Distance from a comprehensive cancer center: A poor proxy for serous endometrial cancer outcomes?

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19084-e19084
Author(s):  
Patrick Blackburn ◽  
Jennifer Gordon ◽  
Naixin Zhang ◽  
Laura Becca Daily ◽  
Todd D. Tillmanns
Keyword(s):  
Overall Survival ◽  
Endometrial Cancer ◽  
Treatment Center ◽  
Cancer Center ◽  
Stage At Diagnosis ◽  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
Rank Analysis ◽  
Referral Center ◽  
Southern Us

e19084 Background: To compare the relationship between outcomes in serous endometrial cancer patients based on distance from a tertiary referral center in the Southern US. Methods: A retrospective cohort study among all women diagnosed with serous endometrial cancer between 2009 to 2018 was completed at a tertiary referral center in a low socioeconomic Southern US city with a predominately African American population. The primary exposure variable was the distance traveled by the patient to the treatment center. This distance was calculated using Google Maps from the patients’ home addresses to the cancer center. Abstracted data from each patient included patient demographics of home address, BMI at time of first visit, race, transportation method to the cancer center, and presence of primary care provider (PCP). Clinical variables of stage at diagnosis and pathology, treatment, and outcomes were included. Chi square analysis and log-rank analysis were completed. Data was analyzed by SPSS software. Results: In total, 202 patients were living a median distance of 31.4miles (range of 0.9mi to 194mi) from the cancer center. Of this cohort, the median age at time of diagnosis was 67 years old with a median BMI of 31.4kg/m2. The most common stage at diagnosis was stage 1A (26.7%). Using log rank analysis, there was no difference in overall survival when compared based on age, race, BMI and access to transportation. 92% (n=185) of the cohort had immediate access to a transportation method via personal car or family car, the remaining patients relied on other methods of transport. The total distance from treatment center was significant when compared with stage at diagnosis (p=0.011) portending greater stage at diagnosis with further distance. However, this did not correlate to progression free or overall survival (p = 0.83) in the cohort. Patients with a PCP were likely to be diagnosed at an earlier stage (Stage IA or Stage IB) compared to those without a PCP with a p=0.003, mean of 0.93, 95% CI (0.89 – 0.97). Conclusions: Living closer to a cancer center and having a PCP were associated with earlier stage at diagnosis in patients with serous endometrial cancer. Distance from the cancer center did not affect overall survival when adequate transportation methods were available.

scholarly journals Increasing Mean Age of Head and Neck Cancer Patients at a German Tertiary Referral Center

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 832
Author(s):  
Julius M. Vahl ◽  
Marlene C. Wigand ◽  
Michael Denkinger ◽  
Dhayana Dallmeier ◽  
Chiara Steiger ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Catchment Area ◽  
Incidence Rates ◽  
Cancer Center ◽  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
Referral Center ◽  
The Impact

Background: The impact of demographic change on the age at diagnosis in German head and neck cancer (HNC) patients is unclear. Here we present an evaluation of aging trends in HNC at a tertiary referral center. Methods: Retrospective cohort study on aging trends at the initial diagnosis of newly diagnosed patients with HNC between 2004 and 2018 at the head and neck cancer center Ulm in relation to demographic data of the catchment area. Results: The study population consisted of 2450 individuals diagnosed with HNC with a mean age of 62.84 (±11.67) years. We observed a significant increase in annual incidence rates and mean age over time. Mean age among HNC patients increased significantly more than among the population in the catchment area. Whereas the incidence rate of patients <50 years did not change, the incidence of HNC patients aged ≥70 years increased the most. The mean patient age in the main tumor sites increased significantly. Surprisingly, HPV-positive patients were not younger than HPV-negative patients, but showed a non-significant trend towards a higher mean age (63.0 vs. 60.7 years). Conclusions: Increasing incidence rates in older patients pose a challenge for health care systems. A nationwide study is needed to assess the dynamics and impact of aging on the incidence of HNC.

A comparison of pathologic and intermediate term oncologic outcomes following open and robotic radical cystectomy.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 440-440
Author(s):  
Janet Baack Kukreja ◽  
Roger Li ◽  
Mohamed Seif ◽  
Xuemei Wang ◽  
Ashish M. Kamat ◽  
...  
Keyword(s):  
Overall Survival ◽  
Radical Cystectomy ◽  
High Volume ◽  
Positive Surgical Margin ◽  
Tertiary Referral ◽  
Free Survival ◽  
Tertiary Referral Center ◽  
Referral Center ◽  
Robotic Radical Cystectomy ◽  
Recurrence Patterns

440 Background: Conflicting data regarding the oncologic efficacy of robotic surgery has led to concerns for possible inferiority. Despite recent prospective results from the RAZOR trial demonstrating non-inferior progression free survival, results from another prospective randomized trial from Memorial Sloan Kettering suggests a possible difference in the pattern of recurrences. We examined our experience with both open (ORC) and robotic radical cystectomy (RRC) with the objective of establishing recurrence patterns and pathologic comparisons at a high volume tertiary referral center. Methods: We performed a retrospective cohort study at a high volume academic tertiary referral center for patients who underwent radical cystectomy (RC) for bladder cancer from 2005 to 2017. The surgical choice of RRC or ORC is based on provider preference. A multivariable analysis was carried out to determine factors predictive of recurrence free survival (RFS) and overall survival after RC. Analysis was done with SAS 9.4. Results: 1813 patients were identified, 10% underwent RRC and no difference in recurrence patterns were found compared to ORC. There was no difference in the severity of pathology distribution between the two cohorts. There was no difference in positive surgical margin status, 2.4% in ORC and 1.1% in RRC. Peritoneal carcinomatosis was seen in 1.1% of ORC and 0.5% in RRC. Shorter RFS was associated with younger age (HR 1.04, 95%CI 1.03-1.05, p<0.001), neoadjuvant chemotherapy (HR1.55 95%CI 1.32-1.82, p<0.001), higher pathologic stage (stage T4 HR 4.38, 95%CI 3.17-6.06, p<0.001), positive lymph nodes at RC (HR 1.82 95%CI 1.53-2.17, p<0.001) and positive surgical margins (HR 1.50 95%CI 1.19-1.89, p<0.001). At a median follow up of 60 months neither progression free or overall survival for ORC compared to RRC was significantly different. Conclusions: The data from this study supports continued use of RRC as a safe oncologic procedure with similar outcomes to ORC.

scholarly journals Patients’ perspective on emergency treatment of ophthalmologic diseases during the first phase of SARS-CoV2 pandemic in a tertiary referral center in Germany – the COVID-DETOUR questionnaire study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Christoph Ehlken ◽  
Constantin von Medem ◽  
Maya Lüdemann ◽  
Anna Maria Kirsch ◽  
Johann Baptist Roider
Keyword(s):  
Health Beliefs ◽  
Risk Groups ◽  
Questionnaire Study ◽  
Treatment Center ◽  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
Referral Center ◽  
Follow Up Care ◽  
Before And After

Abstract Background During the first wave of the COVID-19 pandemic, the need of treatment of urgent ophthalmological diseases and the possible risk of a SARS-CoV-2 infection had to be weighed against each other. In this questionnaire study, we aimed to analyze potential barriers and patients’ health beliefs during and after the lockdown early 2020 in a tertiary referral center in Kiel, Germany. Methods Patients admitted for the treatment of urgent ophthalmic diseases between March 1st, 2020, and June 3rd, 2020, were asked to participate in a questionnaire study. After informed consent was obtained, patients were interviewed using a standardized questionnaire which addressed aspects of their medical history, their health beliefs concerning the COVID-19 pandemic and barriers on their way to the treatment center. The study group was subdivided into two subgroups, depending on the occurrence of their symptoms, before and after the lockdown was ended on April 20th, 2020. Results Ninety-three patients were included, 43 in subgroup A (before April 20th) and 50 in subgroup B (April 20th or later). Retinal disorders were the most common causes for admission (approximately 60%).. Only 8 patients (8.6%) experienced a delay between their decision to visit a doctor until the actual examination. Every fourth patient was afraid of a COVID-19 infection, and expected a higher likelihood for an infection at the hospital. Patients with comorbidities tended to be more likely to be afraid of an infection (correlation coefficient 0.183, p = 0.0785) and were significantly more likely to be concerned about problems with organizing follow-up care (corr. Coefficient 0.222, p = 0.0328). Higher age was negatively correlated with fear of infection (corr. Coefficient − 0.218, p-value 0.034). Conclusion In this questionnaire study, only a minority of patients indicated a delay in treatment, regardless of whether symptoms occurred before or after the lockdown before April 20th, 2020. While patients with comorbidities were more concerned about infection and problems during follow-up care, patients of higher age – who have a higher mortality – were less afraid. Protection of high-risk groups should be prioritized during the SARS-CoV-2 pandemic. Trial registration The study was registered as DRKS00021630 at the DRKS (Deutsches Register Klinischer Studien) before the conduction of the study on May 5th, 2020.

scholarly journals Emergency treatment of ophthalmologic diseases during the first phase of SARS-CoV2 pandemic in a tertiary referral center in Germany – the COVID-DETOUR questionnaire study

2021 ◽  
Author(s):  
Christoph Ehlken ◽  
Constantin von Medem ◽  
Maya Lüdemann ◽  
Anna Maria Barbara Kirsch ◽  
Johann Baptist Roider
Keyword(s):  
Health Beliefs ◽  
Risk Groups ◽  
Questionnaire Study ◽  
Treatment Center ◽  
P Value ◽  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
Referral Center ◽  
Follow Up Care

Abstract Background:During the first wave of the COVID-19 pandemic, the need of treatment of urgent ophthalmological diseases and the possible risk of a SARS-CoV-2 infection had to be weighed against each other. In this questionnaire study, we aimed to analyze potential barriers and patients’ health beliefs during and after the lockdown early 2020 in a tertiary referral center in Kiel, Germany.Methods:Patients admitted for the treatment of urgent ophthalmic diseases between March 1st, 2020, and June 3rd, 2020, were asked to participate in a questionnaire study. After informed consent was obtained, patients were interviewed using a standardized questionnaire which addressed aspects of their medical history, their health beliefs concerning the COVID-19 pandemic and barriers on their way to the treatment center. The study group was subdivided into two subgroups, depending on the occurrence of their symptoms, before and after the lockdown was ended on April 20th, 2020.Results:Ninety-three patients were included, 43 in subgroup A (before April 20th) and 50 in subgroup B (April 20th or later). Retinal disorders were most common (approximately 60%), with retinal detachments being the most singular reason for admission. Only 8 patients (8.6%) experienced a delay between their decision to visit a doctor until the actual examination. Every fourth patient was afraid of a COVID-19 infection, and expected a higher likelihood for an infection at the hospital. Patients with comorbidities tended to be more likely to be afraid of an infection (correlation coefficient 0.183, p=0.0785) and were significantly more likely to be concerned about problems with organizing follow-up care (corr. coefficient 0.222, p=0.0328). Higher age was negatively correlated with fear of infection (corr. coefficient -0.218, p-value 0.034).Conclusion:In this questionnaire study, only a minority of patients indicated a delay in treatment, regardless of whether symptoms occurred before or after the lockdown before April 20th. While patients with comorbidities were more concerned about infection and problems during follow-up care, patients of higher age – who have a higher mortality – were less afraid. Protection of high-risk groups should be prioritized during the SARS-CoV-2 pandemic.Trial registration:The study was registered as DRKS00021630 at the DRKS (Deutsches Register Klinischer Studien) before the conduction of the study on May 5th, 2020.

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