Assessment of Time-to-Treatment Initiation and Survival in a Cohort of Patients With Common Cancers

Cone, Eugene B.; Marchese, Maya; Paciotti, Marco; Nguyen, David‐Dan; Nabi, Junaid; Cole, Alexander P.; Molina, George; Molina, Rose L.; Minami, Christina A.; Mucci, Lorelei A.; Kibel, Adam S.; Trinh, Quoc‐Dien

doi:10.1001/jamanetworkopen.2020.30072

Cited by 129 publications

(123 citation statements)

References 45 publications

Supporting

Mentioning

115

Contrasting

Unclassified

Order By: Relevance

“… 27 Finally, a study found a significant association between delays in treatment initiation and 5‐year mortality for the four most common types of cancer in the USA. 28 The drop in cancer care delivery highlighted by our study will likely have similar implications for cancer patients in our network. Quantifying the effect of care delays will be important for better systemwide resource allocation and planning.…”

Section: Discussionmentioning

confidence: 72%

See 1 more Smart Citation

Trends in cancer imaging by indication, care setting, and hospital type during the COVID‐19 pandemic and recovery at four hospitals in Massachusetts

Zattra

Fraga

et al. 2021

Cancer Medicine

View full text Add to dashboard Cite

Background We aimed to investigate the effects of COVID‐19 on computed tomography (CT) imaging of cancer. Methods Cancer‐related CTs performed at one academic hospital and three affiliated community hospitals in Massachusetts were retrospectively analyzed. Three periods of 2020 were considered as follows: pre‐COVID‐19 (1/5/20–3/14/20), COVID‐19 peak (3/15/20–5/2/20), and post‐COVID‐19 peak (5/3/20–11/14/20). 15 March 2020 was the day a state of emergency was declared in MA; 3 May 2020 was the day our hospitals resumed to non‐urgent imaging. The volumes were assessed by (1) Imaging indication: cancer screening, initial workup, active cancer, and surveillance; (2) Care setting: outpatient and inpatient, ED; (3) Hospital type: quaternary academic center (QAC), university‐affiliated community hospital (UACH), and sole community hospitals (SCHs). Results During the COVID‐19 peak, a significant drop in CT volumes was observed (−42.2%, p < 0.0001), with cancer screening, initial workup, active cancer, and cancer surveillance declining by 81.7%, 54.8%, 30.7%, and 44.7%, respectively ( p < 0.0001). In the post‐COVID‐19 peak period, cancer screening and initial workup CTs did not recover (−11.7%, p = 0.037; −20.0%, p = 0.031), especially in the outpatient setting. CT volumes for active cancer recovered, but inconsistently across hospital types: the QAC experienced a 9.4% decline ( p = 0.022) and the UACH a 41.5% increase ( p < 0.001). Outpatient CTs recovered after the COVID‐19 peak, but with a shift in utilization away from the QAC (−8.7%, p = 0.020) toward the UACH (+13.3%, p = 0.013). Inpatient and ED‐based oncologic CTs increased post‐peak (+20.0%, p = 0.004 and +33.2%, p = 0.009, respectively). Conclusions Cancer imaging was severely impacted during the COVID‐19 pandemic. CTs for cancer screening and initial workup did not recover to pre‐COVID‐19 levels well into 2020, a finding that suggests more patients with advanced cancers may present in the future. A redistribution of imaging utilization away from the QAC and outpatient settings, toward the community hospitals and inpatient setting/ED was observed.

show abstract

Section: Discussionmentioning

confidence: 72%

“…A UK‐based analysis estimated increases in death rates by 4%–16% as a result of diagnostic delays, corresponding to more than 3000 excess deaths in 5 years 27 . Finally, a study found a significant association between delays in treatment initiation and 5‐year mortality for the four most common types of cancer in the USA 28 …”

Section: Discussionmentioning

confidence: 99%

Trends in cancer imaging by indication, care setting, and hospital type during the COVID‐19 pandemic and recovery at four hospitals in Massachusetts

Zattra

Fraga

et al. 2021

Cancer Medicine

View full text Add to dashboard Cite

show abstract

“…Data from Johns Hopkins also suggest that a moderate delay may not matter in the long run, even for men with high‐risk disease 48 . In contrast, some registry data suggest that delays of 3 months or more may be associated with worsened survival in intermediate prostate cancer 49 . We explored this by increasing the definition of definitive treatment to 180 days in our sensitivity analysis.…”

Section: Discussionmentioning

confidence: 99%

Racial differences in the treatment and outcomes for prostate cancer in Massachusetts

Cole

Herzog

Iyer

et al. 2021

Cancer

Self Cite

View full text Add to dashboard Cite

Background Massachusetts is a northeastern state with universally mandated health insurance since 2006. Although Black men have generally worse prostate cancer outcomes, emerging data suggest that they may experience equivalent outcomes within a fully insured system. In this setting, the authors analyzed treatments and outcomes of non‐Hispanic White and Black men in Massachusetts. Methods White and Black men who were 20 years old or older and had been diagnosed with localized intermediate‐ or high‐risk nonmetastatic prostate cancer in 2004‐2015 were identified in the Massachusetts Cancer Registry. Adjusted logistic regression models were used to assess predictors of definitive therapy. Adjusted and unadjusted survival models compared cancer‐specific mortality. Interaction terms were then used to assess whether the effect of race varied between counties. Results A total of 20,856 men were identified. Of these, 19,287 (92.5%) were White. There were significant county‐level differences in the odds of receiving definitive therapy and survival. Survival was worse for those with high‐risk cancer (adjusted hazard ratio [HR], 1.50; 95% CI, 1.4‐1.60) and those with public insurance (adjusted HR for Medicaid, 1.69; 95% CI, 1.38‐2.07; adjusted HR for Medicare, 1.2; 95% CI, 1.14‐1.35). Black men were less likely to receive definitive therapy (adjusted odds ratio, 0.78; 95% CI, 0.74‐0.83) but had a 17% lower cancer‐specific mortality (adjusted HR, 0.83; 95% CI, 0.7‐0.99). Conclusions Despite lower odds of definitive treatment, Black men experience decreased cancer‐specific mortality in comparison with White men in Massachusetts. These data support the growing body of research showing that Black men may achieve outcomes equivalent to or even better than those of White men within the context of a well‐insured population. Lay Summary There is a growing body of evidence showing that the excess risk of death among Black men with prostate cancer may be caused by disparities in access to care, with few or no disparities seen in universally insured health systems such as the Veterans Affairs and US Military Health System. Therefore, the authors sought to assess racial disparities in prostate cancer in Massachusetts, which was the earliest US state to mandate universal insurance coverage (in 2006). Despite lower odds of definitive treatment, Black men with prostate cancer experience reduced cancer‐specific mortality in comparison with White men in Massachusetts. These data support the growing body of research showing that Black men may achieve outcomes equivalent to or even better than those of White men within the context of a well‐insured population.

show abstract

“…Using currently available data 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , the AGO has evaluated the following procedures to reduce false negative rates during the surgical staging of cases who are pN+ CNB before NACT and ycN0 after NACT with AGO + ( Fig. 1 ):…”

Section: Surgical Management Of the Axilla After Neoadjuvant Chemotherapymentioning

confidence: 99%

AGO Recommendations for the Surgical Therapy of the Axilla After Neoadjuvant Chemotherapy: 2021 Update

Friedrich

Kühn

Janni

et al. 2021

Geburtshilfe Frauenheilkd

View full text Add to dashboard Cite

For many decades, the standard procedure to treat breast cancer included complete dissection of the axillary lymph nodes. The aim was to determine histological node status, which was then used as the basis for adjuvant therapy, and to ensure locoregional tumour control. In addition to the debate on how to optimise the therapeutic strategies of systemic treatment and radiotherapy, the current discussion focuses on improving surgical procedures to treat breast cancer. As neoadjuvant chemotherapy is becoming increasingly important, the surgical procedures used to treat breast cancer, whether they are breast surgery or axillary dissection, are changing. Based on the currently available data, carrying out SLNE prior to neoadjuvant chemotherapy is not recommended. In contrast, surgical axillary management after neoadjuvant chemotherapy is considered the procedure of choice for axillary staging and can range from SLNE to TAD and ALND. To reduce the rate of false negatives during surgical staging of the axilla in pN+CNB stage before NACT and ycN0 after NACT, targeted axillary dissection (TAD), the removal of > 2 SLNs (SLNE, no untargeted axillary sampling), immunohistochemistry to detect isolated tumour cells and micro-metastases, and marking positive lymph nodes before NACT should be the standard approach. This most recent update on surgical axillary management describes the significance of isolated tumour cells and micro-metastasis after neoadjuvant chemotherapy and the clinical consequences of low volume residual disease diagnosed using SLNE and TAD and provides an overview of this yearʼs AGO recommendations for surgical management of the axilla during primary surgery and in relation to neoadjuvant chemotherapy.

show abstract

Assessment of Time-to-Treatment Initiation and Survival in a Cohort of Patients With Common Cancers

Cited by 129 publications

References 45 publications

Trends in cancer imaging by indication, care setting, and hospital type during the COVID‐19 pandemic and recovery at four hospitals in Massachusetts

Trends in cancer imaging by indication, care setting, and hospital type during the COVID‐19 pandemic and recovery at four hospitals in Massachusetts

Racial differences in the treatment and outcomes for prostate cancer in Massachusetts

AGO Recommendations for the Surgical Therapy of the Axilla After Neoadjuvant Chemotherapy: 2021 Update

Contact Info

Product

Resources

About