Purpose The purpose of this study was to determine the association of insurance status with disease stage at presentation, treatment, and survival among the top 10 most deadly cancers using the SEER database. Patients and Methods A total of 473,722 patients age 18 to 64 years who were diagnosed with one of the 10 most deadly cancers in the SEER database from 2007 to 2010 were analyzed. A Cox proportional hazards model was used for multivariable analyses to assess the effect of patient and tumor characteristics on cause-specific death. Results Overall, patients with non-Medicaid insurance were less likely to present with distant disease (16.9%) than those with Medicaid coverage (29.1%) or without insurance coverage (34.7%; P < .001). Patients with non-Medicaid insurance were more likely to receive cancer-directed surgery and/or radiation therapy (79.6%) compared with those with Medicaid coverage (67.9%) or without insurance coverage (62.1%; P < .001). In a Cox regression that adjusted for age, race, sex, marital status, residence, percent of county below federal poverty level, site, stage, and receipt of cancer-directed surgery and/or radiation therapy, patients were more likely to die as a result of their disease if they had Medicaid coverage (hazard ratio [HR], 1.44; 95% CI, 1.41 to 1.47; P < .001) or no insurance (HR, 1.47; 95% CI, 1.42 to 1.51; P < .001) compared with non-Medicaid insurance. Conclusion Among patients with the 10 most deadly cancers, those with Medicaid coverage or without insurance were more likely to present with advanced disease, were less likely to receive cancer-directed surgery and/or radiation therapy, and experienced worse survival.

Background To retrospectively evaluate outcomes in patients with cutaneous angiosarcoma of the face/scalp treated curatively with surgery, radiation therapy (RT), or a combination of surgery and RT. Methods 70 patients with non-metastatic angiosarcoma underwent surgery, RT, or combined-modality therapy. Of these, 20 (29%) were treated with surgery alone, 27 (39%) with RT alone, and 23 (33%) with combined-modality therapy. 44 patients received chemotherapy, either neo-adjuvantly or adjuvantly or both. Results Median follow-up was 2.1 years. The overall survival (OS) rate was 43% at 5 years, and disease specific survival was 46% at 5 years. Tumor size > 5 cm and satellitosis were prognostic for inferior OS and DSS. Combined-modality therapy (vs. surgery alone or RT alone) was associated with improved OS, DSS, and local control (LC). Conclusion Primary local therapy with combined-modality therapy was associated with improved LC, OS, and DSS for patients with angiosarcoma of the face/scalp.

Increased travel burden was associated with a decreased likelihood of receiving adjuvant chemotherapy, regardless of insurance status. Patients with nonprivate insurance who resided in low-density oncologist areas were less likely to receive adjuvant chemotherapy. If these findings are validated prospectively, interventions to decrease geographic barriers may improve the timeliness and quality of colon cancer treatment.

Background Radiation-associated angiosarcoma (RAAS) is a devastating disease occasionally observed in breast cancer patients treated with radiation. Due to its rarity, our knowledge—of disease risk factors, epidemiology, treatment, and outcome—is extremely limited. Therefore, we sought to identify clinicopathologic factors associated with local and distant recurrence, and disease-specific survival (DSS). Methods Radiation-associated angiosarcoma was defined as pathologically confirmed breast or chest wall angiosarcoma arising within a previously irradiated field. A comprehensive search of our institutional tumor registry (1/1/93 through 2/28/11) was used to identify patients (n=95 females); patient, original tumor, RAAS treatment, and outcome variables were retrospectively retrieved and assembled into a database. Results The median follow-up for all RAAS patients was 10.3 years (range, 2.4 – 31.8 years). The latency period following radiation exposure ranged from 1.4 to 26 years (median = 7 years). One- and five-year DSS rates were 93.5% and 62.6%, respectively. Reduced risk of local recurrence was observed in patients who received chemotherapy (P = 0.0003). In multivariable analysis, size was found to be an independent predictor of adverse outcome (P = 0.015). Discussion Our study demonstrates that RAAS exhibits high recurrence rates. It also highlights the need for well-designed multicenter clinical trials to inform the true utility of chemotherapy in this disease.