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Honeycutt, Sally; Green, Rhonda; Ballard, Denise; Hermstad, April; Brueder, Alex; Haardörfer, Regine; Yam, Jennifer; Arriola, Kimberly J.
doi: 10.1002/cncr.28033pmid: 23719894
BACKGROUND Colorectal cancer (CRC) is a leading cause of cancer death in the United States. Early detection through recommended screening has been shown to have favorable treatment outcomes, yet screening rates among the medically underserved and uninsured are low, particularly for rural and minority populations. This study evaluated the effectiveness of a patient navigation program that addresses individual and systemic barriers to CRC screening for patients at rural, federally qualified community health centers. METHODS This quasiexperimental evaluation compared low‐income patients at average risk for CRC (n = 809) from 4 intervention clinics and 9 comparison clinics. We abstracted medical chart data on patient demographics, CRC history and risk factors, and CRC screening referrals and examinations. Outcomes of interest were colonoscopy referral and examination during the study period and being compliant with recommended screening guidelines at the end of the study period. We conducted multilevel logistic analyses to evaluate the program's effectiveness. RESULTS Patients at intervention clinics were significantly more likely than patients at comparison clinics to undergo colonoscopy screening (35% versus 7%, odds ratio = 7.9, P < .01) and be guideline‐compliant on at least one CRC screening test (43% versus 11%, odds ratio = 5.9, P < .001). CONCLUSIONS Patient navigation, delivered through the Community Cancer Screening Program, can be an effective approach to ensure that lifesaving, preventive health screenings are provided to low‐income adults in a rural setting. Cancer 2013;119:3059—3066. © 2013 American Cancer Society.
Deal, Allison M.; Milowsky, Matthew I.
doi: 10.1002/cncr.28176pmid: 23719784
Two reports in this issue describe a nomogram for predicting survival and a landmark analysis demonstrating the relation between 6‐month and 9‐month progression‐free status and overall survival in patients with metastatic urothelial cancer. These 2 important tools will be used to improve future clinical trial design in patients with advanced urothelial cancer.
Golan, Talia; Urban, Damien; Berger, Raanan; Lawrence, Yaacov Richard
doi: 10.1002/cncr.28143pmid: 23720150
BACKGROUND Over the past 2 decades, significant progress has been made in the field of metastatic colorectal cancer (mCRC) regarding new imaging techniques, surgical interventions, and systemic therapy. It is not known whether the benefit from these interventions has extended overall survival (OS) within the general mCRC population. A population‐based survival analysis of newly diagnosed patients who presented with mCRC was therefore performed. METHODS Survival statistics were extracted from the Surveillance, Epidemiology, and End Results (SEER) database for patients diagnosed with mCRC between 1988 and 2008. Demographic variables collected included age, race, and tumor grade. Survival was analyzed using the Kaplan‐Meier method and extended Cox proportional hazard model as appropriate. RESULTS The study population consisted of 42,347 patients diagnosed with mCRC between 1988 and 2008 (52% women; mean age, 67 years). The 1‐ and 2‐year estimated OS rates were 44% and 22%, respectively. Prognostic variables included race, sex, age, tumor location, and year of diagnosis. Median OS improved from 8 months to 14 months between 1988 and 2008. Significant improvements in OS were seen for all disease sites, but especially for descending colon cancers. Whereas the median OS increased by 13 months in patients ≤50 years of age and by 7 months in patients 51‐70 years of age, the median OS of patients >70 years of age increased by only 1 month between 1988 and 2008. CONCLUSIONS There has been a continuous improvement in OS of patients diagnosed with mCRC between 1988 and 2008, especially for left‐sided tumors. Little improvement has been seen in patients over 70 years of age. Cancer 2013;119:3084—3091. © 2013 American Cancer Society.
Apisarnthanarax, Smith; Swisher‐McClure, Samuel; Chiu, Wing K.; Kimple, Randall J.; Harris, Stephen L.; Morris, David E.; Tepper, Joel E.
doi: 10.1002/cncr.28149pmid: 23674290
BACKGROUND Randomized controlled trials (RCTs) are commonly used to inform clinical practice; however, it is unclear how generalizable RCT data are to patients in routine clinical practice. The authors of this report assessed the availability and applicability of randomized evidence guiding medical decisions in a cohort of patients who were evaluated for consideration of definitive management in a radiation oncology clinic. METHODS The medical records of consecutive, new patient consultations between January and March 2007 were reviewed. Patient medical decisions were classified as those with (Group 1) or without (Group 2) available, relevant level I evidence (phase 3 RCT) supporting recommended treatments. Group 1 medical decisions were further divided into 3 groups based on the extent of fulfilling eligibility criteria for each RCT: Group 1A included decisions that fulfilled all eligibility criteria; Group 1B, decisions that did not fulfill at least 1 minor eligibility criteria; or Group 1C, decisions that did not fulfill at least 1 major eligibility criteria. Patient and clinical characteristics were tested for correlations with the availability of evidence. RESULTS Of the 393 evaluable patients, malignancies of the breast (30%), head and neck (18%), and genitourinary system (14%) were the most common presenting primary disease sites. Forty‐seven percent of all medical decisions (n = 451) were made without available (36%) or applicable (11%) randomized evidence to inform clinical decision making. Primary tumor diagnosis was significantly associated with the availability of evidence (P < .0001). CONCLUSIONS A significant proportion of medical decisions in an academic radiation oncology clinic were made without available or applicable level I evidence, underscoring the limitations of relying solely on RCTs for the development of evidence‐based health care. Cancer 2013;119:3092—3099. © 2013 American Cancer Society.
Nakabayashi, Mari; Hayes, Julia; Taplin, Mary‐Ellen; Lefebvre, Patrick; Lafeuille, Marie‐Helene; Pomerantz, Mark; Sweeney, Christopher; Duh, Mei Sheng; Kantoff, Philip W.
doi: 10.1002/cncr.28102pmid: 23719969
BACKGROUND This study sought to characterize Modern patients with castration‐resistant prostate cancer (CRPC) and identify pretreatment clinical predictors of survival. METHODS A cohort of men with CRPC with and without metastases (M) treated with secondary hormonal therapy (2eHT) and/or chemotherapy (CT) was identified from the authors' institutional database. Associations of patient and disease characteristics at diagnosis, at androgen‐deprivation therapy (ADT) initiation, at CRPC index date, and survival were evaluated. CRPC index date was defined as the start date of either 2eHT or CT, whichever came first. RESULTS In the cohort of 622 men, 434 men (70%) had M‐positive disease; 552 men (89%) received 2eHT and 70 men (11%) received CT as their initial CRPC treatment. There were 410 deaths (66%) at the time of analysis. Median overall survival (OS) was 35 months (quartile 1, quartile 3: 21 months, 61 months). In multivariate analyses, higher biopsy Gleason score, the presence of M at ADT initiation, shorter time from ADT start to CRPC, higher prostate‐specific antigen and poorer Eastern Cooperative Oncology Group performance status at CRPC and M at CRPC were predictive of shorter OS. Interestingly, whereas some men with biopsy Gleason scores of 6 died of their disease (N = 42), they had a longer OS after CRPC compared with those with a Gleason score ≥ 7. CONCLUSIONS This large retrospective study of patients with CRPC in a tertiary cancer center shows that biopsy Gleason score of 6 is associated with a less aggressive CRPC course, and the impact that M at ADT initiation and CRPC have on outcome is quantified. Cancer 2013;119:2990—2998. © 2013 American Cancer Society.
Fisher, Kate J.; Lee, Ji‐Hyun; Ferrante, Jeanne M.; McCarthy, Ellen P.; Gonzalez, Eduardo C.; Chen, Ren; Love‐Jackson, Kymia; Roetzheim, Richard G.
doi: 10.1002/cncr.28148pmid: 23677482
BACKGROUND Primary care physician (PCP) services may have an impact on breast cancer mortality and incidence, possibly through greater use of screening mammography. METHODS The authors conducted a retrospective, 1:1 matching case‐control study using the Surveillance, Epidemiology, and End Results (SEER)‐Medicare–linked database to examine use of PCP services and their association with breast cancer mortality and incidence. SEER cases representing the 3 outcomes of interest (breast cancer mortality, all‐cause mortality among women diagnosed with breast cancer, and breast cancer incidence) were matched to unaffected controls from the 5% Medicare random sample. Conditional logistic regression was used to examine associations between physician visits and breast cancer outcomes while controlling for other covariates. RESULTS Women who had 2 or more PCP visits during the 24‐month assessment interval had lower odds of breast cancer mortality, all‐cause mortality, and late‐stage breast cancer diagnosis compared with women who had no PCP visits or 1 PCP visit while adjusting for other covariates, including mammography and non‐PCP visits. Women who had 5 to 10 PCP visits had 0.69 times the odds of breast cancer mortality (95% confidence interval, 0.63‐0.75), 0.83 times the odds of death from any cause having been diagnosed with breast cancer (95% confidence interval, 0.79‐0.87), and 0.67 times the odds of a late‐stage breast cancer diagnosis (95% confidence interval, 0.61‐0.73) compared with those who had no PCP visits or 1 PCP visit. CONCLUSIONS The current findings suggest that PCPs play an important role in reducing breast cancer mortality among the Medicare population. Further research is needed to better understand the impact of primary care on breast cancer and other cancers that are amendable to prevention or early detection. Cancer 2013;119:2964‐72. © 2013 American Cancer Society.
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