Patient-Reported Roles, Preferences, and Expectations Regarding Treatment of Stage I Rectal Cancer in the Cancer Care Outcomes Research and Surveillance Consortium

Historically, stage I rectal cancer was treated with total mesorectal excision. However, there has been growing use of local excision, with and without adjuvant therapy to treat these early rectal cancers. Little is known about how patients and providers choose amongst the various treatment approaches

A Population-Based Analysis of Lymphatic Mapping and Sentinel Lymphadenectomy Utilization for Melanoma

INTRODUCTION: Lymphatic mapping and sentinel lymphadenectomy (LM/SL) is considered the nodal staging procedure of choice for patients with intermediate thickness (> 1.0mm, l.0mm and <4.0mm thick and no clinical evidence of nodal or distant metastases were considered eligible for LM/SL. Bivariate and multivariate logistic regression analysis was performed to identify factors associated with receipt of LM/SL. RESULTS: There were 3436 incident cases of melanoma reported for 1999-2001 (1111 in 1999, 1089 in 2000, and 1236 in 2001). 273 cases (8%) were excluded from analysis due to distant metastases or palpable adenopathy. An additional 916 29%) cases were excluded because the T classification of the primary tumor was not reported. Of the remaining 2247 cases, 1242 (55%) were eligible for LM/SL (T2 or T3), of which 48.0% (596/1242) underwent LM/SL. The proportion of subjects undergoing LM/SL was significantly associated with year of diagnosis (44% in 1999, increasing to 52% in 2000 and 50% in 2001, p=0.05). Subjects 60 years and older were less likely to undergo LM/SL compared to subjects less than 60 years (39% vs. 55%, p<0.001 ). Subjects with head or neck primary tumors were significantly less likely to undergo LM/SL compared to subjects with trunk or extremity primaries (32.9% vs. 51.4% and 51.9%, respectively, p<0.001), and subjects with T2 lesions were less likely to receive LM/SL than subjects with T3 lesions (41.7% vs. 53.6%, p<0.001). All of the associations remained statistically significant on multivariate analysis. CONCLUSION: Half of all eligible melanoma patients in North Carolina are failing to receive LM/SL. Predictors of underutilization of LM/SL include thinner primary tumors, advanced age, and head/neck location of the primary tumor. Further investigation is warranted to explore these differences and to improve utilization.Master of Public Healt

Distance to a Plastic Surgeon and Type of Insurance Plan Are Independently Predictive of Postmastectomy Breast Reconstruction

The psychosocial benefits of postmastectomy breast reconstruction are well established; however, health care barriers persist. The authors evaluated statewide patient population to further identify obstacles to reconstruction

Rural representation of the surveillance, epidemiology, and end results database

Purpose: SEER data are widely used to study rural–urban disparities in cancer. However, no studies have directly assessed how well the rural areas covered by SEER represent the broader rural United States. Methods: Public data sources were used to calculate county level measures of sociodemographics, health behaviors, health access and all cause cancer incidence. Driving time from each census tract to nearest Commission on Cancer certified facility was calculated and analyzed in rural SEER and non-SEER areas. Results: Rural SEER and non-SEER counties were similar with respect to the distribution of age, race, sex, poverty, health behaviors, provider density, and cancer screening. Overall cancer incidence was similar in rural SEER vs non-SEER counties. However, incidence for White, Hispanic, and Asian patients was higher in rural SEER vs non-SEER counties. Unadjusted median travel time was 53 min (IQR 34–82) in rural SEER tracts and 54 min (IQR 35–82) in rural non-SEER census tracts. Linear modeling showed shorter travel times across all levels of rurality in SEER vs non-SEER census tracts when controlling for region (Large Rural: 13.4 min shorter in SEER areas 95% CI 9.1;17.6; Small Rural: 16.3 min shorter 95% CI 9.1;23.6; Isolated Rural: 15.7 min shorter 95% CI 9.9;21.6). Conclusions: The rural population covered by SEER data is comparable to the rural population in non-SEER areas. However, patients in rural SEER regions have shorter travel times to care than rural patients in non-SEER regions. This needs to be considered when using SEER-Medicare to study access to cancer care

RE: Colorectal Cancer Incidence Patterns in the United States, 1974–2013

In the latest issue of the Journal, Siegel et al. report that young adults born around 1990 (and so currently age 20 to 29 years) have double and quadruple the risk of colon and rectal cancer (CRC), respectively, compared with the same age group born in 1950. We believe presenting relative increases in incidence isolated from the absolute risk of CRC in younger adults can be misleading. Using relative or ratio measures to communicate risk of young-onset CRC may lead the casual reader or popular press to misinterpret the extent to which incidence is increasing

Practice Patterns and Long-Term Survival for Early-Stage Rectal Cancer

Standard of care treatment for most stage I rectal cancers is total mesorectal excision (TME). Given the morbidity associated with TME, local excision (LE) for early-stage rectal cancer has been explored. This study examines practice patterns and overall survival (OS) for early-stage rectal cancer

Trends in Radical Prostatectomy: Centralization, Robotics, and Access to Urologic Cancer Care

Robotic surgery has been widely adopted for radical prostatectomy. We hypothesize that this change is rapidly shifting procedures away from hospitals that do not offer robotics and consequently increasing patient travel

Medicare/medicaid insurance, rurality, and black race associated with provision of hepatocellular carcinoma treatment and survival

Background: Early treatment of hepatocellular carcinoma (HCC) is associated with improved survival, but many patients with HCC do not receive therapy. We aimed to examine factors associated with HCC treatment and survival among incident patients with HCC in a statewide cancer registry. Materials and Methods: All patients with HCC from 2003 through 2013 were identified in the North Carolina cancer registry. These patients were linked to insurance claims from Medicare, Medicaid, and large private insurers in North Carolina. Associations between prespecified covariates and more advanced HCC stage at diagnosis (ie, multifocal cancer), care at a liver transplant center, and provision of HCC treatment were examined using multivariate logistic regression. A Cox proportional hazards model was developed to assess the association between these factors and survival. Results: Of 1,809 patients with HCC, 53% were seen at a transplant center,90 days from diagnosis, with lower odds among those who were Black (adjusted odds ratio [aOR], 0.54; 95% CI, 0.39-0.74), had Medicare insurance (aOR, 0.35; 95% CI, 0.21-0.59), had Medicaid insurance (aOR, 0.46; 95% CI, 0.28-0.77), and lived in a rural area; odds of transplant center visits were higher among those who had prediagnosis alpha fetoprotein screening (aOR, 1.74; 95% CI, 1.35-2.23) and PCP and gastroenterology care (aOR, 1.66; 95% CI, 1.27-2.18). Treatment was more likely among patients who had prediagnosis gastroenterology care (aOR, 1.68; 95% CI, 0.98-2.86) and transplant center visits (aOR, 2.42; 95% CI, 1.74-3.36). Survival was strongly associated with age, cancer stage, cirrhosis complications, and receipt of HCC treatment. Individuals with Medicare (adjusted hazard ratio [aHR], 1.58; 95% CI, 1.20-2.09) and Medicaid insurance (aHR, 1.55; 95% CI, 1.17-2.05) had shorter survival than those with private insurance. Conclusions: In this population-based cohort of patients with HCC, Medicare/Medicaid insurance, rural residence, and Black race were associated with lower provision of HCC treatment and poorer survival. Efforts should be made to improve access to care for these vulnerable populations

Breast MRI Utilization in Older Patients with Newly Diagnosed Breast Cancer

Recently, use of advanced imaging modalities, such as MRI, has increased dramatically. One novel but still evolving use for MRI is in the diagnosis and clinical staging of newly diagnosed breast cancer patients. Compared with mammography, MRI is more sensitive, but less specific, and far more expensive. The purpose of this study is to examine the prevalence and predictors of MRI use for clinical staging in older women with newly diagnosed breast cancer