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Harrison JM, Timmerhuis HC, Day H, Ngongoni RF, Furst A, Dua MM, Arnow K, Visser BC. Care fragmentation in hepatocellular carcinoma: Opportunities to fix a broken sector. Surgery 2025; 181:109154. [PMID: 39889513 DOI: 10.1016/j.surg.2025.109154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2024] [Revised: 12/28/2024] [Accepted: 01/07/2025] [Indexed: 02/03/2025]
Abstract
BACKGROUND Care fragmentation refers to receipt of health care services through multiple institutions. Although care fragmentation has been linked to inferior oncologic outcomes, it also captures "upgrades" to specialized centers. Herein, we investigate the association between care fragmentation and hepatocellular carcinoma survival in California. STUDY DESIGN Hepatocellular carcinoma cases occurring between January 1, 2007, and December 31, 2017, were retrospectively identified through a maintained, statewide database. Care fragmentation was measured (1) as a binary classification of fragmented or nonfragmented care, (2) by the number of facilities visited, and (3) in terms of care directionality through which care fragmentation occurred between Network of Comprehensive Cancer/National Cancer Institute-designated and -nondesignated centers, within 2 years of diagnosis. Multivariable time-varying covariate Cox regression analyses were used to model the impact of care fragmentation on overall survival. RESULTS Of 10,825 patients with hepatocellular carcinoma, 5,778 patients (53.4%) received fragmented care. Compared with nonfragmented care, fragmented care was associated with worse overall survival (hazard ratio, 1.81; 95% confidence interval, 1.72-1.91, P < .001) by our analyses. The quantity of centers visited also corresponded to a greater mortality (2 facilities: hazard ratio, 1.65; 95% confidence interval, 1.56-1.75, P < .001; 3 facilities: hazard ratio, 2.21; 95% confidence interval, 2.02-2.41, P < .001; 4+ facilities: hazard ratio, 2.66; 95% confidence interval, 2.35-3.02, P < .001). Compared with nonfragmented-designated, all other care fragmentation directionality patterns, including fragmented-designated and nondesignated care, decreased overall survival (hazard ratio, 1.74; 95% confidence interval, 1.55-1.95, P < .001). Care fragmentation in surgical patients showed a similar trend for the fragmented-designated and nondesignated pattern (hazard ratio, 1.67; 95% confidence interval, 1.30-2.14, P < .001). CONCLUSION In hepatocellular carcinoma, fragmented care is associated with worse survival. Although fragmented-designated and nondesignated care was expected to mitigate such effect, this was not observed. Additional mechanisms driving such findings warrant further investigation.
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Affiliation(s)
- Jon M Harrison
- Section of Hepatobiliary & Pancreatic Surgery, Department of General Surgery, Stanford University School of Medicine, Stanford, CA.
| | - Hester C Timmerhuis
- Section of Hepatobiliary & Pancreatic Surgery, Department of General Surgery, Stanford University School of Medicine, Stanford, CA
| | - Heather Day
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford School of Medicine, Stanford, CA
| | - Rejoice F Ngongoni
- Section of Hepatobiliary & Pancreatic Surgery, Department of General Surgery, Stanford University School of Medicine, Stanford, CA
| | - Adam Furst
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford School of Medicine, Stanford, CA
| | - Monica M Dua
- Section of Hepatobiliary & Pancreatic Surgery, Department of General Surgery, Stanford University School of Medicine, Stanford, CA
| | - Katherine Arnow
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford School of Medicine, Stanford, CA
| | - Brendan C Visser
- Section of Hepatobiliary & Pancreatic Surgery, Department of General Surgery, Stanford University School of Medicine, Stanford, CA
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Inoue T, Agatsuma N, Utsumi T, Tanaka Y, Nishikawa Y, Horimatsu T, Shimizu T, Nikaido M, Nakanishi Y, Hoshino N, Takahashi Y, Nakayama T, Seno H. Development and validation of a claims-based algorithm to identify incidents and determine the progression phases of gastric cancer cases in Japan. J Gastroenterol 2025; 60:141-151. [PMID: 39589534 PMCID: PMC11794417 DOI: 10.1007/s00535-024-02167-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2024] [Accepted: 10/30/2024] [Indexed: 11/27/2024]
Abstract
BACKGROUND Although health insurance claims data can address questions that clinical trials cannot answer, the uncertainty of disease names and the absence of stage information hinder their use in gastric cancer (GC) research. This study aimed to develop and validate a claims-based algorithm to identify and determine the progression phases of incident GC cases in Japan. METHODS The gold standard for validation in this retrospective observational study was medical records of patients with incident GC who underwent specific treatments, defined by the claim codes associated with GC treatment. The algorithm was developed and refined using a cohort from two large tertiary care medical centers (April-September 2017 and April-September 2019) and subsequently validated using two independent cohorts: one from different periods (October 2017-March 2019 and October 2019-March 2021) and the other from a different institution (a community hospital). The algorithm identified incident cases based on a combination of the International Classification of Diseases, 10th Revision diagnosis codes for GC (C160-169), and claim codes for specific treatments, classifying them into endoscopic, surgical, and palliative groups. Positive predictive value (PPV), sensitivity of incident case identification, and diagnostic accuracy of progression phase determination were evaluated. RESULTS The developed algorithm achieved PPVs of 90.0% (1119/1244) and 95.9% (94/98), sensitivities of 98.0% (1119/1142) and 98.9% (94/95) for incident case identification, with diagnostic accuracies of 94.1% (1053/1119) and 93.6% (88/94) for progression phase determination in the two validation cohorts, respectively. CONCLUSIONS This validated claims-based algorithm could advance real-world GC research and assist in decision-making regarding GC treatment.
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Affiliation(s)
- Takahiro Inoue
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Nobukazu Agatsuma
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
- Department of Internal Medicine, Hino Memorial Hospital, Shiga, Japan
| | - Takahiro Utsumi
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan.
| | - Yukari Tanaka
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Yoshitaka Nishikawa
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
- Department of Clinical Oncology, Kyoto University Hospital, Kyoto, Japan
| | - Takahiro Horimatsu
- Institute for Advancement of Clinical and Translational Science (iACT), Kyoto University Hospital, Kyoto, Japan
| | - Takahiro Shimizu
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Mitsuhiro Nikaido
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Yuki Nakanishi
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Nobuaki Hoshino
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshimitsu Takahashi
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Hiroshi Seno
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
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Sędłak K, Rawicz-Pruszyński K, Pelc Z, Mlak R, Gęca K, Skórzewska M, Zinkiewicz K, Chawrylak K, Polkowski WP. Association Between Reconstruction Technique and Clinical Outcomes in Advanced Gastric Cancer Patients Undergoing Proximal Gastrectomy. Cancers (Basel) 2024; 16:4282. [PMID: 39766179 PMCID: PMC11674166 DOI: 10.3390/cancers16244282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2024] [Revised: 12/12/2024] [Accepted: 12/17/2024] [Indexed: 01/11/2025] Open
Abstract
BACKGROUND There is an upward shift in the incidence and localization of gastric cancer (GC). Proximal gastrectomy (PG) has been advocated as an alternative operation for upper-third GC. An uneventful postoperative course is currently measured using a well-defined textbook outcome (TO), which represents a composite of surgical quality metrics. The aim of this study was to compare TO after two reconstruction methods following PG: double-tract reconstruction (DTR) and posterior esophagogastrostomy with partial neo-fundoplication (EGF). MATERIALS AND METHODS Primary proximal gastric adenocarcinoma patients who had undergone PG with DTR or EGF were included in this study. In a prospectively collected database, DTR and EGF were identified in 30 and 30 patients, respectively. RESULTS Patients with DTR had a 5.5-fold higher chance of achieving TO compared to those with EGF (OR = 5.67; p = 0.0266). No statistically significant differences in overall survival were noted when both reconstruction methods were compared. CONCLUSION In patients with proximal GC undergoing PG, TO is more likely to be achieved using DTR compared to EGF, with similar overall survival. Randomized controlled trials are warranted to indicate the preferred reconstruction technique after PG.
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Affiliation(s)
- Katarzyna Sędłak
- Department of Surgical Oncology, Medical University of Lublin, 20-080 Lublin, Poland; (K.R.-P.); (Z.P.); (K.G.); (M.S.); (K.Z.); (K.C.); (W.P.P.)
| | - Karol Rawicz-Pruszyński
- Department of Surgical Oncology, Medical University of Lublin, 20-080 Lublin, Poland; (K.R.-P.); (Z.P.); (K.G.); (M.S.); (K.Z.); (K.C.); (W.P.P.)
| | - Zuzanna Pelc
- Department of Surgical Oncology, Medical University of Lublin, 20-080 Lublin, Poland; (K.R.-P.); (Z.P.); (K.G.); (M.S.); (K.Z.); (K.C.); (W.P.P.)
| | - Radosław Mlak
- Department of Laboratory Diagnostics, Medical University of Lublin, 20-093 Lublin, Poland;
| | - Katarzyna Gęca
- Department of Surgical Oncology, Medical University of Lublin, 20-080 Lublin, Poland; (K.R.-P.); (Z.P.); (K.G.); (M.S.); (K.Z.); (K.C.); (W.P.P.)
| | - Magdalena Skórzewska
- Department of Surgical Oncology, Medical University of Lublin, 20-080 Lublin, Poland; (K.R.-P.); (Z.P.); (K.G.); (M.S.); (K.Z.); (K.C.); (W.P.P.)
| | - Krzysztof Zinkiewicz
- Department of Surgical Oncology, Medical University of Lublin, 20-080 Lublin, Poland; (K.R.-P.); (Z.P.); (K.G.); (M.S.); (K.Z.); (K.C.); (W.P.P.)
| | - Katarzyna Chawrylak
- Department of Surgical Oncology, Medical University of Lublin, 20-080 Lublin, Poland; (K.R.-P.); (Z.P.); (K.G.); (M.S.); (K.Z.); (K.C.); (W.P.P.)
| | - Wojciech P. Polkowski
- Department of Surgical Oncology, Medical University of Lublin, 20-080 Lublin, Poland; (K.R.-P.); (Z.P.); (K.G.); (M.S.); (K.Z.); (K.C.); (W.P.P.)
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Leonhardt CS, Lanzenberger L, Puehringer R, Klaiber U, Hauser I, Strobel O, Prager G, Bodingbauer M. Evidence-based cancer care: assessing guideline adherence of multidisciplinary tumor board recommendations for breast and colorectal cancer in a non-academic medical center. J Cancer Res Clin Oncol 2024; 151:4. [PMID: 39630280 PMCID: PMC11618208 DOI: 10.1007/s00432-024-06049-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Accepted: 11/25/2024] [Indexed: 12/08/2024]
Abstract
PURPOSE Multidisciplinary tumor boards (MTB) are associated with improved outcomes. Yet, most patients in Western countries receive cancer care at non-academic medical centers. Guideline adherence of MTB recommendations in non-academic medical centers as well as factors contributing to non-adherence remain largely unexplored. METHODS This retrospective study followed the STROBE recommendations. All cases discussed at the MTB of the Landesklinikum Baden-Moedling, Austria, were eligible for inclusion. Guideline non-adherence was assessed by two reviewers independently using the AWMF S3 guidelines. Factors associated with guideline non-adherence were investigated using multivariable ordinal regression. RESULTS In total, 579 patients were included in the final analysis: 486 were female (83.9%) and 93 were male (16.1%), with a median age of 70 years (IQR 60-80). Most had breast cancer (n = 451; 77.9%), while 128 had colorectal cancer (22.1%). Complete adherence to guidelines was observed in 453 patients (78.2%), major deviations in 60 (10.4%), and minor deviations in 66 (11.4%) patients. Non-adherence was primarily due to patient preferences (n = 24; 40.0%), lack of surgical treatment recommendation (n = 24; 40.0%), and comorbidities (n = 9; 15.0%). After adjusting for relevant variables, predictors of non-adherence included older age at diagnosis (OR 1.02, 95% CI 1.00-1.04), colorectal cancer (OR 3.84, 95% CI 1.99-7.42), higher ECOG status (OR 1.59, 95% CI 1.18-2.16), and a more recent MTB conference (OR 1.20, 95% CI 1.03-1.41). CONCLUSION Overall, guideline adherence was high for colorectal and breast cancer and comparable to results from academic medical centers. However, results need to be confirmed in other tumor entities.
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Affiliation(s)
- Carl-Stephan Leonhardt
- Department of Surgery, Landesklinikum Baden-Moedling, Baden, Austria.
- Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
- Usher Institute, University of Edinburgh, Edinburgh, UK.
| | | | - Raphael Puehringer
- Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Ulla Klaiber
- Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Irene Hauser
- Department of Internal Medicine, Landesklinikum Baden-Moedling, Baden, Austria
| | - Oliver Strobel
- Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Gerald Prager
- Division of Oncology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
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Vierra M, Bansal VV, Morgan RB, Witmer HDD, Reddy B, Dhiman A, Godley FA, Ong CT, Belmont E, Polite B, Shergill A, Turaga KK, Eng OS. Fragmentation of Care in Patients with Peritoneal Metastases Undergoing Cytoreductive Surgery. Ann Surg Oncol 2024; 31:645-654. [PMID: 37737968 DOI: 10.1245/s10434-023-14318-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/05/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND The delivery of multimodal treatment at a high-volume center is known to optimize the outcomes of gastrointestinal malignancies. However, patients undergoing cytoreductive surgery (CRS) for peritoneal metastases often must 'fragment' their surgical and systemic therapeutic care between different institutions. We hypothesized that this adversely affects outcomes. PATIENTS AND METHODS Adults undergoing CRS for colorectal or appendiceal adenocarcinoma at our institution between 2016 and 2022 were identified retrospectively and grouped by care network: 'coordinated care' patients received exclusively in-network systemic therapy, while 'fragmented care' patients received some systemic therapy from outside-network providers. Factors associated with fragmented care were also ascertained. Overall survival (OS) from CRS and systemic therapy-related serious adverse events (SAEs) were compared across the groups. RESULTS Among 85 (80%) patients, 47 (55%) had colorectal primaries and 51 (60%) received fragmented care. Greater travel distance [OR 1.01 (CI 1.00-1.02), p = 0.02] and educational status [OR 1.04 (CI 1.01-1.07), p = 0.01] were associated with receiving fragmented care. OS was comparable between patients who received fragmented and coordinated care in the colorectal [32.5 months versus 40.8 months, HR 0.95 (CI 0.43-2.10), p = 0.89] and appendiceal [31.0 months versus 27.4 months, HR 1.17 (CI 0.37-3.74), p = 0.55] subgroups. The frequency of SAEs (7.8% versus 17.6%, p = 0.19) was also similar. CONCLUSIONS There were no significant differences in survival or SAEs based on the networks of systemic therapy delivery. This suggests that patients undergoing CRS at a high-volume center may safely receive systemic therapy at outside-network facilities with comparable outcomes.
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Affiliation(s)
- Mason Vierra
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Varun V Bansal
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Ryan B Morgan
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Hunter D D Witmer
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Biren Reddy
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Ankit Dhiman
- Department of Surgery, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Frederick A Godley
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Cecilia T Ong
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Erika Belmont
- Department of Medicine, Section of Hematology/Oncology, University of Chicago Medical Center, Chicago, IL, USA
| | - Blasé Polite
- Department of Medicine, Section of Hematology/Oncology, University of Chicago Medical Center, Chicago, IL, USA
| | - Ardaman Shergill
- Department of Medicine, Section of Hematology/Oncology, University of Chicago Medical Center, Chicago, IL, USA
| | - Kiran K Turaga
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Oliver S Eng
- Department of Surgery, University of California, Irvine, Orange, CA, USA.
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Eom SS, Park SH, Eom BW, Man Yoon H, Kim YW, Ryu KW. Real-World Compliance of Surgical Treatment According to the Korean Gastric Cancer Guideline 2018: Evaluation From the Nationwide Survey Data 2019 in Korea. J Gastric Cancer 2023; 23:535-548. [PMID: 37932221 PMCID: PMC10630559 DOI: 10.5230/jgc.2023.23.e32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 08/08/2023] [Accepted: 08/17/2023] [Indexed: 11/08/2023] Open
Abstract
PURPOSE This study evaluated real-world compliance with surgical treatment according to Korea's gastric cancer treatment guidelines. MATERIALS AND METHODS The 2018 Korean Gastric Cancer Treatment Guidelines were evaluated using the 2019 national survey data for surgically treated gastric cancer based on postoperative pathological results in Korea. In addition, the changes in surgical treatments in 2019 were compared with those in the 2014 national survey data implemented before the publication of the guidelines in 2018. The compliance rate was evaluated according to the algorithm recommended in the 2018 Korean guidelines. RESULTS The overall compliance rates in 2019 were 83% for gastric resection extent, 87% for lymph node dissection, 100% for surgical approach, and 83% for adjuvant chemotherapy, similar to 2014. Among patients with pathologic stages IB, II, and III disease who underwent total gastrectomy, the incidence of splenectomy was 8.08%, a practice not recommended by the guidelines. The survey findings revealed that 48.66% of the patients who underwent gastrectomy had pathological stage IV disease, which was not recommended by the 2019 guidelines. Compared to that in 2014, the rate of gastrectomy in stage IV patients was 54.53% in 2014. Compliance rates were similar across all regions of Korea, except for gastrectomy in patients with stage IV disease. CONCLUSIONS Real-world compliance with gastric cancer treatment guidelines was relatively high in Korea.
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Affiliation(s)
- Sang Soo Eom
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
- Department of Surgery, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea
| | - Sin Hye Park
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Bang Wool Eom
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Hong Man Yoon
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Young-Woo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Keun Won Ryu
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
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Guideline adherence and implementation of tumor board therapy recommendations for patients with gastrointestinal cancer. J Cancer Res Clin Oncol 2023; 149:1231-1240. [PMID: 35394231 PMCID: PMC9984328 DOI: 10.1007/s00432-022-03991-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/20/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Although participation in multidisciplinary tumor boards (MTBs) is an obligatory quality criterion for certification, there is scarce evidence, whether MTB recommendations are consistent with consensus guidelines and whether they are followed in clinical practice. Reasons of guideline and tumor board deviations are poorly understood so far. METHODS MTB's recommendations from the weekly MTB for gastrointestinal cancers at the University Cancer Center Leipzig/Germany (UCCL) in 2020 were analyzed for their adherence to therapy recommendations as stated in National German guidelines and implementation within an observation period of 3 months. To assess adherence, an objective classification system was developed assigning a degree of guideline and tumor board adherence to each MTB case. For cases with deviations, underlying causes and influencing factors were investigated and categorized. RESULTS 76% of MTBs were fully adherent to guidelines, with 16% showing deviations, mainly due to study inclusions and patient comorbidities. Guideline adherence in 8% of case discussions could not be determined, especially because there was no underlying guideline recommendation for the specific topic. Full implementation of the MTBs treatment recommendation occurred in 64% of all cases, while 21% showed deviations with primarily reasons of comorbidities and differing patient wishes. Significantly lower guideline and tumor board adherences were demonstrated in patients with reduced performance status (ECOG-PS ≥ 2) and for palliative intended therapy (p = 0.002/0.007). CONCLUSIONS The assessment of guideline deviations and adherence to MTB decisions by a systematic and objective quality assessment tool could become a meaningful quality criterion for cancer centers in Germany.
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Kumar P, Del Rosario M, Chang J, Ziogas A, Jafari MD, Bristow RE, Tanjasiri SP, Zell JA. Population-Based Analysis of National Comprehensive Cancer Network (NCCN) Guideline Adherence for Patients with Anal Squamous Cell Carcinoma in California. Cancers (Basel) 2023; 15:cancers15051465. [PMID: 36900256 PMCID: PMC10000877 DOI: 10.3390/cancers15051465] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 03/02/2023] Open
Abstract
PURPOSE We analyzed adherence to the National Comprehensive Cancer Network treatment guidelines for anal squamous cell carcinoma in California and the associated impacts on survival. METHODS This was a retrospective study of patients in the California Cancer Registry aged 18 to 79 years with recent diagnoses of anal squamous cell carcinoma. Predefined criteria were used to determine adherence. Adjusted odds ratios and 95% confidence intervals were estimated for those receiving adherent care. Disease-specific survival (DSS) and overall survival (OS) were examined with a Cox proportional hazards model. RESULTS 4740 patients were analyzed. Female sex was positively associated with adherent care. Medicaid status and low socioeconomic status were negatively associated with adherent care. Non-adherent care was associated with worse OS (Adjusted HR 1.87, 95% CI = 1.66, 2.12, p < 0.0001). DSS was worse in patients receiving non-adherent care (Adjusted HR 1.96, 95% CI = 1.56, 2.46, p < 0.0001). Female sex was associated with improved DSS and OS. Black race, Medicare/Medicaid, and low socioeconomic status were associated with worse OS. CONCLUSIONS Male patients, those with Medicaid insurance, or those with low socioeconomic status are less likely to receive adherent care. Adherent care was associated with improved DSS and OS in anal carcinoma patients.
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Affiliation(s)
- Priyanka Kumar
- Department of Internal Medicine, University of California, Irvine, CA 92868-3201, USA
- Correspondence: ; Tel.: +1-714-456-5691; Fax: +1-714-456-8874
| | | | - Jenny Chang
- Department of Internal Medicine, University of California, Irvine, CA 92868-3201, USA
| | - Argyrios Ziogas
- Department of Internal Medicine, University of California, Irvine, CA 92868-3201, USA
| | - Mehraneh D. Jafari
- Department of Surgery, Section of Colon and Rectal Surgery, Weill Cornell Medicine, New York, NY 10065, USA
| | - Robert E. Bristow
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine, CA 92868-3201, USA
| | - Sora Park Tanjasiri
- Department of Epidemiology & Biostatistics, University of California, Irvine, CA 92868-3201, USA
- Division of Hematology-Oncology, Department of Medicine, University of California, Irvine, CA 92868-3201, USA
| | - Jason A. Zell
- Division of Hematology-Oncology, Department of Medicine, University of California, Irvine, CA 92868-3201, USA
- Chao Family Comprehensive Cancer Center, University of California, Irvine, CA 92868-3201, USA
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Kaslow SR, Hani L, Sacks GD, Lee AY, Berman RS, Correa-Gallego C. Regional Patterns of Hospital-Level Guideline Adherence in Gastric Cancer: An Analysis of the National Cancer Database. Ann Surg Oncol 2023; 30:300-308. [PMID: 36123415 DOI: 10.1245/s10434-022-12549-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/17/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Adherence to evidence-based guidelines for gastric cancer is low, particularly at the hospital level, despite a strong association with improved overall survival (OS). We aimed to evaluate patterns of hospital and regional adherence to National Comprehensive Cancer Network guidelines for gastric cancer. METHODS Using the National Cancer Database (2004-2015), we identified patients with stage I-III gastric cancer. Hospital-level guideline adherence was calculated by dividing the patients who received guideline adherent care by the total patients treated at that hospital. OS was estimated for each hospital. Associations between adherence, region, and survival were compared using mixed-effects, hierarchical regression. RESULTS Among 576 hospitals, the median hospital guideline adherence rate was 25% (range 0-76%) and varied significantly by region (p = 0.001). Adherence was highest in the Middle Atlantic (29%) and lowest in the East South Central region (19%); hospitals in the New England, Middle Atlantic, and East North Central regions were more likely to be guideline adherent than those in the East South Central region (all p < 0.05), after adjusting for patient and hospital mix. Most (35%) of the adherence variation was attributable to the hospital. Median 2-year OS varied significantly by region. After adjusting for hospital and patient mix, hazard of mortality was 17% lower in the Middle Atlantic (hazard ratio 0.82, 95% confidence interval 0.74-0.90) relative to the East South Central region, with most of the variation (54%) attributable to patient-level factors. CONCLUSIONS Hospital-level guideline adherence for gastric cancer demonstrated significant regional variation and was associated with longer OS, suggesting that efforts to improve guideline adherence should be directed toward lower-performing hospitals.
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Affiliation(s)
- Sarah R Kaslow
- Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA.
| | - Leena Hani
- Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Greg D Sacks
- Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Ann Y Lee
- Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Russell S Berman
- Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA
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Voigt W, Trautwein M. Improved guideline adherence in oncology through clinical decision-support systems: still hindered by current health IT infrastructures? Curr Opin Oncol 2023; 35:68-77. [PMID: 36367223 DOI: 10.1097/cco.0000000000000916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE OF REVIEW Despite several efforts to enhance guideline adherence in cancer management, the rate of adherence remains often dissatisfactory in clinical routine. Clinical decision-support systems (CDSS) have been developed to support the management of cancer patients by providing evidence-based recommendations. In this review, we focus on both current evidence supporting the beneficial effects of CDSS on guideline adherence as well as technical and structural requirements for CDSS implementation in clinical routine. RECENT FINDINGS Some studies have demonstrated a significant improvement of guideline adherence by CDSSs in oncologic diseases such as breast cancer, colon cancer, cervical cancer, prostate cancer, and hepatocellular carcinoma as well as in the management of cancer pain. However, most of these studies were rather small and designs rather simple. One reason for this limited evidence might be that CDSSs are only occasionally implemented in clinical routine. The main limitations for a broader implementation might lie in the currently existing clinical data infrastructures that do not sufficiently allow CDSS interoperability as well as in some CDSS tools themselves, if handling is hampered by poor usability. SUMMARY In principle, CDSSs improve guideline adherence in clinical cancer management. However, there are some technical und structural obstacles to overcome to fully implement CDSSs in clinical routine.
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Affiliation(s)
- Wieland Voigt
- Wieland Voigt, Medical Innovations and Management, Steinbeis University Berlin, Berlin
| | - Martin Trautwein
- Martin Trautwein, Senior Medical Advisor, Cognostics GmbH, Munich, Germany
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11
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Hess E, Anandan A, Osman F, Lee-Miller C, Parkes A. Disparities in Treatment Satisfaction and Supportive Care Receipt for Young Adult Oncology Patients on the Basis of Residential Location. JCO Oncol Pract 2022; 18:e1542-e1552. [DOI: 10.1200/op.21.00818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE: Adolescent and young adult oncology programs are critical but exist primarily in academic centers, prompting potential disparities in care on the basis of patient residence. We studied the impact of residential location on supportive care receipt and treatment satisfaction in young adults (YAs) with cancer age 19-39 years treated at the University of Wisconsin Carbone Cancer Center (UWCCC). METHODS: YA patients with cancer age 19-39 years seen at UWCCC from March 30, 2019, to March 29, 2020, were sent a survey assessing supportive care receipt and satisfaction. Survey results were compared with retrospective chart review of YAs seen at UWCCC between April 1, 2011, and April 1, 2021. Data were categorized on the basis of residential location using distance from UWCCC and 2013 Rural-Urban Continuum Code (RUCC). RESULTS: Survey results were obtained for 145 YAs, including 29 from nonmetro RUCC (20.0%) and 81 living > 20 miles from UWCCC (55.9%). YAs from nonmetro locations had lower satisfaction with available treatments (79.3% v 91.4%, P = .005), and distant YAs living > 20 miles from UWCCC more frequently identified location as a barrier to supportive care receipt (35.6% v 15.8%, P = .02). Metro YAs more frequently listed fertility consultations as unavailable (38.0% v 16.0%, P = .04) in the survey despite chart review data showing higher rates of sexual health assessments (48.2% v 20.4%, P = .002) and fertility visits (29.6% v 18.5%, P = .18). CONCLUSION: We identified differences in both supportive care receipt and treatment satisfaction on the basis of residential location. These findings support the need for measures to successfully meet treatment and supportive care needs regardless of residential location.
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Affiliation(s)
- Eric Hess
- University of Wisconsin-Madison School of Medicine and Public Health Department of Medicine, Division of Hematology, Medical Oncology, and Palliative Care, Madison, WI
| | - Apoorva Anandan
- University of Wisconsin-Madison School of Medicine and Public Health Department of Medicine, Division of Hematology, Medical Oncology, and Palliative Care, Madison, WI
| | - Fauzia Osman
- University of Wisconsin-Madison School of Medicine and Public Health Department of Medicine, Division of Hematology, Medical Oncology, and Palliative Care, Madison, WI
| | - Cathy Lee-Miller
- University of Wisconsin-Madison School of Medicine and Public Health Department of Pediatrics, Division of Hematology, Oncology and Bone Marrow Transplant, Madison, WI
| | - Amanda Parkes
- University of Wisconsin-Madison School of Medicine and Public Health Department of Medicine, Division of Hematology, Medical Oncology, and Palliative Care, Madison, WI
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12
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Kaslow SR, Ma Z, Hani L, Prendergast K, Vitiello G, Lee AY, Berman RS, Goldberg JD, Correa-Gallego C. Adherence to guidelines at the patient- and hospital-levels is associated with improved overall survival in patients with gastric cancer. J Surg Oncol 2022; 126:479-489. [PMID: 35471731 PMCID: PMC9339461 DOI: 10.1002/jso.26895] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Adherence to evidence-based guidelines in gastric cancer is low. We aimed to evaluate adherence to National Comprehensive Cancer Network (NCCN) Guidelines for gastric cancer at both patient- and hospital-levels and examine associations between guideline adherence and treatment outcomes, including overall survival (OS). METHODS We applied stage-specific, annual NCCN Guidelines (2004-2015) to patients with gastric cancer treated with curative-intent within the National Cancer Database and compared characteristics of patients who did and did not receive guideline-adherent care. Hospitals were evaluated by guideline adherence rate. We identified associations with OS through multivariable Cox regression. RESULTS Of 37 659 patients included, 32% received NCCN Guideline-adherent treatment. OS was significantly associated with both guideline adherence (51 months for patients receiving guideline-adherent treatment vs. 22 for patients receiving nonadherent treatment, p < 0.001). Treatment at a hospital with higher adherence was associated with longer OS (21 months for patients treated at lowest adherence quartile hospitals vs. 37 months at highest adherence quartile hospitals, p < 0.001), regardless of type of treatment received. CONCLUSIONS Guideline-adherent treatment was strongly associated with longer median OS. Guideline adherence should be used as a benchmark for focused quality improvement for physicians taking care of patients with gastric cancer and institutions at large.
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Affiliation(s)
| | - Zhongyang Ma
- Division of Biostatistics, Departments of Population Health and Environmental Medicine, NYU Grossman School of Medicine
| | - Leena Hani
- Department of Surgery, NYU Grossman School of Medicine
| | | | | | - Ann Y Lee
- Department of Surgery, NYU Grossman School of Medicine
| | | | - Judith D Goldberg
- Division of Biostatistics, Departments of Population Health and Environmental Medicine, NYU Grossman School of Medicine
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13
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Rhodin KE, Raman V, Eckhoff A, Liu A, Creasy J, Nussbaum DP, Blazer DG. Patterns and Impact of Fragmented Care in Stage II and III Gastric Cancer. Ann Surg Oncol 2022; 29:5422-5431. [PMID: 35723791 PMCID: PMC9378672 DOI: 10.1245/s10434-022-12031-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/02/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Optimal management of stage II/III gastric cancer requires multidisciplinary care, often necessitating treatment at more than one facility. We aimed to determine patterns of "fragmented" care and its impact on outcomes, including concordance with National Comprehensive Cancer Network (NCCN) guidelines and overall survival. METHODS The 2006-2016 National Cancer Database was queried for patients with clinical stage II/III gastric adenocarcinoma who received preoperative therapy in addition to surgery. Patients were stratified based on whether surgery and chemotherapy/chemoradiation were performed at one versus multiple facilities (termed "coordinated" and "fragmented" care, respectively). Multivariable logistic regression was performed to identify factors associated with fragmented care. Survival was compared using Kaplan-Meier and Cox proportional hazards methods. RESULTS Overall, 2033 patients met study criteria: 1043 (51.3%) received coordinated care and 990 (48.7%) fragmented care. There was no significant difference in time to surgery or pathologic upstaging by care structure. On adjusted analysis, factors associated with receipt of fragmented care included increasing age and distance traveled to the treating facility. Factors associated with coordinated care included metropolitan residence and treatment at academic and high-volume centers. Fragmented care was associated with a reduction in guideline-preferred perioperative chemotherapy (odds ratio [OR] 0.78, 95% confidence interval [CI] 0.63-0.97, p = 0.02) and increased mortality (HR 1.16, 95% CI 1.00-1.34, p = 0.05). CONCLUSIONS For patients with stage II/III gastric cancer, fragmented care is associated with inferior outcomes, including a reduction in preferred perioperative treatment and survival. Further work is needed to ensure equitable outcomes among patients as complex cancer care becomes more regionalized.
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Affiliation(s)
- Kristen E Rhodin
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Vignesh Raman
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Austin Eckhoff
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Annie Liu
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Daniel P Nussbaum
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Dan G Blazer
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
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14
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Chen VW, Portuondo JI, Cooper Z, Massarweh NN. Use of Palliative Interventions at End of Life for Advanced Gastrointestinal Cancer. Ann Surg Oncol 2022; 29:7281-7292. [PMID: 35947309 DOI: 10.1245/s10434-022-12342-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/01/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Despite the well-established benefits of palliative care, little is known about the use of palliative interventions among patients with advanced gastrointestinal (GI) cancer near the end of life (EOL). METHODS A national cohort study analyzed 142,304 patients with advanced GI cancers (stage 3 or 4) near EOL (death within 1 year of diagnosis) in the National Cancer Database (2004-2014) who received palliative interventions (defined as treatment to relieve symptoms: surgery, radiation, chemotherapy, and/or pain management). The study used multivariable hierarchical regression evaluate the association between the use of palliative interventions, temporal trends, and patient and hospital factors. RESULTS Overall, 16.5% of the patients were treated with a palliative intervention, and use increased over time (13.4% in 2004 vs 19.8% in 2014; trend test, p < 0.001). Palliative interventions were used most frequently for esophageal cancer (20.6%) and least frequently for gallbladder cancer (13.3%). Palliative interventions were associated with younger age (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.98-0.99), recent diagnosis year (OR, 1.05; 95% CI, 1.04-1.06), black race (white [ref]; OR, 1.07; 95% CI, 1.01-1.12), insurance status (no insurance [ref]; private: OR, 0.92; 95% CI ,0.95-0.99), hospital type (community cancer program [ref]; integrated network cancer programs: OR, 1.37; 95% CI ,1.07-1.75), and stage 4 disease (OR, 2.17; 95% CI, 2.07-2.27). Patients in southern and western regions were less likely to receive palliative intervention (Northeast [ref]; OR, 0.76; 95% CI, 0.62-0.94 and OR 0.46; 95% CI, 0.37-0.57, respectively). CONCLUSION Increased palliative intervention use over time suggests ongoing changes in how care is delivered to GI cancer patients toward EOL. However, sociodemographic and geographic variation suggests opportunities to address barriers to optimal EOL care.
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Affiliation(s)
- Vivi W Chen
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E DeBakey VA Medical Center, Houston, TX, USA. .,Michael E. DeBakey VA Medical Center, Department of Surgery at Baylor College of Medicine, Houston, TX, USA.
| | - Jorge I Portuondo
- Michael E. DeBakey VA Medical Center, Department of Surgery at Baylor College of Medicine, Houston, TX, USA
| | - Zara Cooper
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Nader N Massarweh
- Surgical and Perioperative Service, Atlanta VA Health Care System, Decatur, GA, USA.,Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.,Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA
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15
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Schroeder MC, Gao X, Lizarraga I, Kahl AR, Charlton ME. The Impact of Commission on Cancer Accreditation Status, Hospital Rurality and Hospital Size on Quality Measure Performance Rates. Ann Surg Oncol 2022; 29:2527-2536. [PMID: 35067792 PMCID: PMC11559211 DOI: 10.1245/s10434-021-11304-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/10/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Rural cancer patients receive lower-quality care and experience worse outcomes than urban patients. Commission on Cancer (CoC) accreditation requires hospitals to monitor performance on evidence-based quality measuresPlease confirm the list of authors is correc, but the impact of accreditation is not clear due to lack of data from non-accredited facilities and confounding between patient rurality and hospital accreditation, rurality, and size. METHODS This retrospective, observational study assessed associations between rurality, accreditation, size, and performance rates for four CoC quality measures (breast radiation, breast chemotherapy, colon chemotherapy, colon nodal yield). Iowa Cancer Registry data were queried to identify all eligible patients diagnosed between 2011 and 2017. Cases were assigned to the surgery hospital to calculate performance rates. Univariate and multivariate regression models were fitted to identify patient- and hospital-level predictors and assess trends. RESULTS The study cohort included 10,381 patients; 46% were rural. Compared with urban patients, rural patients more often received treatment at small, rural, and non-accredited facilities (p < 0.001 for all). Rural hospitals had fewer beds and were far less likely to be CoC-accredited than urban hospitals (p < 0.001 for all). On multivariate analysis, CoC accreditation was the strongest, independent predictor of higher hospital performance for all quality measures evaluated (p < 0.05 in each model). Performance rates significantly improved over time only for the colon nodal yield quality measure, and only in urban hospitals. CONCLUSIONS CoC accreditation requires monitoring and evaluating performance on quality measures, which likely contributes to better performance on these measures. Efforts to support rural hospital accreditation may improve existing disparities in rural cancer treatment and outcomes.
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Affiliation(s)
- Mary C Schroeder
- Division of Health Services Research, University of Iowa College of Pharmacy, Iowa City, IA, USA.
| | - Xiang Gao
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Ingrid Lizarraga
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Amanda R Kahl
- Iowa Cancer Registry, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Mary E Charlton
- Iowa Cancer Registry, University of Iowa College of Public Health, Iowa City, IA, USA
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA
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16
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Zhang YJ, Xiang RC, Li J, Liu Y, Xie SM, An L, Li HL, Mai G. Superior pancreatic lymphadenectomy with portal vein priority via posterior common hepatic artery approach in laparoscopic radical gastrectomy. World J Clin Cases 2022; 10:1834-1842. [PMID: 35317149 PMCID: PMC8891763 DOI: 10.12998/wjcc.v10.i6.1834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/16/2021] [Accepted: 01/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND D2 lymph node dissection for advanced gastric cancer is advocated, and station 8p lymph node should be considered in selected patients, which is, however, technically difficult.
AIM To introduce a new and easy-to-perform procedure for dissection of the lymph nodes superior to the pancreas.
METHODS A series of patients who underwent laparoscopic gastrectomy for gastric cancer were retrospectively included with utilization of a new procedure for superior pancreatic lymphadenectomy (LND) with portal vein priority via the posterior common hepatic artery approach (SPLD-PPPH) based on a newly defined portal triangle. The surgical outcome of the patients, as well as the efficacy and safety of SPLD-PPPH are reported.
RESULTS A total of 51 patients were included with most of them being male (n = 34, 66.7%). According to the 8th edition of AJCC TNM staging, there were four (7.8%) patients in stage I, 13 (25.5%) in stage II, 33 (64.7%) in stage III and one (2.0%) in stage IV. The average duration for LND was about 1 h (67.7 ± 6.9 min). After surgery, four patients developed morbidities, but all were treated successfully with no perioperative mortality. Among the 51 patients included, the percentage of patients who had lymph node metastasis at station 8p was 9.8%. Of note, with a total of 14 lymph nodes harvested at station 8p, the incidence of nodal metastasis was 14.3%.
CONCLUSION About one in 10 patients with advanced gastric cancer had nodal metastasis at station 8p. The new approach of SPLD-PPPH is safe and effective for D2+ LND during laparoscopic radical gastrectomy.
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Affiliation(s)
- Yu-Jia Zhang
- Department of General Surgery, Deyang City People's Hospital, Deyang 618000, Sichuan Province, China
| | - Rong-Chao Xiang
- Department of General Surgery, Deyang City People's Hospital, Deyang 618000, Sichuan Province, China
| | - Jun Li
- Department of General Surgery, Deyang City People's Hospital, Deyang 618000, Sichuan Province, China
| | - Yong Liu
- Department of General Surgery, Deyang City People's Hospital, Deyang 618000, Sichuan Province, China
| | - Si-Ming Xie
- Department of General Surgery, Deyang City People's Hospital, Deyang 618000, Sichuan Province, China
| | - Liang An
- Department of General Surgery, Deyang City People's Hospital, Deyang 618000, Sichuan Province, China
| | - Hua-Lin Li
- Department of General Surgery, Deyang City People's Hospital, Deyang 618000, Sichuan Province, China
| | - Gang Mai
- Department of General Surgery, Deyang City People's Hospital, Deyang 618000, Sichuan Province, China
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17
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Spolverato G, Paro A, Capelli G, Dalmacy D, Poultsides GA, Fields RC, Weber SM, Votanopoulos KI, He J, Maithel SK, Pucciarelli S, Pawlik TM. Surgical treatment of gastric adenocarcinoma: Are we achieving textbook oncologic outcomes for our patients? J Surg Oncol 2021; 125:621-630. [PMID: 34964983 DOI: 10.1002/jso.26778] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/28/2021] [Accepted: 11/30/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES Composite measures are increasingly used to assess quality of care in surgical oncology. We sought to define the incidence of "textbook oncologic outcome" (TOO) following resection of gastric adenocarcinoma among a large, international cohort of patients. METHODS Gastric adenocarcinoma patients undergoing resection between 2000 and 2020 were identified from an international database. TOO was defined as margin-negative resection, examination of ≥16 lymph nodes, no prolonged length-of-stay (LOS), no 30-day mortality, and stage-appropriate receipt of chemotherapy. RESULTS Among a total of 910 patients, 321 patients (35.3%) achieved a postoperative TOO. While failure to evaluate ≥16 lymph nodes (n = 591, 65.0%) and receipt of chemotherapy (n = 651, 71.5%) had the greatest negative impact on the ability to obtain a TOO, no 30-day mortality (n = 880, 96.7%), margin-negative resection (n = 831, 91.3%), and no extended LOS (n = 706, 77.6%) were more commonly achieved. No postoperative complications (OR: 0.44; 95% CI: 0.31-0.63) and T1a/T1b-stage disease (OR: 2.87; 95% CI: 1.59-5.18) were independently associated with achieving a TOO (p < 0.05). The odds of achieving a TOO improved over time (p-trend < 0.05), which was largely attributable to improved odds of evaluating ≥16 lymph nodes (2010-2014 vs. 2000-2004: OR, 5.21; 95% CI: 3.22-8.45). CONCLUSIONS Only about one in three patients achieved a TOO following resection of gastric adenocarcinoma. Odds of TOO increased over time, largely due to improved lymph node evaluation.
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Affiliation(s)
- Gaya Spolverato
- Department of Surgical Oncological and Gastrointestinal Science, University of Padova, Padova, Italy
| | - Alessandro Paro
- Department of Surgery, The Ohio State Wexner Medical Center, Columbus, Ohio, USA
| | - Giulia Capelli
- Department of Surgical Oncological and Gastrointestinal Science, University of Padova, Padova, Italy
| | - Djhenne Dalmacy
- Department of Surgery, The Ohio State Wexner Medical Center, Columbus, Ohio, USA
| | | | - Ryan C Fields
- Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Sharon M Weber
- Division of Surgical Oncology, Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | | | - Jin He
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | | | - Salvatore Pucciarelli
- Department of Surgical Oncological and Gastrointestinal Science, University of Padova, Padova, Italy
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State Wexner Medical Center, Columbus, Ohio, USA
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18
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McKay GE, Zakas AL, Osman F, Parkes A. Factors Affecting Genetic Consultation in Adolescent and Young Adult Patients With Sarcoma. J Natl Compr Canc Netw 2021; 19:1-8. [PMID: 34666309 DOI: 10.6004/jnccn.2021.7034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/03/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Given a link between sarcomas and hereditary cancer predisposition syndromes, including Li-Fraumeni syndrome, the consideration for genetic counseling is recommended for all adolescent and young adult (AYA) patients diagnosed with sarcoma. The aim of this study was to evaluate factors influencing genetic consultations in AYA patients with sarcoma at the University of Wisconsin (UW). METHODS A retrospective chart review was performed on AYA patients diagnosed with sarcoma between the ages of 15 and 39 years who were seen at least once between 2015 to 2019 at UW. Our chart review identified discussions regarding genetics, referrals to genetics, genetic consultations, and results of genetic testing. Variables hypothesized to affect patient referrals for genetic consultation were identified a priori. Descriptive statistical methods and a univariate analysis were used to identify patient characteristics associated with genetic counseling referral. RESULTS We identified 87 AYA patients with sarcoma. Only 19 (22%) of these patients had documentation of a discussion about genetics, 15 (17%) of whom were subsequently referred for genetic consultation. Of these 15 patients, 9 (60%) were seen in consultation. All 9 patients seen by genetics underwent genetic testing, with 4 (44%) of these patients having identified heritable cancer predisposition syndromes. Likelihood for genetics referral was linked most strongly to documented genetics discussion with an oncology provider (P<.001). CONCLUSIONS Despite the recommendation for consideration for genetic counseling in AYA patients with sarcoma, <25% of such patients in our study had a documented discussion about genetics. Supporting this need, all referred patients met criteria for genetic testing, and 44% of tested patients were found to have a heritable cancer predisposition syndrome. These data support the initial conversation by a provider as critical to genetic referral and suggest the need for more specific national recommendations for the genetic evaluation of all AYA patients with sarcoma.
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Affiliation(s)
- Grace E McKay
- 1Section of Hematology/Oncology, Department of Medicine, and
| | - Anna L Zakas
- 2Section of Oncology Genetics, Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Fauzia Osman
- 1Section of Hematology/Oncology, Department of Medicine, and
| | - Amanda Parkes
- 1Section of Hematology/Oncology, Department of Medicine, and
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19
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Sędłak K, Rawicz-Pruszyński K, Mlak R, Gęca K, Skórzewska M, Pelc Z, Małecka-Massalska T, Polkowski WP. Union is strength: Textbook outcome with perioperative chemotherapy compliance decreases the risk of death in advanced gastric cancer patients. Eur J Surg Oncol 2021; 48:356-361. [PMID: 34404560 DOI: 10.1016/j.ejso.2021.08.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/08/2021] [Accepted: 08/05/2021] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Perioperative chemotherapy (POC) in advanced gastric cancer (GC) patients significantly increases the curative resection rate and overall survival (OS). Textbook outcome (TO) represents a composite of surgical quality metrics strongly associated with improved OS. However, the current definition of TO after resection for GC does not include POC. Herein we propose to supplement the current description of TO with an additional feature, POC compliance. The present study aimed to evaluate prognostic impact of thus defined textbook oncological outcome (TOO) among patients undergoing gastrectomy for advanced GC. PATIENTS AND METHODS We collected data from a prospectively maintained database of all patients operated for GC between 2010 and 2020 in our institution. Patients with histologically confirmed and resectable advanced GC but without distant metastases, in whom multimodal treatment was planned by institutional MDT were included. RESULTS A total of 194 patients were analyzed. In the multivariate analysis, patients with TOO had a 50 % lower risk of death than patients without TOO (medians: NR vs 42 months; HR = 0.50, p = 0.0109). Patients treated with POC had a 43 % lower risk of death than patients treated with only preoperative chemotherapy (medians: 78 vs 33 months; HR = 0.57, p = 0.0450). Patients with a pathological response (PR) in the primary tumor had a 59 % lower risk of death than patients without PR (medians: NR vs 36 months; HR = 0.41, p = 0.0229). POC combined with TO surgery significantly decreased the risk of death in advanced GC patients (medians: NR vs 42 months; HR = 0.35, p = 0.0258). CONCLUSION Since TOO is associated with improved survival, it may serve as a multimodal treatment quality parameter in patients with advanced GC.
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Affiliation(s)
- Katarzyna Sędłak
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080, Lublin, Poland
| | - Karol Rawicz-Pruszyński
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080, Lublin, Poland.
| | - Radosław Mlak
- Department of Human Physiology, Medical University of Lublin, Radziwiłłowska 11 St., 20-080, Lublin, Poland
| | - Katarzyna Gęca
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080, Lublin, Poland
| | - Magdalena Skórzewska
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080, Lublin, Poland
| | - Zuzanna Pelc
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080, Lublin, Poland
| | - Teresa Małecka-Massalska
- Department of Human Physiology, Medical University of Lublin, Radziwiłłowska 11 St., 20-080, Lublin, Poland
| | - Wojciech P Polkowski
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080, Lublin, Poland
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20
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Leifeld L, Denzer U, Frieling T, Jakobs R, Koop H, van Leeuwen P, Madisch A, Rosien U, Stier A, Siegmund B, Tappe U, Lammert F, Lynen Jansen P. [Quality management in the field of gastroenterology - Proposals of the Quality Commission of the German Society of Gastroenterology, Digestive and Metabolic Diseases (DGVS) for Outpatient and Inpatient Quality Assurance]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2021; 59:665-676. [PMID: 34255315 DOI: 10.1055/a-1451-6350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The quality of the medical care depends on numerous factors that can often be influenced by the doctor itself. It is a great challenge to follow the constant scientific progress in practice. Scientific standards in gastroenterology are defined in DGVS guidelines and regularly revised. The implementation of evidence-based recommendations in practice remains challenging. On the basis of the DGVS guidelines, the Quality Commission has therefore developed a selection of quality indicators with particular relevance using standardized criteria, the broad implementation of which could contribute to improved patient care in gastroenterology.
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Affiliation(s)
- Ludger Leifeld
- Klinik für Allgemeine Innere Medizin & Gastroenterologie - Medizinische Klinik III, St. Bernward Krankenhaus, Hildesheim
| | - Ulrike Denzer
- Klinik für Gastroenterologie und Endokrinologie, Universitätsklinikum Gießen und Marburg
| | - Thomas Frieling
- Medizinische Klinik II - Gastroenterologie, Helios Klinikum Krefeld
| | - Ralf Jakobs
- Medizinische Klinik C mit Schwerpunkt Gastroenterologie, Klinikum Ludwigshafen
| | - Herbert Koop
- ehem. Klinik für Innere Medizin und Gastroenterologie, Helios-Klinikum Berlin-Buch, Berlin
| | - Pia van Leeuwen
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten, Berlin
| | - Ahmed Madisch
- Klinik für Gastroenterologie, interventionelle Endoskopie und Diabetologie, Klinikum Siloah, Klinikum Region Hannover
| | - Ulrich Rosien
- Medizinische Klinik, Israelitisches Krankenhaus, Hamburg
| | - Albrecht Stier
- Klinik für Allgemein- u. Viszeralchirurgie, Helios Klinikum Erfurt
| | - Britta Siegmund
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Charité Campus Benjamin Franklin - Universitätsmedizin Berlin
| | | | | | - Petra Lynen Jansen
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten, Berlin
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21
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Lawler M, Oliver K, Gijssels S, Aapro M, Abolina A, Albreht T, Erdem S, Geissler J, Jassem J, Karjalainen S, La Vecchia C, Lievens Y, Meunier F, Morrissey M, Naredi P, Oberst S, Poortmans P, Price R, Sullivan R, Velikova G, Vrdoljak E, Wilking N, Yared W, Selby P. The European Code of Cancer Practice. J Cancer Policy 2021; 28:100282. [DOI: 10.1016/j.jcpo.2021.100282] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/19/2021] [Accepted: 03/31/2021] [Indexed: 12/11/2022]
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22
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McKay GE, Zakas AL, Osman F, Lee-Miller C, Pophali P, Parkes A. Disparities Between Provider Assessment and Documentation of Care Needs in the Care of Adolescent and Young Adult Patients With Sarcoma. JCO Oncol Pract 2021; 17:e891-e900. [PMID: 33852368 DOI: 10.1200/op.20.00938] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Given the occurrence of cancer during a complex developmental time, adolescent and young adult (AYA) patients have unique psychosocial needs that necessitate supportive care, which is optimally provided using National Comprehensive Cancer Network (NCCN) AYA guidelines. We sought to explore compliance with NCCN AYA guidelines and compare with oncology providers' perceptions of AYA care needs. METHODS Retrospective chart reviews of AYA patients (15-39 years at time of cancer diagnosis) with sarcoma seen at least once in 2019 at the University of Wisconsin identified documentation of discussions deemed critical per NCCN AYA guidelines. As per the ASCO Quality Oncology Practice Initiative certification, we considered a threshold of these factors being discussed 75% of the time or higher to be compliant. Compliance was compared with an electronic survey of University of Wisconsin oncology providers regarding AYA patient needs, with items determined to have adequate resources if noted sufficient by at least 75% of providers. RESULTS We identified 43 AYA patients with sarcoma. Less than 75% of patients had documentation of discussion of contraception, sexual health, fertility, finances, genetics, social work referral, and clinical trials indicating noncompliance with NCCN guidelines. Surveys, completed by 38 oncology providers, showed significant discordance between providers' perceptions of AYAs' access to resources and providers' documented discussions of supportive care resources. CONCLUSION Disparities between oncology provider assessment of AYA care needs and documentation of critical components of AYA patient care demonstrate the need for novel tools to evaluate AYA care needs beyond provider assessments.
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Affiliation(s)
- Grace E McKay
- Division of Hematology, Medical Oncology, and Palliative Care, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Anna L Zakas
- Division of Oncology Genetics, Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Fauzia Osman
- Division of Hematology, Medical Oncology, and Palliative Care, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Cathy Lee-Miller
- Division of Hematology, Oncology and Bone Marrow Transplant, Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Priyanka Pophali
- Division of Hematology, Medical Oncology, and Palliative Care, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Amanda Parkes
- Division of Hematology, Medical Oncology, and Palliative Care, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
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23
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Zhang D, Liu Y, Wu Q, Zheng Y, Kaweme NM, Zhang Z, Cai M, Dong Y. Pygo2 as a novel biomarker in gastric cancer for monitoring drug resistance by upregulating MDR1. J Cancer 2021; 12:2952-2959. [PMID: 33854595 PMCID: PMC8040896 DOI: 10.7150/jca.53356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 02/28/2021] [Indexed: 11/18/2022] Open
Abstract
Chemotherapy is the main therapy for gastric cancer (GC) both before and after surgery, but the emergence of multidrug resistance (MDR) often leads to disease progression and recurrence. P-glycoprotein, encoded by MDR1, is a well-known multidrug efflux transporter involved in drug resistance development. Pygo2 overexpression has been identified in several cancers. Previous studies have shown that abnormal expression of Pygo2 is related to tumorigenesis, chemoresistance, and tumor progression. In this study, to evaluate the underlying relationship between Pygo2 and MDR1 in GC, we constructed GC drug-resistant cell lines, SGC7901/cis-platinum (DDP), and collected tissue from GC patients' pre-and post-chemotherapy. We found that Pygo2 was overexpressed in GC, especially in GC drug-resistant cell lines and GC patients who underwent neoadjuvant DDP-based chemotherapy. Pygo2 overexpression may precede MDR1 and correlates with MDR1 in GC patients. Furthermore, knock-down of Pygo2 induced downregulation of MDR1 and restored SGC7901/DDP's sensitivity to DDP. Further mechanistic analysis demonstrated that Pygo2 could modulate MDR1 transcription by binding to the MDR1 promoter region and promoting MDR1 activation. The overall findings reveal that Pygo2 may be a promising biomarker for monitoring drug resistance in GC by regulating MDR1.
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Affiliation(s)
- Dongdong Zhang
- Department of Oncology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, China
| | - Yu Liu
- Department of Medical Oncology, Xiamen Key Laboratory of Antitumor Drug Transformation Research, The First Affiliated Hospital of Xiamen University, School of clinical Medicine, Fujian Medical University, Xiamen 361003, Fujian Province, P.R. China
| | - Qiuwan Wu
- Department of Medical Oncology, Xiamen Key Laboratory of Antitumor Drug Transformation Research, The First Affiliated Hospital of Xiamen University, School of clinical Medicine, Fujian Medical University, Xiamen 361003, Fujian Province, P.R. China
| | - Yahong Zheng
- Xiamen Huli District Maternal and Child Health Hospital, 361005 Xiamen, Fujian, China
| | | | - Zhiming Zhang
- Department of Medical Oncology, Xiamen Key Laboratory of Antitumor Drug Transformation Research, The First Affiliated Hospital of Xiamen University, School of clinical Medicine, Fujian Medical University, Xiamen 361003, Fujian Province, P.R. China
| | - Mingquan Cai
- Department of Medical Oncology, Xiamen Key Laboratory of Antitumor Drug Transformation Research, The First Affiliated Hospital of Xiamen University, School of clinical Medicine, Fujian Medical University, Xiamen 361003, Fujian Province, P.R. China
| | - Youhong Dong
- Department of Oncology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, China
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24
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Mallath MK. Gastric Cancer. GERIATRIC GASTROENTEROLOGY 2021:1829-1880. [DOI: 10.1007/978-3-030-30192-7_77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
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25
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Stahl KA, Olecki EJ, Dixon ME, Peng JS, Torres MB, Gusani NJ, Shen C. Gastric Cancer Treatments and Survival Trends in the United States. ACTA ACUST UNITED AC 2020; 28:138-151. [PMID: 33704182 PMCID: PMC7816178 DOI: 10.3390/curroncol28010017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/19/2020] [Accepted: 12/21/2020] [Indexed: 02/06/2023]
Abstract
Gastric cancer is the third most common cause of cancer deaths worldwide. Despite evidence-based recommendation for treatment, the current treatment patterns for all stages of gastric cancer remain largely unexplored. This study investigates trends in the treatments and survival of gastric cancer. The National Cancer Database was used to identify gastric adenocarcinoma patients from 2004-2016. Chi-square tests were used to examine subgroup differences between disease stages: Stage I, II/III and IV. Multivariate analyses identified factors associated with the receipt of guideline concordant care. The Kaplan-Meier method was used to assess three-year overall survival. The final cohort included 108,150 patients: 23,584 Stage I, 40,216 Stage II/III, and 44,350 Stage IV. Stage specific guideline concordant care was received in only 73% of patients with Stage I disease and 51% of patients with Stage II/III disease. Patients who received guideline consistent care had significantly improved survival compared to those who did not. Overall, we found only moderate improvement in guideline adherence and three-year overall survival during the 13-year study time period. This study showed underutilization of stage specific guideline concordant care for stage I and II/III disease.
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Affiliation(s)
- Kelly A. Stahl
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA 17036, USA; (K.A.S.); (E.J.O.); (M.E.D.); (J.S.P.); (M.B.T.); (N.J.G.)
| | - Elizabeth J. Olecki
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA 17036, USA; (K.A.S.); (E.J.O.); (M.E.D.); (J.S.P.); (M.B.T.); (N.J.G.)
| | - Matthew E. Dixon
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA 17036, USA; (K.A.S.); (E.J.O.); (M.E.D.); (J.S.P.); (M.B.T.); (N.J.G.)
| | - June S. Peng
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA 17036, USA; (K.A.S.); (E.J.O.); (M.E.D.); (J.S.P.); (M.B.T.); (N.J.G.)
| | - Madeline B. Torres
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA 17036, USA; (K.A.S.); (E.J.O.); (M.E.D.); (J.S.P.); (M.B.T.); (N.J.G.)
| | - Niraj J. Gusani
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA 17036, USA; (K.A.S.); (E.J.O.); (M.E.D.); (J.S.P.); (M.B.T.); (N.J.G.)
| | - Chan Shen
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA 17036, USA; (K.A.S.); (E.J.O.); (M.E.D.); (J.S.P.); (M.B.T.); (N.J.G.)
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA 17036, USA
- Correspondence: ; Tel.: +1-717-531-4494
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26
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Polkowski WP, Sędłak K, Rawicz-Pruszyński K. Treatment of Gastric Cancer Patients During COVID-19 Pandemic: The West is More Vulnerable. Cancer Manag Res 2020; 12:6467-6476. [PMID: 32801886 PMCID: PMC7402851 DOI: 10.2147/cmar.s260842] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 06/28/2020] [Indexed: 12/24/2022] Open
Abstract
The outbreak of the COVID-19 is currently the biggest international concern. Treatment of gastric cancer (GC) patients in the pandemic era with high hospital burden and under severe oncological/surgical resource constraints should implicate a need for resource re-allocation with a new "pandemic" GC treatment algorithm. The neoadjuvant/perioperative (radio-)chemotherapy is applied in the majority of advanced GC cases with poor postoperative therapy compliance. In the East, radical surgery is frequently used in the first instance, with adjuvant chemotherapy reserved for patients with a high risk of recurrence. Moreover, the elderly population might be effectively treated by surgery alone, thus saving oncological resources for younger people who need a more aggressive approach. In this framework, prioritization is a key concept based on the severity of symptoms and the need for urgent (surgical) intervention. High-risk and marginally effective surgery should be replaced with definitive radio- and/or chemotherapy. The pandemic framework to provide optimal care for GC patients must be based on multidisciplinary decision-making and include all anti-cancer treatment options: surgery, systemic therapy, and radiotherapy. The priority and staffing dictate adherence to the new algorithm. We believe that these priorities may improve the delivery of care to all, including elderly GC patients.
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Affiliation(s)
| | - Katarzyna Sędłak
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
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27
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Pluchino LA, D'Amico TA. National Comprehensive Cancer Network Guidelines: Who Makes Them? What Are They? Why Are They Important? Ann Thorac Surg 2020; 110:1789-1795. [PMID: 32298647 DOI: 10.1016/j.athoracsur.2020.03.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/08/2020] [Indexed: 11/29/2022]
Abstract
The National Comprehensive Cancer Network (NCCN) is a not-for-profit alliance of 28 leading cancer centers dedicated to improving and facilitating quality, effective, efficient, and accessible cancer care so that patients can live better lives. The NCCN offers a number of programs and resources to give clinicians access to tools and knowledge that can help guide decision making in the management of cancer, including the flagship product, the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines). The NCCN Guidelines provide evidence-based, consensus-driven guidance for cancer management to ensure that all patients receive preventive, diagnostic, therapeutic, and supportive services that are most likely to lead to optimal outcomes. They are intended to assist all individuals who impact decision making in cancer care, including physicians, nurses, pharmacists, payers, patients and their families, and many others. The development of the NCCN Guidelines is an ongoing and iterative process based on a critical review of the best available evidence and the consensus recommendations made by a multidisciplinary panel of oncology experts. The NCCN Guidelines are the most detailed and frequently updated clinical practice guidelines available in any area of medicine and are the recognized standard for cancer care throughout the world. NCCN Guidelines are used by clinicians, payers, and other health care decision makers around the world to ensure delivery of high-quality, accessible, patient-centered care aimed at optimizing patient outcomes.
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Affiliation(s)
- Lenora A Pluchino
- Clinical Information Operations, National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania
| | - Thomas A D'Amico
- Division of Thoracic Surgery, Duke Cancer Institute, Durham, North Carolina.
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