Referral to Medical Oncology: A Crucial Step in the Treatment of Older Patients with Stage III Colon Cancer

Luo, Rui; Giordano, Sharon H.; Freeman, Jean L.; Zhang, Dong; Goodwin, James S.

doi:10.1634/theoncologist.11-9-1025

Cited by 80 publications

(75 citation statements)

References 40 publications

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“…Few studies have quantified the percentage of patients with stage III colon adenocarcinoma who had a consultation with an oncologist. However, 1 large study conducted in the United States that included patients who were insured under Medicare (patients aged 65 years) indicated that 78% of patients with stage III colon adenocarcinoma had a consultation with a medical oncologist within 6 months of their diagnosis, 22 consistent with our finding of 80%. In that study, factors that were related to consulting with an oncologist included age, race, sex, marital status, year of diagnosis (1992-1999), region of residence, tumor grade, number of positive lymph nodes, comorbidities, and poverty level, 22 similar to our current findings.…”

Section: Discussionsupporting

confidence: 87%

Characteristics of patients with stage III colon adenocarcinoma who fail to receive guideline‐recommended treatment

PhD

Hossain

Yasui

et al. 2010

Cancer

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BACKGROUND: Many patients with stage III colon adenocarcinoma do not receive adjuvant chemotherapy despite the proven survival advantage it offers. To enhance the provision of optimal cancer care, patient characteristics associated with not receiving guideline-adherent treatment must be identified among patients with operable, stage III colon adenocarcinoma. METHODS: This was a population-based, retrospective study of all patients who underwent surgery for stage III colon adenocarcinoma diagnosed from 2002 through 2005 in Alberta, Canada. Demographic and treatment information captured in the Alberta Cancer Registry were linked to: 1) hospital discharge data to determine comorbidities, 2) electronic medical records to identify consults with oncologists, and 3) the 2001 Canadian census for neighborhood-level socioeconomic data. Multivariate log-binomial regression models were used to identify patient characteristics that were associated with not having a consultation with a medical oncologist and not receiving adjuvant chemotherapy. RESULTS: Of the 772 patients who underwent surgery for stage III colon adenocarcinoma and met the eligibility criteria, 618 patients (80%) had a consultation with an oncologist. Of those, 388 patients (63%) initiated adjuvant chemotherapy within 84 days of their surgery. Patient characteristics that were associated with not having a consultation with an oncologist were neighborhood income, geography, age, and comorbidities. Of those patients who had a consultation, after adjusting for comorbidities, only older age was related to not receiving adjuvant chemotherapy. CONCLUSIONS: The current results indicated that the proportion of patients with stage III colon adenocarcinoma who did not receive treatment according to evidence-based guidelines was appreciable. The authors concluded that the association of this failure with patient age, geography, and income is concerning and that evaluation of referral patterns and interventions are needed. Cancer 2010;116:4849-56.

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Section: Discussionsupporting

confidence: 87%

Characteristics of patients with stage III colon adenocarcinoma who fail to receive guideline‐recommended treatment

PhD

Hossain

Yasui

et al. 2010

Cancer

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“…13,20,24 Uneven geographic distribution of medical oncologists was also shown in this study. Nearly one tenth of patients in this study lived in HSAs without medical oncologists, whereas approximately 65% of patients lived in HSAs with Ն nine medical oncologists.…”

Section: Discussionsupporting

confidence: 72%

“…1,5 However, a significant proportion of patients do not receive chemotherapy. [6][7][8][9][10][11][12] Patients who are older, 7,8,10,13 female, 8,14 African American, 9,12,13 and not currently married 9,13 and who live in poverty areas 15 are less likely to receive chemotherapy after colectomy. Being seen by a medical oncologist has also been shown to predict chemotherapy receipt.…”

Section: Introductionmentioning

confidence: 99%

“…9,13,16,17 Studies have shown that patients who saw a medical oncologist were significantly more likely to receive chemotherapy. 13,17,18 Even though an American Society of Clinical Oncology (ASCO) study of the oncologist workforce 19 found that supply and demand were balanced in the past decade, nearly one third of patients with stage III colon cancer still did not see a medical oncologist. 20 In addition, uneven geographic distribution of medical oncologists may decrease the likelihood of accessing cancer care.…”

Section: Introductionmentioning

confidence: 99%

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Association Between the Availability of Medical Oncologists and Initiation of Chemotherapy for Patients With Stage III Colon Cancer

Lin

Virgo²

2013

JOP

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Purpose: Although the number of medical oncologists (MOs) has steadily increased over time, and adjuvant chemotherapy provides significant survival benefit for patients with stage III colon cancer, many patients still do not receive chemotherapy. Uneven geographic distribution of MOs may contribute to decreasing access to cancer care. This study explored the association of MO availability by hospital service area (HSA) of patient residence and access to chemotherapy treatment. Methods:Using the linked SEER-Medicare database, the study identified 9,262 patients who were age Ն66 years and underwent colectomy for stage III colon cancer diagnosed from 2000 to 2005. MOs were identified by physician specialty codes. HSAs are geographic areas that are relatively self-contained with respect to routine hospital care. Multivariate logistic regression was used to investigate the association between MO availability by HSA of patient residence and initiation of chemotherapy.

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“…This is in agreement with other studies, which demonstrated that the decision to get a medical oncology referral is a key step in the eventual receipt of chemotherapy. [37][38][39] From 1992 to 2002, the combination of chemotherapeutic agents also changed. Our results suggest that carboplatin and paclitaxel came into wide use as agents for patients with NSCLC in the U.S.…”

mentioning

confidence: 99%

Temporal trends and predictors of perioperative chemotherapy use in elderly patients with resected nonsmall cell lung cancer

Wang

Kuo

Freeman

et al. 2007

Cancer

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Objectives: This study reports on mid‐term safety and performance of valve‐in‐valve implantation as rescue strategy to overcome acute PPL after TAVI. Background. Moderate to severe para‐prosthetic leaks (PPL) after transcatheter aortic valve implantation (TAVI) have been described with both self‐expandable and balloon‐expandable device.Methods: We analyzed data regarding patients who underwent valve‐in‐valve implantation, enrolled in the ongoing single‐center prospective registry of TAVI, the Padova University REVALVing experience Registry. All procedures were performed by a totally percutaneous approach, using the self‐expanding Medtronic CoreValve (Medtronic, Minneapolis, MN). Results: Out of 87 patients who underwent TAVI, six received valve‐in‐valve implantation because of persisting severe PPL, due to prosthesis malposition. In all patients, the second device was successfully deployed, with a significant reduction in aortic regurgitation: PPL was no longer appreciable in two of six patients, and it decreased from severe to mild or trivial in four patients. Four patients developed atrio‐ventricular block requiring pace‐maker implantation. At follow‐up (6–24 months) two patients died, whereas no prosthesis‐related death occurred. Transprosthesis pressure gradient, effective orifice area, and aortic regurgitation did not change at serial echocardiograms throughout the follow‐up. Conclusions: Valve‐in‐valve implantation using self‐expandable bioprosthesis seems safe and highly effective to overcome severe PPL due to prosthesis malposition early after TAVI. Moreover, the implantation of two valves does not affect the performance of prosthesis at follow‐up. © 2011 Wiley Periodicals, Inc.

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Referral to Medical Oncology: A Crucial Step in the Treatment of Older Patients with Stage III Colon Cancer

Cited by 80 publications

References 40 publications

Characteristics of patients with stage III colon adenocarcinoma who fail to receive guideline‐recommended treatment

Characteristics of patients with stage III colon adenocarcinoma who fail to receive guideline‐recommended treatment

Association Between the Availability of Medical Oncologists and Initiation of Chemotherapy for Patients With Stage III Colon Cancer

Temporal trends and predictors of perioperative chemotherapy use in elderly patients with resected nonsmall cell lung cancer

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