scholarly journals An analysis of 37 patients with uterine leiomyosarcoma at a high-volume cancer center

2015 ◽  
Vol 12 (3) ◽  
pp. 158-163 ◽  
Author(s):  
Ulaş Solmaz ◽  
Levent Dereli ◽  
Gülşah Selvi Demirtaş ◽  
Atalay Ekin ◽  
Emre Mat ◽  
...  
Keyword(s):  
High Volume ◽  
Cancer Center ◽  
Uterine Leiomyosarcoma

Evaluation of the role of aromatase inhibitors (AIs) in the treatment of uterine leiomyosarcoma (uLMS)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 5590-5590
Author(s):  
R. O'Cearbhaill ◽  
Q. Zhou ◽  
A. Iasonos ◽  
R. A. Soslow ◽  
M. M. Leitao ◽  
...  
Keyword(s):  
Objective Response ◽  
Hot Flashes ◽  
Progression Free Survival ◽  
High Volume ◽  
Cancer Center ◽  
Control Group ◽  
Uterine Leiomyosarcoma ◽  
Kaplan Meier ◽  
Best Response ◽  
Few Data

5590 Background: Although AIs are sometimes used in selected patients with uLMS, there are few data assessing the efficacy of AIs in this setting. Methods: A retrospective electronic medical record review of patients (pts) with uLMS treated with an AI at Memorial Sloan-Kettering Cancer Center between 1998–2008 was performed. The primary endpoint was progression free survival (PFS), defined as time from the start of AI until death, progression or last follow-up. PFS was estimated by Kaplan-Meier method. Best response using RECIST was also assessed. Results: 34 pts with advanced, measurable uLMS were treated with AIs. Median age was 53 yrs (range 35–74); median body mass index 28.1 kg/m2 (range 16.1–52.1); LMS grade low: 5, high: 29; hormone receptor status: 19 ER+, 9 ER-, 6 ER unknown, 9 PR+, 9 PR-, 16 PR unknown; low volume of disease (no lesion >2 cm): 19 pts(56%), high volume: 15 pts (44%). 23 pts (68%) had had prior chemotherapy (1 regimen: 29%, 2 regimens: 18%, 3 regimens: 15%, >4 regimens: 6%); 12 pts (35%) had had prior pelvic radiotherapy. AIs used were: letrozole 74% (9% with leuprolide if premenopausal), anastrozole 21%, exemestane 6%. Median PFS was 2.9 months (95% CI: 1.8–5.1). 8 pts (23.5%) had a PFS >6months. Among pts with ER or PR + uLMS, median PFS was 5months (95% CI: 1.8–9.4) versus 1.9months (95% CI: 0.9–3.2) with ER and PR negative uLMS. Best response was partial response in 3 pts (8.8%) (all of whom were ER+), stable disease in 12 (35%), and progressive disease in 19 (56%). Common toxicities were grade 1–2 asthenia (30%), hot flashes (30%), and arthralgias (27%). Conclusions: In this highly selected population of pts with uLMS AIs fail to achieve objective response. While relatively prolonged PFS was observed among ER and/or PR+ uLMS pts, in the absence of a no-treatment control group this outcome cannot be attributed solely to the activity of the AI treatment. No significant financial relationships to disclose.

Educational system for acquiring appropriate laparoscopic colorectal surgical skills: analysis in a Japanese high-volume cancer center

2020 ◽  
Author(s):  
Ryota Nakanishi ◽  
Yosuke Fukunaga ◽  
Toshiki Mukai ◽  
Toshiya Nagasaki ◽  
Tomohiro Yamaguchi ◽  
...  
Keyword(s):  
Educational System ◽  
High Volume ◽  
Surgical Skills ◽  
Cancer Center

scholarly journals High volume pancreaticoduodenectomy performed at a community cancer center

HPB ◽  
2018 ◽  
Vol 20 ◽  
pp. S38-S39
Author(s):  
A. Sabesan ◽  
B. Gough ◽  
C. Anderson ◽  
R. Abdel-Misih ◽  
N.J. Petrelli ◽  
...  
Keyword(s):  
High Volume ◽  
Cancer Center

scholarly journals Prior Authorization for Medications in a Breast Oncology Practice: Navigation of a Complex Process

2017 ◽  
Vol 13 (4) ◽  
pp. e273-e282 ◽  
Author(s):  
Ankit Agarwal ◽  
Rachel A. Freedman ◽  
Felicia Goicuria ◽  
Catherine Rhinehart ◽  
Kathleen Murphy ◽  
...  
Keyword(s):  
Care Delivery ◽  
High Volume ◽  
Cancer Center ◽  
Prior Authorization ◽  
Patient Demographics ◽  
Approval Rate ◽  
Decision Points ◽  
Oncology Practice ◽  
The Cost ◽  
The Impact

Introduction: The cost and burden associated with prior authorization (PA) for specialty medications are concerns for oncologists, but the impact of the PA process on care delivery has not been well described. We examined PA processes and approval patterns within a high-volume breast oncology clinic at a major academic cancer center. Methods: We met with institutional staff to create a PA workflow and process map. We then abstracted pharmacy and medical records for all patients with breast cancer (N = 279) treated at our institution who required a PA between May and November 2015 (324 prescriptions). We examined PA approval rates, time to approval, and associations of these outcomes with the type of medication being prescribed, patient demographics, and method of PA. Results: Seventeen possible process steps and 10 decision points were required for patients to obtain medications requiring a PA. Of the 324 PAs tracked, 316 (97.5%) were approved on the first PA request after an average time of 0.82 days (range, 0 to 14 days). Approximately half of PAs were for either palbociclib (26.5%) or pegfilgrastim (22.2%), and 13.6% of PAs were for generic hormonal therapy. Requirements to fax PA requests were associated with greater delay in approval time (1.31 v 0.17 days for online requests; P < .001). The use of specialty pharmacies increased staff burden and delays in medication receipt. Conclusion: The PA process is complicated and labor intensive. Given the high PA approval rate, it is unlikely that PA requirements reduce medication utilization in practice, and these requirements may impose unnecessary burdens on patient care. The goals and requirements for PAs should be readdressed.

Factors influencing treatment of inflammatory breast cancer in the United States.

2015 ◽  
Vol 33 (28_suppl) ◽  
pp. 118-118
Author(s):  
Heather Y. Lin ◽  
Gildy Babiera ◽  
Isabelle Bedrosian ◽  
Simona Flora Shaitelman ◽  
Henry Mark Kuerer ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Inflammatory Breast Cancer ◽  
Standard Of Care ◽  
High Volume ◽  
The United States ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Cancer Data ◽  
Number Of Patients ◽  
Facility Level

118 Background: Guidelines for treating inflammatory breast cancer (IBC) using trimodality (chemotherapy, surgery and radiation) therapy (TT) remain largely unchanged since 2000. However, many such patients did not receive TT. It is unknown how patient-level (PL) and facility-level (FL) factors contribute to TT utilization. Methods: Using the National Cancer Data Base (NCDB), patients who underwent surgical treatment of locoregional IBC from 2003-2011 were identified. We correlated patient, tumor, and treatment data with TT. An observed to expected (O/E) ratio of number of patients treated with TT was calculated for each hospital by adjusting for PL factors. Hierarchical mixed effects models were used to assess the proportion of variation in the use of TT attributable to PL and FL factors, respectively. Results: Among 5,537 patients who met the study criteria, the use of TT fluctuated annually (67.3%-75.7%) and was less likely for patients who were over 70, had a lower income or had an N0 tumor (all p < 0.05). By insurance type, TT use was lowest among Medicare patients. Of the 542 hospitals examined, 55 (10.1%) and 24 (4.4%) were identified as significantly low and high outliers for the use of TT (p < 0.05), respectively. While comprehensive cancer centers represented the majority of high outliers, the TT use by facility type overall was not significantly different demonstrating variability within comprehensive cancer center practice. The percentage of the total variance in the use of TT attributable to facility (11%) was almost triple the variance attributable to the measured PL factors (3.4%). Conclusions: The use of standard of care TT varied widely across facilities with some high volume centers clearly underutilizing TT. To improve clinical outcomes for this rare and aggressive malignancy, it is critical to identify facility level factors impacting the use of TT to ensure the guideline adherence of IBC treatment.

Predictors of rectal cancer resection at high-volume hospitals among Medicare patients.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 808-808
Author(s):  
Mary E. Charlton ◽  
Catherine Chioreso ◽  
Irena Gribovskaja-Rupp ◽  
Chi Lin ◽  
Marcia M Ward ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Rectal Adenocarcinoma ◽  
High Volume ◽  
Neoadjuvant Chemoradiation ◽  
Sphincter Preservation ◽  
Cancer Center ◽  
Medicare Beneficiaries ◽  
Co Morbidity ◽  
High Volume Hospital ◽  
Low Volume

808 Background: Hospitals that perform high volumes of rectal cancer resections achieve superior rates of sphincter preservation and survival compared to those that do not, but many rectal cancer resections are still performed in low-volume centers. We aimed to determine the patient, provider and pathway characteristics associated with receipt of surgery from high-volume hospitals. Methods: Patient and provider characteristics were extracted from the SEER-Medicare database for Medicare beneficiaries (age 66+) with stage II/III rectal adenocarcinoma diagnosed 2007-2011 who received rectal cancer-directed surgery. Hospitals were divided into quartiles by volume of rectal cancer resections, and were also classified by NCI cancer center designation. Results: 2056 patients were included, and 57% received surgery in a high-volume hospital or NCI-designated center. Those residing in census tracts classified as rural and having higher median incomes, lower poverty, and higher levels of education more frequently received surgery in high-volume hospitals; there were no differences by age, gender, stage, or co-morbidity status. 55% of patients received surgery at the same facility where they received the colonoscopy that identified their cancer. In multivariate analyses, the strongest predictor of receiving one’s surgery in a high-volume hospital was receipt of colonoscopy at a high-volume facility (OR = 3.75, 95% CI: 2.93-4.79). Those treated in high-volume hospitals more often had guideline-recommended staging (TRUS/MRI) and treatment (neoadjuvant chemoradiation). Conclusions: Rectal cancer patients tended to stay at the facility where their cancer was diagnosed; and did not typically seek out high-volume providers if their colonoscopy was performed in a low-volume facility. This suggests that colonoscopists may have substantial influence over where patients receive surgery. Given that rurality, income and education appear to more strongly predict receipt of surgery at a high-volume hospital compared to clinical characteristics, further research is needed to understand considerations driving patient decisions and referring providers’ recommendations for care.

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