Medical oncology referral and systemic therapy of patients with advanced stage urothelial carcinoma

2020 ◽  
Vol 9 (13) ◽  
pp. 945-957
Author(s):  
Abdalla Aly ◽  
Courtney Johnson ◽  
Yunes Doleh ◽  
Rahul Shenolikar ◽  
Marc F Botteman ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Medical Oncology ◽  
Stage Iv ◽  
Care Physician ◽  
Older Age ◽  
Medical Oncologist ◽  
Negatively Associated ◽  
Medicare Data ◽  
Adjusted Model ◽  
Timely Referral

Aim: To understand physician visit patterns among patients with stage IV (including nonmetastatic [M0] and metastatic [M1] disease) urothelial carcinoma (UC) and understand factors associated with a timely referral to a medical oncologist and systemic treatment. Patients & methods: Retrospective analysis of Surveillance, Epidemiology and End Results-Medicare data. Results: First physician encounter was with a urologist (M0: 69%; M1: 53%) or primary care physician ([PCP]; M0: 19%, M1: 25%) for the majority of patients around UC diagnosis. After the index urologist encounter, most patients had a subsequent medical oncologist visit at a median of 52 days (M0: 69.5 days, M1: 33 days). In an adjusted model, older age, index PCP visit, higher comorbidities and M0 disease were negatively associated with a medical oncologist referral. Among those referred to a medical oncologist, older age, Hispanic or non-Hispanic Black race and not being married were negatively associated with subsequent chemotherapy receipt (p < 0.05). Conclusion: Many patients with advanced UC encounter multiple specialists during their disease course. Older patients or those with a first UC-related encounter with a PCP are less likely to be referred to medical oncology. Once referred to medical oncology, social determinants, including race and marital status, are relevant predictors of receiving chemotherapy.

Examination of current Algoma District cancer program practices and local referral processes for patients with prostate cancer.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 352-352
Author(s):  
Daniella Febbraro ◽  
Silvana Spadafora
Keyword(s):  
Prostate Cancer ◽  
Cancer Patients ◽  
Medical Oncology ◽  
Stage Iv ◽  
Standards Of Care ◽  
Study Patient ◽  
Medical Oncologist ◽  
Northern Ontario ◽  
Cancer Program ◽  
Medical Oncologists

352 Background: The Algoma District Cancer Program (ADCP) is located in Sault Ste. Marie, ON, Canada and services the needs of the 125,000 individuals residing in the Algoma District, which has an area of approximately 49,000 square kilometres. Due to its geographic isolation in Northern Ontario, maintaining standards of care can be challenging to deliver. The objective of this project is to document any improvements in the referral process and treatment of patients with prostate cancer at the ADCP since the arrival of new medical oncologists in July 2013. Methods: Patients who had been seen by a medical oncologist at ADCP from July 2013 to July 2015 were included in this study. Patient charts were analyzed in order to gather information including date of diagnosis, stage at time of referral, date of consult with medical oncologist, previous treatments trialed, and dates of treatment. Patients were divided into two groups, diagnosed prior to 2014 and after 2014, to examine progress at ADCP. Results: From July 2013 to July 2015, there were 73 patients seen by a medical oncologist at ADCP with a diagnosis of prostate cancer. Of these patients, 54 were diagnosed prior to 2014 and 19 were diagnosed after 2014. For all patients diagnosed prior to 2014, the average number of years from diagnosis to a medical oncology consult was 5.24 years, with the longest being 19 years for two patients. In comparison, for all patients diagnosed after 2014, a medical oncologist saw them only 0.26 years on average after they were diagnosed. Since 2014, lines of therapy administered after referral to medical oncology have become greater than before 2014. Specifically for stage IV prostate cancer patients, the average number of lines of therapy ordered by a medical oncologist has increased for patients diagnosed after 2014. Conclusions: Since the arrival of new medical oncologists at ADCP in July 2013, the average number of years after diagnosis that a patient is referred to the clinic has decreased, while the average lines of therapies utilized after their consult with a medical oncologist has increased, showing an improvement in both referral processes and adherence to standard guidelines in the treatment of prostate cancer patients.

The impact of time of medical oncologist visit on survival among elderly patients with stage IV prostate cancer: An analysis using SEER-Medicare data

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e17509-e17509
Author(s):  
C. D. Mullins ◽  
E. Onukwugha ◽  
B. Seal ◽  
A. Hussain ◽  
A. Hussain
Keyword(s):  
Prostate Cancer ◽  
Stage Iv ◽  
Survival Models ◽  
Medical Oncologist ◽  
Sample Mean ◽  
Medicare Data ◽  
Risk Of Mortality ◽  
Starting Point ◽  
Medicare Database ◽  
The Impact

e17509 Background: The association between physician referrals and treatment receipt has been established in other disease settings. The impact of time to a medical oncologist or hematologist/oncologist (MOH) visit on survival has not been examined in patients (pts) with advanced prostate cancer (A-PC). The objective of this study is to determine whether the time to a MOH visit is associated with survival. Methods: The SEER-Medicare database was used for the analysis. Pts aged >65 diagnosed with A-PC between 1994 and 2002 and who visited a urologist post-diagnosis were included. Pts who saw a MOH before the urologist visit were excluded. For pts who saw a MOH, time to a MOH visit was identified using the diagnosis date and the urologist visit as starting points. Survival models were used to examine the effect of the time (in months) to MOH visit on survival, controlling for demographic, clinical, continuity-of-care, and ecological measures. Results: There were 6,498 pts in the sample (mean age 76 years, 82% White race). PC-specific mortality was 38%. Two-thirds (67%) of patients did not visit a MOH after visiting a urologist. Among those with a visit to a MOH, an additional month from diagnosis till the MOH visit was positively associated with PC mortality (HR: 1.03; p < 0.001) - i.e. a shorter time to a MOH visit was associated with PC survival. Similar results were obtained using the month of the urologist visit as the starting point (HR: 1.02; p < 0.001). Conclusions: Among A-PC patients who are referred to an oncologist, each additional month between diagnosis/urologist visit and the oncologist visit is associated with an increased relative risk of mortality. [Table: see text]

Physician referral patterns among men with advanced prostate cancer.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 211-211
Author(s):  
Candice Yong ◽  
Ebere Onukwugha ◽  
C. Daniel Mullins ◽  
Abdulla M. Abdulhalim ◽  
Yi Qian ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Advanced Prostate Cancer ◽  
Stage Iv ◽  
Care Physician ◽  
Referral Pattern ◽  
Limited Data ◽  
Medical Oncologist ◽  
Referral Patterns ◽  
The Us ◽  
Medicare Database

211 Background: Among men diagnosed with localized prostate cancer (PC), the type of specialist visited has been shown to influence the type of treatment regimen prescribed. There is limited data on referral patterns among men diagnosed with advanced PC. The objective of this study was to characterize referral patterns across physician types who treat men with stage IV nonmetastatic (M0) and metastatic (M1) PC. Methods: Using the linked US SEER (Surveillance, Epidemiology, and End Results) and Medicare database, we identified men aged 66 or older who were diagnosed with incident stage IV M0 or M1 PC between 2000 and 2007. We evaluated patterns of the first and second type of physicians visited after diagnosis of PC for men with visits to the following physician types: urologist, medical oncologist (medonc), radiation oncologist (radonc), or primary care physician (PCP). Results were stratified by M0 and M1 disease. Results: We identified 9,826 men with stage IV PC (median age=77 years). Of these 9,826 men, 8,736 (89%) visited at least two physician types (93% among men with M0 and 87% among men with M1). Across the physician types of interest, 94% of men initially visited a urologist (52%) or PCP (42%). Among men who visited a urologist first, most were referred to a PCP, while smaller percentages were referred to a medonc or radonc (Table). Among men who saw a PCP first, most were referred to a urologist next; smaller proportions were referred to a medonc or radonc. Men with M1 PC had more referrals to medonc and fewer referrals to radonc than men with M0 PC. Conclusions: In this analysis of nearly 10,000 men aged 66 or older with stage IV PC in the US, most men initially visited a urologist or PCP regardless of whether or not they had distant metastasis. Based on the patterns observed, the most frequent referral pattern occurred between urologists and PCPs. More referrals to a medonc were evident if the men had M1 disease. [Table: see text]

scholarly journals What Medical Oncologist Residents Think about the Italian Speciality Schools: A Survey of the Italian Association of Medical Oncology (AIOM) on Educational, Clinical and Research Activities

PLoS ONE ◽  
2016 ◽  
Vol 11 (7) ◽  
pp. e0159146 ◽  
Author(s):  
Anna Moretti ◽  
Michele Ghidini ◽  
Carmine De Angelis ◽  
Matteo Lambertini ◽  
Chiara Cremolini ◽  
...  
Keyword(s):  
Medical Oncology ◽  
Medical Oncologist ◽  
Italian Association ◽  
Research Activities

Fear of Death and Death Acceptance Among Bereaved Adults: Associations With Prolonged Grief

2020 ◽  
pp. 003022282092104
Author(s):  
Goda Gegieckaite ◽  
Evaldas Kazlauskas
Keyword(s):  
Cause Of Death ◽  
Significant Loss ◽  
Older Age ◽  
Fear Of Death ◽  
Prolonged Grief ◽  
Negatively Associated ◽  
Natural Cause Of Death ◽  
Death Acceptance

This study aimed to analyze fear of death and neutral acceptance of death after a significant loss and their associations with prolonged grief. The sample of the study included 239 bereaved participants. Time since the loss ranged from 6 to 72 months. We found that neutral acceptance of death was associated with older age, a natural cause of death, and the ability to find meaning in the death of a close one. Fear of death was negatively associated with the frequency of practicing religion. We found that fear of death but not neutral acceptance was significantly associated with prolonged grief symptoms.

scholarly journals Spending for Advanced Cancer Diagnoses: Comparing Recurrent Versus De Novo Stage IV Disease

2019 ◽  
Vol 15 (7) ◽  
pp. e616-e627 ◽  
Author(s):  
Michael J. Hassett ◽  
Matthew Banegas ◽  
Hajime Uno ◽  
Shicheng Weng ◽  
Angel M. Cronin ◽  
...  
Keyword(s):  
Advanced Cancer ◽  
Cancer Diagnosis ◽  
De Novo ◽  
Stage Iv ◽  
Absolute Difference ◽  
Medicare Data ◽  
Stage Iv Disease ◽  
De Novo Cancer ◽  
Payment Models ◽  
Diagnosis Age

PURPOSE: Spending for patients with advanced cancer is substantial. Past efforts to characterize this spending usually have not included patients with recurrence (who may differ from those with de novo stage IV disease) or described which services drive spending. METHODS: Using SEER-Medicare data from 2008 to 2013, we identified patients with breast, colorectal, and lung cancer with either de novo stage IV or recurrent advanced cancer. Mean spending/patient/month (2012 US dollars) was estimated from 12 months before to 11 months after diagnosis for all services and by the type of service. We describe the absolute difference in mean monthly spending for de novo versus recurrent patients, and we estimate differences after controlling for type of advanced cancer, year of diagnosis, age, sex, comorbidity, and other factors. RESULTS: We identified 54,982 patients with advanced cancer. Before diagnosis, mean monthly spending was higher for recurrent patients (absolute difference: breast, $1,412; colorectal, $3,002; lung, $2,805; all P < .001), whereas after the diagnosis, it was higher for de novo patients (absolute difference: breast, $2,443; colorectal, $4,844; lung, $2,356; all P < .001). Spending differences were driven by inpatient, physician, and hospice services. Across the 2-year period around the advanced cancer diagnosis, adjusted mean monthly spending was higher for de novo versus recurrent patients (spending ratio: breast, 2.39 [95% CI, 2.05 to 2.77]; colorectal, 2.64 [95% CI, 2.31 to 3.01]; lung, 1.46 [95% CI, 1.30 to 1.65]). CONCLUSION: Spending for de novo cancer was greater than spending for recurrent advanced cancer. Understanding the patterns and drivers of spending is necessary to design alternative payment models and to improve value.

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