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Rincon NL, McDowell KR, Weatherspoon D, Ritchwood TD, Rocke DJ, Adjei Boakye E, Osazuwa-Peters N. Racial and ethnic disparities in human papillomavirus (HPV) vaccine uptake among United States adults, aged 27-45 years. Hum Vaccin Immunother 2024; 20:2313249. [PMID: 38538572 PMCID: PMC10984122 DOI: 10.1080/21645515.2024.2313249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 01/29/2024] [Indexed: 04/04/2024] Open
Abstract
In 2018, the Food and Drug Administration expanded the age of eligibility for the human papillomavirus (HPV) vaccine to 27 to 45 years. However, it is unclear if there are racial/ethnic disparities in HPV vaccine uptake for this age-group following this expanded recommendation. We aimed to identify any disparities in HPV vaccine in 27 to 45 year-olds based on sociodemographic factors. We analyzed nationally representative, cross-sectional data from the 2019 National Health Interview Survey (n = 9440). Logistic regression models estimated the odds of vaccine uptake (receipt of ≥1 vaccine dose) based on sociodemographic factors. Participants were mostly Non-Hispanic Whites (60.7%) and females (50.9%). In adjusted models, females had over three times greater odds of vaccine uptake compared to males (aOR = 3.58; 95% CI 3.03, 4.23). Also, compared to Non-Hispanic Whites, Non-Hispanic Blacks were 36% more likely (aOR = 1.36; 95% CI 1.09, 1.70), and Hispanics were 27% less likely (aOR = 0.73; 95% CI 0.58, 0.92) to receive the vaccine. Additionally, individuals without a usual place of care had lower odds of vaccine uptake (aOR = 0.72; 95% CI 0.57, 0.93), as were those with lower educational levels (aORhigh school = 0.62; 95% CI 0.50, 0.78; aORsome college = 0.83; 95% CI 0.70, 0.98). There are disparities in HPV vaccine uptake among 27 to 45 year-olds, and adult Hispanics have lower odds of receiving the vaccine. Given the vaccine's importance in cancer prevention, it is critical that these disparities are addressed and mitigated.
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Affiliation(s)
- Natalie L. Rincon
- Trinity College of Arts & Sciences, Duke University, Durham, NC, USA
- REACH Equity Summer Undergraduate Research Program (RESURP), Duke University School of Medicine, Durham, NC, USA
| | - Kelsey Rae McDowell
- REACH Equity Summer Undergraduate Research Program (RESURP), Duke University School of Medicine, Durham, NC, USA
- School of Nursing, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Darien Weatherspoon
- Department of Dental Public Health, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - Tiarney D. Ritchwood
- REACH Equity Summer Undergraduate Research Program (RESURP), Duke University School of Medicine, Durham, NC, USA
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
| | - Daniel J. Rocke
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Eric Adjei Boakye
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
- Department of Otolaryngology–Head and Neck Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Nosayaba Osazuwa-Peters
- REACH Equity Summer Undergraduate Research Program (RESURP), Duke University School of Medicine, Durham, NC, USA
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA
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Assaad S, Dov D, Park C, Davis R, Kovalsky SZ, Lee WT, Kahmke RR, Rocke DJ, Cohen J, Weiss-Meilik A, Henao R, Carin L, Elliott Range D. A Preliminary Study Comparing the Performance of Thyroid Molecular Tests to a Deep Learning Algorithm in Predicting Malignancy in Indeterminate Thyroid Fine Needle Aspiration Biopsies. Thyroid 2024; 34:531-535. [PMID: 38010913 PMCID: PMC10998704 DOI: 10.1089/thy.2023.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Affiliation(s)
- Serge Assaad
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina, USA
- I-Medata AI Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - David Dov
- I-Medata AI Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - Christine Park
- Department of Head and Neck Surgery and Duke University Medical Center, Durham, North Carolina, USA
- Department of Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Richard Davis
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - Shahar Z. Kovalsky
- Department of Mathematics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Walter T. Lee
- Department of Head and Neck Surgery and Duke University Medical Center, Durham, North Carolina, USA
- Department of Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Russel R. Kahmke
- Department of Head and Neck Surgery and Duke University Medical Center, Durham, North Carolina, USA
- Department of Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Daniel J. Rocke
- Department of Head and Neck Surgery and Duke University Medical Center, Durham, North Carolina, USA
- Department of Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Jonathan Cohen
- Department of Head and Neck Surgery and Duke University Medical Center, Durham, North Carolina, USA
- Department of Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Ricardo Henao
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina, USA
- Office of the Provost, King Abdullah University of Science and Technology, Thuwal, Makkah, Saudi Arabia
| | - Lawrence Carin
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina, USA
- Office of the Provost, King Abdullah University of Science and Technology, Thuwal, Makkah, Saudi Arabia
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Bischoff LA, Ganly I, Fugazzola L, Buczek E, Faquin WC, Haugen BR, McIver B, McMullen CP, Newbold K, Rocke DJ, Russell MD, Ryder M, Sadow PM, Sherman E, Shindo M, Shonka DC, Singer MC, Stack BC, Wirth LJ, Wong RJ, Randolph GW. Molecular Alterations and Comprehensive Clinical Management of Oncocytic Thyroid Carcinoma: A Review and Multidisciplinary 2023 Update. JAMA Otolaryngol Head Neck Surg 2024; 150:265-272. [PMID: 38206595 DOI: 10.1001/jamaoto.2023.4323] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Importance Oncocytic (Hürthle cell) thyroid carcinoma is a follicular cell-derived neoplasm that accounts for approximately 5% of all thyroid cancers. Until recently, it was categorized as a follicular thyroid carcinoma, and its management was standardized with that of other differentiated thyroid carcinomas. In 2022, given an improved understanding of the unique molecular profile and clinical behavior of oncocytic thyroid carcinoma, the World Health Organization reclassified oncocytic thyroid carcinoma as distinct from follicular thyroid carcinoma. The International Thyroid Oncology Group and the American Head and Neck Society then collaborated to review the existing evidence on oncocytic thyroid carcinoma, from diagnosis through clinical management and follow-up surveillance. Observations Given that oncocytic thyroid carcinoma was previously classified as a subtype of follicular thyroid carcinoma, it was clinically studied in that context. However, due to its low prevalence and previous classification schema, there are few studies that have specifically evaluated oncocytic thyroid carcinoma. Recent data indicate that oncocytic thyroid carcinoma is a distinct class of malignant thyroid tumor with a group of distinct genetic alterations and clinicopathologic features. Oncocytic thyroid carcinoma displays higher rates of somatic gene variants and genomic chromosomal loss of heterozygosity than do other thyroid cancers, and it harbors unique mitochondrial DNA variations. Clinically, oncocytic thyroid carcinoma is more likely to have locoregional (lymph node) metastases than is follicular thyroid carcinoma-with which it was formerly classified-and it develops distant metastases more frequently than papillary thyroid carcinoma. In addition, oncocytic thyroid carcinoma rarely absorbs radioiodine. Conclusions and Relevance The findings of this review suggest that the distinct clinical presentation of oncocytic thyroid carcinoma, including its metastatic behavior and its reduced avidity to radioiodine therapy, warrants a tailored disease management approach. The reclassification of oncocytic thyroid carcinoma by the World Health Organization is an important milestone toward developing a specific and comprehensive clinical management for oncocytic thyroid carcinoma that considers its distinct characteristics.
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Affiliation(s)
- Lindsay A Bischoff
- Department of Medicine, Division of Endocrinology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ian Ganly
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Laura Fugazzola
- Endocrine Oncology Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Erin Buczek
- Department of Otolaryngology Head and Neck Surgery, The University of Kansas, Kansas City
| | - William C Faquin
- Departments of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Bryan R Haugen
- Department of Medicine, University of Colorado Cancer Center, University of Colorado School of Medicine, Aurora
| | - Bryan McIver
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Caitlin P McMullen
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Kate Newbold
- Thyroid Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Daniel J Rocke
- Department of Otolaryngology Head and Neck Surgery, Weill Medical College, Cornell University, New York, New York
| | - Marika D Russell
- Department of Otolaryngology-Head and Neck Surgery, Division of Thyroid and Parathyroid Endocrine Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Mabel Ryder
- Division of Endocrinology and Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Peter M Sadow
- Departments of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Eric Sherman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Maisie Shindo
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland
| | - David C Shonka
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville
| | - Michael C Singer
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan
| | - Brendan C Stack
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield
| | - Lori J Wirth
- Departments of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Richard J Wong
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gregory W Randolph
- Department of Otolaryngology-Head and Neck Surgery, Division of Thyroid and Parathyroid Endocrine Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
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Abouelella DK, Watts TL, Rocke DJ, Barnes JM, Osazuwa-Peters N, Adjei Boakye E. Reasons for parental refusal of human papillomavirus vaccine during the COVID-19 pandemic in 2020. Public Health 2023; 223:e9-e11. [PMID: 36870828 PMCID: PMC9889255 DOI: 10.1016/j.puhe.2023.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 01/16/2023] [Accepted: 01/22/2023] [Indexed: 02/04/2023]
Affiliation(s)
- Dina K Abouelella
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Tammara L Watts
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA; Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Daniel J Rocke
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA; Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Justin M Barnes
- Department of Radiation Oncology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA; Duke Cancer Institute, Duke University, Durham, NC, USA; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Eric Adjei Boakye
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA; Department of Otolaryngology - Head and Neck Surgery, Henry Ford Health System, Detroit, MI, USA.
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Dov D, Elliott Range D, Cohen J, Bell J, Rocke DJ, Kahmke RR, Weiss-Meilik A, Lee WT, Henao R, Carin L, Kovalsky SZ. Deep-Learning-Based Screening and Ancillary Testing for Thyroid Cytopathology. Am J Pathol 2023; 193:1185-1194. [PMID: 37611969 PMCID: PMC10477952 DOI: 10.1016/j.ajpath.2023.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/06/2023] [Accepted: 05/19/2023] [Indexed: 08/25/2023]
Abstract
Thyroid cancer is the most common malignant endocrine tumor. The key test to assess preoperative risk of malignancy is cytologic evaluation of fine-needle aspiration biopsies (FNABs). The evaluation findings can often be indeterminate, leading to unnecessary surgery for benign post-surgical diagnoses. We have developed a deep-learning algorithm to analyze thyroid FNAB whole-slide images (WSIs). We show, on the largest reported data set of thyroid FNAB WSIs, clinical-grade performance in the screening of determinate cases and indications for its use as an ancillary test to disambiguate indeterminate cases. The algorithm screened and definitively classified 45.1% (130/288) of the WSIs as either benign or malignant with risk of malignancy rates of 2.7% and 94.7%, respectively. It reduced the number of indeterminate cases (N = 108) by reclassifying 21.3% (N = 23) as benign with a resultant risk of malignancy rate of 1.8%. Similar results were reproduced using a data set of consecutive FNABs collected during an entire calendar year, achieving clinically acceptable margins of error for thyroid FNAB classification.
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Affiliation(s)
- David Dov
- I-Medata AI Center, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel; Department of Pathology, Duke University Medical Center, Durham, North Carolina.
| | | | - Jonathan Cohen
- Department of Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Jonathan Bell
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - Daniel J Rocke
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina
| | - Russel R Kahmke
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina
| | - Ahuva Weiss-Meilik
- I-Medata AI Center, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel
| | - Walter T Lee
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina
| | - Ricardo Henao
- Biological, Environmental Sciences and Engineering Division, King Abdullah University of Science and Technology, Thuwal, Kingdom of Saudi Arabia; Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Lawrence Carin
- Computer Science Program, Computer, Electrical and Mathematical Sciences and Engineering (CEMSE) Division, King Abdullah University of Science and Technology, Thuwal, Kingdom of Saudi Arabia
| | - Shahar Z Kovalsky
- Department of Mathematics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Campbell JC, Lee HJ, Cannon TY, Kahmke RR, Lee WT, Puscas L, Rocke DJ. Lateral neck dissection surgeon volume and complications in head and neck endocrine malignancy. Gland Surg 2023; 12:917-927. [PMID: 37727340 PMCID: PMC10506124 DOI: 10.21037/gs-22-385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 06/08/2023] [Indexed: 09/21/2023]
Abstract
Background Increased surgeon volume is associated with decreased complications for many surgeries, including thyroidectomy. We sought to use two national databases to assess for associations between surgeon volume and complications in patients undergoing lateral neck dissection for thyroid or parathyroid malignancy. Methods Lateral neck dissections for thyroid and parathyroid cancer from the Nationwide Inpatient Sample and State Inpatient Database were analyzed. The primary outcome was any inpatient complication common to thyroidectomy, parathyroidectomy, or lateral neck dissection. The principle independent variable was surgeon volume. Multivariable analysis was then performed on this retrospective cohort study. Results The 1,094 Nationwide Inpatient Sample discharges had a 28% (305/1,094) complication rate. After adjustment, surgeons with volumes between 3-34 neck dissections/year demonstrated a surgeon volume-complication rate association [adjusted odds ratio: 1.03; 95% confidence interval (CI): 1.01-1.05]. The 1,235 State inpatient Database discharges had a 21% (258/1,235) overall complication rate, and no association between surgeon volume and complication rates (P=0.25). Conclusions This retrospective review of 2,329 discharges for patients undergoing lateral neck dissection for thyroid or parathyroidectomy demonstrated somewhat conflicting results. The Nationwide Inpatient Sample demonstrated increasing complication rates for increasing surgeon volume among intermediate volume surgeons, while the State Inpatient Database demonstrated no surgeon volume-complication association. Given these disparate results, and further limitations with these databases, conclusions regarding surgical volume and clinical decision making based on these data should be assessed cautiously.
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Affiliation(s)
- James C. Campbell
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Hui-Jie Lee
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Trinitia Y. Cannon
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Russel R. Kahmke
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Walter T. Lee
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Liana Puscas
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Daniel J. Rocke
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
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Rames JD, Frisco NA, Jiang R, Shah KP, Kahmke RR, Puscas L, Osazuwa-Peters N, Rocke DJ. Integrated Health Maintenance Reminders for Improved HPV Vaccine Administration: Toward Improvements in Completion Disparities. Otolaryngol Head Neck Surg 2023. [PMID: 36939623 DOI: 10.1002/ohn.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/23/2022] [Accepted: 12/11/2022] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To evaluate the effect of a health maintenance reminder (HMR) on human papillomavirus (HPV) vaccine administration and completion across different age, insurance, and race cohorts. STUDY DESIGN Retrospective pre-post analysis. SETTING Academic primary care. METHODS Patients aged 9 to 26 who had initiated the HPV vaccine series from 2016 to 2021 were analyzed, based on current age-based standards. The cohort was divided based on vaccine uptake before and after the implementation of the HMR program in February 2020. The multivariate analysis estimated the odds of vaccine completion based on sociodemographic factors, and variable interactions were investigated to determine independent associations between sociodemographic factors and HMR implementation. RESULTS There were 7654 individual patients (mean age was 15.8 years; 46.7 were males; and 50.7% were white). HPV vaccine completion rates increased post-HMR implementation by 59.2% (37% pre-, and 58.9% post-HMR; p < .001) in the entire cohort. Overall, black patients (adjusted odds ratio [aOR] = 0.68; 95% confidence interval [CI]: 0.60, 0.70) and patients ≥18 years (aOR = 0.13; 95% CI: 0.11, 0.15) were significantly less likely to complete their vaccine series; however, this improved significantly following HMR in these groups (p < .001). Post-HMR, race, and insurance status were not independently associated with disparate vaccine completion rates, however, age was, and patients ≤14 or younger had higher odds of vaccine completion (aOR = 3.54; 95% CI: 2.91, 4.32). CONCLUSION The implementation of an HMR was associated with increased HPV vaccine uptake across age and race groups in this single-institution study. Future research should explore barriers to implementing HMRs in different healthcare settings.
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Affiliation(s)
- Jess D Rames
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina, USA.,Duke University Pratt School of Engineering, Durham, North Carolina, USA.,Department of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicholas A Frisco
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina, USA
| | - Rong Jiang
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Kevin P Shah
- Department of Medicine, Duke Primary Care, Durham, North Carolina, USA
| | - Russel R Kahmke
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina, USA.,Duke Cancer Institute, Durham, North Carolina, USA
| | - Liana Puscas
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina, USA
| | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina, USA.,Duke Cancer Institute, Durham, North Carolina, USA.,Duke University School of Medicine, Durham, North Carolina, USA.,Duke Department of Population Health Sciences, Durham, North Carolina, USA
| | - Daniel J Rocke
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina, USA.,Duke Cancer Institute, Durham, North Carolina, USA
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Sag AA, Perkins JM, Kazaure HS, Stang MT, Rocke DJ, Collins A, Choe JH, Scheri RP. Salvage Cryoablation for Local Recurrences of Thyroid Cancer Inseparable from the Trachea and Neurovascular Structures. J Vasc Interv Radiol 2023; 34:54-62. [PMID: 36220608 DOI: 10.1016/j.jvir.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/17/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To demonstrate safety, feasibility, and effectiveness of cryoablation of recurrent papillary thyroid cancer ineligible for reoperation because of scarring, eligible for focal ablation as defined within 2015 American Thyroid Association guideline sections C16 and C17. MATERIALS AND METHODS With multidisciplinary consensus, cryoablation was performed with curative intent for 15 tumors in 10 patients between January 2019 and July 2021. Demographics, procedural details, and serial postprocedural imaging findings were analyzed. RESULTS The mean age was 72.5 years (range, 57-88 years), and 80% of the patients were women. The tumors (mean size, 16 mm ± 6; range, 9-29 mm) received 1 session of cryoablation with 100% technical success. The mean and median postcryoablation tumor volumetric involution rates were 88% and 99%, respectively, with 9 (60%) of 15 tumors involuting completely or down to the scar and 6 (40%) involuting partially at the end of the study period. Tumor size did not increase after cryoablation (0% local progression rate). All tumors abutted the trachea, skin, and/or vascular structures, and hydrodissection failed in all cases because of scarring. The major adverse event rate was 20% (3/15), with 2 cases of voice change and 1 case of Horner syndrome; all resolved at 6 months with no permanent sequelae. No vascular, tracheal, dermal, or infectious adverse events occurred during a mean follow-up of 242 days (range, 114-627 days). One patient died at 386 days after cryoablation because of unrelated cholangiocarcinoma. CONCLUSIONS Cryoablation of local recurrences of papillary thyroid cancer abutting the trachea and/or neurovascular structures in the setting of hydrodissection failure because of scarring yielded a mean volumetric involution of 88%, primary efficacy of 60%, and objective response rate of 100% with no local recurrences or permanent complications during a mean follow-up of 242 days. The secondary efficacy and longer-term outcomes remain forthcoming.
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Affiliation(s)
- Alan Alper Sag
- Division of Interventional Radiology, Department of Radiology, Duke University Medical Center, Durham, North Carolinia.
| | - Jennifer M Perkins
- Division of Endocrinology, University of California San Francisco Medical Center, San Francisco, California
| | - Hadiza S Kazaure
- Section of Endocrine Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Michael T Stang
- Section of Endocrine Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Daniel J Rocke
- Division of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina
| | - Alissa Collins
- Division of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina
| | - Jennifer H Choe
- Division of Hematology and Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Randall P Scheri
- Section of Endocrine Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
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Talip MF, Casimir T, Hurst JH, Rocke DJ, Watts TL, Cannon TY, Boakye EA, Osazuwa-Peters N. Abstract P023: The impact of limited English proficiency and healthcare access on HPV vaccine uptake in the United States. Cancer Prev Res (Phila) 2023. [DOI: 10.1158/1940-6215.precprev22-p023] [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: 01/05/2023]
Abstract
Abstract
Background: Limited English proficiency (LEP) impacts patient-provider communication and access to healthcare, both of which are also associated with human papillomavirus (HPV) vaccine uptake. We examined the association between LEP and HPV vaccine uptake among parents/guardians of adolescents and young adults eligible for the HPV vaccination in the United States. Methods: Using a cross-sectional study design, we analyzed nationally representative data from the National Health and Nutrition Examination Survey between 2017 and 2020 (n = 3,993). Outcome of interest was HPV vaccine uptake, defined as initiation (at least one dose), or completion (at least two or three doses). LEP was defined as completing the questionnaire in a language other than English and/or using an interpreter. Logistic regression models estimated odds of HPV vaccine uptake based on LEP, adjusting for covariates, including age, sex, healthcare access, income, race, and ethnicity. Analyses were stratified into groups aged 9-17 and 18-26 years. Results: LEP rate was 11.2% in the 9 to 17 age-group (n = 2,584), and 8.8% in the 18-26 age-group (n = 1,409). In the adjusted analyses, we found no association between LEP and HPV vaccination in either age groups (for 9-17 years: aORinitiation = 1.10; 95% CI 0.69, 1.77; aORcompletion = 1.04; 95% CI 0.60, 1.81; and for 18-26 years: aORinitiation = 0.70; 95% CI 0.40, 1.25; aORcompletion for 18-26 years = 1.23; 95% CI 0.56, 2.70). However, we found significant associations between HPV vaccine uptake and age, sex, race/ethnicity, and healthcare access variables in both age groups. Conclusions: While language proficiency status was not significantly associated with HPV vaccine uptake in our study, we found that age, sex, race/ethnicity, and access to care are associated with HPV vaccination. This indicates the need for continued interventions targeting factors to increase access to HPV vaccine.
Citation Format: Marian F. Talip, Trinity Casimir, Jillian H. Hurst, Daniel J. Rocke, Tammara L. Watts, Trinitia Y. Cannon, Eric Adjei Boakye, Nosayaba Osazuwa-Peters. The impact of limited English proficiency and healthcare access on HPV vaccine uptake in the United States. [abstract]. In: Proceedings of the AACR Special Conference: Precision Prevention, Early Detection, and Interception of Cancer; 2022 Nov 17-19; Austin, TX. Philadelphia (PA): AACR; Can Prev Res 2023;16(1 Suppl): Abstract nr P023.
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Cohen J, Reed W, Foster MW, Kahmke RR, Rocke DJ, Puscas L, Cannon TY, Lee WT. Octreotide may improve pharyngocutaneous fistula healing through downregulation of cystatins: A pilot study. Laryngoscope Investig Otolaryngol 2022; 8:113-119. [PMID: 36846407 PMCID: PMC9948565 DOI: 10.1002/lio2.962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/27/2022] [Accepted: 10/15/2022] [Indexed: 11/30/2022] Open
Abstract
Background Pharyngocutaneous fistula (PCF) and salivary leaks are well known complications of head and neck surgery. The medical management of PCF has included the use of octreotide without a well-defined understanding of its therapeutic mechanism. We hypothesized that octreotide induces alterations in the saliva proteome and that these alterations may provide insight into the mechanism of action underlying improved PCF healing. We undertook an exploratory pilot study in healthy controls that involved collecting saliva before and after a subcutaneous injection of octreotide and performing proteomic analysis to determine the effects of octreotide. Methods Four healthy adult participants provided saliva samples before and after subcutaneous injection of octreotide. A mass-spectrometry based workflow optimized for the quantitative proteomic analysis of biofluids was then employed to analyze changes in salivary protein abundance after octreotide administration. Results There were 3076 human, 332 Streptococcus mitis, 102 G. haemolyans, and 42 Granulicatella adiacens protein groups quantified in saliva samples. A paired statistical analysis was performed using the generalized linear model (glm) function in edgeR. There were and ~300 proteins that had a p < .05 between the pre- and post-octreotide groups ~50 proteins with an FDR-corrected p < .05 between pre- and post-groups. These results were visualized using a volcano plot after filtering on proteins quantified by 2 more or unique precursors. Both human and bacterial proteins were among the proteins altered by octreotide treatment. Notably, four isoforms of the human cystatins, belonging to a family of cysteine proteases, that had significantly lower abundance after treatment. Conclusion This pilot study demonstrated octreotide-induced downregulation of cystatins. By downregulation of cystatins in the saliva, there is decreased inhibition of cysteine proteases such as Cathepsin S. This results in increased cysteine protease activity that has been linked to enhanced angiogenic response, cell proliferation and migration that have resulted in improved wound healing. These insights provide first steps at furthering our understanding of octreotide's effects on saliva and reports of improved PCF healing.
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Affiliation(s)
| | - William Reed
- Department of Head and Neck Surgery and Communication SciencesDuke University Health SystemDurhamNorth CarolinaUSA
| | - Matthew W. Foster
- Department of Medicine, and Duke Proteomics and Metabolomics Core FacilityDuke University Health SystemDurhamNorth CarolinaUSA
| | - Russel R. Kahmke
- Department of Head and Neck Surgery and Communication SciencesDuke University Health SystemDurhamNorth CarolinaUSA
| | - Daniel J. Rocke
- Department of Head and Neck Surgery and Communication SciencesDuke University Health SystemDurhamNorth CarolinaUSA
| | - Liana Puscas
- Department of Head and Neck Surgery and Communication SciencesDuke University Health SystemDurhamNorth CarolinaUSA
| | - Trinitia Y. Cannon
- Department of Head and Neck Surgery and Communication SciencesDuke University Health SystemDurhamNorth CarolinaUSA
| | - Walter T. Lee
- Department of Head and Neck Surgery and Communication SciencesDuke University Health SystemDurhamNorth CarolinaUSA
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11
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Jacobs CD, Barak I, Jung SH, Rocke DJ, Kahmke RR, Suneja G, Mowery YM. Prediction model to estimate overall survival benefit of postoperative radiotherapy for resected major salivary gland cancers. Oral Oncol 2022; 132:105955. [PMID: 35752134 DOI: 10.1016/j.oraloncology.2022.105955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/26/2022] [Accepted: 05/31/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To develop and validate a prediction model to estimate overall survival (OS) with and without postoperative radiotherapy (PORT) for resected major salivary gland (SG) cancers. MATERIALS AND METHODS Adults in the National Cancer Database diagnosed with invasive non-metastatic major SG cancer between 2004 and 2015 were identified. Exclusion criteria included prior malignancy, pT1N0 or unknown stage, no or unknown surgery, and neoadjuvant therapy. Cox proportional hazards models evaluated the effect of covariates on OS. A multivariate regression model was utilized to predict 2-, 5-, and 10-year OS. Internal cross-validation was performed using 50-50 hold-out and Harrell's concordance index. RESULTS 18,400 subjects met inclusion criteria, including 9,721 (53%) who received PORT. Distribution of SG involvement was 86% parotid, 13% submandibular, and 1% sublingual. Median follow-up for living subjects was 4.9 years. PORT was significantly associated with improved OS for the following subgroups by log-rank test: pT3 (p < 0.001), pT4 (p < 0.001), high grade (p < 0.001), node-positive (p < 0.001), and positive margin (p < 0.001). The following variables were incorporated into a multivariate model: age, sex, Charlson-Deyo comorbidity score, involved SG, pathologic T-stage, grade, margin status, ratio of nodal positivity, and PORT. The resulting model based on data from 6,138 subjects demonstrated good accuracy in predicting OS, with Harrell's concordance index of 0.73 (log-rank p < 0.001). CONCLUSION This cross-validated prediction model estimates 2-, 5-, and 10-year differences in OS based on receipt of PORT for resected major SG cancers using readily available clinicopathologic features. Clinicians can utilize this tool to aid personalized adjuvant therapy decisions.
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Affiliation(s)
| | - Ian Barak
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA.
| | - Sin-Ho Jung
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA.
| | - Daniel J Rocke
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA.
| | - Russel R Kahmke
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA.
| | - Gita Suneja
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT, USA.
| | - Yvonne M Mowery
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA; Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA.
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12
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Smith BD, Oyekunle TO, Thomas SM, Puscas L, Rocke DJ. Association of Lymph Node Ratio With Overall Survival in Patients With Metastatic Papillary Thyroid Cancer. JAMA Otolaryngol Head Neck Surg 2021; 146:962-964. [PMID: 32761147 DOI: 10.1001/jamaoto.2020.2053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Blaine D Smith
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina
| | - Taofik O Oyekunle
- Duke Cancer Institute Biostatistics, Duke University, Durham, North Carolina
| | - Samantha M Thomas
- Duke Cancer Institute Biostatistics, Duke University, Durham, North Carolina
| | - Liana Puscas
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina
| | - Daniel J Rocke
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina
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13
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Campbell JC, Lee HJ, Cannon T, Kahmke RR, Lee WT, Puscas L, Rocke DJ. Surgeon Volume and Complications in Lateral Neck Dissection for Squamous Cell Carcinoma: A Multidatabase Analysis. Otolaryngol Head Neck Surg 2021; 165:838-844. [PMID: 33689518 DOI: 10.1177/01945998211000438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine whether annual surgeon volume of lateral neck dissections for squamous cell carcinoma is associated with complication rates. STUDY DESIGN Retrospective review. SETTING Two US databases spanning 2000 to 2014. METHODS Neck dissections for squamous cell carcinoma from the National Inpatient Sample and State Inpatient Databases were analyzed. The primary outcome was any in-hospital complication common to neck dissection. The principal independent variable was surgeon volume. A multivariable logistic generalized estimating equation with a piecewise linear spline for surgeon volume was fit to assess its association with complication. RESULTS The National Inpatient Sample had 3517 discharges fitting criteria, a median surgeon volume of 12, and an 11.1% complication rate. A 1-unit increase in surgeon volume was associated with a 7% increase in the odds of complication when volume ranged between 4 and 19 (adjusted odds ratio [AOR], 1.07; 95% CI, 1.04-1.11) and with a 3% decrease in the odds of complication when volume ranged between 19 and 51 (AOR, 0.97; 95% CI, 0.96-0.99). The State Inpatient Databases had 2876 discharges fitting criteria, a median surgeon volume of 30, and a 13.5% complication rate. Surgeon volume was not associated with complication when <27 (AOR, 1.01; 95% CI, 0.99-1.02), but a 5-unit increase in volume was associated with a 7% decrease in the odds of complication with volume ≥27 (AOR, 0.93; 95% CI, 0.88-0.98). CONCLUSIONS Surgeon volume was associated with complications for most volume ranges and with lower odds of complication for high-volume surgeons.
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Affiliation(s)
- James C Campbell
- Department of Head and Neck Surgery and Communication Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Hui-Jie Lee
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina, USA
| | - Trinitia Cannon
- Department of Head and Neck Surgery and Communication Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Russel R Kahmke
- Department of Head and Neck Surgery and Communication Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Walter T Lee
- Department of Head and Neck Surgery and Communication Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Liana Puscas
- Department of Head and Neck Surgery and Communication Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Daniel J Rocke
- Department of Head and Neck Surgery and Communication Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
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14
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Jacobs CD, Williamson H, Barak I, Rocke DJ, Kahmke RR, Suneja G, Mowery YM. Postoperative radiotherapy is associated with improved overall survival for alveolar ridge squamous cell carcinoma with adverse pathologic features. Head Neck 2021; 43:203-211. [PMID: 32969107 PMCID: PMC9113753 DOI: 10.1002/hed.26475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 08/24/2020] [Accepted: 09/09/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Alveolar ridge squamous cell carcinoma (ARSCC) is poorly represented in randomized trials. METHODS Adults in the National Cancer Database diagnosed with ARSCC between 2010 and 2014 who should be considered for postoperative radiotherapy (PORT) based on National Comprehensive Cancer Network (NCCN)-defined risk factors were identified. RESULTS Eight hundred forty-five (58%) of 1457 patients meeting the inclusion criteria received PORT. PORT was associated with improved overall survival (OS) on unadjusted (hazard ratio [HR] 0.83, 95% confidence interval [CI] 0.70-0.98, P = .02) and multivariable (HR 0.78, 95% CI 0.64-0.94, P = .002) analyses. PORT was associated with significantly improved 5-year OS for patients with 1 (68% vs 58%, P < .001), 2 (52% vs 31%, P < .001), and ≥3 (38% vs 24%, P < .001) NCCN-defined risk factors. Prognostic variables significantly associated with worse OS on multivariable analysis included advanced age, primary tumor size ≥3 cm, high grade, positive margin(s), stage N2-3, level IV/V nodal metastasis, and extranodal extension. CONCLUSION PORT for resected ARSCC with adverse pathologic features is associated with significantly improved OS.
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Affiliation(s)
- Corbin D. Jacobs
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Hannah Williamson
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Ian Barak
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Daniel J. Rocke
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina
| | - Russel R. Kahmke
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina
| | - Gita Suneja
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Yvonne M. Mowery
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
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15
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Issa K, Stevens MN, Sun Y, Thomas S, Collins A, Cohen J, Esclamado RM, Rocke DJ. A Retrospective Study of Lymph Node Yield in Lateral Neck Dissection for Papillary Thyroid Carcinoma. Ear Nose Throat J 2020; 101:456-462. [PMID: 33090902 DOI: 10.1177/0145561320967339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Lateral neck dissection (LND) is important in managing papillary thyroid carcinomas (PTCs). This study aimed to evaluate the relationship between lymph node yield (LNY) for LND and patient outcomes, specifically postoperative serum thyroglobulin levels (sTG) and radioiodine uptake on thyroid scan, and to estimate a threshold LNY to signify adequate LND. METHODS Patients diagnosed with PTC who underwent LND from 2006 to 2015 at a single institution were included. Linear regression with restricted cubic splines was used to characterize the association of LNY with outcomes. Outcomes were log-transformed to achieve a more symmetric distribution prior to regression. For nonlinear associations, a Monte Carlo Markov Chain procedure was used to estimate a threshold LNY associated with postoperative outcome. This threshold was then used to define high LNY versus low LNY in the subsequent analyses. RESULTS In total, 107 adult patients were included. There was a significant relationship between LNY and postoperative sTG level (P = .004), but not radioiodine uptake (P = .64). An LNY of 42.96 was identified, which was associated with the maximum change in sTG level. No association was found between LNY groups (LNY ≥ 43 vs < 43) and radioiodine uptake, risk of complication, or longer operative times (all P > .05). High LNY was associated with a decrease in log(sTG) (estimate = -1.855, P = .03), indicating that adequacy of LND is associated with an 84.4% decrease in sTG. CONCLUSION These results suggest an association between LNY and postoperative sTG level, with an estimated threshold of 43 nodes. This has implications for adequate therapeutic LND; additional work is needed to validate thresholds for clinical practice.
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Affiliation(s)
- Khalil Issa
- Department of Head and Neck Surgery & Communication Sciences, 12277Duke University Health System, Durham, NC, USA
| | - Madelyn N Stevens
- Department of Head and Neck Surgery & Communication Sciences, 12277Duke University Health System, Durham, NC, USA.,Department of Otolaryngology-Head and Neck Surgery, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yuhui Sun
- Department of Biostatistics and Bioinformatics, 12277Duke University, Durham, NC, USA
| | - Samantha Thomas
- Department of Biostatistics and Bioinformatics, 12277Duke University, Durham, NC, USA.,Duke Cancer Institute, 12277Duke University, Durham, NC USA
| | - Alissa Collins
- Department of Head and Neck Surgery & Communication Sciences, 12277Duke University Health System, Durham, NC, USA
| | - Jonathan Cohen
- Department of Head and Neck Surgery & Communication Sciences, 12277Duke University Health System, Durham, NC, USA
| | - Ramon M Esclamado
- Department of Head and Neck Surgery & Communication Sciences, 12277Duke University Health System, Durham, NC, USA
| | - Daniel J Rocke
- Department of Head and Neck Surgery & Communication Sciences, 12277Duke University Health System, Durham, NC, USA.,Duke Cancer Institute, 12277Duke University, Durham, NC USA
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16
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Rocke DJ, Mulder H, Cyr D, Kahmke R, Lee WT, Puscas L, Schulz K, Witsell DL. The effect of lateral neck dissection on complication rate for total thyroidectomy. Am J Otolaryngol 2020; 41:102421. [PMID: 32089352 DOI: 10.1016/j.amjoto.2020.102421] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 02/10/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To determine the complication profile for total thyroidectomy with and without concomitant lateral neck dissection using a large administrative database. MATERIALS AND METHODS The IBM MarketScan® Commercial Database (2010-2014) analytic cohort was queried for patients ≥18 years or older undergoing total thyroidectomy (or equivalent procedures) from January 1, 2010 to June 30, 2014. Subgroup analysis was performed for patients undergoing concomitant unilateral and bilateral lateral neck dissection. The complication profiles were described. RESULTS 55,204 patients underwent total thyroidectomy or equivalent procedures. Hypoparathyroidism or hypocalcemia was coded in 20.3% overall, with 4.7% having permanent hypoparathyroidism. Vocal cord paralysis was coded in 3.3% overall with permanent rate of 0.7%. Tracheotomy was performed in 0.3% of patients. 2743 underwent total thyroidectomy with concomitant unilateral lateral neck dissection, and 560 of these patients underwent bilateral lateral neck dissection. In patients undergoing unilateral lateral neck dissection, 30.5% of patients have hypoparathyroidism/hypocalcemia coded, with a permanent rate of 8.8%. Vocal cord paralysis was coded in 8.3% of patients, with a permanent rate of 1.9%. Tracheotomy was performed in 1.2% of patients. In patients undergoing bilateral lateral neck dissection, 39.6% had hypoparathyroidism/hypocalcemia coded, with a permanent rate of 10.9%. These patients had vocal cord paralysis coded in 10.2% of cases, with a permanent rate of 2.1%. Tracheotomy was performed in 2.5% of patients. CONCLUSION The addition of unilateral and especially bilateral lateral neck dissection increases both overall and permanent complication rates for total thyroidectomy. These data may help to inform preoperative discussions with patients.
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17
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Jacobs CD, Rocke DJ, Kahmke RR, Williamson H, Suneja G, Mowery YM. HSR19-092: Adjuvant Radiotherapy Is Associated with Improved Overall Survival for Resected Alveolar Ridge Squamous Cell Carcinoma With Adverse Pathologic Features. J Natl Compr Canc Netw 2019. [DOI: 10.6004/jnccn.2018.7170] [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: 11/17/2022]
Abstract
Background: Alveolar ridge (AR) squamous cell carcinoma (SCC) is poorly represented on prospective clinical trials. Adjuvant management is extrapolated from more common head and neck SCC, including those with a stronger influence from the human papillomavirus. The objective of this analysis is to determine the association between adjuvant radiotherapy (RT) and overall survival (OS) for resected ARSCC based on adverse pathologic features. Methods: Adult subjects in the National Cancer Database diagnosed with invasive nonmetastatic ARSCC between 2010–2014 were identified. Exclusion criteria included prior malignancy, no/unknown surgery, unknown receipt of RT, RT dose <50 Gy or >80 Gy, RT fractions >68, T1–2N0 disease without identifiable NCCN-defined risk factors (positive margin, lymphovascular invasion, pT3–4, N2–3, extranodal extension, or level IV/V nodal metastasis), and unknown/missing NCCN risk factor data. Log-rank test stratified by RT and Cox regression analyses with respect to OS were performed. Results: 1,450 subjects met inclusion criteria, of which 825 (57%) received RT. Median follow-up was 27 months. Adjuvant RT was associated with improved OS (72% vs 65% at 2 years, log-rank P=.004). Stratified by number of NCCN-defined risk factors, adjuvant RT was associated with improved OS for subjects with 2 (74% vs 58% at 2 years, log-rank P<.001) and ≥3 (54% vs 29% at 2 years, log-rank P<.001) risk factors. Adjuvant RT was significantly associated with improved OS on univariate (HR, 0.80; 95% CI, 0.68–0.94; P=.008) and multivariate (HR, 0.72; 95% CI, 0.60–0.87; P=.001) analyses, the latter adjusted for age, comorbidity score, and adverse pathologic features. Each NCCN-defined risk factor, high tumor grade, primary tumor ≥3 cm, and ≥5% nodal positivity (number of pathologic nodes positive among nodes resected) were significantly associated with worse OS on univariate and multivariate analyses. Conclusions: Adjuvant RT for resected ARSCC with adverse pathologic features is associated with significantly improved OS. Subjects with a primary tumor ≥3 cm, high tumor grade, and ≥5% nodal positivity in addition to the NCCN-defined risk factors should be considered for adjuvant RT.
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18
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Palmer GM, Zhang H, Lee CT, Mikati H, Herbert JA, Krieger M, von Windheim J, Koester D, Stevenson D, Rocke DJ, Esclamado R, Erkanli A, Ramanujam N, Dewhirst MW, Lee WT. Assessing effects of pressure on tumor and normal tissue physiology using an automated self-calibrated, pressure-sensing probe for diffuse reflectance spectroscopy. J Biomed Opt 2018; 23:1-8. [PMID: 29766688 PMCID: PMC5981029 DOI: 10.1117/1.jbo.23.5.057004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 04/25/2018] [Indexed: 05/03/2023]
Abstract
Diffuse reflectance spectroscopy (DRS) represents a quantitative, noninvasive, nondestructive means of assessing vascular oxygenation, vascularity, and structural properties. However, it is known that such measurements can be influenced by the effects of pressure, which is a major concern for reproducible and operator-independent assessment of tissues. Second, regular calibration is a necessary component of quantitative DRS to account for factors such as lamp decay and fiber bending. Without a means of reliably controlling for these factors, the accuracy of any such assessments will be reduced, and potentially biased. To address these issues, a self-calibrating, pressure-controlled DRS system is described and applied to both a patient-derived xenograft glioma model, as well as a set of healthy volunteers for assessments of oral mucosal tissues. It was shown that pressure had a significant effect on the derived optical parameters, and that the effects on the optical parameters were magnified with increasing time and pressure levels. These findings indicate that not only is it critical to integrate a pressure sensor into a DRS device, but that it is also important to do so in an automated way to trigger a measurement as soon as possible after probe contact is made to minimize the perturbation to the tissue site.
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Affiliation(s)
- Gregory M. Palmer
- Duke University Medical Center, Department of Radiation Oncology, Durham, North Carolina, United States
- Zenalux Biomedical, Inc., Durham, North Carolina, United States
- Address all correspondence to: Gregory M. Palmer, E-mail:
| | - Hengtao Zhang
- Duke University Medical Center, Department of Radiation Oncology, Durham, North Carolina, United States
| | - Chen-Ting Lee
- Duke University Medical Center, Department of Radiation Oncology, Durham, North Carolina, United States
| | - Husam Mikati
- Duke University Medical Center, Department of Radiation Oncology, Durham, North Carolina, United States
| | - Joseph A. Herbert
- Duke University Medical Center, Department of Radiation Oncology, Durham, North Carolina, United States
| | - Marlee Krieger
- Zenalux Biomedical, Inc., Durham, North Carolina, United States
- Duke University, Department of Biomedical Engineering, Durham, North Carolina, United States
| | | | - Dave Koester
- Zenalux Biomedical, Inc., Durham, North Carolina, United States
| | | | - Daniel J. Rocke
- Duke University Medical Center, Department of Surgery, Durham, North Carolina, United States
| | - Ramon Esclamado
- Duke University Medical Center, Department of Surgery, Durham, North Carolina, United States
| | - Alaatin Erkanli
- Duke University Medical Center, Department of Biostatistics and Bioinformatics, Durham, North Carolina, United States
| | - Nirmala Ramanujam
- Zenalux Biomedical, Inc., Durham, North Carolina, United States
- Duke University, Department of Biomedical Engineering, Durham, North Carolina, United States
| | - Mark W. Dewhirst
- Duke University Medical Center, Department of Radiation Oncology, Durham, North Carolina, United States
- Duke University, Department of Biomedical Engineering, Durham, North Carolina, United States
| | - Walter T. Lee
- Duke University Medical Center, Department of Surgery, Durham, North Carolina, United States
- Durham Veterans Affairs Medical Center, Durham, North Carolina, United States
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19
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Crowson MG, Rocke DJ, Hoang JK, Weissman JL, Kaylie DM. Cost-effectiveness analysis of a non-contrast screening MRI protocol for vestibular schwannoma in patients with asymmetric sensorineural hearing loss. Neuroradiology 2017. [PMID: 28623482 DOI: 10.1007/s00234-017-1859-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE We aimed to determine if a non-contrast screening MRI is cost-effective compared to a full MRI protocol with contrast for the evaluation of vestibular schwannomas. METHODS A decision tree was constructed to evaluate full MRI and screening MRI strategies for patients with asymmetric sensorineural hearing loss. If a patient were to have a positive screening MRI, s/he received a full MRI. Vestibular schwannoma prevalence, MRI specificity and sensitivity, and gadolinium anaphylaxis incidence were obtained through literature review. Institutional charge data were obtained using representative patient cohorts. One-way and probabilistic sensitivity analyses were completed to determine CE model threshold points for MRI performance characteristics and charges. RESULTS The mean charge for a full MRI with contrast was significantly higher than a screening MRI ($4089 ± 1086 versus $2872 ± 741; p < 0.05). The screening MRI protocol was more cost-effective than a full MRI protocol with a willingness-to-pay from $0 to 20,000 USD. Sensitivity analyses determined that the screening protocol dominated when the screening MRI charge was less than $4678, and the imaging specificity exceeded 78.2%. The screening MRI protocol also dominated when vestibular schwannoma prevalence was varied between 0 and 1000 in 10,000 people. CONCLUSION A screening MRI protocol is more cost-effective than a full MRI with contrast in the diagnostic evaluation of a vestibular schwannoma. A screening MRI likely also confers benefits of shorter exam time and no contrast use. Further investigation is needed to confirm the relative performance of screening protocols for vestibular schwannomas.
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Affiliation(s)
- Matthew G Crowson
- Division of Otolaryngology-Head & Neck Surgery, Duke University Medical Center, 2301 Erwin Road, Durham, NC, 27710, USA.
| | - Daniel J Rocke
- Division of Otolaryngology-Head & Neck Surgery, Duke University Medical Center, 2301 Erwin Road, Durham, NC, 27710, USA
| | - Jenny K Hoang
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Jane L Weissman
- Professor Emerita of Diagnostic Radiology, Oregon Health Sciences University, Portland, OR, USA
| | - David M Kaylie
- Division of Otolaryngology-Head & Neck Surgery, Duke University Medical Center, 2301 Erwin Road, Durham, NC, 27710, USA
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20
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Crowson MG, Ryan MA, Rocke DJ, Raynor EM, Puscas L. Variation in tonsillectomy rates by health care system type. Int J Pediatr Otorhinolaryngol 2017; 94:40-44. [PMID: 28167009 DOI: 10.1016/j.ijporl.2017.01.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 08/17/2016] [Revised: 01/07/2017] [Accepted: 01/10/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To analyze variation in tonsillectomy procedure rates between health care system types around the world. STUDY DESIGN International database analysis. METHODS The 2015 Organization for Economic Co-operation and Development (OECD) Health Statistics surgical procedures database was used to ascertain tonsillectomy procedure volumes for 31 countries. Each country's health system type and structure were classified by overall system type, and by health care regulation, financing, and provision methods. Each system type and structure variable were compared using the rate of tonsillectomy procedures per 100,000 citizens. RESULTS 10.5 million tonsillectomy procedures completed between 1993 and 2014 were analyzed. Overall, social health insurance system types had higher total tonsillectomy rates versus other health care system types (p < 0.05 for each comparison). Health systems with private care provision had a higher procedure rate versus state provided care (159.1 vs. 131.1 per 100,000 citizens; p = 0.002). Health care systems with societal regulation and financing had a higher procedure count versus state regulated or financed care (regulation 193.3 vs. 139.7 per 100,000 citizens, p < 0.0001; financing 168.2 vs. 135.0 per 100,000 citizens, p = 0.0004). CONCLUSIONS The volume of tonsillectomy procedures is associated with a health care system's overall structure, regulation, financing, and provision methods. International health care systems with state mediated provision, regulation, and financing had lower tonsillectomy rates versus systems with private provision, and societal regulation or financing. Further study is needed to determine differences in indications for tonsillectomy between countries, but these results underscore potential variation in health care delivery in different systems.
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Affiliation(s)
- Matthew G Crowson
- Division of Otolaryngology-Head & Neck Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Marisa A Ryan
- Division of Otolaryngology-Head & Neck Surgery, Duke University Medical Center, Durham, NC, USA
| | - Daniel J Rocke
- Division of Otolaryngology-Head & Neck Surgery, Duke University Medical Center, Durham, NC, USA
| | - Eileen M Raynor
- Division of Otolaryngology-Head & Neck Surgery, Duke University Medical Center, Durham, NC, USA
| | - Liana Puscas
- Division of Otolaryngology-Head & Neck Surgery, Duke University Medical Center, Durham, NC, USA
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Rocke DJ, Goldstein DP, de Almeida JR. A Cost-Utility Analysis of Recurrent Laryngeal Nerve Monitoring in the Setting of Total Thyroidectomy. JAMA Otolaryngol Head Neck Surg 2016; 142:1199-1205. [DOI: 10.1001/jamaoto.2016.2860] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Daniel J. Rocke
- Department of Surgery, Division of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina
| | - David P. Goldstein
- Department of Otolaryngology–Head and Neck Surgery, Princess Margaret Hospital, Toronto, Ontario, Canada
| | - John R. de Almeida
- Department of Otolaryngology–Head and Neck Surgery, Princess Margaret Hospital, Toronto, Ontario, Canada
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Rocke DJ, Beumer HW, Taylor DH, Thomas S, Puscas L, Lee WT. Physician and Patient and Caregiver Health Attitudes and Their Effect on Medicare Resource Allocation for Patients With Advanced Cancer. JAMA Otolaryngol Head Neck Surg 2014; 140:497-503. [PMID: 24763550 DOI: 10.1001/jamaoto.2014.494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Physicians must participate in end-of-life discussions, but they understand poorly their patients' end-of-life values and preferences. A better understanding of these preferences and the effect of baseline attitudes will improve end-of-life discussions. OBJECTIVE To determine how baseline attitudes toward quality vs quantity of life affect end-of-life resource allocation. DESIGN, SETTING, AND PARTICIPANTS Otolaryngology-head and neck surgery (OHNS) physicians were recruited to use a validated online tool to create a Medicare health plan for advanced cancer patients. During the exercise, participants allocated a limited pool of resources among 15 benefit categories. These data were compared with preliminary data from patients with cancer and their caregivers obtained from a separate study using the same tool. Attitudes toward quality vs quantity of life were assessed for both physicians and patients and caregivers. INTERVENTIONS Participation in online assessment exercise. MAIN OUTCOMES AND MEASURES Medicare resource allocation. RESULTS Of 9120 OHNS physicians e-mailed, 767 participated. Data collected from this group were compared with data collected from 146 patients and 114 caregivers. Compared with patients and caregivers, OHNS physician allocations differed significantly in all 15 benefit categories except home care. When stratified by answers to 3 questions about baseline attitudes toward quality vs quantity of life, there were 3 categories in which allocations of patients and caregivers differed significantly from the group with the opposite attitude for at least 2 questions: other medical care (question 1, P < .001; question 2, P = .005), palliative care (question 1, P = .008; question 2, P = .006; question 3, P = .009), and treatment for cancer (questions 1 and 2, P < .001). In contrast, physician preferences showed significant differences in only 1, nonmatching category for each attitude question: cash (question 1, P = .02), drugs (question 2, P = .03), and home care (question 3, P = .048). CONCLUSIONS AND RELEVANCE Patients with cancer and their caregivers have different preferences from physicians. These preferences are, for these patients and their caregivers, affected by their baseline health attitudes, but physician preferences are not. Understanding the effect of baseline attitudes is important for effective end-of-life discussions.
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Affiliation(s)
- Daniel J Rocke
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Halton W Beumer
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina2now with Medical Corps, US Air Force, Joint Base Langley-Eustis, Virginia
| | - Donald H Taylor
- Duke Sanford School of Public Policy, Durham, North Carolina4Community and Family Medicine and Nursing, Duke University Medical Center, Durham, North Carolina
| | - Steven Thomas
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Liana Puscas
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Walter T Lee
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina6Section of Otolaryngology, Durham VA Medical Center, Durham, North Carolina
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Rocke DJ, Beumer HW, Thomas S, Lee WT. Effect of physician perspective on allocation of Medicare resources for patients with advanced cancer. Otolaryngol Head Neck Surg 2014; 150:792-800. [PMID: 24474714 DOI: 10.1177/0194599814520689] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess how physician perspective (perspective of patient vs perspective of physician) affects Medicare resource allocation for patients with advanced cancer and compare physician allocations with actual cancer patient and caregiver allocations. STUDY DESIGN Cross-sectional assessment. SETTING National assessment. SUBJECTS Otolaryngologists. METHODS Physicians used a validated tool to create a Medicare plan for patients with advanced cancer. Participants took the perspective of an advanced cancer patient and made resource allocations between 15 benefit categories (assessment 2, November/December 2012). Results were compared with data from a prior assessment made from a physician's perspective (assessment 1, February/March 2012) and with data from a separate study with patients with cancer and caregivers. RESULTS In total, 767 physicians completed assessment 1 and 237 completed assessment 2. Results were compared with 146 cancer patient and 114 caregiver assessments. Assessment 1 physician responses differed significantly from patients/caregivers in 14 categories (P < .05), while assessment 2 differed in 11. When comparing physician data, assessment 2 allocations differed significantly from assessment 1 in 7 categories. When these 7 categories were compared with patient/caregiver data, assessment 2 allocations in emotional care, drug coverage, and nursing facility categories were not significantly different. Assessment 1 allocations in cosmetic care, dental, home care, and primary care categories were more similar to patient/caregiver preferences, although all but home care were still significantly different. CONCLUSIONS Otolaryngology-head and neck surgery physician perspectives on end-of-life care differ significantly from cancer patient/caregiver perspectives, even when physicians take a patient's perspective when allocating resources. This demonstrates the challenges inherent in end-of-life discussions.
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Affiliation(s)
- Daniel J Rocke
- Department of Surgery, Division of Otolaryngology, Head & Neck Surgery (OHNS), Duke University Medical Center, Durham, North Carolina, USA
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Rocke DJ, Thomas S, Puscas L, Lee WT. Physician knowledge of and attitudes toward the Patient Protection and Affordable Care Act. Otolaryngol Head Neck Surg 2013; 150:229-34. [PMID: 24334959 DOI: 10.1177/0194599813515839] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess otolaryngology physician knowledge of and attitudes toward the Patient Protection and Affordable Care Act (PPACA) and compare the association of bias toward the PPACA with knowledge of the provisions of the PPACA. STUDY DESIGN Cross-sectional survey. SETTING Nationwide assessment. SUBJECTS Members of the American Academy of Otolaryngology-Head and Neck Surgery. METHODS Otolaryngology physicians answered 10 true/false questions about major provisions of the PPACA. They also indicated their level of agreement with 9 statements about health care and the PPACA. Basic demographic information was collected. RESULTS Email solicitation was sent to 9972 otolaryngologists and 647 responses were obtained (6.5% response rate). Overall correct response rate was 74%. Fewer than 60% of physicians correctly answered questions on whether small businesses receive tax credits for providing health insurance, the effect of the PPACA on Medicare benefits, and whether a government-run health insurance plan was created. Academic center practice setting, bias toward the PPACA, and Democratic Party affiliation were associated with significantly more correct responses. CONCLUSION Overall physician knowledge of the PPACA is assessed as fair, although better than the general public in 2010. There are several areas where knowledge of physicians regarding the PPACA is poor, and this knowledge deficit is more pronounced within certain subgroups. These knowledge issues should be addressed by individual physicians and medical societies.
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Affiliation(s)
- Daniel J Rocke
- Department of Surgery, Division of Otolaryngology, Head & Neck Surgery (OHNS), Duke University Medical Center, Durham, North Carolina, USA
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Rocke DJ, Beumer HW, Taylor DH, Schulz KA, Thomas S, Puscas L, Lee WT. Effect of Physician Perspective on Allocation of Medicare Resources for Patients with Advanced Cancer. Otolaryngol Head Neck Surg 2013. [DOI: 10.1177/0194599813495815a87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: 1) Assess how physician perspective affects Medicare resource allocation for advanced cancer patients. 2) Compare how physician allocations differ from advanced cancer patients and their caregivers. Methods: Otolaryngology–head and neck surgery (OHNS) physicians nationwide used a validated tool to create a Medicare plan for advanced cancer patients. Participants took the perspective of an advanced cancer patient and made resource allocations between 15 benefit categories (round 2, November/December 2012). Results were compared with data from a prior assessment made from a physician’s perspective (round 1, February/March 2012) and with data from an ongoing study with cancer patients and caregivers. Results: Seven hundred and sixty-seven physicians completed round 1, and 237 completed round 2. Results were compared with 146 cancer patients and 114 caregivers. Round 1 physician responses differed significantly from patients/caregivers in 13 categories ( P < 0.05), while round 2 differed significantly in 11. When comparing physician data, round 2 allocations differed significantly from round 1 in 7 categories. When these 7 categories were compared with patient/caregiver data, round 2 allocations in the Emotional Care, Drug Coverage, and Nursing Facility categories were not significantly different from patient/caregiver allocations. In 4 categories, Cosmetic Care, Dental, Home Care, and Primary Care, round 1 allocations were more similar to patient/caregiver allocations, although all but Home Care were still significantly different. Conclusions: OHNS physician perspectives on end-of-life care differ significantly from cancer patient/caregiver perspectives even when physicians take a patient’s perspective when allocating resources. These findings demonstrate the challenges inherent in end-of-life discussions between physicians and patients.
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Rocke DJ, Lee WT, Beumer HW, Taylor DH, Schulz K, Thomas S, Puscas L. Physician allocation of Medicare resources for patients with advanced cancer. J Palliat Med 2013; 16:857-66. [PMID: 23802131 DOI: 10.1089/jpm.2012.0636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Little is known about what patients and physicians value in end-of-life care, or how these groups would craft a health plan for those with advanced cancer. OBJECTIVE The study objective was to assess how otolaryngology, head and neck surgery (OHNS) physicians would structure a Medicare benefit plan for patients with advanced cancer, and to compare this with cancer patient and cancer patient caregiver preferences. DESIGN OHNS physicians used an online version of a validated tool for assessing preferences for health plans in the setting of limited resources. These data were compared to cancer patient and caregiver preferences. SETTING AND PARTICIPANTS OHNS physicians nationwide were assessed with comparison to similar data obtained in a separate study of cancer patients and their caregivers treated at Duke University Medical Center. RESULTS Otolaryngology physicians (n=767) completed the online assessment and this was compared with data from 146 patients and 114 caregivers. OHNS physician allocations differed significantly in 14 of the 15 benefit categories when compared with patients and caregivers. Physicians elected more coverage in the Advice, Emotional Care, Palliative Care, and Treatment for Cancer benefit categories. Patients and their caregivers elected more coverage in the Cash, Complementary Care, Cosmetic Care, Dental and Vision, Drug Coverage, Home Improvement, House Calls, Nursing Facility, Other Medical Care, and Primary Care benefit categories. CONCLUSIONS Otolaryngology physicians have significantly different values in end-of-life care than cancer patients and their caregivers. This information is important for efficient allocation of scarce Medicare resources and for effective end-of-life discussions, both of which are key for developing appropriate health policy.
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Affiliation(s)
- Daniel J Rocke
- Department of Surgery, Division of Otolaryngology, Head, and Neck Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA
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