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

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

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

Exploring the Burden of Inpatient Readmissions After Major Cancer Surgery

Travel distances to care have increased substantially with centralization of complex cancer procedures at high-volume centers. We hypothesize that longer travel distances are associated with higher rates of postoperative readmission and poorer outcomes

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

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

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

Patterns of Sociodemographic and Clinicopathologic Characteristics of Stages II and III Colorectal Cancer Patients by Age: Examining Potential Mechanisms of Young-Onset Disease

Background and Aims. As a first step toward understanding the increasing incidence of colorectal cancer (CRC) in younger (age < 50) populations, we examined demographic, clinicopathologic, and socioeconomic characteristics and treatment receipt in a population-based sample of patients newly diagnosed with stages II and III CRC. Methods. Patients were sampled from the National Cancer Institute’s Patterns of Care studies in 1990/91, 1995, 2000, 2005, and 2010 (n=6,862). Tumor characteristics and treatment data were obtained through medical record review and physician verification. We compared sociodemographic and clinicopathologic characteristics and treatment patterns of younger (age < 50) and older (age 50–69, age ≥ 70) CRC patients. Results. Younger patients were more likely to be black (13%) and Hispanic (15%) than patients aged 50–69 years (11% and 10%, resp.) and ≥70 years (7% each). A larger proportion of young white (41%) and Hispanic (33%) patients had rectal tumors, whereas tumors in the right colon were the most common in young black patients (39%). The majority of younger patients received chemotherapy and radiation therapy, although receipt of microsatellite instability testing was suboptimal (27%). Conclusion. Characteristics of patients diagnosed with young-onset CRC differ considerably by race/ethnicity, with a higher proportion of black and Hispanic patients diagnosed at the age of < 50 years

Distance to Diagnosing Provider as a Measure of Access for Patients With Melanoma

To examine the effect of travel distance and other sociodemographic factors on access to a diagnosing provider for patients with melanoma

Factors Associated With Use of Preoperative Chemoradiation Therapy for Rectal Cancer in the Cancer Care Outcomes Research and Surveillance Consortium

Pre-operative (pre-op) chemoradiation therapy (CRT) improves local control and reduces toxicity more than post-operative (post-op) CRT for the treatment of stages II/III rectal cancer, but studies suggest many patients still receive post-op CRT. We examined patient beliefs, and clinical and provider characteristics associated with receipt of recommended therapy