scholarly journals Time, Distance and Economics Influencing Cancer Care: Experience From a Regional Cancer Center in India

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 76s-76s
Author(s):  
N. Ballari ◽  
R. Miriyala ◽  
T. Jindia ◽  
S. Gedela ◽  
L. Annam ◽  
...  
Keyword(s):  
Cancer Treatment ◽  
Cancer Patients ◽  
Early Stage ◽  
Private Insurance ◽  
Locally Advanced ◽  
Cancer Center ◽  
Advanced Stage ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Time Distance

Background: There is a geographical, socioeconomical and logistic diversity among the cancer patients who reach a regional cancer center. In a developing economy like that of India's, only a minority of patients have medical insurance. So in our setup a cancer patient is met with time, distance and financial challenges. These intangible factors theoretically are expected to influence the ultimate outcome of cancer treatment. Aim: To evaluate the prevailing demographic and economic variables of cancer patients visiting our RCC and to look for any correlation among each other. Methods: The demographic details of cancer patients registered at our RCC between August 2017- September 2017 were retrieved retrospectively. Distance traveled to get to the RCC and get a diagnosis of cancer, time taken for diagnosis and initiation of treatment, and the source of finances for treatment were collected. A correlation among these factors was attempted to be identified. Statistical correlation was identified using Student t-test. Results: Among 591 patients who were analyzed, the median age of patient was 55 years old. The median time taken for the patient to reach the RCC from permanent residence after the beginning of cancer related complaints was 3.19 months. The median distance traveled for the same was 131 km. The source of income was private employment for 223 patients and government employment for 164 patients and self-employment for 200 patients. Only 164 patients had some kind of structured health scheme to manage their health care expenses. Among these, 96 patients had private insurance/reimbursement and 64 patients had government reimbursement. 384 (64%) of patients presented with advanced and locally advanced stage disease while 114 (19%) patients presented to us with early stage disease. However a correlation between delay in presentation to the RCC, distance traveled to reach the RCC, source of income and advanced stage of disease couldn't not be established. Conclusion: Majority of patients visiting our RCC is from far off places and most of these patients pay for the cancer treatment themselves without any support from government or private insurances. All these factors may be responsible for late or advanced stage presentation of cancer patients.

Human papillomavirus, radiation dose and survival of patients with anal cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15071-e15071
Author(s):  
Rafi Kabarriti ◽  
Patrik Brodin ◽  
Nitin Ohri ◽  
Rahul Narang ◽  
Renee Huang ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Cancer Patients ◽  
Anal Cancer ◽  
Advanced Disease ◽  
Early Stage ◽  
Locally Advanced ◽  
Early Stage Disease ◽  
Locally Advanced Disease ◽  
Stage Disease ◽  
Hpv Status

e15071 Background: To determine if anal cancer patients with HPV positive disease have different overall survival (OS) compared to those with HPV negative disease, and to elucidate differences in the association between radiation dose and OS. Methods: We utilized the National Cancer Database (NCDB) registry to identify a cohort of non-metastatic anal cancer patients treated with curative intent between 2008 – 2015. Propensity score matching was used to account for potential selection bias between patients with HPV positive and negative disease. Multivariable Cox regression was used to determine the association between HPV status and OS. Kaplan-Meier methods were used to compare actuarial survival estimates. Results: We identified 5,927 patients with tumor HPV status for this analysis, 3,523 (59.4%) had HPV positive disease and 2,404 (40.6%) had HPV negative disease. Propensity-matched analysis demonstrated that patients with HPV positive locally advanced (T3-4 or node positive) anal cancer had better OS (HR=0.81 (95%CI: 0.68-0.96), p=0.018). For patients with early stage disease (T1-2 and node negative) there was no difference in OS (HR=1.11 (95%CI:0.86-1.43), p=0.43). In the unmatched cohort, there was an increase in 3-year OS for patients with HPV positive tumors or early stage disease up to 45-49.9 Gy (p<0.001), whereas for patients with HPV negative and locally advanced disease there was an increase in survival from 46% at 30-44.9 Gy, to 64% at 45-49.9 Gy (p=0.093) and further to 71% at 50-54.9 Gy (p=0.005). Conclusions: We found HPV to be a significant prognostic marker in anal tumors, especially for locally advanced disease. We further found that higher radiation dose up to 50-55 Gy was associated with better OS, mainly for locally advanced disease in HPV negative patients. Multivariable Cox proportional hazards regression for OS. [Table: see text]

scholarly journals Clinical outcomes and impact of prognostic factors following adjuvant radiotherapy in oral tongue cancer patients

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Sidharth Pant ◽  
Punita Lal ◽  
Shagun Misra ◽  
Piyush Gupta ◽  
K. J. Maria Das ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Cancer Patients ◽  
Advanced Disease ◽  
Tongue Cancer ◽  
Early Stage ◽  
Locally Advanced ◽  
Oral Tongue ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Oral Tongue Cancer

Abstract Background The purpose of the study was to evaluate survival outcomes in post-operative oral tongue cancer patients undergoing adjuvant radiotherapy (RT) at a tertiary cancer care center and to critically review the impact of various clinical-pathological factors on recurrence and survival. Demographic factors, stage of all the histology proven oral tongue cancer, and treatment details were documented. Overall survival (OS) and recurrence-free survival (RFS) were analyzed along with the potential prognostic factors affecting outcome. Results One hundred forty-four post-operative oral tongue cancer patients referred to our department for adjuvant treatment were evaluated. Median age at presentation was 45 years. Forty-seven patients had pathological early stage disease (stages I and II) and 95 had locally advanced (stages III and IV) disease while post-op details were not present in 2 patients. At a median follow-up of 87 months (60–124) of alive patients, the median RFS for entire cohort was 62 months while median OS was 74 months respectively. Age, perineural invasion (PNI), and grade of the tumor emerged as independent prognostic factors for OS and RFS. Among patients with early stage disease, depth of invasion (DOI), age, and PNI were found as independent prognostic factors for RFS and OS. In locally advanced disease, higher grade, age, and PNI independently impacted the respective survival end points. Conclusions Age (> 45 years), higher grade, and presence of PNI showed inferior survival outcomes across the sub-groups (early versus locally advanced disease). This may warrant adjuvant treatment intensification. DOI > 10 mm was particularly found to worsen survival in early node negative SCC oral tongue patients.

Prognosis for papillary serous carcinoma of the endometrium after surgical staging

2001 ◽  
Vol 11 (4) ◽  
pp. 305-311
Author(s):  
D. Semer ◽  
N. P. Nguyen ◽  
S. Sallah ◽  
U. Karlsson ◽  
P. Vos ◽  
...  
Keyword(s):  
Early Stage ◽  
Locally Advanced ◽  
Distant Metastases ◽  
Serous Carcinoma ◽  
Advanced Stage ◽  
Pattern Of Failure ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Papillary Serous Carcinoma ◽  
Abdominal Irradiation

Abstract.Nguyen NP, Sallah S, Karlsson U, Vos P, Ludin A, Semer D, Tait D, Salehpour M, Jendrasiak G, Robiou C. for papillary serous carcinoma of the endometrium after surgical staging.Background: To investigate the pattern of failure and the prognosis following pathological staging for uterine papillary serous carcinoma (UPSC).Patients and methods: A retrospective review was conducted of 22 patients with UPSC, treated between 1989 and 1998 at a single institution. All patients were surgically staged. Two patients with advanced disease received chemotherapy only. Two patients with early-stage disease were followed without further treatment. Eighteen patients received postoperative irradiation; eight patients received whole abdominal irradiation (WART), and the remaining 10 patients, pelvic irradiation (PRT). In addition, seven of these patients received vaginal cuff irradiation with low-dose-rate or high-dose-rate brachytherapy. Toxicity, pattern of failure, and survival were evaluated and compared to the literature.Results: Seven patients (32%) developed distant metastases, three out of seven (42%) after WART. Four out of seven patients who had distant metastases died from disease progression during subsequent chemotherapy. All patients with distant metastases had locally advanced-stage disease at presentation (six stage III, one stage IV). Four patients with pelvic recurrences developed concurrent (2) and subsequent (2) distant metastases. Three patients had isolated distant metastases. No patient with early stage-disease (stage I and II) died from disease progression.Conclusion: Pathological staging should be performed for all patients with UPSC to determine the prognosis as well as to tailor the treatment. The role of abdominal irradiation in the treatment of UPSC is yet to be determined; however, such an approach may not be necessary for the control of disease for patients with early-stage (I and II) disease. Patients with locally advanced-stage (stage III) disease are at risk of local regional failures and distant metastases despite WART. Therefore, the benefit of WART for advanced-stage disease is also questionable. Paclitaxel-based chemotherapy is currently being investigated in this setting.

scholarly journals A Tertiary Cancer Center Experience of 52 Cases of Primary Ovarian Mucinous Adenocarcinomas

2020 ◽  
Vol 9 (02) ◽  
pp. 090-092
Author(s):  
Gaurav Das ◽  
V. Sridevi ◽  
Mohanaraj Natarajan
Keyword(s):  
Early Stage ◽  
Clinicopathological Characteristics ◽  
Cancer Center ◽  
Advanced Stage ◽  
Ovarian Adenocarcinoma ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Long Term Follow Up ◽  
Tertiary Cancer Center

Abstract Background Primary mucinous epithelial ovarian adenocarcinoma (mEOC) constitutes a small percentage (2–5%) of ovarian cancer. Our aim is to understand the clinicopathological characteristics and survival results of patients with mEOC after a long-term follow-up. Materials and Methods This is a retrospective study of primary mEOC cases treated at a tertiary cancer center in India, from January 1, 2005, to December 31, 2012. Results Out of 958 malignant ovarian tumors, 52 (5.43%) were mucinous adenocarcinoma. Nearly 71.2% of cases were of early-stage disease, and the remaining were of advanced-stage disease. After a follow-up period of 63 months (range: 1–138 months), the 5-year actuarial overall survival for stages I, II, III, and IV was 92.5, 70, 38.5, and 0%, respectively. Among advanced-stage tumors, half of them progressed without undergoing cytoreductive surgery and died. Conclusion Most of the mEOC cases present in early stages and have good clinical outcome. Patients with advanced-stage disease do not respond well to standard chemotherapy regimens in use and have poor survival figures. The use of primary cytoreduction should be considered in the place of interval cytoreduction for advanced mEOC.

scholarly journals Clinical and Cost Implications of Universal Versus Locally Advanced-Stage and Advanced-Stage-Only Molecular Testing for Epidermal Growth Factor Receptor Mutations and Anaplastic Lymphoma Kinase Rearrangements in Non–Small Cell Lung Carcinoma: A Tertiary Academic Institution Experience

2016 ◽  
Vol 140 (4) ◽  
pp. 358-361 ◽  
Author(s):  
Jennifer L. Sauter ◽  
Kelly J. Butnor
Keyword(s):  
Early Stage ◽  
Small Cell Lung Carcinoma ◽  
Locally Advanced ◽  
Growth Factor Receptor ◽  
Molecular Testing ◽  
Advanced Stage ◽  
Early Stage Disease ◽  
Cell Lung Carcinoma ◽  
Anaplastic Lymphoma ◽  
Stage Disease

Although epidermal growth factor receptor (EGFR)– and anaplastic lymphoma kinase (ALK)–directed therapies are not approved for patients with early-stage non–small cell lung carcinoma (NSCLC), many institutions perform EGFR and ALK testing for all patients with NSCLC at the time of initial diagnosis. Current consensus guidelines recommend EGFR testing and suggest ALK testing at the time of initial diagnosis for patients with advanced disease.Context.— To examine the cost and clinical impact of EGFR and ALK testing of patients with early-stage NSCLC.Objectives.— Records from all patients with a diagnosis of NSCLC made on a nonresection specimen at our institution during a single calendar year (2012) were reviewed, and a cost analysis was performed.Design.— Of 133 total patients, 47 (35%) had early-stage (stage I or II) disease and 86 (65%) had locally advanced (stage III) or advanced (stage IV) disease at presentation. Eight of 47 patients with early-stage disease (17%) had progression/recurrence during 18 to 30 months of follow-up, 6 of 8 (75%) of whom had pathologic confirmation of progression/recurrence. The estimated additional cost of EGFR and ALK testing for all newly diagnosed patients with NSCLC at our institution is $75 200 per year, compared to testing only patients with locally advanced and advanced-stage disease.Results.— The cost of universal molecular testing of NSCLC is substantial. EGFR and ALK testing of patients with early-stage disease appears to have negligible clinical impact, as most patients do not have disease recurrence/progression. Those whose disease recurs/progresses typically undergo rebiopsy. Our findings do not support the practice of universal EGFR and ALK testing in NSCLC at the time of initial diagnosis.Conclusions.—

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.

scholarly journals Institutional experience of the multimodality treatment of cancer tongue

2017 ◽  
Vol 4 (6) ◽  
pp. 1896
Author(s):  
Mrinal Shankar ◽  
Manisa Pattanayak ◽  
Vipul Nautiyal ◽  
Sunil Saini
Keyword(s):  
Early Stage ◽  
Locally Advanced ◽  
Early Recurrence ◽  
Prognostic Indicators ◽  
Medical Sciences ◽  
Early Stage Disease ◽  
Aggressive Approach ◽  
Stage Disease ◽  
Definitive Surgery ◽  
Multimodality Approach

Background: Cancer (Ca) tongue incidence has shown a rising trend in India in the last couple of years. Increasing use of tobacco being the main risk factor. Guidelines available for management of this disease include it broadly under oral cavity cancers. However, the biological behaviour of this disease is warrant of more aggressive approach to treatment. In early stage disease, treatment is mainly with single modality, surgery being the most preferred. Locally advanced disease treated with multimodality approach with surgery and adjuvant RT/chemoRT. Adverse histopathological factors are important prognostic indicators for early recurrence. Even if the mainstay of treatment in metastatic disease is palliation, multimodality approach is preferred. The aim of the study is to study clinical profile of Ca tongue ant to study outcome of multimodality management of SCC tongue and identification of treatment failure.Methods: The study was conducted in the Department of Surgery, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India over a period of 12 months on patients attending Surgical Oncology OPD. Written informed consent and ethical committee clearance was obtained in all 64 cases included, and study type is observational.Results: This is an observational study conducted at Himalayan Institute of Medical Sciences, Dehradun over a period of 12 months. 64 patients diagnosed with SCC tongue were included. Treatment protocols were prescribed by the multidisciplinary tumour board, and patients were followed up to 6 months after completion of the planned treatment. 68.75% patients were below 55 years of age. 87.5% were chronic tobacco chewers. 79.68% had lesion in the anterior tongue. 84.37% received treatment with curative intent (of these 16.66% patients showed early recurrence). 71.86% patients underwent definitive surgery (of these 78.26% remained disease free after 6 months of completion of treatment). Radiotherapy was used in both adjuvant and primary setting. Nodal recurrence was the commonest pattern of recurrence in patients who had underwent definitive surgery. Co-relation with adverse histopathological prognostic indicators also establish early recurrence.Conclusions: Ca tongue was found to be commoner in individuals between 36-55 years. Tobacco users were seen to be at high risk. Surgery was the preferred modality of treatment in early stage disease. Regional lymph node metastasis is the commonest site of early treatment failure. Adverse histopathological factors were important indicators of prognosis and need consideration in planning adjuvant treatment.

scholarly journals The role of perioperative radiotherapy in gastric cancer

2012 ◽  
Vol 6 (2) ◽  
pp. 23 ◽  
Author(s):  
Thales Paulo Batista ◽  
Lucas Marque De Mendonça ◽  
Ana Luiza Fassizoli-Fonte
Keyword(s):  
Gastric Cancer ◽  
Therapeutic Strategy ◽  
Multimodal Therapy ◽  
Early Stage ◽  
Locally Advanced ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Locally Advanced Tumors ◽  
Related Mortality

Gastric cancer is one of the most common neoplasms and a main cause of cancer-related mortality worldwide. Surgery remains the mainstay for cure and is considered for all patients with potentially curable disease. However, despite the fact that surgery alone usually leads to favorable outcomes in early stage disease, late diagnosis usually means a poor prognosis. In these settings, multimodal therapy has become the established treatment for locally advanced tumors, while the high risk of locoregional relapse has favored the inclusion of radiotherapy in the comprehensive therapeutic strategy. We provide a critical, non-systematic review of gastric cancer and discuss the role of perioperative radiation therapy in its treatment.

Increased Cyclooxygenase-2 Expression Is Associated With Chemotherapy Resistance and Poor Survival in Cervical Cancer Patients

2002 ◽  
Vol 20 (4) ◽  
pp. 973-981 ◽  
Author(s):  
G. Ferrandina ◽  
L. Lauriola ◽  
M. G. Distefano ◽  
G. F. Zannoni ◽  
M. Gessi ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Patients ◽  
Early Stage ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Rabbit Antiserum ◽  
Immunohistochemical Analysis ◽  
Response To Treatment ◽  
Advanced Stage ◽  
Cox 2

PURPOSE: To investigate the expression of cyclooxygenase (COX-2) and its association with clinicopathologic parameters and clinical outcome in patients with cervical cancer. PATIENTS AND METHODS: The study included 84 patients with stage IB to IVA cervical cancer. Patients with early-stage cases (n = 21) underwent radical surgery, whereas patients with locally advanced cervical cancer (LACC) (n = 63) were first administered neoadjuvant cisplatin-based treatment and subjected to surgery in case of response. Immunohistochemical analysis was performed on paraffin-embedded sections with rabbit antiserum against COX-2. RESULTS: COX-2–integrated density values in the overall population ranged from 1.2 to 82.3, with mean ± SE values of 27.4 ± 2.4. According to the chosen cutoff value, 36 (42.9%) of 84 patients were scored as COX-2 positive. COX-2 levels were shown to be highly associated with tumor susceptibility to neoadjuvant treatment. COX-2 showed a progressive increase from mean ± SE values of 19.9 ± 8.0 in complete responders through 31.5 ± 3.5 in partial responses to 44.8 ± 3.9 in patients who were not responsive (P = .0054). When logistic regression was applied, only advanced stage and COX-2 positivity retained independent roles in predicting a poor chance of response to treatment. COX-2–positive patients had a shorter overall survival (OS) rate than COX-2–negative patients. In patients with LACC, the 2-year OS rate was 38% in COX-2–positive versus 85% in COX-2–negative patients (P = .0001). In the multivariate analysis, only advanced stage and COX-2 positivity retained independent negative prognostic roles for OS. CONCLUSION: The assessment of COX-2 status could provide additional information to identify patients with cervical cancer with a poor chance of response to neoadjuvant treatment and unfavorable prognosis.

Sign in / Sign up

Export Citation Format

Share Document