Qualitative analysis of Iowa rectal cancer patients’ decisions on where to receive surgery.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 835-835
Author(s):  
Mary E. Charlton ◽  
Ariana Shahnazi ◽  
Irena Gribovskaja-Rupp ◽  
Chi Lin ◽  
Lisa Hunter ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Cancer Patients ◽  
Rectal Adenocarcinoma ◽  
High Volume ◽  
Rectal Cancer Surgery ◽  
Targeted Interventions ◽  
Treatment Information ◽  
Surgeon Experience ◽  
Low Volume ◽  
To Receive

835 Background: Current literature suggests surgeons and hospitals that perform large volumes of rectal cancer care achieve superior outcomes, but only about half of rectal cancer resections are performed by high-volume surgeons in comprehensive hospitals. Little is known about considerations of patients with rectal cancer when deciding where to receive surgery. Methods: A purposive sample of stage II/III rectal adenocarcinoma survivors diagnosed 2013-2015 were identified through the Iowa Cancer Registry and interviewed by telephone about factors influencing decisions on where to receive rectal cancer surgery. Interviews were recorded and transcribed, and a thematic analysis was conducted. Results: Thematic saturation was reached after interviewing 15 survivors. Mean age was 63; 60% were male, 53% resided in non-metropolitan areas and 60% received surgery at low-volume centers. Recommendation from a trusted source, usually a physician, appeared to be a main driver of where patients received surgery. Patients who chose high-volume centers were directed by a trusted source to seek care there, whereas patients who chose low-volume centers described valuing hospitals that were closer to home, knowing individuals at the hospital and receiving prior care there, and being familiar with others who received care from a specific surgeon. Most considered surgeon volume and experience to be important determinants of outcomes, but few actually assessed it. Most characterized surgeon experience based on subjective assessments including interpersonal skills, ability to explain procedures and perceived surgeon confidence. Several reported not trusting online sources for treatment information. Conclusions: Most rectal cancer patients in our sample relied on physician referrals to decide where to receive surgery. Further research is needed to determine rectal cancer patients’ preferences for obtaining information about surgeon/hospital volume and experience since our findings suggest they are neither discussing these factors with their surgeon nor researching them on their own. Once preferences are determined, targeted interventions facilitating more informed decision-making by patients can be developed.

Predictors of rectal cancer resection at high-volume hospitals among Medicare patients.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 808-808
Author(s):  
Mary E. Charlton ◽  
Catherine Chioreso ◽  
Irena Gribovskaja-Rupp ◽  
Chi Lin ◽  
Marcia M Ward ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Rectal Adenocarcinoma ◽  
High Volume ◽  
Neoadjuvant Chemoradiation ◽  
Sphincter Preservation ◽  
Cancer Center ◽  
Medicare Beneficiaries ◽  
Co Morbidity ◽  
High Volume Hospital ◽  
Low Volume

808 Background: Hospitals that perform high volumes of rectal cancer resections achieve superior rates of sphincter preservation and survival compared to those that do not, but many rectal cancer resections are still performed in low-volume centers. We aimed to determine the patient, provider and pathway characteristics associated with receipt of surgery from high-volume hospitals. Methods: Patient and provider characteristics were extracted from the SEER-Medicare database for Medicare beneficiaries (age 66+) with stage II/III rectal adenocarcinoma diagnosed 2007-2011 who received rectal cancer-directed surgery. Hospitals were divided into quartiles by volume of rectal cancer resections, and were also classified by NCI cancer center designation. Results: 2056 patients were included, and 57% received surgery in a high-volume hospital or NCI-designated center. Those residing in census tracts classified as rural and having higher median incomes, lower poverty, and higher levels of education more frequently received surgery in high-volume hospitals; there were no differences by age, gender, stage, or co-morbidity status. 55% of patients received surgery at the same facility where they received the colonoscopy that identified their cancer. In multivariate analyses, the strongest predictor of receiving one’s surgery in a high-volume hospital was receipt of colonoscopy at a high-volume facility (OR = 3.75, 95% CI: 2.93-4.79). Those treated in high-volume hospitals more often had guideline-recommended staging (TRUS/MRI) and treatment (neoadjuvant chemoradiation). Conclusions: Rectal cancer patients tended to stay at the facility where their cancer was diagnosed; and did not typically seek out high-volume providers if their colonoscopy was performed in a low-volume facility. This suggests that colonoscopists may have substantial influence over where patients receive surgery. Given that rurality, income and education appear to more strongly predict receipt of surgery at a high-volume hospital compared to clinical characteristics, further research is needed to understand considerations driving patient decisions and referring providers’ recommendations for care.

scholarly journals AB014. SOH21AS002. Rectal cancer surgery: does low volume imply worse outcome?—a single surgeon experience

2021 ◽  
Vol 5 ◽  
pp. AB014-AB014
Author(s):  
Niamh Aine Dundon ◽  
Adel Hassan Al Ghazwi ◽  
William Pius Joyce
Keyword(s):  
Rectal Cancer ◽  
Cancer Surgery ◽  
Rectal Cancer Surgery ◽  
Surgeon Experience ◽  
Low Volume

Outcome of Rectal Cancer Surgery After the Introduction of Preoperative Radiotherapy in a Low-Volume Hospital

2007 ◽  
Vol 38 (2-4) ◽  
pp. 63-70 ◽  
Author(s):  
A. Doeksen ◽  
P. J. Tanis ◽  
B. C. Vrouenraets ◽  
J. A. H. Gooszen ◽  
J. J. B. van Lanschot ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Preoperative Radiotherapy ◽  
Cancer Surgery ◽  
Rectal Cancer Surgery ◽  
Low Volume

Organ preservation in rectal cancer patients treated with total neoadjuvant therapy.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 692-692
Author(s):  
Rosa Maria Jimenez-Rodriguez ◽  
Felipe Fernando Quezada-Diaz ◽  
Irbaz Hameed ◽  
Sujata Patil ◽  
Jesse Joshua Smith ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Therapy ◽  
Cancer Patients ◽  
Rectal Adenocarcinoma ◽  
Case Series ◽  
Complete Response ◽  
Stage Ii ◽  
Clinical Complete Response ◽  
Mri Staging ◽  
Total Neoadjuvant Therapy

692 Background: Retrospective case series suggest that watch-and-wait (WW) is a safe alternative to total mesorectal excision (TME) in selected patients with a clinical complete response (cCR) after chemoradiotherapy (CRT). Because treatment strategies vary widely and total numbers of patients treated at different institutions have not been reported, the proportion of rectal cancer patients who can potentially benefit from WW is not known. Here, we report the results of a treatment strategy incorporating WW in a cohort of rectal cancer patients treated with total neoadjuvant therapy (TNT). Methods: Consecutive patients with stage II/III (MRI staging) rectal adenocarcinoma treated with TNT from 2012 to 2017 by a single surgeon were included. TNT consisted of mFOLFOX6 (8 cycles) or CapeOX (5 cycles) either before or after CRT (5600 cGy in 28 fractions with sensitizing fluorouracil or capecitabine). Tumor response was assessed with a digital rectal exam, endoscopy, and MRI according to predefined criteria. Patients with a cCR were offered WW, and patients with residual tumor were offered TME. WW and TME patients were compared based on intention to treat, using the chi-square or rank sum test. Relapse-free survival (RFS) was evaluated by Kaplan-Meier analysis. Results: A total of 109 patients were identified. One patient died during CRT. Of the 108 patients, 64 (59%) had an incomplete clinical response; 4 of the 64 patients declined surgery or had local excision, and 60 underwent TME. The remaining 44 patients (41%) had a cCR and underwent WW. On average, patients in the WW group were older and had smaller, more distal tumors. Median radiation dose, number of chemotherapy cycles, number ofadverse events, or length of follow-up (28 months) did not differ between the TME and WW groups. Five (11%) of the 44 WW patients had local tumor regrowth, at a median of 14 (4–25) months after TNT; 2 of the 5 also had distant metastasis. Six (10%) of the 60 TME patients had a pathological complete response. RFS did not differ between the TME and WW groups (log rank P= 0.09). Conclusions: Approximately 40% of patients with stage II/III rectal cancer treated with TNT achieve a clinical complete response and can benefit from a WW approach with the aim of preserving the rectum.

A multicenter phase Ib/II study of DNA-PK inhibitor peposertib (M3814) in combination with capecitabine and radiotherapy in patients with locally advanced rectal cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. TPS4117-TPS4117
Author(s):  
Paul Bernard Romesser ◽  
Emma B. Holliday ◽  
Tony Philip ◽  
Barbara Sarholz ◽  
Mirjam Kuipers ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Colon Cancer ◽  
Phase Ii ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Rectal Adenocarcinoma ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Phase Ib ◽  
To Receive

TPS4117 Background: Preoperative chemo-radiotherapy with or without sequential chemotherapy, followed by surgical intervention, is standard of care for patients with locally advanced rectal cancer (LARC). However, 1/3 of these patients still develop distant metastases, indicating the need for more effective therapies. DNA-dependent protein kinase (DNA-PK) regulates a key DNA damage repair pathway for double-strand break repair. Peposertib (M3814), a potent, selective, orally administered DNA-PK inhibitor, has been shown to potentiate the effect of ionizing radiation in a human colon cancer xenograft model and several colon cancer cell lines. Peposertib is being investigated in several different trials across multiple indications. This Phase Ib/II study (NCT03770689) aims to evaluate the safety, tolerability, pharmacokinetics (PK), and efficacy of the neoadjuvant treatment combination of peposertib, capecitabine, and radiotherapy (RT) in patients with LARC. Methods: Patients aged ≥18 years with histologically confirmed and resectable Stage II/III rectal adenocarcinoma are eligible. Induction chemotherapy is permitted, but residual disease must first be documented by MRI, digital rectal examination and endoscopy. Patients who received other anticancer therapies or those with prior pelvic RT are excluded. During open-label Phase Ib (open), 18–30 patients (n = 3 per cohort) are due to receive peposertib + capecitabine (orally, 825 mg/m2 twice daily [BID]) + RT (45–50 Gy), 5 days/week. Peposertib 50 mg once daily (QD) is the starting dose. Additional dose levels will be between 100─800 mg QD. Dose escalation is determined by the safety monitoring committee and guided by a Bayesian 2-parameter logistic regression model. At Phase II (planned), 150 patients will be randomized (1:1) to receive oral capecitabine (825 mg/m2 BID) + RT (45–50 Gy), with either oral peposertib (recommended phase II dose [RP2D]) or placebo, QD for 5 days/week. Primary objectives are to define a maximum tolerated dose and RP2D (Phase Ib), and to evaluate the efficacy of peposertib + capecitabine + RT in terms of pathological/clinical complete response (Phase II). Secondary objectives include assessment of antitumor activity (Phase Ib), quality of life outcomes (Phase II), and PK of peposertib, and the safety and tolerability of the combination therapy (both phases). One patient has received peposertib 50 mg QD and six patients have received peposertib 100 mg QD. Patients are currently receiving peposertib 150 mg QD. Clinical trial information: NCT03770689 .

scholarly journals The effect of rectal washout on local recurrence following rectal cancer surgery

2018 ◽  
Vol 100 (2) ◽  
pp. 146-151 ◽  
Author(s):  
SR Moosvi ◽  
K Manley ◽  
J Hernon
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Anterior Resection ◽  
High Volume ◽  
Conclusive Evidence ◽  
Rectal Cancer Surgery ◽  
Single Institution ◽  
Recurrence Rates ◽  
Rectal Washout ◽  
Significant Difference

Introduction Local recurrence after surgery for rectal cancer is associated with significant morbidity and debilitating symptoms. Intraoperative rectal washout has been linked to a reduction in local recurrence but there is no conclusive evidence. The aim of this study was to evaluate whether performing rectal washout had any effect on the incidence of local recurrence in patients undergoing anterior resection for rectal cancer in the context of the current surgical management. Methods A total of 395 consecutive patients who underwent anterior resection with or without rectal washout for rectal cancer between January 2003 and July 2009 at a high volume single institution were analysed retrospectively. A standardised process for performing washout was used and all patients had standardised surgery in the form of total mesorectal excision. Neoadjuvant and adjuvant therapy was used on a selected basis. Patients were followed up for five years and local recurrence rates were compared in the two groups. Results Of the 395 patients, 297 had rectal washout and 98 did not. Both groups were well matched with regard to various important clinical, operative and histopathological characteristics. Overall, the local recurrence rate was 5.3%. There was no significant difference in the incidence of local recurrence between the washout group (5.7%) and the no washout group (4.1%). Conclusions Among our cohort of patients, there was no statistical difference in the incidence of local recurrence after anterior resection with or without rectal washout. This suggests that other factors are more significant in the development of local recurrence.

scholarly journals Outcomes for Cervical Cancer Patients Treated With Radiation in High-Volume and Low-Volume Hospitals

2018 ◽  
Vol 102 (1) ◽  
pp. 184-193 ◽  
Author(s):  
Shih-Min Lin ◽  
Hsiu-Ying Ku ◽  
Ting-Chang Chang ◽  
Tsang-Wu Liu ◽  
Cheng-Shyong Chang ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Patients ◽  
High Volume ◽  
Low Volume

scholarly journals Thresholds for Surgery and Surgical Outcomes for Patients with Primary Hyperparathyroidism: A National Survey of Endocrine Surgeons

1998 ◽  
Vol 83 (8) ◽  
pp. 2658-2665 ◽  
Author(s):  
Julie Ann Sosa ◽  
Neil R. Powe ◽  
Michael A. Levine ◽  
Robert Udelsman ◽  
Martha A. Zeiger
Keyword(s):  
Primary Hyperparathyroidism ◽  
Clinical Outcomes ◽  
High Volume ◽  
Urinary Calcium ◽  
Complication Rates ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Primary Operation ◽  
Surgeon Experience ◽  
Low Volume

abstract A 1991 NIH Consensus Development Conference statement provided recommendations for the management of patients with asymptomatic and minimally symptomatic primary hyperparathyroidism (1° HPT), but adherence to these guidelines has not been documented. We conducted a cross-sectional survey of North American members of the American Association of Endocrine Surgeons inquiring about surgeon and 1° HPT patient characteristics, thresholds for surgery, and clinical outcomes. Multivariate regression was used to assess the relationship of physician characteristics to practice patterns and outcomes. Of 190 surgeons surveyed, 147 (77%) responded; 109 provided complete responses (57%). These surgeons spend 66% of their time in patient care and perform an average of 33 (range, 1–130) parathyroidectomies/yr. More than 72% of 1° HPT patients who underwent surgery were asymptomatic or minimally symptomatic. High volume surgeons (>50 cases/yr) had significantly lower thresholds for surgery with respect to abnormalities in preoperative creatinine clearance, bone densitometry changes, and levels of intact PTH and urinary calcium compared to their low volume colleagues (1–15 cases/yr). Overall reported surgical cure rates were 95.2% after primary operation and 82.7% after reoperation. Compared to high volume surgeons, low volume endocrine surgeons had significantly higher complication rates after primary operation (1.9% vs. 1.0% respectively; P < 0.01) and reoperation (3.8% vs. 1.5%; P < 0.001) as well as higher in-hospital mortality rates (1.0% vs. 0.04%; P < 0.05). Endocrine surgeons operate on a large number of asymptomatic or minimally symptomatic 1° HPT patients. Even among a group of highly experienced surgeons who typically see patients after referral from endocrinologists, clinical outcomes and criteria for surgery vary widely and appear to be associated with surgeon experience. Their criteria for surgery diverge from NIH guidelines. These results implore the endocrine community to examine the evidential basis for decisions made in the management of 1° HPT.

scholarly journals Self-rating depression during early postoperative period after colostomy following radical surgery for rectal cancer

2018 ◽  
Vol 5 (1) ◽  
pp. 75-81
Author(s):  
Xue Hao ◽  
Ma Liying ◽  
Zhong Ming ◽  
Jay Shah
Keyword(s):  
Rectal Cancer ◽  
Cancer Patients ◽  
Postoperative Period ◽  
Radical Surgery ◽  
Normal Population ◽  
Multiple Logistic Regression Analysis ◽  
Depression Scale ◽  
Early Postoperative Period ◽  
Rectal Cancer Surgery ◽  
Self Rating

Introductions: Colorectal cancer (CRC) is 3rd most common cancer. Half of which requires colostomy. It leads to anxiety and depression with less than optimal quality of life. Zung Self-rating Depression Scale is a reliable tool used in Chinese population for identifying and addressing mental health status for appropriate education. The aim of this study is to investigate the depression state in rectal cancer patients after colostomy, then analyze its influence factors. Methods: A cross sectional study in rectal cancer patients who had colostomy after radical surgery for rectal cancer were investigated for depression during early postoperative period within one week using Zung’s self-rating depression scale (SDS). Multiple logistic regression analysis was done to identify the risk factor. Results: There were 55 colostomies patients (male 30 and female 25 patients, age 50.11+/-13.17 years) after rectal cancer surgery during the study period. The SDS score of was higher than national norm (P<0.01). The risk factors for depression were female gender, younger age, lower economic status, and lesser degree of understanding of the disease. Conclusions: The depression level of rectal cancer patients after colostomy was higher than normal population, especially in female, young age, with poor understanding of disease and lower economy status. The effective measures should be targeted to strengthen the health psychosocial health of these patients.

Occurrence and timing of organ space surgical site infections (SSI) in rectal cancer patients: A NSQIP database review.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 552-552
Author(s):  
Hiromichi Miyagaki ◽  
HMC Shantha Kumara ◽  
Yan Xiaohong ◽  
Vesna Cekic ◽  
Richard L. Whelan
Keyword(s):  
Rectal Cancer ◽  
Cancer Patients ◽  
Categorical Variables ◽  
Rectal Cancer Surgery ◽  
Delayed Presentation ◽  
Continuous Variables ◽  
Mean Delay ◽  
Stoma Formation ◽  
Sphincter Saving ◽  
The Mean

552 Background: This study’s aim was to determine the incidence and date of presentation of organ space SSI (in this setting most likely due to anastomotic leak or pelvic abscess) in rectal cancer resection patients. A second purpose was to determine which variable(s) impacted the timing of the presentation. Methods: The NSQIP database was queried from 2007 to 2011 for elective rectal cancer resections. Exclusion criteria included; ASA 5 status, preoperative(preop) shock/sepsis, SIRS, and recent surgery. Demographic parameters, comorbidities, lab data, and incidence and timing of organ space SSI were assessed. The statistical methods used were Fisher’s exact test (categorical variables) and Wilcoxon’s rank tests (continuous variables). Results: 8,093 rectal cancer patients were identified (Male/Female; 60.1%/39.9%; median age, 60; APR, 28 %; sphincter saving procedures,72%). The incidence of organ space SSI was 6 % (485 patients; 2.7% presented before and 3.3% after discharge). The rate was significantly greater for men, younger patients (< 60), smokers, sphincter saving resections (vs. APR). Preop radiotherapy (RT) did not increase the rate of and stomas did not protect against the formation of organ space SSI. The mean date of detection was 14.6±7.3 days after surgery (Mean±SD). A further delay was noted in those who had preop RT regardless of the operation performed (n=184, added delay 2.7 days, p<0.05). Significant delays (p<0.05) were also noted in patients that had APR (n=112, mean delay 2.4days), stoma formation (n=285, mean delay 1.6days) and open surgery (n=368, mean delay 1.8 days). Multivariate analysis revealed preop RT (p=0.0002) and APR (p=0.0258) as independent risk factors for delayed presentation. Conclusions: Most organ space SSI after rectal cancer surgery occur after hospital discharge. The mean presentation date is about 2 weeks after surgery. Patients who received preop RT or underwent APR presented about 2.5 days later than the mean date. Rectal cancer patients should be followed closely for 3 weeks as regards organ space SSI.

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