Radiation oncologist density and pancreatic cancer mortality.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 350-350 ◽  
Author(s):  
S. Aneja ◽  
J. B. Yu
Keyword(s):  
Pancreatic Cancer ◽  
Radiation Oncology ◽  
Cancer Mortality ◽  
Multidisciplinary Care ◽  
Cancer Registries ◽  
Health Care Facilities ◽  
Curative Treatment ◽  
County Level ◽  
Radiation Oncologist ◽  
The Impact

350 Background: Though the role of radiation oncologists (RO) in the curative treatment of pancreatic cancer (PC) is not well defined, RO are important for the multidisciplinary care of cancer patients. The impact of this variation on PC outcomes remains unexplored. The goal of this study was to determine the effect of RO density on PC mortality. Methods: Using county-level data from the 2008 Area Resource File, National Program for Cancer Registries, and U.S. Centers for Disease Control, a multivariate regression model was constructed for PC mortality, controlling for county-level categorized RO density, demographics, socioeconomic status, and existing health care facilities. Results: There was a statistically significant reduction in PC mortality (reduction ranging from 27% to 51% p<.001) associated with counties that possessed at least one RO. Also there existed a statistically significant improvement in mortality in counties with a density of at least two RO per 100,000 people compared to counties with one radiation oncologist per 100,000 people. Conclusions: The presence of a RO is associated with lowered morality for PC within that county. In contrast to our other density analyses investigating the association between radiation oncology density and colorectal cancer and esophageal cancer mortality, the association between additional RO and PC mortality was equivocal. This may reflect the varying use of radiation oncology in different counties for the curative treatment of PC. Our study suggests that RO play an important role in the treatment of PC. [Table: see text] No significant financial relationships to disclose.

Radiation oncologist density and colorectal cancer mortality.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 605-605 ◽  
Author(s):  
S. Aneja ◽  
J. B. Yu
Keyword(s):  
Colorectal Cancer ◽  
Radiation Therapy ◽  
Cancer Mortality ◽  
Cancer Registries ◽  
County Level ◽  
Radiation Oncologist ◽  
Healthcare Facilities ◽  
Radiation Oncologists ◽  
Level Data ◽  
The Impact

605 Background: Although the use of radiation therapy is increasing, there exists geographic variation among the distribution of radiation oncologists. The impact of this variation on colorectal cancer (CRC) outcomes remains unexplored. The goal of this study was to determine the effect of radiation oncologist density on CRC mortality. Methods: Using county-level data from the 2008 Area Resource File, National Program for Cancer Registries, and US Centers for Disease Control, a regression model was constructed for CRC mortality, controlling for county-level categorized radiation oncologists density, demographics, socioeconomic status and existing healthcare facilities. Results: There was a statistically significant reduction in CRC mortality (reduction in mortality ranging from 12% to 47%, p<0.001) associated with counties that possessed at least one radiation oncologist. However, increasing the county density to greater than two radiation oncologists per 100,000 people had no statistically significant reduction in CRC mortality. Conclusions: The presence of a radiation oncologist is associated with lowered mortality for CRC within that county, but increasing radiation oncologist density does not yield further improvements. Therefore, as the use of radiation therapy to treat CRC increases, a detailed understanding of distribution of the radiation oncologists is essential for providing the greatest improvement in cancer mortality outcomes. [Table: see text] No significant financial relationships to disclose.

Radiation oncologist density and esophageal cancer mortality.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 116-116
Author(s):  
S. Aneja ◽  
J. B. Yu
Keyword(s):  
Esophageal Cancer ◽  
Radiation Therapy ◽  
Cancer Mortality ◽  
Cancer Registries ◽  
County Level ◽  
Radiation Oncologist ◽  
Radiation Oncologists ◽  
Level Data ◽  
Resource File ◽  
The Impact

116 Background: Although the use of radiation therapy to treat esophageal cancer is increasing, there exists a geographic variation among the distribution of radiation oncologists. The impact of this variation on esophageal cancer (EC) outcomes remains unexplored. The goal of this study was to determine the effect of radiation oncologist density on EC mortality. Methods: Using county- level data from the 2008 Area Resource File, National Program for Cancer Registries, and U.S. Centers for Disease Control, a multivariate regression model was constructed for EC mortality, controlling for county-level categorized radiation oncologists density, demographics, socioeconomic status, and existing hospital facilities. Results: There was a statistically significant reduction in esophageal cancer mortality (reduction ranging from 22% to 79% p < 0.001) associated with counties that possessed at least one radiation oncologist. However, increasing the county density to greater than two radiation oncologists per 100,000 people had no statistically significant reduction in EC mortality. Conclusions: The presence of a radiation oncologist is associated with lowered mortality for EC within that county, but increasing radiation oncologist density does not yield further improvements. Therefore, as the use of radiation therapy to treat EC increases, a detailed understanding of distribution of the radiation oncologists is essential for providing the greatest improvement in EC mortality outcomes. [Table: see text] No significant financial relationships to disclose.

scholarly journals Urologist Density and County-Level Urologic Cancer Mortality

2010 ◽  
Vol 28 (15) ◽  
pp. 2499-2504 ◽  
Author(s):  
Anobel Y. Odisho ◽  
Matthew R. Cooperberg ◽  
Vincent Fradet ◽  
Ardalan E. Ahmad ◽  
Peter R. Carroll
Keyword(s):  
Kidney Cancer ◽  
Cancer Mortality ◽  
Population Level ◽  
Work Force ◽  
The United States ◽  
Test Case ◽  
County Level ◽  
Care Providers ◽  
Urologic Cancers ◽  
The Impact

Purpose The surgical work force distribution at the county level varies widely across the United States, and the impact of differential access on cancer outcomes is unclear. We used urologists as a test case because they are the first care providers for urologic cancers, can easily be identified from available data sources, and are unevenly distributed throughout the country. The goal of this study was to determine the effect of increasing urologist density on local prostate, bladder, and kidney cancer mortality. Patients and Methods Using county-level data from the Area Resource File, US Census, National Cancer Institute, and Centers for Disease Control, regression models were built for prostate, bladder, and kidney cancer mortality, controlling for categorized urologist density, county demographics, socioeconomic factors, and preexisting health care infrastructure. Results For each of the three cancers, there was a statistically significant cancer-specific mortality reduction associated with counties that had more than zero urologists (16% to 22% reduction for prostate cancer, 17% to 20% reduction for bladder cancer, and 8% to 14% reduction for kidney cancer with increasing urologist density) relative to zero urologists. However, increasing density greater than two urologists per 100,000 people had no statistically significant impact on mortality for any of the tumors studied. Conclusion The presence of a urologist is associated with lower mortality for urologic cancers in that county, but increasing urologist density does not yield further improvements. Therefore, a nuanced and geographically aware policy toward the size and distribution of the future work force is most likely to provide the greatest population-level improvement in cancer mortality outcomes.

scholarly journals The Impact of Surgeon Referral and a Radiation Oncologist Productivity-Based Metric on Radiotherapy Receipt Among Elderly Women with Early-Stage Breast Cancer: Analysis from a Tertiary Cancer Network

2021 ◽  
Author(s):  
Mira A Patel ◽  
Elaine E. Cha ◽  
Stephanie Lobaugh ◽  
Zhigang Zhang ◽  
Beryl McCormick ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Radiation Oncology ◽  
Financial Incentives ◽  
Elderly Women ◽  
Early Stage ◽  
Practice Change ◽  
Early Stage Breast Cancer ◽  
Radiation Oncologist ◽  
Cancer Network ◽  
The Impact

Abstract Purpose: Guidelines for early-stage breast cancer allow for radiotherapy (RT) omission following breast conserving surgery (BCS) among older women, though high utilization of RT persists. This study explores surgeon referral and the effect of a productivity-based bonus metric for radiation oncologists in an academic institution with centralized quality assurance (QA) review.Methods: We evaluated patients >70 years of age treated with BCS for ER+ pT1N0 breast cancer at a single tertiary cancer network between 2015-2018. The primary outcomes were radiation oncology referral and RT receipt. Covariables included patient and physician characteristics, and treatment decisions before versus after productivity metric implementation. Univariable generalized linear effects models explored associations between these outcomes and covariables. Results: Of 703 patients included, 483 (69%) were referred to radiation oncology and 273 (39%) received RT (among those referred, 57% received RT). No difference in RT receipt pre- versus post- productivity metric implementation was observed (p=0.57). RT receipt was associated with younger patient age (70-74 years, OR 2.66, 95% CI 1.54-4.57) and higher grade (grade 3, OR 7.75, 95% CI 3.33-18.07). Initial referral was associated with younger age (70-74, OR 5.64, 95% CI 3.37-0.45) and higher performance status (KPS ³90, OR 5.34, 95% CI 2.63-10.83). Conclusion: Non-referral to radiation oncology accounted for half of RT omission, but was based on age and KPS, in accordance with guidelines. Lack of radiation oncologist practice change in response to misaligned financial incentives is reassuring, potentially reflecting centralized QA review. Multi-institutional studies are needed to confirm these findings.

Improving the Accessibility of Patient Care Through Integration of the Hospital and Radiation Oncology Electronic Health Records

2017 ◽  
pp. 1-8
Author(s):  
Abhishek Ashok Solanki ◽  
Murat Surucu ◽  
Amishi Bajaj ◽  
Barbara Kaczmarz ◽  
Brendan Martin ◽  
...  
Keyword(s):  
Patient Care ◽  
Radiation Oncology ◽  
Multidisciplinary Care ◽  
Cancer Center ◽  
Health Records ◽  
Staff Members ◽  
Patients With Cancer ◽  
Electronic Health ◽  
The Impact

Purpose Radiation therapy (RT)–specific aspects of a patient’s cancer care commonly are documented and scheduled through a radiation oncology electronic health record (rEHR). However, patients who receive RT also receive multidisciplinary care from providers who use the hospital EHR (hEHR). We created an electronic interface to integrate our hEHR and rEHR to improve communication of the RT aspects of care between our department and the rest of the hospital. The objective of this study was to assess the impact of rEHR and hEHR integration on the accessibility of the RT-specific aspects of patient care to providers. Methods and Materials We performed a preintegration and postintegration survey of 175 staff members at our academic cancer center. Respondents rated the importance and accessibility of several RT encounters and documents on a Likert scale. The Wilcoxon-Mann-Whitney, χ2, and Fisher’s exact tests were used to compare preintegration and postintegration responses. Results There were 32 and 19 responses to the pre- and postintegration surveys, respectively. rEHR items most commonly reported to be at least moderately important were the dates of first treatment (n = 29 [91%]), last treatment (n = 29 [91%]), brachytherapy (n = 22 [69%]), radiosurgery (n = 22 [69%]), and computed tomography simulation (n = 21 [66%]). A drastic improvement was found in most items made visible in the hEHR through the interface. Conclusion By integrating our hEHR and rEHR, we improved the communication of patient care between the RT department and the multidisciplinary team. Institutions should pursue and support integration of the EHRs to improve the quality of care provided to patients with cancer.

scholarly journals Food Environments and Hepatocellular Carcinoma Incidence

2021 ◽  
Vol 18 (11) ◽  
pp. 5740
Author(s):  
Mimi Ton ◽  
Michael J. Widener ◽  
Peter James ◽  
Trang VoPham
Keyword(s):  
Hepatocellular Carcinoma ◽  
Food Environment ◽  
Variance Estimation ◽  
Cancer Registries ◽  
County Level ◽  
Individual Level ◽  
Retail Food Environment ◽  
Food Retailers ◽  
Environment Index ◽  
Rate Ratios

Research into the potential impact of the food environment on liver cancer incidence has been limited, though there is evidence showing that specific foods and nutrients may be potential risk or preventive factors. Data on hepatocellular carcinoma (HCC) cases were obtained from the Surveillance, Epidemiology, and End Results (SEER) cancer registries. The county-level food environment was assessed using the Modified Retail Food Environment Index (mRFEI), a continuous score that measures the number of healthy and less healthy food retailers within counties. Poisson regression with robust variance estimation was used to calculate incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for the association between mRFEI scores and HCC risk, adjusting for individual- and county-level factors. The county-level food environment was not associated with HCC risk after adjustment for individual-level age at diagnosis, sex, race/ethnicity, year, and SEER registry and county-level measures for health conditions, lifestyle factors, and socioeconomic status (adjusted IRR: 0.99, 95% CI: 0.96, 1.01). The county-level food environment, measured using mRFEI scores, was not associated with HCC risk.

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