Contributive compared with subsidized insurance in colorectal cancer in the Colombian National Administrative Cancer Registry.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18136-e18136
Author(s):  
Robert Hsu ◽  
Paula Ramirez ◽  
Lizbeth Acuña ◽  
Gilberto Lopes
Keyword(s):  
Colorectal Cancer ◽  
Adjuvant Therapy ◽  
Neoadjuvant Therapy ◽  
Cancer Care ◽  
Nutritional Support ◽  
Early Stage ◽  
Care Delivery ◽  
Tnm Staging ◽  
Wait Times ◽  
Curative Surgery

e18136 Background: Colombia has gone to great lengths to provide nearly universal health care insurance for its patients, as 96.6% of its constituents now have health insurance as of 2014 compared to 23.5% in 1993. Most Colombians are associated with either contributive insurance (CI) in which employees and employers contribute to the insurance or subsidized insurance (SI) in which government funds cover the insurance cost. Colorectal cancer (CRC) has the 5th highest incidence of all malignancies in Colombia. This abstract aims to compare CRC care delivery metrics between CI and SI. Methods: We used the Colombian National Administrative Cancer Registry (NACR) data compiled from the Department of Health Ministry from January 2, 2016- January 1, 2017 consisting of 32 departments and 1122 municipalities. CRC cases were investigated by incidence, mortality, percentage of cases with early stage detection, stage I-III with curative surgery intent, nutritional support, and TNM staging, and days between suspicion to diagnosis, diagnosis to first treatment, neoadjuvant therapy to surgery, and surgery to adjuvant therapy. Results: There were 2605 new CRC cases in the NACR in 2017, with 1691 CI cases and 823 SI cases. There was a noticeably higher incidence in CI (7.2 new cases per 100,000 people) than in SI (3.7 new cases per 100,000), and a higher mortality rate (5.0 deaths per 100,000) in CI compared with SI cases (2.6 deaths per 100,000). There was a significant increase in average wait time for SI CRC cases from diagnosis to first treatment (77.7 days vs. 57.3 days, p = .027) and in average time to neoadjuvant therapy to surgery in CI cases (123.1 days vs. 92.5 days, p = .054) with longer but statistically insignificant wait times in SI cases in average time to adjuvant therapy (83.6 days vs. 73.9 days, p = .0168) and suspicion to diagnosis (56.1 days vs. 46.9 days, p = .811). Similar percentages of CI and SI cases had early stage detection (37.2% in SI vs. 34.3% in CI, p = 0.311), TNM staging (50.7% in CI vs. 49.3% in SI, p = 0.146), stage I-III cases with curative surgery intent (23.3% in CI vs. 21.8% in SI, p = 0.833), and nutritional support (10.5% in CI vs. 8.5% in SI, p = 0.942). Conclusions: The NACR represents a model for developing countries to improve cancer care delivery efficiently. As evidenced by higher incidence and mortality in CI cases and longer wait times before treatment in SI cases, there are differences in cancer care delivery between major modes of healthcare delivery in Colombia. More investigation needs to be done with a goal of streamlining cancer care delivery.

Review of updated colorectal cancer disease management data in the Colombian National Administrative Cancer Registry.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 508-508
Author(s):  
Robert Hsu ◽  
Paula Ramirez ◽  
Lizbeth Acuña ◽  
Gilberto Lopes
Keyword(s):  
Disease Management ◽  
Nutritional Support ◽  
Treatment Time ◽  
Tnm Staging ◽  
Wait Times ◽  
Curative Surgery ◽  
Health Ministry ◽  
Management Indicators ◽  
Time To Diagnosis

508 Background: The Office of High Cost of the Colombian Health Ministry created the National Administrative Cancer Registry (NACR) in 2015 to obtain nationwide cancer data to find areas for improvement in cancer delivery. From initial data, a collaboration of healthcare experts identified 15 disease management indicators in colorectal (CRC) cancer in Colombia. In this study, we look at 2017 NACR data to investigate significant findings. Methods: We obtained NACR data compiled from the Department of Health Ministry from January 2, 2016-January 1, 2017 consisting of 32 departments and 1122 municipalities. The 2017 NACR data for CRC includes 11 of 15 updated disease management indicators - time to diagnosis, proportion of patients with colorectal cancer in situ, proportion of new cases identified in early stages, proportion of patients with TNM staging, proportion of patients with TNM staging before treatment, time before treatment, time between neoadjuvant therapy and surgery, time between surgery and adjuvant therapy, proportion of stage I and II patients receiving curative surgery, proportion of patients with nutritional support, mortality rate, and incidence. Results: The incidence of CRC was 5.2 cases per 100,000 people and the mortality was 3.6 cases per 100,000 people. The time to diagnosis was on average 50.7 days. 3.6% of CRC cases were in situ. 35.6% of cases were identified in early stages, and 51.3% of cases had TNM staging with 45.1% staged prior to treatment. The time to initial treatment was 63.7 days. The time between neoadjuvant therapy and surgery was 116.1 days and the time between surgery and adjuvant therapy was 75.5 days. 24.2% of stage I and II patients received curative surgery. 9.8% patients received nutritional support. Conclusions: The updated NACR data show significant wait times for treatment and exaggerated wait times for patients needing neoadjuvant or adjuvant therapies. The findings show significant work is needed in providing supportive services. There needs to be further investigation into follow-up after initial treatment. Further directions should include more data collection of adjuvant and neoadjuvant wait times and outcomes data of specific treatment modalities.

Evolving oncology provider perspectives on care delivery during the COVID-19 pandemic.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18609-e18609
Author(s):  
Divya Ahuja Parikh ◽  
Meera Vimala Ragavan ◽  
Sandy Srinivas ◽  
Sarah Garrigues ◽  
Eben Lloyd Rosenthal ◽  
...  
Keyword(s):  
Cancer Care ◽  
Care Delivery ◽  
The United States ◽  
Advanced Practice ◽  
Curative Surgery ◽  
Time Points ◽  
Patients With Cancer ◽  
Provider Perspectives ◽  
Significant Difference ◽  
The Impact

e18609 Background: The COVID-19 pandemic prompted rapid changes in cancer care delivery. We sought to examine oncology provider perspectives on clinical decisions and care delivery during the pandemic and to compare provider views early versus late in the pandemic. Methods: We invited oncology providers, including attendings, trainees and advanced practice providers, to complete a cross-sectional online survey using a variety of outreach methods including social media (Twitter), email contacts, word of mouth and provider list-serves. We surveyed providers at two time points during the pandemic when the number of COVID-19 cases was rising in the United States, early (March 2020) and late (January 2021). The survey responses were analyzed using descriptive statistics and Chi-squared tests to evaluate differences in early versus late provider responses. Results: A total of 132 providers completed the survey and most were white (n = 73/132, 55%) and younger than 49 years (n = 88/132, 67%). Respondents were attendings in medical, surgical or radiation oncology (n = 61/132, 46%), advanced practice providers (n = 48/132, 36%) and oncology fellows (n = 16/132, 12%) who predominantly practiced in an academic medical center (n = 120/132, 91%). The majority of providers agreed patients with cancer are at higher risk than other patients to be affected by COVID-19 (n = 121/132, 92%). However, there was a significant difference in the proportion of early versus late providers who thought delays in cancer care were needed. Early in the pandemic, providers were more likely to recommend delays in curative surgery or radiation for early-stage cancer (p < 0.001), delays in adjuvant chemotherapy after curative surgery (p = 0.002), or delays in surveillance imaging for metastatic cancer (p < 0.001). The majority of providers early in the pandemic responded that “reducing risk of a complication from a COVID-19 infection to patients with cancer” was the primary reason for recommending delays in care (n = 52/76, 68%). Late in the pandemic, however, providers were more likely to agree that “any practice change would have a negative impact on patient outcomes” (p = 0.003). At both time points, the majority of providers agreed with the need for other care delivery changes, including screening patients for infectious symptoms (n = 128/132, 98%) and the use of telemedicine (n = 114/132, 86%) during the pandemic. Conclusions: We found significant differences in provider perspectives of delays in cancer care early versus late in the pandemic which reflects the swiftly evolving oncology practice during the COVID-19 pandemic. Future studies are needed to determine the impact of changes in treatment and care delivery on outcomes for patients with cancer.

Innovating Cancer Care Delivery: the Example of the 4R Oncology Model for Colorectal Cancer Patients

2019 ◽  
Vol 20 (2) ◽  
Author(s):  
Julia Trosman ◽  
Christine Weldon ◽  
Sheetal Kircher ◽  
William Gradishar ◽  
Al Benson
Keyword(s):  
Colorectal Cancer ◽  
Cancer Patients ◽  
Cancer Care ◽  
Care Delivery ◽  
Colorectal Cancer Patients

Weekly Fluorouracil and Leucovorin as Adjuvant Therapy for Early Stage Colon Cancer or Primary Therapy for Advanced Colorectal Cancer

2001 ◽  
Vol 36 (3) ◽  
pp. 243-249
Author(s):  
J. Aubrey Waddell ◽  
Dominic A. Solimando
Keyword(s):  
Colorectal Cancer ◽  
Colon Cancer ◽  
Adjuvant Therapy ◽  
Cancer Chemotherapy ◽  
Advanced Colorectal Cancer ◽  
Early Stage ◽  
Primary Therapy ◽  
Toxic Agents ◽  
Early Stage Colon Cancer

The increasing complexity of cancer chemotherapy makes it mandatory that pharmacists be familiar with these highly toxic agents. This column reviews various issues related to the preparation, dispensing, and administration of cancer chemotherapy, both commercially available and investigational.

Neoadjuvant Therapy Followed by Resection Versus Upfront Resection for Resectable Pancreatic Cancer: A Propensity Score Matched Analysis

2017 ◽  
Vol 35 (5) ◽  
pp. 515-522 ◽  
Author(s):  
Ali A. Mokdad ◽  
Rebecca M. Minter ◽  
Hong Zhu ◽  
Mathew M. Augustine ◽  
Matthew R. Porembka ◽  
...  
Keyword(s):  
Overall Survival ◽  
Propensity Score ◽  
Adjuvant Therapy ◽  
Neoadjuvant Therapy ◽  
Pancreatic Adenocarcinoma ◽  
Early Stage ◽  
Clinical Stage ◽  
Pancreatic Head ◽  
Hazard Ratio ◽  
Stage I

Purpose To compare overall survival between patients who received neoadjuvant therapy (NAT) followed by resection and those who received upfront resection (UR)—as well as a subgroup of UR patients who also received adjuvant therapy—for early-stage resectable pancreatic adenocarcinoma. Patients and Methods Adult patients with resected, clinical stage I or II adenocarcinoma of the head of the pancreas were identified in the National Cancer Database from 2006 to 2012. Patients who underwent NAT followed by curative-intent resection were matched by propensity score with patients whose tumors were resected upfront. Overall survival was compared by using a Cox proportional hazards regression model. Early postoperative and oncologic outcomes were evaluated. Results We identified 15,237 patients with clinical stage I or II resected pancreatic head adenocarcinoma. From the NAT group, 2,005 patients (95%) were matched with 6,015 patients who underwent UR. The NAT group was associated with improved survival compared with UR (median survival, 26 months v 21 months, respectively; stratified log-rank P < .01; hazard ratio, 0.72; 95% CI, 0.68 to 0.78). Patients in the UR group had higher pathologic T stage (pT3 and T4: 86% v 73%; P < .01), higher positive lymph nodes (73% v 48%; P < .01), and higher positive resection margin (24% v 17%; P < .01). Compared with a subset of UR patients who received adjuvant therapy, NAT patients had a better survival (adjusted hazard ratio, 0.83; 95% CI, 0.73 to 0.89). Conclusion NAT followed by resection has a significant survival benefit compared with UR in early-stage, resected pancreatic head adenocarcinoma. These findings support the use of NAT, particularly as a patient selection tool, in the management of resectable pancreatic adenocarcinoma.

scholarly journals Efficiency of Colorectal Cancer Care Among Veterans: Analysis of Treatment Wait Times at Veterans Affairs Medical Centers

2013 ◽  
Vol 9 (4) ◽  
pp. e154-e163 ◽  
Author(s):  
Ryan P. Merkow ◽  
Karl Y. Bilimoria ◽  
Karen L. Sherman ◽  
Martin D. McCarter ◽  
Howard S. Gordon ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Care ◽  
Veterans Affairs ◽  
Wait Times ◽  
Prolonged Time ◽  
Medical Centers ◽  
Rectal Cancers ◽  
Hospital Factors ◽  
Veterans Affairs Medical Centers ◽  
Time To First Treatment

Time to first treatment has increased for those with colon and rectal cancers at VA Medical Centers. Patient, tumor, and hospital factors are associated with prolonged time to treatment.

scholarly journals Phenotype-Genotype Correlation in Colorectal Cancer: A Real-Life Study

2021 ◽  
pp. 1-9
Author(s):  
Catarina Frias-Gomes ◽  
Ana Carla Sousa ◽  
Inês Rolim ◽  
Ana Raquel Henriques ◽  
Francisco Branco ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Mismatch Repair ◽  
Early Stage ◽  
Small Sample Size ◽  
Real Life ◽  
Disease Free Survival ◽  
Small Sample ◽  
Stage I ◽  
Curative Surgery ◽  
Genetic Characteristics

<b><i>Background and Aims:</i></b> Colorectal cancer (CRC) is a heterogeneous disease with distinctive genetic pathways, such as chromosomal instability, microsatellite instability and methylator pathway. Our aim was to correlate clinical and genetic characteristics of CRC patients in order to understand clinical implications of tumour genotype. <b><i>Methods:</i></b> Single-institution retrospective cohort of patients who underwent curative surgery for CRC, from 2012 to 2014. <i>RAS</i> and <i>BRAF</i> mutations were evaluated with the real-time PCR technique Idylla®. Mismatch repair deficiency (dMMR) was characterized by absence of MLH1, MSH6, MSH2 and/or PMS2 expression, evaluated by tissue microarrays. Overall survival (OS) and disease-free survival (DFS) were assessed using survival analysis. <b><i>Results:</i></b> Overall, 242 patients were included (males 57.4%, age 69.3 ± 12.9 years; median follow-up 49 months). <i>RAS</i>-mutated tumours were associated with reduced DFS (<i>p</i> = 0.02) and OS (<i>p</i> = 0.045) in stage I–III CRC. <i>BRAF</i>-mutated tumours were more predominant in females and in the right colon, similarly to dMMR tumours. BRAF status did not influence OS (4 years)/DFS (3.5 years) in stage I–III disease. However, after relapse, length of survival was 3.5 months in <i>BRAF</i>-mutated tumours in contrast to 18.6 months in <i>BRAF</i> wild-type tumours (<i>p</i> = NS). No germline mutations in mismatch repair genes were so far identified in the patients with dMMR tumours. Molecular phenotype (<i>RAS, BRAF</i> and MMR) did not influence OS in metastatic patients. Our small sample size may be a limitation of the study. <b><i>Conclusion:</i></b> In our cohort, <i>RAS</i>-mutated tumours were associated with worse DFS and OS in early-stage CRC, whereas the remaining molecular variables had no prognostic influence.

Moving Toward Improved Teamwork in Cancer Care: The Role of Psychological Safety in Team Communication

2016 ◽  
Vol 12 (11) ◽  
pp. 1000-1011 ◽  
Author(s):  
Anshu K. Jain ◽  
Mary L. Fennell ◽  
Anees B. Chagpar ◽  
Hannah K. Connolly ◽  
Ingrid M. Nembhard
Keyword(s):  
Cancer Care ◽  
Planning Process ◽  
Early Stage ◽  
Care Delivery ◽  
Clinical Care ◽  
Community Setting ◽  
Psychological Safety ◽  
Future Research ◽  
Care Providers ◽  
High Quality

Effective communication is a requirement in the teamwork necessary for improved coordination to deliver patient-centered, value-based cancer care. Communication is particularly important when care providers are geographically distributed or work across organizations. We review organizational and teams research on communication to highlight psychological safety as a key determinant of high-quality communication within teams. We first present the concept of psychological safety, findings about its communication effects for teamwork, and factors that affect it. We focus on five factors applicable to cancer care delivery: familiarity, clinical hierarchy–related status differences, geographic dispersion, boundary spanning, and leader behavior. To illustrate how these factors facilitate or hinder psychologically safe communication and teamwork in cancer care, we review the case of a patient as she experiences the treatment-planning process for early-stage breast cancer in a community setting. Our analysis is summarized in a key principle: Teamwork in cancer care requires high-quality communication, which depends on psychological safety for all team members, clinicians and patients alike. We conclude with a discussion of the implications of psychological safety in clinical care and suggestions for future research.

Efficacy of Oral Adjuvant Therapy After Resection of Colorectal Cancer: 5-Year Results From Three Randomized Trials

2004 ◽  
Vol 22 (3) ◽  
pp. 484-492 ◽  
Author(s):  
Keyword(s):  
Colorectal Cancer ◽  
Adjuvant Therapy ◽  
Oral Therapy ◽  
Randomized Trials ◽  
Early Stage ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Free Survival ◽  
Oral Fluoropyrimidines ◽  
Disease Free

Purpose Adjuvant therapy of colorectal cancer with oral fluorinated pyrimidines is attractive because of its ease of administration and good tolerability. The purpose of this meta-analysis is to assess the survival and disease-free survival benefits of treating patients after surgical resection of a primary colorectal tumor with oral fluoropyrimidines for 1 year. Patients and Methods This meta-analysis was performed on individual data from three randomized trials conducted by the Japanese Foundation for Multidisciplinary Treatment for Cancer involving a total of 5,233 patients with stages I to III colorectal cancer. Results The overall hazard ratio in favor of oral therapy was 0.89 for survival (95% CI, 0.80 to 0.99; P = .04), and 0.85 for disease-free survival (95% CI, 0.77 to 0.93; P < .001). Thus oral therapy reduced the risk of death by 11% and the risk of recurrence or death by 15%. There was no significant heterogeneity between trials, nor did the benefit of oral therapy depend on tumor stage (I, II, or III), tumor site (rectum or colon), patient age, or patient sex. Conclusion Oral fluoropyrimidines improve disease-free survival and survival of patients after resection of early-stage colorectal cancer. These observations support the use of these agents alone after resection of early-stage disease, as well as further testing of oral agents in combination with new drugs that have recently shown antitumor activity in advanced colorectal cancer.

scholarly journals Colorectal Cancer Care Among Young Adult Patients After the Dependent Coverage Expansion Under the Affordable Care Act

2019 ◽  
Vol 112 (10) ◽  
pp. 1063-1066 ◽  
Author(s):  
Leticia Nogueira ◽  
Neetu Chawla ◽  
Xuesong Han ◽  
Ahmedin Jemal ◽  
K Robin Yabroff
Keyword(s):  
Colorectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Confidence Interval ◽  
Affordable Care Act ◽  
Cancer Care ◽  
Early Stage ◽  
Hazard Ratio ◽  
Coverage Expansion ◽  
The Affordable Care Act ◽  
Dependent Coverage

Abstract The effect of the Dependent Coverage Expansion (DCE) under the Affordable Care Act (ACA) on receipt of colorectal cancer treatment has yet to be determined. We identified newly diagnosed DCE–eligible (aged 19–25 years, n = 1924) and DCE–ineligible (aged 27–34 years, n = 8313) colorectal cancer patients from the National Cancer Database from 2007 to 2013. All statistical tests were two-sided. Post-ACA, there was a statistically significant increase in early-stage diagnosis among DCE–eligible (15 percentage point increase, confidence interval = 9.8, 20.2; P &lt; .001), but not DCE–ineligible (P = .09), patients. DCE–eligible patients resected for IIB–IIIC colorectal cancer were more likely to receive timely adjuvant chemotherapy (hazard ratio = 1.34, 95% confidence interval = 1.05 to 1.71; 7.0 days’ decrease in restricted mean time from surgery to chemotherapy, P = .01), with no differences in DCE–ineligible patients (hazard ratio = 1.10, 95% confidence interval = 0.98 to 1.24; 2.1 days’ decrease, P = .41) post-ACA. Our findings highlight the role of the ACA in improving access to potentially lifesaving cancer care, including a shift to early-stage diagnosis and more timely receipt of adjuvant chemotherapy.

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