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  1. Article ; Online: Association of patient socioeconomic status with outcomes after palliative treatment for disseminated cancer.

    Maduka, Richard C / Canavan, Maureen E / Walters, Samantha L / Ermer, Theresa / Zhan, Peter L / Kaminski, Michael F / Li, Andrew X / Pichert, Matthew D / Salazar, Michelle C / Prsic, Elizabeth H / Boffa, Daniel J

    Cancer medicine

    2024  Volume 13, Issue 9, Page(s) e7028

    Abstract: Background: Palliative treatment has been associated with improved quality of life and survival for a wide variety of metastatic cancers. However, it is unclear whether the benefits of palliative treatment are uniformly experienced across the US cancer ... ...

    Abstract Background: Palliative treatment has been associated with improved quality of life and survival for a wide variety of metastatic cancers. However, it is unclear whether the benefits of palliative treatment are uniformly experienced across the US cancer population. We evaluated patterns and outcomes of palliative treatment based on socioeconomic, sociodemographic and treating facility characteristics.
    Methods: Patients diagnosed between 2008 and 2019 with Stage IV primary cancer of nine organ sites were analyzed in the National Cancer Database. The association between identified variables, and outcomes concerning the administration of palliative treatment were analyzed with multivariable logistic regression and Cox proportional hazard models.
    Results: Overall 238,995 (23.6%) of Stage IV patients received palliative treatment, which increased over time for all cancers (from 20.7% in 2008 to 25.6% in 2019). Palliative treatment utilization differed significantly by region (West less than Northeast, OR: 0.55 [0.54-0.56], p < 0.001) and insurance payer status (uninsured greater than private insurance, OR: 1.35 [1.32-1.39], p < 0.001). Black race and Hispanic ethnicity were also associated with lower rates of palliative treatment compared to White and non-Hispanics respectively (OR for Blacks: 0.91 [0.90-0.93], p < 0.001 and OR for Hispanics: 0.79 [0.77-0.81] p < 0.001).
    Conclusions: There are important differences in the utilization of palliative treatment across different populations in the United States. A better understanding of variability in palliative treatment use and outcomes may identify opportunities to improve informed decision making and optimize quality of care at the end-of-life.
    MeSH term(s) Humans ; Palliative Care ; Male ; Female ; Middle Aged ; Aged ; Neoplasms/therapy ; United States ; Social Class ; Quality of Life ; Adult ; Treatment Outcome ; Neoplasm Staging
    Language English
    Publishing date 2024-05-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2659751-2
    ISSN 2045-7634 ; 2045-7634
    ISSN (online) 2045-7634
    ISSN 2045-7634
    DOI 10.1002/cam4.7028
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Optimal Radiation Dose for Stage III Lung Cancer-Should "Definitive" Radiation Doses Be Used in the Preoperative Setting?

    Saffarzadeh, Areo G / Canavan, Maureen / Resio, Benjamin J / Walters, Samantha L / Flores, Kaitlin M / Decker, Roy H / Boffa, Daniel J

    JTO clinical and research reports

    2021  Volume 2, Issue 8, Page(s) 100201

    Abstract: Introduction: There are currently two recommended radiation strategies for clinical stage III NSCLC: a lower "preoperative" (45-54 Gy) and a higher "definitive/nonsurgical" (60-70 Gy) dose. We sought to determine if definitive radiation doses should be ... ...

    Abstract Introduction: There are currently two recommended radiation strategies for clinical stage III NSCLC: a lower "preoperative" (45-54 Gy) and a higher "definitive/nonsurgical" (60-70 Gy) dose. We sought to determine if definitive radiation doses should be used in the preoperative setting given that many clinical stage III patients planned for surgery are ultimately managed with chemoradiation alone.
    Methods: Using the National Cancer Database data from 2006 to 2016, we performed a comparative effectiveness analysis of stage III N2 patients who received chemoradiotherapy. Patients were stratified into subgroups across 2 parameters: (1) radiation dose: lower (45-54 Gy) and higher (60-70 Gy); and (2) the use of surgery (i.e., surgical and nonsurgical treatment approaches). Long-term survival and perioperative outcomes were evaluated using multivariable Cox proportional hazards and logistic regression models.
    Results: A cohort of 961 patients received radiation before surgery including 321 who received a higher dose and 640 who received a lower dose. A higher preoperative dose revealed similar long-term mortality risk (hazard ratio = 0.99, 95% confidence interval: 0.82-1.21,
    Conclusions: For clinical stage III NSCLC, the administration of 60 to 70 Gy of radiation seems to be more effective than the lower dose for nonsurgical patients without compromising surgical safety for those that undergo resection. This evidence supports the implementation of 60 to 70 Gy as a single-dose strategy for both preoperative and definitive chemoradiotherapy.
    Language English
    Publishing date 2021-06-24
    Publishing country United States
    Document type Journal Article
    ISSN 2666-3643
    ISSN (online) 2666-3643
    DOI 10.1016/j.jtocrr.2021.100201
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  3. Article ; Online: Understanding the Implications of Medicaid Expansion for Cancer Care in the US: A Review.

    Ermer, Theresa / Walters, Samantha L / Canavan, Maureen E / Salazar, Michelle C / Li, Andrew X / Doonan, Michael / Boffa, Daniel J

    JAMA oncology

    2021  Volume 8, Issue 1, Page(s) 139–148

    Abstract: Importance: Insurance status has been linked to important differences in cancer treatment and outcomes in the US. With more than 15 million individuals gaining health insurance through Medicaid expansion, there is an increasing need to understand the ... ...

    Abstract Importance: Insurance status has been linked to important differences in cancer treatment and outcomes in the US. With more than 15 million individuals gaining health insurance through Medicaid expansion, there is an increasing need to understand the implications of this policy within the US cancer population. This review provides an overview of the fundamental principles and nuances of Medicaid expansion, as well as the implications for cancer care.
    Observations: The Patient Protection and Affordable Care Act presented states with an option to expand Medicaid coverage by broadening the eligibility criteria (eg, raising the eligible income level). During the past 10 years, Medicaid expansion has been credited with a 30% reduction in the population of uninsured individuals in the US. Such a significant change in the insurance profile could have important implications for the 1.7 million patients diagnosed with cancer each year, the oncology teams that care for them, and policy makers. However, several factors may complicate efforts to characterize the effect of Medicaid expansion on the US cancer population. Most notably, there is considerable variation among states in terms of whether Medicaid expansion took place, when expansion occurred, eligibility criteria for Medicaid, and coverage types that Medicaid provides. In addition, economic and health policy factors may be intertwined with factors associated with Medicaid expansion. Finally, variability in the manner in which cancer care has been captured and depicted in large databases could affect the interpretation of findings associated with expansion.
    Conclusions and relevance: The expansion of Medicaid was a historic public policy initiative. To fully leverage this policy to improve oncological care and to maximize learning for subsequent policies, it is critical to understand the effect of Medicaid expansion. This review aims to better prepare investigators and their audiences to fully understand the implications of this important health policy initiative.
    MeSH term(s) Humans ; Insurance Coverage ; Insurance, Health ; Medicaid ; Medically Uninsured ; Neoplasms/epidemiology ; Neoplasms/therapy ; Patient Protection and Affordable Care Act ; United States
    Language English
    Publishing date 2021-11-30
    Publishing country United States
    Document type Journal Article ; Review
    ISSN 2374-2445
    ISSN (online) 2374-2445
    DOI 10.1001/jamaoncol.2021.4323
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  4. Article ; Online: Evaluation of Cancer Care After Medicaid Expansion Under the Affordable Care Act.

    Salazar, Michelle C / Canavan, Maureen E / Walters, Samantha L / Herrin, Jeph / Schwartz, Jason L / Leapman, Michael / Boffa, Daniel J

    JAMA network open

    2020  Volume 3, Issue 9, Page(s) e2017544

    MeSH term(s) Adult ; Breast Neoplasms/diagnosis ; Breast Neoplasms/pathology ; Breast Neoplasms/therapy ; Eligibility Determination/legislation & jurisprudence ; Evaluation Studies as Topic ; Female ; Humans ; Medicaid/legislation & jurisprudence ; Medically Uninsured ; Middle Aged ; Neoplasm Staging ; Neoplasms/diagnosis ; Neoplasms/therapy ; Patient Protection and Affordable Care Act/legislation & jurisprudence ; Propensity Score ; United States
    Language English
    Publishing date 2020-09-01
    Publishing country United States
    Document type Journal Article
    ISSN 2574-3805
    ISSN (online) 2574-3805
    DOI 10.1001/jamanetworkopen.2020.17544
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  5. Article ; Online: A National Study of Surgically Managed Atypical Pulmonary Carcinoid Tumors.

    Walters, Samantha L / Canavan, Maureen E / Salazar, Michelle C / Resio, Benjamin J / Blasberg, Justin D / Mase, Vincent / Boffa, Daniel J

    The Annals of thoracic surgery

    2020  Volume 112, Issue 3, Page(s) 921–927

    Abstract: Background: Atypical pulmonary carcinoid tumors represent a subset of non-small cell lung cancer; however, their relative infrequency has left prognosis, management and long-term survival associated with atypical carcinoids, incompletely characterized.!# ...

    Abstract Background: Atypical pulmonary carcinoid tumors represent a subset of non-small cell lung cancer; however, their relative infrequency has left prognosis, management and long-term survival associated with atypical carcinoids, incompletely characterized.
    Methods: Patients aged 18 years or more diagnosed with atypical or typical pulmonary carcinoid between 2010 and 2015 within the National Cancer Database were evaluated. Survival was measured using Kaplan-Meier survival and multivariable Cox proportional hazards regression, adjusting for patient and tumor attributes.
    Results: A total of 816 atypical and 5688 typical carcinoid patients were identified in the cohort. Patients with atypical carcinoids tended to be older, have larger tumors, and later stage disease. The unadjusted overall 5-year survival for atypical carcinoid patients was 84%, 74%, 52%, and 51% for stages I, II, III, and IV, respectively. The unadjusted 5-year survival for typical carcinoids was 93%, 93%, 89%, and 87% for stages I, II, III, and IV, respectively. Nodal upstaging (ie, lymph node metastases identified in surgical specimens of clinically staged N0 patients) was seen in 16% of atypical and 7% of typical carcinoid patients. Increasing age, comorbidities, and stage were identified as significant predictors of mortality for atypical patients in multivariable analysis. Extent of surgical resection (lobectomy vs sublobar) was not identified as a predictor of survival for atypical carcinoid.
    Conclusions: Atypical carcinoid tumors represent a distinct subset of carcinoid tumors, with a tendency toward more aggressive behavior. Further study of the optimal surgical management is warranted.
    MeSH term(s) Aged ; Aged, 80 and over ; Carcinoid Tumor/mortality ; Carcinoid Tumor/surgery ; Female ; Humans ; Lung Neoplasms/mortality ; Lung Neoplasms/surgery ; Male ; Middle Aged ; Survival Rate ; Treatment Outcome ; United States
    Language English
    Publishing date 2020-11-04
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 211007-6
    ISSN 1552-6259 ; 0003-4975
    ISSN (online) 1552-6259
    ISSN 0003-4975
    DOI 10.1016/j.athoracsur.2020.09.029
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  6. Article ; Online: The Survival Advantage of Lobectomy over Wedge Resection Lessens as Health-Related Life Expectancy Decreases.

    Salazar, Michelle C / Canavan, Maureen E / Walters, Samantha L / Chilakamarry, Sitaram / Ermer, Theresa / Blasberg, Justin D / Yu, James B / Gross, Cary P / Boffa, Daniel J

    JTO clinical and research reports

    2021  Volume 2, Issue 3, Page(s) 100143

    Abstract: Introduction: Patients with early-stage NSCLC typically must choose between a surgery with superior local control (lobectomy) or one that preserves lung parenchyma (wedge). Recognizing that many patients with cancer have competing mortality risks ... ...

    Abstract Introduction: Patients with early-stage NSCLC typically must choose between a surgery with superior local control (lobectomy) or one that preserves lung parenchyma (wedge). Recognizing that many patients with cancer have competing mortality risks unrelated to cancer, we investigated whether an established model of predicting life expectancy could be used to identify patients with stage I NSCLC for whom survival after wedge is not different from lobectomy.
    Methods: A retrospective cohort study using the National Cancer Institute's Surveillance Epidemiology and End Results-Medicare was performed to evaluate survival among treatment-naive patients, diagnosed 2005-2015, who underwent lobectomy or wedge for stage I (≤2 cm tumors) NSCLC. Comorbidity-related life expectancy (CR-LE) was estimated using a standard life-table approach based on comorbid conditions, sex, and age. Cox models and perioperative complications were stratified by 5-year CR-LE.
    Results: A total of 4560 patients (median age 74, interquartile range 70-78) were identified. CR-LE was greater than or equal to 5 years for 4016 patients (wedge = 23%). CR-LE was less than 5 years for 544 patients (wedge = 41%). Among patients with CR-LE greater than or equal to 5, wedge resection was associated with higher risk of mortality than lobectomy (hazard ratio: 1.68, 95% confidence interval: 1.52-1.86,
    Conclusion: The survival advantage of lobectomy over wedge for stage I NSCLC seems to dissipate among patients with shorter life expectancy owing to age and comorbidities. Wedge resection may be a reasonable option for patients at high risk of dying from non-cancer-related causes.
    Language English
    Publishing date 2021-01-21
    Publishing country United States
    Document type Journal Article
    ISSN 2666-3643
    ISSN (online) 2666-3643
    DOI 10.1016/j.jtocrr.2021.100143
    Database MEDical Literature Analysis and Retrieval System OnLINE

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