ANALYSIS OF AN OVARIAN CANCER COHORT IN A HEALTH SYSTEM WITH A SAFETY-NET HOSPITAL AND A COMPREHENSIVE CANCER CENTER

153 Background: Financial toxicity is a patient-reported outcome reflecting burdens of cancer treatment costs. There is a need to assess financial toxicity in cancer care, as its unique domains—upstream factors like direct medical costs or downstream economic impact like bankruptcy—predict worse QOL, adherence, and mortality. Socioeconomically disadvantaged patients bear disparate financial toxicity burdens. We thus developed and report performance of a new measure, the Economic StraiN and Resilience in Cancer (ENRICh), to assess all financial toxicity domains in economically diverse patients. Methods: We studied 238 patients with Stage I-IV cancer from a tertiary academic comprehensive cancer center (MDA) and county safety-net hospital serving socioeconomically disadvantaged patients (LBJ). Financial toxicity domains and corresponding subscales were developed from qualitative/cognitive (n = 104) interviews. ENRICh and Comprehensive Score for Financial Toxicity (COST) questions were administered (n = 127; MDA = 71, LBJ = 56). To demonstrate known-group validity, we compared ENRICh scores between centers; for concurrent validity, we correlated ENRICh and COST; for reliability, we calculated Cronbach's coefficient α for ENRICh subscales (range 0, none, to 10, high burden). Results: There were 4 distinct, valid financial toxicity domains/subscales: 1) Burden of cost; 2) Disruption of financial stability; 3) Depletion of financial coping; 4) Depletion of instrumental coping. Patients from the 2 centers significantly differed in subscale and overall ENRICh scores. Socioeconomically disadvantaged patients had worse mean scores (4.9 vs 2.1, 95%CI -3.6,-2.1, effect size 1.4, P < .001). ENRICh significantly correlated with COST (r = -0.82, 95%CI -0.87,-0.77, P < .001). Subscales were reliable with excellent internal consistency (Cronbach α = 0.78 to 0.94). The 4 ENRICh domains collectively had synergistic impact on overall financial toxicity burden. Conclusions: ENRICh is valid, reliable, and identifies and 4 novel domains of financial toxicity. Future utility of this tool is to guide assessment/interventions targeting financial toxicity domains affecting diverse cancer patients, to mitigate disparities.

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Incidence, characteristics, pattern and management of ovarian cancer in Abuja, Nigeria

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20203665 ◽

2020 ◽

Vol 8 (9) ◽

pp. 3187

Author(s):

Malachy Emeka Ayogu ◽

Habiba Ibrahim Abdullahi ◽

Innocent O. Eze

Keyword(s):

Ovarian Cancer ◽

Relevant Information ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Advanced Stage ◽

Survival Times ◽

Pattern Of Care ◽

Ovarian Cancers ◽

Compliance To Treatment ◽

Lost To Follow Up

Background: The prevalence of ovarian cancer is thought to be increasing with huge burden of the disease with no comprehensive cancer center that can offer appropriate care in developing countries. However, little is known about the incidence, pattern and outcome of this disease in Abuja, Nigeria. Therefore, the aim of this study was to review the pattern of care offered to patients with ovarian cancer in our center and to evaluate patients’ outcome.Methods: This was a retrospective review of all the patients with histologically confirmed ovarian cancers admitted to the gynecological ward of the hospital over a period of 5 years. Relevant information was extracted from the ward register and patients medical case records. Data were analyzed using statistical package for social science version 23 and results were then presented in tables and chart.Results: Ovarian cancers constituted 19.6% and 5.6% of all gynecological cancers and all gynecological admissions respectively. The mean age at presentation was 50.2±8.5 years and premenopausal 32 (55%) constituting the majority. A large proportion 43 (74.1%) of the patients were parous. The commonest symptoms at presentation were abdominal swelling (86.2%), and abdominal pain (53.4%) with the majority 38 (65.5%) presenting in an advanced stage. The commonest histological type of ovarian cancers was epithelial accounting for 30 (51.7%) of all ovarian cancers. Common treatment modality was surgery and chemotherapy and majority 32 (55.3%) of the patients had cytoreductive surgery with 19 of them having optimum cytoreduction and 33 (57%) benefitted from chemotherapy. Lost to follow- up was significantly high (55%) and mortality rate was 15.5%.Conclusion: Cases of ovarian cancers are on the increase. Women presented at an advanced stage of the disease, which resulted in short survival times. Failure of optimal management was also worsened by poor compliance to treatment with high patients' default rate.

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Comprehensive Analysis of Breast Cancer Survival Outcomes in a Public Safety-Net Hospital Compared with an Adjacent Academic Cancer Center

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2019.08.324 ◽

2019 ◽

Vol 229 (4) ◽

pp. S146-S147

Author(s):

Kristin N. Kelly ◽

Emily Ryon ◽

Francis Igor B. Macedo ◽

Dido Franceschi ◽

Mecker Moller ◽

...

Keyword(s):

Breast Cancer ◽

Public Safety ◽

Cancer Survival ◽

Safety Net ◽

Comprehensive Analysis ◽

Breast Cancer Survival ◽

Cancer Center ◽

Survival Outcomes ◽

Safety Net Hospital

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Impact of increased utilization of neoadjuvant chemotherapy on survival in patients with advanced ovarian cancer: Experience from a comprehensive cancer center

Gynecologic Oncology ◽

10.1016/j.ygyno.2018.04.367 ◽

2018 ◽

Vol 149 ◽

pp. 160

Author(s):

Y.J. Lee ◽

Y.S. Chung ◽

J.W. Kim ◽

E.J. Nam ◽

S.W. Kim ◽

...

Keyword(s):

Ovarian Cancer ◽

Neoadjuvant Chemotherapy ◽

Advanced Ovarian Cancer ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Cancer Experience

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Intraperitoneal chemotherapy outcomes following interval cytoreductive surgery for advanced-stage ovarian cancer at a comprehensive cancer center

Gynecologic Oncology ◽

10.1016/j.ygyno.2016.04.098 ◽

2016 ◽

Vol 141 ◽

pp. 29 ◽

Cited By ~ 1

Author(s):

J.J. Mueller ◽

A. Kelly ◽

Q. Zhou ◽

A. Iasonos ◽

K. Long Roche ◽

...

Keyword(s):

Ovarian Cancer ◽

Intraperitoneal Chemotherapy ◽

Cytoreductive Surgery ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Advanced Stage

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Differences in breast cancer outcomes amongst Black United States-born and Caribbean-born immigrants.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.1088 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 1088-1088

Author(s):

Priscila Barreto Coelho ◽

Danielle Cerbon ◽

Matthew Schlumbrecht ◽

Carlos Parra ◽

Judith Hurley ◽

...

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Safety Net ◽

Cancer Center ◽

Advanced Stage ◽

Cancer Data ◽

Hispanic Caribbean ◽

Safety Net Hospital ◽

The Usa ◽

The Caribbean

1088 Background: The Black population in the US constitutes of 4 million immigrants, with 50% from the Caribbean. It has been shown that breast cancer is responsible for 14%-30% of cancer deaths in the Caribbean; this is up to two times higher than the USA. Methods: Retrospective cohort of 1369 self-identified Black women with breast cancer. Data was obtained from Jackson Memorial Health Systems and University of Miami Health System Tumor Registry. Individual-level data from 1132 cases was used to estimate hazard rations (HRs) of women born in the Caribbean (CB) or in the USA (USB) using Cox proportional hazards regression analysis for overall survival. Median follow-up was 115 months (interquartile range, 91.9-138.1 months) per participant. Results: Data from 622 (54.9%) USB women and 507 (45%) CB women diagnosed with breast cancer between 2006-2017. 90% (n = 1232) of the cohort is of non-Hispanic ethnicity. Caribbean immigrants from Haiti (18.3%), Jamaica (6.5%), Bahamas (3.1%), Cuba and Dominica Republic (2.8% each), Trinidad and Tobago (1%) and other nationalities from the Organization of Eastern Caribbean States were included, mean age 55.7 [95% CI, 54.7-56.8]; USB mean age 57.6 [95% CI, 56.4-58.7] (P = 0.02). Compared to USB, CB had lower BMI at diagnosis 29.6 [95% CI, 28.9-30.3] versus 30.9 [95% CI, 30.1-31.7, P = 0.015]. Compared to CB patients, USB patients had more ER- [31.4% vs 39.1 %, P = 0.018] and triple negative breast cancers [19.6% vs 27.9%, P = 0.003]. Compared to USB patients, CB presented at more advanced stage, III and IV [44.2% vs 35.2%], p = 0.016. In spite of higher advanced stage at diagnoses, CB patients had a better breast cancer overall survival [HR = 0.75; 95%CI, 0.59-0.96; P = 0.024]. Black Hispanic patients had a better overall survival [HR = 0.51; 95%CI, 0.28-0.93; p = 0.028] compared to non-Hispanic Blacks. Compared to Hispanic Caribbean, non-Hispanic Caribbean had a worse overall survival [HR = 1.98; 95%CI, 1.00-3.94; P = 0.048]. The distribution of patients treated at the private cancer center and the safety net hospital were the same, differences in outcomes observed are due to intrinsic differences. Conclusions: This is the largest analysis to date of self-identified Black breast cancer patients in the context of nativity, race, ethnic identity and overall survival with clinico-pathologic characteristics. CB immigrants diagnosed with breast cancer have a better overall survival than US born Black patients. This finding suggests that within the African diaspora in the USA, additional factors beyond race contribute to the outcomes.

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Outcomes of rectal cancer patients treated using Polish II neoadjuvant short course radiation therapy and chemotherapy approach in comprehensive cancer center.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e16088 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e16088-e16088

Author(s):

Stephen Haff ◽

Syed Mohammad Ali Kazmi ◽

Nina Niu Sanford ◽

Todd Anthony Aguilera ◽

Muhammad Shaalan Beg ◽

...

Keyword(s):

Rectal Cancer ◽

Cancer Patients ◽

Safety Net ◽

Pathological Response ◽

Stage I ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Complete Pathological Response ◽

Post Surgery ◽

Short Course

e16088 Background: Neoadjuvant short-course (SC) radiation (RT) followed by fluoropyrimidine based chemotherapy prior to surgery (Polish II approach) is a less utilized treatment in the United States for rectal cancer. Based on data suggesting equivalent or improved outcomes at lower cost compared to the long course neoadjuvant chemoradiation, our team started utilizing this approach for rectal cancer management at Simmons Comprehensive Cancer Center. We aim to document our experience with Polish II approach at NCI-designated comprehensive cancer center program. Methods: A retrospective review of stage I-IV rectal cancer patients, seen at an academic center or the Dallas County safety net hospital and treated at Simmons Comprehensive Cancer Center from Nov 2017 to Dec 2019. Patients were treated with neoadjuvant SC-RT followed by 3 cycles of FOLFOX prior to surgery and followed by adjuvant FOLFOX. Descriptive data for demographic, radiation, chemotherapy and surgery, hospitalizations, 30 day post-surgery admission, time to relapse, and laboratory parameters was collected. Results: Thirty-nine patients met the inclusion criteria (average age 58 years; 74% men/26% women). Forty-six percent of patients were Hispanic, 28.2% White, 15.4% African American and 7.7% Asian. The majority of patients had stage IIIB (46.2%), followed by IIIC (17.9%), IIA (12.8%), IIIA (7.7%), while rest were stage I, IVA or unknown (5.1%). All patients received 5 x 5 SC-RT, 100% completed 3 cycles of planned neoadjuvant FOLFOX (12.8% received 4-8 cycles) and 36/39 (92%) of patients underwent planned surgery. Median duration from SC-RT to chemotherapy was 12 days, and from chemotherapy to surgery was 37 days. Hospitalization occurred in 3 patients (7.7%) during neoadjuvant therapy, and in 8 patients (20.5%) within 30 days post-surgery. Complete pathological response was seen in 6 patients (16.6%) and near-complete pathological response in 3 patients (8.3%). Relapse occurred in 10.3% patients at time of data acquisition. Grade 3 and 4 neutropenia, anemia, and thrombocytopenia in neoadjuvant phase was observed in 8.6%, 25.7%, and 2.8% patients, respectively. Conclusions: In rectal cancer patients treated at a comprehensive cancer center, neoadjuvant Polish-II approach was feasible and well tolerated. Pathological response rates were comparable to historical data. SC-RT based neo-adjuvant therapy approach should be favored due to lower pelvic radiation dose, tolerance and convenience to patients.

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