diagnosed with biopsy-confirmed DCIS in 2008-14 was selected from 1,330 Commission on Cancer-accredited facilities (20/site). Patients who received a mastectomy within 6 months of diagnosis were excluded. Subsequent breast events were abstracted up to 10 years after diagnosis. Primary outcomes were the population-averaged 8-year absolute risks of iIBC for the following five treatment modalities: BCS alone, SV alone, BCS + ET, SV+ET, BCS+RT, and BCS+ET+RT (where ET was defined as ≥5 years of continuous treatment). Secondary outcomes were the average treatment effects (ATE) of SV+ET vs SV, BCS+RT vs SV+ET, and BCS+RT+ET vs SV+ET. A propensity score (PS) model for treatment choice BCS vs SV was fitted with sampling design (SD) weighting and random effects for patients within facilities. Relative treatment effects (hazard ratios [HR]) for the five treatment groups were obtained using multivariable Cox proportional hazards models adjusted for tumor and patient characteristics. The models were weighted by SD and PS and included a robust sandwich covariance estimator to account for clustering of patients within facilities. Population-averaged risks and ATEs were derived from the marginal outcome probabilities: assuming that the entire population received the treatment of interest, each patient’s counterfactual probability of an iIBC event by 8 years was predicted, and then averaged across the weighted population. 95% confidence intervals (CI) were obtained by bootstrapping. Results. The final analytic cohort contained 14,245 (88.2%) BCS and 1,914 (11.8%) SV patients. Overall, median age at diagnosis was 61 years (IQR: 52-69) and median follow-up was 5.8 years (95% CI 5.7-6.1). The majority of patients were Caucasian (81.9%), with hormone receptor-positive (79.9%), and nuclear grade I/II (54.5%) DCIS. Uptake of any ET was 48.5% and 23.7% in BCS and SV patients, respectively. The relative treatment effects (HR) for the receipt of BCS, RT and ≥5 years of ET were 1.65 (95% CI: 1.14-2.39), 0.40 (95% CI: 0.27-0.61) and 0.55 (95% CI: 0.17-1.72) respectively. The 8-year population-averaged iIBC risks and corresponding ATEs are shown Table 1. Conclusion. The 8-year risk of iIBC was below 7% for all six management options. Relative and absolute treatment effects of ET and RT were comparable to previously reported estimates. In SV patients, receipt of ≥5 years of ET nearly halved the 8-year risk, indicating a substantial risk reduction potential for ET in patients who do not receive immediate surgery after diagnosis.
Table 1: Population-averaged 8-year iIBC risk and ATEs.TreatmentiIBC risk (%)95% CISurveillance6.906.79-7.01Surveillance + ET3.903.83-3.96BCS4.264.21-4.31BCS + RT1.761.73-1.79BCS + ET2.392.35-2.43BCS + ET + RT0.980.96-0.99Treatment comparisonATE (%)95% CISV+ET vs SV3.02.95-3.04BCS+RT vs SV+ET2.142.11-2.17BCS+RT+ET vs SV+ET2.922.78-2.97
Citation Format: Marc D Ryser, Christel N Rushing, Samantha M Thomas, Thomas Lynch, Anne McCarthy, Zahed A Mohammed, Amanda B Francescatti, Elizabeth S Frank, Anne H Partridge, Alastair M Thompson, Terry Hyslop, E. Shelley Hwang. Ipsilateral invasive cancer risk after diagnosis with ductal carcinoma in situ in patients with and without index surgery: The effects of endocrine therapy and radiation treatment [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD5-03.
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Affiliation(s)
| | | | | | | | - Anne McCarthy
- 2Cancer Programs, American College of Surgeons, Chicago, IL
| | | | | | | | - Anne H Partridge
- 4Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
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Strickler JH, Rushing CN, Uronis HE, Morse MA, Niedzwiecki D, Blobe GC, Moyer AN, Bolch E, Webb R, Haley S, Hatch AJ, Altomare IP, Sherrill GB, Chang DZ, Wells JL, Hsu SD, Jia J, Zafar SY, Nixon AB, Hurwitz HI. Cabozantinib and Panitumumab for RAS Wild-Type Metastatic Colorectal Cancer. Oncologist 2021; 26:465-e917. [PMID: 33469991 DOI: 10.1002/onco.13678] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 01/08/2021] [Indexed: 12/17/2022] Open
Abstract
LESSONS LEARNED Antitumor activity was observed in the study population. Dose modifications of cabozantinib improve long-term tolerability. Biomarkers are needed to identify patient populations most likely to benefit. Further study of cabozantinib with or without panitumumab in patients with metastatic colorectal cancer is warranted. BACKGROUND The epidermal growth factor receptor (EGFR) antibody panitumumab is active in patients with RAS wild-type (WT) metastatic colorectal cancer (mCRC), but nearly all patients experience resistance. MET amplification is a driver of panitumumab resistance. Cabozantinib is an inhibitor of multiple kinases, including vascular endothelial growth factor receptor 2 (VEGFR2) and c-MET, and may delay or reverse anti-EGFR resistance. METHODS In this phase Ib clinical trial, we established the maximum tolerated dose (MTD) and recommended phase II dose (RP2D) of cabozantinib and panitumumab. We then treated an expansion cohort to further describe the tolerability and clinical activity of the RP2D. Eligibility included patients with KRAS WT mCRC (later amended to include only RAS WT mCRC) who had received prior treatment with a fluoropyrimidine, oxaliplatin, irinotecan, and bevacizumab. RESULTS Twenty-five patients were enrolled and treated. The MTD/RP2D was cabozantinib 60 mg p.o. daily and panitumumab 6 mg/kg I.V. every 2 weeks. The objective response rate (ORR) was 16%. Median progression free survival (PFS) was 3.7 months (90% confidence interval [CI], 2.3-7.1). Median overall survival (OS) was 12.1 months (90% CI, 7.5-14.3). Five patients (20%) discontinued treatment due to toxicity, and 18 patients (72%) required a dose reduction of cabozantinib. CONCLUSION The combination of cabozantinib and panitumumab has activity. Dose reductions of cabozantinib improve tolerability.
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Affiliation(s)
| | - Christel N Rushing
- Duke Cancer Institute, Biostatistics, Duke University Medical Center, Durham, North Carolina, USA
| | - Hope E Uronis
- Duke University Medical Center, Durham, North Carolina, USA
| | | | - Donna Niedzwiecki
- Duke Cancer Institute, Biostatistics, Duke University Medical Center, Durham, North Carolina, USA
| | - Gerard C Blobe
- Duke University Medical Center, Durham, North Carolina, USA
| | - Ashley N Moyer
- Duke University Medical Center, Durham, North Carolina, USA
| | - Emily Bolch
- Duke University Medical Center, Durham, North Carolina, USA
| | - Renee Webb
- Duke University Medical Center, Durham, North Carolina, USA
| | - Sherri Haley
- Duke University Medical Center, Durham, North Carolina, USA
| | - Ace J Hatch
- Duke University Medical Center, Durham, North Carolina, USA
| | - Ivy P Altomare
- Duke University Medical Center, Durham, North Carolina, USA
| | - Gary B Sherrill
- Moses Cone Regional Cancer Center, Greensboro, North Carolina, USA
| | - David Z Chang
- Virginia Oncology Associates, Hampton, Virginia, USA
| | - James L Wells
- Lexington Oncology, West Columbia, South Carolina, USA
| | - S David Hsu
- Duke University Medical Center, Durham, North Carolina, USA
| | - Jingquan Jia
- Duke University Medical Center, Durham, North Carolina, USA
| | - S Yousuf Zafar
- Duke University Medical Center, Durham, North Carolina, USA
| | - Andrew B Nixon
- Duke University Medical Center, Durham, North Carolina, USA
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8
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Morse M, Halperin DM, Uronis HE, Hsu DS, Hurwitz H, Bolch E, Warren D, Haley S, John L, Moyer A, Rushing CN, Niedzwiecki D. Phase Ib/II study of pembrolizumab with lanreotide depot for advanced, progressive gastroenteropancreatic neuroendocrine tumors (PLANET). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.3_suppl.369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
369 Background: Pembrolizumab has antitumor activity in a subset of GEP-NETs patients. We hypothesized that the lanreotide, by its antitumor effects and reduction of serotonin, a modulator of immunity, would synergize with pembrolizumab in low/intermediate grade GEPNETs. Methods: GEP-NETs patients who had progressed on a prior somatostatin analogue received lanreotide 90mg sq and pembrolizumab 200mg IV every 3 weeks until progressive disease or intolerable toxicity. The primary endpoint was ORR at any time on study and secondary endpoints were PFS and OS. Results: 22 patients were treated (F/M 10/12; Caucasian/AA/other 10/7/5; GI/pancreatic 14/8; median Ki67 5%, median time since diagnosis 5.3 yrs (IQR 2.3-7.9 yrs)). Prior octreotide LAR/lanreotide/both was administered to 20/1/1. Patients had a median of 2 prior systemic therapies (range 1-9) and six had prior locoregional therapy and 3 external beam radiotherapy. Of the 12 tumors analyzed thus far, 4 had detectable PD-L1 expression and 11 had detectable TILs. A median of 6 pembrolizumab doses (range 2-15) and 7 lanreotide doses (range 2-15) were administered. Six patients experienced treatment related SAEs (abdominal pain, pneumonitis, colitis, and hyperglycemia, all related to the pembrolizumab). Selected treatment related adverse events included: Hypothyroidism 23%, colitis 9%, hyperglycemia 14%, and pneumonitis 5%. Best response by RECIST 1.1 was SD/PD/Not available:39/52/9% and by irRECIST was 43/48/9%. Median PFS was 5.4 months (95% CI 1.7-8.3 mo). The median overall survival at a median follow-up of 15 months was not reached. Peripheral blood immunologic correlates will be reported subsequently. Conclusions: In a population of GEP-NET patients, progressing on a median of 2 prior therapies, including prior somatostatin analogue therapy, a minority of whom had PD-L1 expressing tumors, the combination of lanreotide and pembrolizumab produced stable disease in approximately 40% of patients. No new safety signals were identified. Clinical trial information: NCT03043664.
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Affiliation(s)
| | | | | | - David S. Hsu
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, NC
| | | | | | | | | | - Lisa John
- Duke University Medical Center, Durham, NC
| | | | | | - Donna Niedzwiecki
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC
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9
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Plichta JK, Rushing CN, Lewis HC, Blazer DG, Hyslop T, Greenup RA. Missing data in breast cancer: Relationship with survival in national databases. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e19114] [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
e19114 Background: National cancer registries are valuable tools used to analyze patterns of care and clinical oncology outcomes; yet, patients with missing data may impact the accuracy and generalizability of these data. We sought to evaluate the association between missing data and overall survival (OS). Methods: Using the NCDB and SEER, we compared data missingness among patients diagnosed with invasive breast cancer from 2010-2014. Key variables included: demographic variables (age, race, ethnicity, insurance, education, income), tumor variables (grade, ER, PR, HER2, TNM stage), and treatment variables (surgery in both databases; chemotherapy and radiation in NCDB). OS was compared between those with and without missing data via Cox proportional hazards models. Results: Overall, 775,996 patients in the NCDB and 263,016 in SEER were identified; missingness of at least 1 key variable was 29% and 13%, respectively. Of those, the majority were missing a tumor variable (NCDB 80%; SEER 88%), while demographic and treatment variables were missing less often. When compared to patients with complete data, missingness was associated with a greater risk of death; NCDB 17% vs. 14% (HR 1.23, 99% CI 1.21-1.25) and SEER 27% vs 14% (HR 2.11, 99% CI 2.05-2.18). Rate of death was similar whether the patient was missing 1 or ≥2 variables. When stratified by the type of missing variable, differences in OS between those with and without missing data in the NCDB were small. In SEER, reductions in OS were largest for those missing tumor variables (HR 2.26, 99% CI 2.19-2.33) or surgery data (HR 3.84, 99% CI 3.32-4.45). Among the tumor variables specifically, few clinically meaningful differences in OS were noted in the NCDB, while the most significant differences in SEER were noted in T and N stage (table). Conclusions: Missingness of select variables is associated with a worse OS and is not uncommon within large national cancer registries. Therefore, researchers must use caution when choosing inclusion/exclusion criteria for outcomes studies. Future research is needed to elucidate which patients are most often missing data and why OS differences are observed. [Table: see text]
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Affiliation(s)
| | | | | | - Dan G. Blazer
- Duke University Medical Center, Department of Surgery and Duke Cancer Institute, Durham, NC
| | - Terry Hyslop
- Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Durham, NC
| | - Rachel Adams Greenup
- Duke University Medical Center, Department of Surgery and Duke Cancer Institute, Durham, NC
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10
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Strickler JH, Rushing CN, Niedzwiecki D, McLeod A, Altomare I, Uronis HE, Hsu SD, Zafar SY, Morse MA, Chang DZ, Wells JL, Blackwell KL, Marcom PK, Arrowood C, Bolch E, Haley S, Rangwala FA, Hatch AJ, Nixon AB, Hurwitz HI. A phase Ib study of capecitabine and ziv-aflibercept followed by a phase II single-arm expansion cohort in chemotherapy refractory metastatic colorectal cancer. BMC Cancer 2019; 19:1032. [PMID: 31675952 PMCID: PMC6824108 DOI: 10.1186/s12885-019-6234-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 10/02/2019] [Indexed: 12/21/2022] Open
Abstract
Background Patients with chemotherapy refractory metastatic colorectal cancer (CRC) have a poor prognosis and limited therapeutic options. In this phase Ib/II clinical trial, we established the maximum tolerated dose (MTD) and recommended phase II dose (RPTD) for the combination of capecitabine and ziv-aflibercept, and then we evaluated the efficacy of the combination in patients with chemotherapy refractory metastatic CRC. Methods All patients were required to have a Karnofsky Performance Status > 70% and adequate organ function. The phase Ib dose escalation cohort included patients with advanced solid tumors who had progressed on all standard therapies. Using a standard 3 + 3 design, we identified the MTD and RPTD for the combination. Fifty patients with metastatic CRC who had progressed on or were intolerant of a fluoropyrimidine, oxaliplatin, irinotecan, and bevacizumab were then enrolled in a single-arm phase II expansion cohort, and were treated at the RPTD. Prior EGFR antibody therapy was required for subjects with RAS wildtype tumors. The primary endpoint for the expansion cohort was progression-free survival (PFS) at two months. Secondary endpoints included objective response rate (ORR) and overall survival (OS). Results A total of 63 patients were enrolled and evaluable for toxicity (13 dose escalation; 50 expansion). The MTD and RPTD were: capecitabine 850 mg/m2, P.O. bid, days 1–14, and ziv-aflibercept 6 mg/kg I.V., day 1, of each 21-day cycle. In the expansion cohort, 72% of patients were progression-free at two months (95% confidence interval [CI], 60–84%). Median PFS and OS were 3.9 months (95% CI, 2.3–4.5) and 7.1 months (95% CI: 5.8–10.0), respectively. Among all patients evaluable for toxicity, the most common treatment related adverse events (all grade [%]; grade ≥ 3 [%]) included palmar-plantar erythrodysesthesia (41%; 6%), hypertension (33%; 22%), and mucositis (19%; 5%). RNA was isolated from archived tumor specimens and gene expression analyses revealed no association between angiogenic biomarkers and clinical outcomes. Conclusion The combination of capecitabine and ziv-aflibercept at the RPTD demonstrated acceptable safety and tolerability. PFS at 2 months in patients with chemotherapy refractory metastatic CRC was significantly greater than that in historical controls, indicating that this combination warrants further study. Trial registration This clinical trial was registered in the www.clinicaltrials.gov system as NCT01661972 on July 31, 2012.
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Affiliation(s)
- John H Strickler
- Duke University Medical Center, Box 3216, 30 Duke Medicine Circle, Room #0050, Durham, NC, 27705, USA.
| | - Christel N Rushing
- Duke Cancer Institute Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, 27705, USA
| | - Donna Niedzwiecki
- Duke Cancer Institute Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, 27705, USA
| | - Abigail McLeod
- Duke University Medical Center, Box 3216, 30 Duke Medicine Circle, Room #0050, Durham, NC, 27705, USA
| | - Ivy Altomare
- Duke University Medical Center, Box 3216, 30 Duke Medicine Circle, Room #0050, Durham, NC, 27705, USA
| | - Hope E Uronis
- Duke University Medical Center, Box 3216, 30 Duke Medicine Circle, Room #0050, Durham, NC, 27705, USA
| | - S David Hsu
- Duke University Medical Center, Box 3216, 30 Duke Medicine Circle, Room #0050, Durham, NC, 27705, USA
| | - S Yousuf Zafar
- Duke University Medical Center, Box 3216, 30 Duke Medicine Circle, Room #0050, Durham, NC, 27705, USA
| | - Michael A Morse
- Duke University Medical Center, Box 3216, 30 Duke Medicine Circle, Room #0050, Durham, NC, 27705, USA
| | - David Z Chang
- Virginia Oncology Associates, Hampton, VA, 23666, USA
| | - James L Wells
- Lexington Oncology Associates, West Columbia, SC, 29169, USA
| | - Kimberly L Blackwell
- Duke University Medical Center, Box 3216, 30 Duke Medicine Circle, Room #0050, Durham, NC, 27705, USA
| | - P Kelly Marcom
- Duke University Medical Center, Box 3216, 30 Duke Medicine Circle, Room #0050, Durham, NC, 27705, USA
| | - Christy Arrowood
- Duke University Medical Center, Box 3216, 30 Duke Medicine Circle, Room #0050, Durham, NC, 27705, USA
| | - Emily Bolch
- Duke University Medical Center, Box 3216, 30 Duke Medicine Circle, Room #0050, Durham, NC, 27705, USA
| | - Sherri Haley
- Duke University Medical Center, Box 3216, 30 Duke Medicine Circle, Room #0050, Durham, NC, 27705, USA
| | | | - Ace J Hatch
- Duke University Medical Center, Box 3216, 30 Duke Medicine Circle, Room #0050, Durham, NC, 27705, USA
| | - Andrew B Nixon
- Duke University Medical Center, Box 3216, 30 Duke Medicine Circle, Room #0050, Durham, NC, 27705, USA
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11
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Clarke JM, Blobe GC, Strickler JH, Uronis HE, Zafar SY, Morse M, Dropkin E, Howard L, O'Neill M, Rushing CN, Niedzwiecki D, Watson H, Bolch E, Arrowood C, Liu Y, Nixon AB, Hurwitz HI. A phase Ib study of the combination regorafenib with PF-03446962 in patients with refractory metastatic colorectal cancer (REGAL-1 trial). Cancer Chemother Pharmacol 2019; 84:909-917. [PMID: 31444620 PMCID: PMC6769092 DOI: 10.1007/s00280-019-03916-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 07/27/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE This study aimed to evaluate the maximum tolerated dose (MTD) and recommended phase II dose (RPTD), as well as the safety and tolerability of PF-03446962, a monoclonal antibody targeting activin receptor like kinase 1 (ALK-1), in combination with regorafenib in patients with refractory metastatic colorectal cancer. METHODS The first stage of this study was a standard "3 + 3" open-label dose-escalation scheme. Cohorts of 3-6 subjects were started with 120 mg of regorafenib given PO daily for 3 weeks of a 4 week cycle, plus 4.5 mg/kg of PF-03446962 given IV every 2 weeks. Doses of both drugs were adjusted according to dose-limiting toxicities (DLT). Plasma was collected for multiplexed ELISA analysis of factors related to tumor growth and angiogenesis. RESULTS Seventeen subjects were enrolled, of whom 11 were deemed evaluable. Seven subjects were enrolled at dose level 1, and four were enrolled at level - 1. Overall, three DLTs were observed during the dose-escalation phase: two in level 1 and one in level - 1. A planned dose-expansion cohort was not started due to early termination of the clinical trial. Common adverse events were infusion-related reaction, fatigue, palmar-plantar erythrodysesthesia syndrome, abdominal pain, dehydration, nausea, back pain, anorexia, and diarrhea. One subject achieved stable disease for 5.5 months, but discontinued treatment due to adverse events. CONCLUSIONS The regimen of regorafenib and PF-03446962 was associated with unacceptable toxicity and did not demonstrate notable clinical activity in patients with refractory metastatic colorectal cancer.
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Affiliation(s)
- Jeffrey Melson Clarke
- Duke Cancer Institute, Duke University Medical Center, 20 Medicine Circle, Morris Building, Rm 25178, DUMC Box 3198, Durham, NC, 27710, USA.
| | - Gerard C Blobe
- Duke Cancer Institute, Duke University Medical Center, 20 Medicine Circle, Morris Building, Rm 25178, DUMC Box 3198, Durham, NC, 27710, USA
| | - John H Strickler
- Duke Cancer Institute, Duke University Medical Center, 20 Medicine Circle, Morris Building, Rm 25178, DUMC Box 3198, Durham, NC, 27710, USA
| | - Hope Elizabeth Uronis
- Duke Cancer Institute, Duke University Medical Center, 20 Medicine Circle, Morris Building, Rm 25178, DUMC Box 3198, Durham, NC, 27710, USA
| | - S Yousuf Zafar
- Duke Cancer Institute, Duke University Medical Center, 20 Medicine Circle, Morris Building, Rm 25178, DUMC Box 3198, Durham, NC, 27710, USA
| | - Michael Morse
- Duke Cancer Institute, Duke University Medical Center, 20 Medicine Circle, Morris Building, Rm 25178, DUMC Box 3198, Durham, NC, 27710, USA
| | - Evan Dropkin
- Duke Cancer Institute, Duke University Medical Center, 20 Medicine Circle, Morris Building, Rm 25178, DUMC Box 3198, Durham, NC, 27710, USA
| | - Leigh Howard
- Duke Cancer Institute, Duke University Medical Center, 20 Medicine Circle, Morris Building, Rm 25178, DUMC Box 3198, Durham, NC, 27710, USA
| | - Margot O'Neill
- Duke Cancer Institute, Duke University Medical Center, 20 Medicine Circle, Morris Building, Rm 25178, DUMC Box 3198, Durham, NC, 27710, USA
| | - Christel N Rushing
- Duke Cancer Institute, Duke University Medical Center, 20 Medicine Circle, Morris Building, Rm 25178, DUMC Box 3198, Durham, NC, 27710, USA
| | - Donna Niedzwiecki
- Duke Cancer Institute, Duke University Medical Center, 20 Medicine Circle, Morris Building, Rm 25178, DUMC Box 3198, Durham, NC, 27710, USA
| | - Hollie Watson
- Duke Cancer Institute, Duke University Medical Center, 20 Medicine Circle, Morris Building, Rm 25178, DUMC Box 3198, Durham, NC, 27710, USA
| | - Emily Bolch
- Duke Cancer Institute, Duke University Medical Center, 20 Medicine Circle, Morris Building, Rm 25178, DUMC Box 3198, Durham, NC, 27710, USA
| | - Christy Arrowood
- Duke Cancer Institute, Duke University Medical Center, 20 Medicine Circle, Morris Building, Rm 25178, DUMC Box 3198, Durham, NC, 27710, USA
| | - Yingmiao Liu
- Duke Cancer Institute, Duke University Medical Center, 20 Medicine Circle, Morris Building, Rm 25178, DUMC Box 3198, Durham, NC, 27710, USA
| | - Andrew B Nixon
- Duke Cancer Institute, Duke University Medical Center, 20 Medicine Circle, Morris Building, Rm 25178, DUMC Box 3198, Durham, NC, 27710, USA
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12
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Mowery YM, Patel K, Chowdhary M, Rushing CN, Roy Choudhury K, Lowe JR, Olson AC, Wisdom AJ, Salama JK, Hanks BA, Khan MK, Salama AKS. Retrospective analysis of safety and efficacy of anti-PD-1 therapy and radiation therapy in advanced melanoma: A bi-institutional study. Radiother Oncol 2019; 138:114-120. [PMID: 31252292 PMCID: PMC7566286 DOI: 10.1016/j.radonc.2019.06.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 01/11/2019] [Revised: 06/05/2019] [Accepted: 06/11/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE Antibodies against programmed cell death protein 1 (PD-1) are standard treatments for advanced melanoma. Palliative radiation therapy (RT) is commonly administered for this disease. Safety and optimal timing for this combination for melanoma has not been established. MATERIALS AND METHODS In this retrospective cohort study, records for melanoma patients who received anti-PD-1 therapy at Duke University or Emory University (1/1/2013-12/30/2015) were reviewed. Patients were categorized by receipt of RT and RT timing relative to anti-PD-1. RESULTS 151 patients received anti-PD-1 therapy. Median follow-up was 12.9 months. Patients receiving RT (n = 85) had worse baseline prognostic factors than patients without RT (n = 66). One-year overall survival (OS) was lower for RT patients than patients without RT (66%, 95% CI: 55-77% vs 83%, 95% CI: 73-92%). One-year OS was 61% for patients receiving RT before anti-PD-1 (95% CI: 46-76%), 78% for RT during anti-PD-1 (95% CI: 60-95%), and 58% for RT after anti-PD-1 (95% CI: 26-89%). On Cox regression, OS for patients without RT did not differ significantly from patients receiving RT during anti-PD-1 (HR 1.07, 95% CI: 0.41-2.84) or RT before anti-PD-1 (HR 0.56, 95% CI: 0.21-1.45). RT and anti-PD-1 therapy administered within 6 weeks of each other was well tolerated. CONCLUSION RT can be safely administered with anti-PD-1 therapy. Despite worse baseline prognostic characteristics for patients receiving RT, OS was similar for patients receiving concurrent RT with anti-PD-1 therapy compared to patients receiving anti-PD-1 therapy alone.
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Affiliation(s)
- Yvonne M Mowery
- Department of Radiation Oncology, Duke University Medical Center, Durham, United States.
| | - Kirtesh Patel
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, United States.
| | - Mudit Chowdhary
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, United States.
| | - Christel N Rushing
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, United States.
| | - Kingshuk Roy Choudhury
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, United States; Department of Radiology, Duke University Medical Center, Durham, United States.
| | - Jared R Lowe
- Department of Medicine, Duke University Medical Center, Durham, United States.
| | - Adam C Olson
- Department of Radiation Oncology, Duke University Medical Center, Durham, United States.
| | - Amy J Wisdom
- Duke University School of Medicine, Durham, United States.
| | - Joseph K Salama
- Department of Radiation Oncology, Duke University Medical Center, Durham, United States.
| | - Brent A Hanks
- Department of Medicine, Duke University Medical Center, Durham, United States.
| | - Mohammad K Khan
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, United States.
| | - April K S Salama
- Department of Medicine, Duke University Medical Center, Durham, United States.
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13
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Turner MC, Keenan JE, Rushing CN, Gulack BC, Nussbaum DP, Benrashid E, Hyslop T, Strickler JH, Mantyh CR, Migaly J. Adjuvant Chemotherapy Improves Survival Following Resection of Locally Advanced Rectal Cancer with Pathologic Complete Response. J Gastrointest Surg 2019; 23:1614-1622. [PMID: 30635829 DOI: 10.1007/s11605-018-04079-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 11/30/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Controversy exists over the use of adjuvant chemotherapy for locally advanced (stages II-III) rectal cancer (LARC) patients who demonstrate pathologic complete response (pCR) following neoadjuvant chemoradiation. We conducted a retrospective analysis to determine whether adjuvant chemotherapy imparts survival benefit among this population. METHODS The National Cancer Database (NCDB) was queried to identify LARC patients with pCR following neoadjuvant chemoradiation. The cohort was stratified by receipt of adjuvant chemotherapy. Multiple imputation and a Cox proportional hazards model were employed to estimate the effect of adjuvant chemotherapy on overall survival. RESULTS There were 24,418 patients identified in the NCDB with clinically staged II or III rectal cancer who received neoadjuvant chemoradiation. Of these, 5606 (23.0%) had pCR. Among patients with pCR, 1401 (25%) received adjuvant chemotherapy and 4205 (75%) did not. Patients who received adjuvant chemotherapy were slightly younger, more likely to have private insurance, and more likely to have clinically staged III disease, but did not differ significantly in comparison to patients who did not receive adjuvant chemotherapy with respect to race, sex, facility type, Charlson comorbidity score, histologic tumor grade, procedure type, length of stay, or rate of 30-day readmission following surgery. On adjusted analysis, receipt of adjuvant chemotherapy was associated with a lower risk of death at a given time compared to patients who did not receive adjuvant chemotherapy (HR 0.808; 95% CI 0.679-0.961; p = 0.016). CONCLUSION Supporting existing NCCN guidelines, the findings from this study suggest that adjuvant chemotherapy improves survival for LARC with pCR following neoadjuvant chemoradiation.
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Affiliation(s)
- Megan C Turner
- Division of Surgical Oncology, Department of Surgery, Duke University Medical Center, 2817, Durham, NC, 27710, USA.
| | - Jeffrey E Keenan
- Division of Surgical Oncology, Department of Surgery, Duke University Medical Center, 2817, Durham, NC, 27710, USA
| | - Christel N Rushing
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Brian C Gulack
- Division of Surgical Oncology, Department of Surgery, Duke University Medical Center, 2817, Durham, NC, 27710, USA
| | - Daniel P Nussbaum
- Division of Surgical Oncology, Department of Surgery, Duke University Medical Center, 2817, Durham, NC, 27710, USA
| | - Ehsan Benrashid
- Division of Surgical Oncology, Department of Surgery, Duke University Medical Center, 2817, Durham, NC, 27710, USA
| | - Terry Hyslop
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - John H Strickler
- Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Christopher R Mantyh
- Division of Surgical Oncology, Department of Surgery, Duke University Medical Center, 2817, Durham, NC, 27710, USA
| | - John Migaly
- Division of Surgical Oncology, Department of Surgery, Duke University Medical Center, 2817, Durham, NC, 27710, USA
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14
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Greenup RA, Rushing CN, Fish LJ, Lane WO, Peppercorn JM, Bellavance E, Tolnitch L, Hyslop T, Myers ER, Zafar SY, Hwang ES. Perspectives on the Costs of Cancer Care: A Survey of the American Society of Breast Surgeons. Ann Surg Oncol 2019; 26:3141-3151. [PMID: 31342390 DOI: 10.1245/s10434-019-07594-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Cancer treatment costs are not routinely addressed in shared decisions for breast cancer surgery. Thus, we sought to characterize cost awareness and communication among surgeons treating breast cancer. METHODS We conducted a self-administered, confidential electronic survey among members of the American Society of Breast Surgeons from 1 July to 15 September 2018. Questions were based on previously published or validated survey items, and assessed surgeon demographics, cost sensitivity, and communication. Descriptive summaries and cross-tabulations with Chi-square statistics were used, with exact tests where warranted, to assess findings. RESULTS Of those surveyed (N = 2293), 598 (25%) responded. Surgeons reported that 'risk of recurrence' (70%), 'appearance of the breast' (50%), and 'risks of surgery' (47%) were the most influential on patients' decisions for breast cancer surgery; 6% cited out-of-pocket costs as significant. Over half (53%) of the surgeons agreed that doctors should consider patient costs when choosing cancer treatment, yet the majority of surgeons (58%) reported 'infrequently' (43%) or 'never' (15%) considering patient costs in medical recommendations. The overwhelming majority (87%) of surgeons believed that patients should have access to the costs of their treatment before making medical decisions. Surgeons treating a higher percentage of Medicaid or uninsured patients were more likely to consistently consider costs (p < 0.001). Participants reported that insufficient knowledge or resources (61%), a perceived inability to help with costs (24%), and inadequate time (22%) impeded cost discussions. Notably, 20% of participants believed that discussing costs might impact the quality of care patients receive. CONCLUSIONS Cost transparency remains rare, however in shared decisions for breast cancer surgery, improved cost awareness by surgeons has the potential to reduce financial hardship.
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Affiliation(s)
- Rachel A Greenup
- Department of Surgery, Duke University, Durham, NC, USA. .,Department of Population Health Sciences, Duke University, Durham, NC, USA. .,Duke Cancer Institute, Duke University, Durham, NC, USA. .,Duke Cancer Control and Population Sciences, Duke University, Durham, NC, USA.
| | - Christel N Rushing
- Duke Cancer Institute, Duke University, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Laura J Fish
- Duke Cancer Institute, Duke University, Durham, NC, USA.,Duke Cancer Control and Population Sciences, Duke University, Durham, NC, USA.,Duke School of Medicine, Duke University, Durham, NC, USA
| | | | | | | | - Lisa Tolnitch
- Department of Surgery, Duke University, Durham, NC, USA
| | - Terry Hyslop
- Duke Cancer Institute, Duke University, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Evan R Myers
- Department of Medicine, Duke University, Durham, NC, USA.,Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
| | - S Yousuf Zafar
- Department of Population Health Sciences, Duke University, Durham, NC, USA.,Duke Cancer Institute, Duke University, Durham, NC, USA.,Duke Cancer Control and Population Sciences, Duke University, Durham, NC, USA.,Department of Medicine, Duke University, Durham, NC, USA
| | - E Shelley Hwang
- Department of Surgery, Duke University, Durham, NC, USA.,Duke Cancer Institute, Duke University, Durham, NC, USA
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15
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Abdelazim YA, Rushing CN, Palta M, Willett CG, Czito BG. Role of pelvic chemoradiation therapy in patients with initially metastatic anal canal cancer: A National Cancer Database review. Cancer 2019; 125:2115-2122. [PMID: 30825391 DOI: 10.1002/cncr.32017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/30/2018] [Revised: 01/09/2019] [Accepted: 01/14/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND Although the management of localized anal canal squamous cell carcinomas is well established, the role of pelvic chemoradiation (CRT) in the treatment of patients presenting with synchronous metastatic (stage IV) disease is poorly defined. This study used a national cancer database to compare the overall survival (OS) rates of patients with synchronous metastatic disease receiving CRT to the pelvis and patients treated with chemotherapy (CT) alone. METHODS This study included adult patients with anal canal squamous cell carcinomas presenting with synchronous metastases diagnosed from 2004 to 2012. Multiple imputation and 2:1 propensity score matching were used to create a matched data set for testing. The proportional hazards model was used to estimate the hazard ratio (HR) for the effect of the treatment group on OS. With only patients in the matched data set, the OS of the treatment groups was estimated with the Kaplan-Meier method by treatment group. RESULTS This study started with an unmatched data set of 978 patients, and 582 patients were selected for the matched data set: 388 in the CRT group and 194 in the CT-alone group. The HR for the group effect was 0.75 (95% confidence interval [CI], 0.61-0.92; P = .006). The median OS was 21.1 months in the CRT group (95% CI, 17.4-24.0 months) and 14.6 months in the CT group (95% CI, 12.2-18.4 months). The corresponding 5-year OS rates were 23% (95% CI, 18%-28%) and 14% (95% CI, 7%-21%), respectively. CONCLUSIONS In this large series analyzing OS in patients with stage IV anal cancer, CRT was associated with improved OS in comparison with CT alone. Because of the lack of prospective data in this setting, this evidence will help to guide treatment approaches in this group of patients.
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Affiliation(s)
- Yasser A Abdelazim
- Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt.,Department of Radiation Oncology, Duke University, Durham, North Carolina
| | - Christel N Rushing
- Biostatistics, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Manisha Palta
- Department of Radiation Oncology, Duke University, Durham, North Carolina
| | | | - Brian G Czito
- Department of Radiation Oncology, Duke University, Durham, North Carolina
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16
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Natarajan BD, Rushing CN, Cummings MA, Jutzy JM, Choudhury KR, Moravan MJ, Fecci PE, Adamson J, Chmura SJ, Milano MT, Kirkpatrick JP, Salama JK. Predicting intracranial progression following stereotactic radiosurgery for brain metastases: Implications for post SRS imaging. J Radiosurg SBRT 2019; 6:179-187. [PMID: 31998538 PMCID: PMC6774486] [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] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
PURPOSE Follow-up imaging after stereotactic radiosurgery (SRS) is crucial to identify salvageable brain metastases (BM) recurrence. As optimal imaging intervals are poorly understood, we sought to build a predictive model for time to intracranial progression. METHODS Consecutive patients treated with SRS for BM at three institutions from January 1, 2002 to June 30, 2017 were retrospectively reviewed. We developed a model using stepwise regression that identified four prognostic factors and built a predictive nomogram. RESULTS We identified 755 patients with primarily non-small cell lung, breast, and melanoma BMs. Factors such as number of BMs, histology, history of prior whole-brain radiation, and time interval from initial cancer diagnosis to metastases were prognostic for intracranial progression. Per our nomogram, risk of intracranial progression by 3 months post-SRS in the high-risk group was 21% compared to 11% in the low-risk group; at 6 months, it was 43% versus 27%. CONCLUSION We present a nomogram estimating time to BM progression following SRS to potentially personalize surveillance imaging.
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Affiliation(s)
| | - Christel N Rushing
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Michael A Cummings
- Department of Radiation Oncology, University of Rochester, Rochester, NY, USA
| | - Jessica Ms Jutzy
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
| | - Kingshuk R Choudhury
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | | | - Peter E Fecci
- Department of Neurosurgery, Duke University, Durham, NC, USA
| | - Justus Adamson
- Department of Radiation Oncology, Duke University, Durham, NC, USA
| | - Steven J Chmura
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
| | - Michael T Milano
- Department of Radiation Oncology, University of Rochester, Rochester, NY, USA
| | | | - Joseph K Salama
- Department of Radiation Oncology, Duke University, Durham, NC, USA
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17
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Ray EM, Riedel RF, LeBlanc TW, Rushing CN, Galanos AN. Assessing the Impact of a Novel Integrated Palliative Care and Medical Oncology Inpatient Service on Health Care Utilization before Hospice Enrollment. J Palliat Med 2018; 22:420-423. [PMID: 30394821 DOI: 10.1089/jpm.2018.0235] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Evidence increasingly supports the integration of specialist palliative care (PC) into routine cancer care. A novel, fully integrated PC and medical oncology inpatient service was developed at Duke University Hospital in 2011. OBJECTIVE To assess the impact of PC integration on health care utilization among hospitalized cancer patients before hospice enrollment. METHODS Retrospective cohort study. Patients in the solid tumor inpatient unit who were discharged to hospice between September 1, 2009, and June 30, 2010 (pre-PC integration), and September 1, 2011, to June 30, 2012 (postintegration). Cohorts were compared on the following outcomes from their final hospitalization before hospice enrollment: intensive care unit days, invasive procedures, subspecialty consultations, radiographic studies, hospital length of stay, and use of chemotherapy or radiation. Cohort differences were examined with descriptive statistics and nonparametric tests. RESULTS Two hundred ninety-six patients were included in the analysis (133 pre-PC integration; 163 post-PC integration). Patient characteristics were similar between cohorts. Health care utilization was relatively low in both groups, although 26% and 24% were receiving chemotherapy at the time of admission or during hospitalization in the pre- and post-PC integration cohorts, respectively, and 6.8% in each cohort spent time in an intensive care unit. We found no significant differences in utilization between cohorts. DISCUSSION PC integration into an inpatient solid tumor service may not impact health care utilization during the final hospitalization before discharge to hospice. This likely reflects the greater benefits of integrating PC farther upstream from the terminal hospitalization, if one hopes to meaningfully impact utilization near the end of life.
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Affiliation(s)
- Emily M Ray
- 1 Division of Hematology and Oncology, University of North Carolina , Chapel Hill, North Carolina
| | - Richard F Riedel
- 2 Duke Cancer Institute, Duke University Medical Center , Durham, North Carolina
| | - Thomas W LeBlanc
- 2 Duke Cancer Institute, Duke University Medical Center , Durham, North Carolina.,3 Palliative Medicine, Duke University Medical Center , Durham, North Carolina
| | - Christel N Rushing
- 2 Duke Cancer Institute, Duke University Medical Center , Durham, North Carolina.,4 Biostatistics Shared Resource, Duke University Medical Center , Duke Cancer Institute, Durham, North Carolina
| | - Anthony N Galanos
- 2 Duke Cancer Institute, Duke University Medical Center , Durham, North Carolina.,3 Palliative Medicine, Duke University Medical Center , Durham, North Carolina
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18
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Hong JC, Cui Y, Patel BN, Rushing CN, Faught AM, Eng JS, Higgins K, Yin FF, Das S, Czito BG, Willett CG, Palta M. Association of Interim FDG-PET Imaging During Chemoradiation for Squamous Anal Canal Carcinoma With Recurrence. Int J Radiat Oncol Biol Phys 2018; 102:1046-1051. [DOI: 10.1016/j.ijrobp.2018.04.062] [Citation(s) in RCA: 12] [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: 11/29/2017] [Revised: 03/08/2018] [Accepted: 04/23/2018] [Indexed: 10/17/2022]
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19
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Tandberg DJ, Cui Y, Rushing CN, Hong JC, Ackerson BG, Marin D, Zhang X, Czito BG, Willett CW, Palta M. Intratreatment Response Assessment With 18F-FDG PET: Correlation of Semiquantitative PET Features With Pathologic Response of Esophageal Cancer to Neoadjuvant Chemoradiotherapy. Int J Radiat Oncol Biol Phys 2018; 102:1002-1007. [PMID: 30055238 DOI: 10.1016/j.ijrobp.2018.07.187] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 02/28/2018] [Revised: 06/30/2018] [Accepted: 07/17/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE This prospective study seeks to extract semiquantitative positron emission tomography (PET) features from 18F-fluorodeoxyglucose PET scans performed before and during neoadjuvant chemoradiotherapy for esophageal cancer and to compare their accuracy in predicting histopathologic response. METHODS AND MATERIALS From 2012 to 2016, 26 patients with esophageal cancer underwent pretreatment and intratreatment PET scans during chemoradiotherapy followed by surgery. Median patient age was 63 years (interquartile range, 58-68 years); 26 patients had esophageal adenocarcinoma, and 3 had esophageal squamous cell carcinoma. The intratreatment PET scan was performed at a median of 32.4 Gy (interquartile range, 30.6-32.4 Gy). PET features of the primary site including maximum standardized uptake value (SUV), SUV mean, metabolic tumor volume, and total lesion glycolysis were extracted from the pretreatment and intratreatment PET scans. Patients were histopathologic responders if there was complete or near-complete tumor response by modified Ryan scheme. Mean values of PET features were compared between histopathologic responders and nonresponders. The area under the receiver operating characteristic curve (AUC) was used to compare the accuracy of PET features in predicting histopathologic response. RESULTS Eleven patients (42%) were histopathologic responders. PET features most discriminatory of histopathologic response on AUC analysis were volumetric PET features from the intratreatment PET including metabolic tumor volume based on manual contour (AUC, 0.73; 95% confidence interval, 0.52-0.93) and total lesion glycolysis based on semiautomatic 40% SUV threshold (AUC, 0.73; 95% confidence interval, 0.53-0.94). CONCLUSIONS Volumetric PET features from the intratreatment PET were the most accurate predictors of histopathologic response.
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Affiliation(s)
- Daniel J Tandberg
- Department of Radiation Oncology, Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina
| | - Yunfeng Cui
- Department of Radiation Oncology, Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina
| | - Christel N Rushing
- Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina
| | - Julian C Hong
- Department of Radiation Oncology, Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina
| | - Bradley G Ackerson
- Department of Radiation Oncology, Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina
| | - Daniele Marin
- Department of Radiology, Duke University School of Medicine, Durham, North Carolina
| | - Xuenfeng Zhang
- Department of Pathology, Duke University School of Medicine, Durham, North Carolina
| | - Brian G Czito
- Department of Radiation Oncology, Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina
| | - Christopher W Willett
- Department of Radiation Oncology, Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina
| | - Manisha Palta
- Department of Radiation Oncology, Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina.
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Arrowood C, Rushing CN, Niedzwiecki D, Howard L, Honeycutt W, Hurwitz H, Cardones A. Topical sildenafil in the treatment of hand-foot syndrome and hand-foot skin reaction: A retrospective study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e22095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
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21
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Ray EM, Riedel RF, Rushing CN, Galanos AN. Healthcare utilization among cancer patients prior to hospice. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.26_suppl.135] [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
135 Background: The integration of palliative medicine in oncologic care has become increasingly recognized and supported. We have previously reported improved health system and quality of care outcomes for solid tumor patients admitted to our novel, fully-integrated palliative care (PC) and medical oncology inpatient service at Duke University Medical Center (DUMC). In this study, we explored healthcare utilization in patients specifically discharged to hospice pre- and post-PC integration. Methods: We conducted a retrospective cohort study of hospitalized patients on the solid tumor unit at DUMC who were discharged to hospice care between September 1, 2009-June 30, 2010 (pre-PC integration) and September 1, 2011-June 30, 2012 (post-PC integration). Cohorts were compared on the following outcome variables occurring within 30 days prior to discharge to hospice: number of hospitalizations, ICU days, ED visits, invasive procedures, subspecialty consultations, radiologic studies, medical oncology clinic visits, and use of chemotherapy or radiation. Wilcoxon rank-sum and Chi square tests were used for statistical analyses. Results: A total of 296 patients were included (133 pre-PC integration; 163 post-PC integration) in the analyses. Patient characteristics were well matched between cohorts. The overall mean age was 63 years (range 25-96), 62% were Caucasian, 51% were male, and 98% of patients had recurrent or metastatic disease. Of particular note, there were no significant differences noted between cohorts with regards to the resource utilization outcome variables assessed. Conclusions: Understanding healthcare utilization in this patient population is of great interest to clinical providers and policymakers alike. While we have previously demonstrated the benefit of integrating palliative care and medical oncology for reducing hospital readmissions and length of stay, this study shows no significant impact of an integrated approach on the utilization of healthcare resources measured within the 30 days prior to discharge to hospice. This may reflect the aggressive approach to management of symptoms for end-of-life patients, which often involves invasive procedures, use of imaging, and other resources to meet their needs.
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Nussbaum DP, Rushing CN, Lane WO, Cardona DM, Kirsch DG, Peterson BL, Blazer DG. Preoperative or postoperative radiotherapy versus surgery alone for retroperitoneal sarcoma: a case-control, propensity score-matched analysis of a nationwide clinical oncology database. Lancet Oncol 2016; 17:966-975. [DOI: 10.1016/s1470-2045(16)30050-x] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 03/30/2016] [Accepted: 03/30/2016] [Indexed: 12/20/2022]
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Strickler JH, Rushing CN, Uronis HE, Morse M, Blobe GC, Zafar Y, Hsu SD, Arrowood C, Haley S, Dropkin E, Niedzwiecki D, Hurwitz H. Phase Ib study of cabozantinib plus panitumumab in KRAS wild-type (WT) metastatic colorectal cancer (mCRC). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.3548] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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
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Clarke JM, Blobe GC, Strickler JH, Uronis HE, Zafar Y, Morse M, Dropkin E, Howard L, O'Neill M, Rushing CN, Niedzwiecki D, Watson H, Arrowood C, Hurwitz H. Phase Ib study of regorafenib (rego) and PF-03446962 (PF) in patients with refractory metastatic colorectal cancer (mCRC) (REGAL). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e15013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
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Hwang ES, Locklear TD, Rushing CN, Samsa G, Abernethy AP, Hyslop T, Atisha DM. Patient-Reported Outcomes After Choice for Contralateral Prophylactic Mastectomy. J Clin Oncol 2016; 34:1518-27. [PMID: 26951322 DOI: 10.1200/jco.2015.61.5427] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [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
PURPOSE The rate of contralateral prophylactic mastectomies (CPMs) continues to rise, although there is little evidence to support improvement in quality of life (QOL) with CPM. We sought to ascertain whether patient-reported outcomes and, more specifically, QOL differed according to receipt of CPM. METHODS Volunteers recruited from the Army of Women with a history of breast cancer surgery took an electronically administered survey, which included the BREAST-Q, a well-validated breast surgery outcomes patient-reporting tool, and demographic and treatment-related questions. Descriptive statistics, hypothesis testing, and regression analysis were used to evaluate the association of CPM with four BREAST-Q QOL domains. RESULTS A total of 7,619 women completed questionnaires; of those eligible, 3,977 had a mastectomy and 1,598 reported receipt of CPM. Women undergoing CPM were younger than those who did not choose CPM. On unadjusted analysis, mean breast satisfaction was higher in the CPM group (60.4 v 57.9, P < .001) and mean physical well-being was lower in the CPM group (74.6 v 76.6, P < .001). On multivariable analysis, the CPM group continued to report higher breast satisfaction (P = .046) and psychosocial well-being (P = .017), but no difference was reported in the no-CPM group in the other QOL domains. CONCLUSION Choice for CPM was associated with an improvement in breast satisfaction and psychosocial well-being. However, the magnitude of the effect may be too small to be clinically meaningful. Such patient-reported outcomes data are important to consider when counseling women contemplating CPM as part of their breast cancer treatment.
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Affiliation(s)
- E Shelley Hwang
- E. Shelley Hwang, Tracie D. Locklear, Christel N. Rushing, Greg Samsa, Amy P. Abernethy, Terry Hyslop, Duke University and Duke Cancer Institute, Durham, NC; and Dunya M. Atisha, University of South Florida, Tampa, FL.
| | - Tracie D Locklear
- E. Shelley Hwang, Tracie D. Locklear, Christel N. Rushing, Greg Samsa, Amy P. Abernethy, Terry Hyslop, Duke University and Duke Cancer Institute, Durham, NC; and Dunya M. Atisha, University of South Florida, Tampa, FL
| | - Christel N Rushing
- E. Shelley Hwang, Tracie D. Locklear, Christel N. Rushing, Greg Samsa, Amy P. Abernethy, Terry Hyslop, Duke University and Duke Cancer Institute, Durham, NC; and Dunya M. Atisha, University of South Florida, Tampa, FL
| | - Greg Samsa
- E. Shelley Hwang, Tracie D. Locklear, Christel N. Rushing, Greg Samsa, Amy P. Abernethy, Terry Hyslop, Duke University and Duke Cancer Institute, Durham, NC; and Dunya M. Atisha, University of South Florida, Tampa, FL
| | - Amy P Abernethy
- E. Shelley Hwang, Tracie D. Locklear, Christel N. Rushing, Greg Samsa, Amy P. Abernethy, Terry Hyslop, Duke University and Duke Cancer Institute, Durham, NC; and Dunya M. Atisha, University of South Florida, Tampa, FL
| | - Terry Hyslop
- E. Shelley Hwang, Tracie D. Locklear, Christel N. Rushing, Greg Samsa, Amy P. Abernethy, Terry Hyslop, Duke University and Duke Cancer Institute, Durham, NC; and Dunya M. Atisha, University of South Florida, Tampa, FL
| | - Dunya M Atisha
- E. Shelley Hwang, Tracie D. Locklear, Christel N. Rushing, Greg Samsa, Amy P. Abernethy, Terry Hyslop, Duke University and Duke Cancer Institute, Durham, NC; and Dunya M. Atisha, University of South Florida, Tampa, FL
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LeBlanc TW, Nipp RD, Rushing CN, Samsa GP, Locke SC, Kamal AH, Cella DF, Abernethy AP. Correlation between the international consensus definition of the Cancer Anorexia-Cachexia Syndrome (CACS) and patient-centered outcomes in advanced non-small cell lung cancer. J Pain Symptom Manage 2015; 49:680-9. [PMID: 25461669 DOI: 10.1016/j.jpainsymman.2014.09.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 09/08/2014] [Accepted: 09/22/2014] [Indexed: 02/05/2023]
Abstract
CONTEXT The cancer anorexia-cachexia syndrome (CACS) is common in patients with advanced solid tumors and is associated with adverse outcomes including poor quality of life (QOL), impaired functioning, and shortened survival. OBJECTIVES To apply the recently posed weight-based international consensus CACS definition to a population of patients with advanced non-small cell lung cancer (NSCLC) and explore its impact on patient-reported outcomes. METHODS Ninety-nine patients participated in up to four study visits over a six-month period. Longitudinal assessments included measures of physical function, QOL, and other clinical variables such as weight and survival. RESULTS Patients meeting the consensus CACS criteria at Visit 1 had a significantly shorter median survival (239.5 vs. 446 days; hazard ratio, 2.06, P < 0.05). Physical function was worse in the CACS group (mean Karnofsky Performance Status score 68 vs. 77, Eastern Cooperative Oncology Group Performance Status score 1.8 vs. 1.3, P < 0.05 for both), as was QOL (Functional Assessment of Cancer Therapy-General [FACT-G] Lung Cancer subscale of 17.2 vs. 19.9, Anorexia/Cachexia subscale of 31.4 vs. 37.9, P < 0.05 for both). Differences in the FACT-G and the Functional Assessment of Chronic Illness Therapy-Fatigue subscale approached but did not reach statistical significance. Longitudinally, all measures of physical function and QOL worsened regardless of CACS status, but the rate of decline was more rapid in the CACS group. CONCLUSION The weight-based component of the recently proposed international consensus CACS definition is useful in identifying patients with advanced NSCLC who are likely to have significantly inferior survival and who will develop more precipitous declines in physical function and QOL. This definition may be useful for clinical screening purposes and identify patients with high palliative care needs.
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Affiliation(s)
- Thomas W LeBlanc
- Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, USA; Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina, USA; Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Ryan D Nipp
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Christel N Rushing
- Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Greg P Samsa
- Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Susan C Locke
- Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Arif H Kamal
- Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, USA; Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina, USA; Division of Medical Oncology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - David F Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Amy P Abernethy
- Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, USA; Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina, USA; Division of Medical Oncology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
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Atisha DM, Rushing CN, Samsa GP, Locklear TD, Cox CE, Shelley Hwang E, Zenn MR, Pusic AL, Abernethy AP. A National Snapshot of Satisfaction with Breast Cancer Procedures. Ann Surg Oncol 2014; 22:361-9. [DOI: 10.1245/s10434-014-4246-9] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Indexed: 11/18/2022]
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Atisha DM, Locklear TD, Rogers UA, Rushing CN, Samsa GP, Abernethy AP. Partnering with engaged patients accelerates research. J Surg Oncol 2013; 109:504-5. [DOI: 10.1002/jso.23515] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 11/11/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Dunya M. Atisha
- Department of Surgery, Division of Plastic Surgery, Morsani College of Medicine; University of South Florida; Tampa Florida
| | - Tracie D. Locklear
- Center for Learning Health Care; Duke University Medical Center; Durham North Carolina
| | - Ursula A. Rogers
- Center for Learning Health Care; Duke University Medical Center; Durham North Carolina
| | - Christel N. Rushing
- Department of Biostatistics and Bioinformatics; Duke University Medical Center; Durham North Carolina
| | - Gregory P. Samsa
- Department of Biostatistics and Bioinformatics; Duke University Medical Center; Durham North Carolina
| | - Amy P. Abernethy
- Center for Learning Health Care; Duke University Medical Center; Durham North Carolina
- Health Policy and Management Gillings, School of Global Public Health; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
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