Utilization of adjuvant therapy in Medicaid and uninsured seminoma patients: Results from the National Cancer Database.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 388-388
Author(s):  
Jonathan J. Paly ◽  
Chun Chieh Lin ◽  
Phillip John Gray ◽  
Ahmedin Jemal ◽  
Jason Alexander Efstathiou
Keyword(s):  
Adjuvant Therapy ◽  
Early Stage ◽  
National Cancer Data Base ◽  
Adjuvant Radiation ◽  
Cancer Specific Survival ◽  
Early Stage Disease ◽  
Cancer Data ◽  
Stage Disease ◽  
Education Levels ◽  
Stage Ia

388 Background: Seminoma is the most common testicular cancer, and cancer specific survival approaches 100% if diagnosed and treated early. Following orchiectomy, several adjuvant therapy options exist for patients with stage 1A/B and 2A/B disease. As the Affordable Care Act’s (ACA) individual insurance mandate and expansion of Medicaid coverage will begin in 2014, we sought to understand whether differences exist in receipt of adjuvant therapy between uninsured and Medicaid patients in order to predict possible treatment patterns after the ACA takes effect. Methods: Uninsured and Medicaid patients diagnosed with seminoma from 1998-2010 in the National Cancer Data Base were identified. Multivariate logistic regressions were used to assess the relationship between uninsured status vs. Medicaid and receipt of adjuvant therapy. Results: Of 41,745 seminoma patients, 5,895 (14%) patients were on Medicaid or uninsured. Compared to Medicaid patients, uninsured patients were more likely to be younger (<29 years old), Hispanic, live in the South, treated in community hospitals, reside in areas with higher education levels, and present with stage IA/B disease (66.5% vs 59.4%, p < 0.01). After controlling for sociodemographic and clinical characteristics, uninsured stage IA/B patients had a 16% decreased likelihood of receiving adjuvant radiation or chemotherapy than Medicaid patients (p<0.05). In addition, stage 1A/B patients who were Hispanic, aged 50 or more, diagnosed in 2006-2010, treated in low-volume-case facilities or had tumor size < 4cm were less likely to receive adjuvant therapy. No treatment differences by insurance were seen in stage IIA/B patients. Conclusions: Our analysis suggests a modest association between the decision to seek optional adjuvant therapy and uninsured vs. Medicaid status in patients with stage IA/B seminoma. Given that national recommendations support surveillance, it will be increasingly important to counsel newly insured patients on the benefits of post-orchiectomy surveillance for early stage disease. In addition, no difference in management was identified for CS 2A/B patients suggesting that required therapy was not modified or avoided in the uninsured.

Neuroendocrine carcinoma of the cervix: A single institution’s experience.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e15585-e15585
Author(s):  
Megan Preston ◽  
Georgia Anne-Lee McCann ◽  
David M. O'Malley ◽  
Christina Boutsicaris ◽  
Larry J. Copeland ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Metastatic Disease ◽  
Survival Data ◽  
Early Stage ◽  
Stage I ◽  
Stage Ii ◽  
Advanced Stage ◽  
Single Institution ◽  
Early Stage Disease ◽  
Stage Disease

e15585 Background: Neuroendocrine carcinomas (NEC) of the cervix comprise only 2% of all cervical cancers. As a result, prospective data is limited and treatment guidelines rely on literature from lung NEC. The objective of this study was to examine and report on our experience in the management of this rare, aggressive disease. Methods: This was an IRB-approved, single-institution, retrospective review. Study criteria included patients with cervical NEC diagnosed between 1990-2011. Demographic, treatment and survival data was collected. Progression-free survival (PFS) and overall survival (OS) was defined as the time from date of initial treatment until progression or death respectively, or date of last contact. Results: A total of 24 patients met inclusion criteria. The median age at diagnosis was 43. Median PFS was 13.6 months and median OS was 16.4 months. The majority of patients had advanced-stage disease (61% stage II-IV, 39% stage I). Of the 9 patients with stage I disease, 4 were treated with platinum + etoposide-based neoadjuvant chemotherapy and 5 were treated with initial radical surgery. Seven of the 9 patients had post-operative adjuvant therapy consisting of chemotherapy, chemo-radiation or radiation only. Seven of the 9 patients (78%) were alive at last follow-up. Of the two patients who were deceased, one had metastatic disease found at surgery and the other declined adjuvant therapy and died of recurrence. Patients with stage II-IV disease (n=15) had a median PFS and OS of 11.5 and 12.1 months, respectively. Only 2 had no evidence of disease at last encounter. The remainder died without achieving remission. Patients with metastatic disease had significantly worse survival when compared to those with loco-regional disease with a median OS of 8 vs. 28 months (p = .03), respectively. Conclusions: We report one of the largest single-institution experiences of neuroendocrine cervical cancer. Advanced-stage patients had a poor prognosis regardless of therapy. However, multi-modality therapy in early-stage disease resulted in an excellent prognosis (78% survival) for these rare, highly aggressive tumors. These findings support the goal of curative intent for early-stage disease using multi-modality therapy.

Management and outcomes of clinical stage II a/b seminoma: Results from the National Cancer Database.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 378-378
Author(s):  
Jonathan J. Paly ◽  
Phillip John Gray ◽  
Chun Chieh Lin ◽  
Helmneh Sineshaw ◽  
Ahmedin Jemal ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Clinical Stage ◽  
National Cancer Data Base ◽  
Treatment Center ◽  
Adjuvant Radiation ◽  
Testicular Seminoma ◽  
Cancer Data ◽  
Factors Associated ◽  
Significant Difference

378 Background: Testicular seminoma is the most common solid tumor seen in patients aged 15-35 and disease specific survival approaches 100% in controlled studies, even for those with node-positive disease. We sought to describe modern practice patterns as well as survival outcomes and factors associated with receipt of adjuvant therapy for patients presenting with initial clinical stage (CS) IIA/B disease. Methods: Data on patients diagnosed with CS IIA/B testicular seminoma from 1998-2011 were extracted from the National Cancer Data Base. Demographic, clinical, treatment, payer characteristics were evaluated using multivariate logistic regression to identify factors associated with receipt of chemotherapy or adjuvant radiation therapy (ART) within 6 months of orchiectomy. Five-year Kaplan-Meier overall survival (OS) by CS and treatment was calculated. Results: In total, 2,185 patients with CS II A/B were included. Management included orchiectomy alone (11.35%), adjuvant chemotherapy (27.46%), or ART (52.72%). In multivariate analysis, receipt of orchiectomy plus ART rather than adjuvant chemotherapy was more likely with CS IIA status (OR 2.4, p < 0.01), treatment outside of teaching or NCI network institution (OR 1.9-2.8, p < 0.02), or tumor size ≥4cm (OR 1.6, p < 0.01). Receipt of ART was less likely in Hispanic patients (OR 0.6, p=0.03) or in those diagnosed from 2006-2011 (OR 0.5, p < 0.01). Five-year OS for all patients was 97.2% for orchiectomy + ART, and 93.9% for orchiectomy + chemotherapy (log-rank p = 0.01). For CS IIA patients, 5-year OS was 98.3% for orchiectomy + ART versus 93.6% for orchiectomy + chemotherapy (log-rank p < 0.01). Differences in OS for CS IIB treated with chemotherapy or ART were not statistically significant. Conclusions: Consistent with national guideline recommendations, our analysis suggest that compared to chemotherapy, ART is associated with a survival advantage for CS IIA patients. Chemotherapy or ART showed no significant difference in effectiveness in patients with CS IIB. Disease bulk, race, treatment center type, and time period are associated with choice of adjuvant therapy. Longer follow-up and validation of these results is needed to account for late effects of treatment.

Loss in working years after a breast cancer diagnosis: A population-based study (Sweden).

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 209-209
Author(s):  
Mats Lambe ◽  
Paul Lambert ◽  
Irma Fredriksson ◽  
Anna Plym
Keyword(s):  
Breast Cancer ◽  
Cancer Diagnosis ◽  
Early Stage ◽  
Stage Iv ◽  
Population Level ◽  
Breast Cancer Diagnosis ◽  
Early Stage Disease ◽  
Cancer Data ◽  
Stage Disease ◽  
Working Age

209 Background: More than half of all women with breast cancer are diagnosed during working age. We present a new measure of clinical and public health relevance to estimate the loss in working years after a breast cancer diagnosis. Methods: Women of working age diagnosed with breast cancer between 1997 and 2012 were identified in the Breast Cancer Data Base Sweden (N = 19,661), together with a breast cancer-free comparison cohort (N = 81,303). Women were followed until permanent exit from the labour market (defined as receipt of disability pension, old-age retirement or death) or censoring. Using flexible parametric survival modelling, the loss in working years was calculated as the difference in the remaining years in the work force between women with and women without breast cancer. Results: The loss in working years was most pronounced in women of younger ages and in women with advanced stage disease. Women aged 50 years at diagnosis with stage I disease lost on average 0.6 years (95% CI, 0.4-0.8) of their remaining working time; the corresponding estimates were 1.2 years (1.0-1.5) in stage II, 3.2 years (2.7-3.7) in stage III, and 8.8 years (7.9-9.8) in stage IV disease. Type of treatment was a clear determinant in women with early stage disease, with a higher loss in working years among women treated with axillary surgery, mastectomy and chemotherapy. Conclusions: Our measure provides a new perspective of the burden of breast cancer in women of working age. The modest loss in working years in women with early stage disease is reassuring, although the economic consequences on a population-level are likely to be high given the large number of women diagnosed with breast cancer every year.

Characteristics and outcomes of resected pancreatic cystadenocarcinoma: 1,205 cases from the National Cancer Data Base.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 4129-4129
Author(s):  
Jiping Wang ◽  
Xuefei Wang ◽  
Lianne Heuthorst ◽  
Thomas E. Clancy ◽  
Christopher Pezzi
Keyword(s):  
Prognostic Factors ◽  
Lymph Nodes ◽  
Data Base ◽  
Clinical Decision Making ◽  
Early Stage ◽  
National Cancer Data Base ◽  
Ductal Adenocarcinoma ◽  
Operating Characteristics ◽  
Early Stage Disease ◽  
Cancer Data

4129 Background: Cystadenocarcinoma (CAC) of the pancreas is a rare pancreatic and therefore there is limited data on the characteristics, treatment and prognosis of this disease. Methods: Patients who underwent resection for CAC (n = 1,205) between 2003 and 2012 were identified from National Cancer Data Base. The clinicopathological characteristics and treatment outcomes were compared to patients with resected ductal adenocarcinoma (DAC) (n = 15,696). Cox-proportional hazard model was used to adjust for potential prognostic factors. A nomogram was constructed and validated to predict the outcomes of patients with CAC by using multiple variable Cox-proportional model and receiver operating characteristics curve methods. Results: Compared with resected DAC, patients with resected CAC are diagnosed at a younger age (58.7 vs. 61.2, p < 0.0001); female predominant (63.7% vs. 48.8%, p < 0.0001); more often Black (15.0% vs. 9.3%, p < 0.0001);had larger tumor (0-2, 2-4 and > 4cm:17.5%, 24.3%, 53.5% vs. 16.8%, 48.3% , 32.1%, respectively, p < 0.0001); have less total number of examined lymph nodes (10.6 vs. 14.5, p < 0.0001) and fewer positive lymph nodes(0.6 vs. 2.3, respectively). CAC patients were less likely to receive chemotherapy (28.8% vs. 62.5%, p < 0.0001) and radiation therapy (16.4% vs. 36.9%, p < 0.0001). CAC patients had significantly better overall survival than those with DAC (5 year survival: 55.6% vs. 17.3%, p < 0.0001). The survival advantage was primarily seen in patients with early stage disease (5 year survival: 70.9% vs. 36.9% in stage I patients, p < 0.0001, and 32.7% vs. 14.5% in stage II patients, p < 0.0001 respectively) and persisted after adjusting the known prognostic factors including age, AJCC staging, Charlson-Deyo score, type of surgery, chemotherapy, tumor size, and lymph node ratio (adjusted hazard ratio: 0.43, 95% confidence interval: 0.39-0.48, p < 0.0001). Conclusions: Patients with CAC had significantly better survival than those with pancreatic DAC even after controlling for known prognostic factors. The proposed nomogram could accurately predict patients’ outcome and may be used as a tool for clinical decision making.

How I treat nodular lymphocyte-predominant Hodgkin lymphoma

Blood ◽  
2020 ◽  
Vol 136 (26) ◽  
pp. 2987-2993
Author(s):  
Dennis A. Eichenauer ◽  
Andreas Engert
Keyword(s):  
Hodgkin Lymphoma ◽  
Early Stage ◽  
Treatment Options ◽  
Relative Survival ◽  
Treatment Modalities ◽  
High Dose ◽  
Combined Modality Treatment ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Stage Ia

Abstract Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare lymphoma entity with distinct pathologic and clinical characteristics. Unlike the malignant cells in classical Hodgkin lymphoma, the disease-defining lymphocyte-predominant cells in NLPHL are consistently positive for CD20, but do not express CD30. The clinical course of NLPHL is indolent in the majority of cases. Most patients present with early-stage disease at the initial diagnosis. First-line treatment of stage IA NLPHL usually consists of limited-field radiotherapy alone. Patients with early-stage NLPHL other than stage IA and intermediate-stage disease mostly receive combined-modality treatment, whereas individuals with advanced NLPHL are treated with chemotherapy alone. In relapsed NLPHL, conventional chemotherapy, anti-CD20 antibodies, and radiotherapy represent active treatment modalities. Only patients with poor-risk characteristics such as early disease recurrence are candidates for aggressive salvage treatment with high-dose chemotherapy and autologous stem cell transplantation. The overall and relative survival of patients with NLPHL is excellent as indicated by a low excess mortality compared with the general population. This article discusses treatment options for patients with NLPHL and factors that influence the choice of therapy on the basis of the available data and 2 clinical cases.

Novel approaches to improve prostate cancer diagnosis and management in early-stage disease

2012 ◽  
Vol 109 ◽  
pp. 1-7 ◽  
Author(s):  
Michael Marberger ◽  
Jelle Barentsz ◽  
Mark Emberton ◽  
Jonas Hugosson ◽  
Stacy Loeb ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Diagnosis ◽  
Early Stage ◽  
Early Stage Disease ◽  
Prostate Cancer Diagnosis ◽  
Diagnosis And Management ◽  
Stage Disease ◽  
Novel Approaches ◽  
Improve Prostate Cancer

scholarly journals Surgery in Small-Cell Lung Cancer

Cancers ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 390
Author(s):  
Nicola Martucci ◽  
Alessandro Morabito ◽  
Antonello La Rocca ◽  
Giuseppe De Luca ◽  
Rossella De Cecio ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Early Stage ◽  
Small Cell ◽  
Stage I ◽  
Phase Iii ◽  
Small Cell Lung ◽  
Early Stage Disease ◽  
Stage Disease

Small-cell lung cancer (SCLC) is one of the most aggressive tumors, with a rapid growth and early metastases. Approximately 5% of SCLC patients present with early-stage disease (T1,2 N0M0): these patients have a better prognosis, with a 5-year survival up to 50%. Two randomized phase III studies conducted in the 1960s and the 1980s reported negative results with surgery in SCLC patients with early-stage disease and, thereafter, surgery has been largely discouraged. Instead, several subsequent prospective studies have demonstrated the feasibility of a multimodality approach including surgery before or after chemotherapy and followed in most studies by thoracic radiotherapy, with a 5-year survival probability of 36–63% for patients with completely resected stage I SCLC. These results were substantially confirmed by retrospective studies and by large, population-based studies, conducted in the last 40 years, showing the benefit of surgery, particularly lobectomy, in selected patients with early-stage SCLC. On these bases, the International Guidelines recommend a surgical approach in selected stage I SCLC patients, after adequate staging: in these cases, lobectomy with mediastinal lymphadenectomy is considered the standard approach. In all cases, surgery can be offered only as part of a multimodal treatment, which includes chemotherapy with or without radiotherapy and after a proper multidisciplinary evaluation.

scholarly journals Female Breast Cancer in Suriname: Pathways to Treatment—A Patient’s Perception

2020 ◽  
Vol 6 (Supplement_1) ◽  
pp. 49-49
Author(s):  
Euridice R. Irving ◽  
Dennis R. A. Mans ◽  
Els Th. M. Dams ◽  
Maureen Y. Lichtveld
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Access To Health Care ◽  
Early Stage ◽  
Diagnosis And Treatment ◽  
Related Factors ◽  
Entire Interval ◽  
Early Stage Disease ◽  
Resource Setting ◽  
Stage Disease

PURPOSE Delays across the entire cancer care continuum are not uncommon. This cross-sectional study explored the health care trajectories of Surinamese women with breast cancer and identified predictors of timely diagnosis and treatment initiation. METHODS One hundred women age 30 years or older who were newly diagnosed with breast cancer in 2017 to 2018 were recruited from all 4 hospitals in Paramaribo. Data on their demographics, lifestyle, reproductive and medical history, health status, and family history of breast cancer and other malignancies were collected using a validated semistructured questionnaire. Using Anderson’s Model of Pathways to Treatment, we defined a patient interval (from detection to first consultation), diagnostic interval (from consultation to histopathologic diagnosis), and treatment interval (from diagnosis to first treatment). Log-transformed data were analyzed using linear regression, and variables with P ≤ .05 were considered statistically significant predictors of intervals. RESULTS All participants had health insurance and access to health care. Eighty-five percent of patients presented with early-stage disease. Ninety percent of patients had self-detected their disease, with 70% finding a lump. Average age was 55.6 years (± 11.8 years). Median durations of patient, diagnostic, and treatment intervals were 13 days (interquartile, range, 4-63 days), 40 days (IQR, 21-57 days), and 18 days (IQR, 8-38 days), respectively. Median duration of the entire interval was 95 days (IQR, 59-272 days). Patient-related factors associated with the intervals were religion (β = −530; P = .003), being employed (β = 149.4; P = .007), and age 50 years and older (β = −195.8; P = .037). Disease-related factors were lump as first symptom (β = −175.6; P = .038) and late-stage disease at diagnosis (β = 213.5; P = .004). CONCLUSION Given the limited-resource setting, delays in Suriname’s health care can be minimized by programs aimed at increasing breast cancer awareness and education; however, delays may have been underestimated as a result of the over-representation of early-stage disease and recall bias regarding the first symptom detected.

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