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Comprehensive Cancer Center (comprehensive + cancer_center)
Selected AbstractsShared Care in Geriatric Oncology: Primary Care Providers' and Medical/Oncologist's PerspectivesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2009Cynthia Owusu MD Existing literature lends support to the benefit of shared care in the management of chronic diseases, but there are limited data on the feasibility, cost-effectiveness, or benefits of shared care in oncology. A recent conference organized by the Aging and Cancer Program of the Case Comprehensive Cancer Center sought to explore the perceptions of physicians and other allied health professionals who attended the conference about shared care in the acute management of older patients with cancer using a case history presentation and an anonymous audience response system. Analyses of the audience response indicated that shared responsibility and enhanced information exchange in addition to the current level of communication between providers involved in the acute management of older patients with cancer is desirable. Studies exploring the feasibility and benefits of a shared care model in the management of older patients with cancer are needed. [source] The Impact of Surgery in the Management of the Head and Neck Carcinoma Involving the Carotid Artery,THE LARYNGOSCOPE, Issue 10 2008Enver Ozer MD Abstract Objectives/Hypothesis: To demonstrate the feasibility of the carotid artery dissection and/or resection and reanastomosis, and to show its positive impact on survival and disease control rates for the head and neck carcinomas involving the carotid artery. Study Design: Tertiary center (Comprehensive Cancer Center). Case series review. Methods: The data of 90 patients with head and neck malignancies involving the carotid artery were operated for the carotid artery dissection and/or resection, and reanastomosis in the last 10 years were retrospectively reviewed and analyzed. Results: Eighty (89%) of the 90 patients' head and neck malignancies were squamous cell carcinoma. Fifty-two (65%) and 28 (35%) of 80 patients were recurrent and stage IV disease, respectively. There was no stage I to III disease. Carotid artery was dissected and preserved in 64 (71.1%) of the 90 patients. Eighteen (20%) of 90 patients needed carotid artery dissection with resection and reanastomosis. Eight (8.9%) patients were unresectable. Sixty (75%) of 80 patients needed reconstruction with regional or free flaps and grafts. Overall 2- and 5-year estimated survivals were 32.4% and 27.8% for all; 14.3% and 10.7% for recurrent; 64.3% and 57.8% for stage IV previously untreated; and 22.0% and 22.0% for carotid artery resected-reanastomosed patients, respectively. Conclusions: The carotid artery dissection without resection is an achievable goal in majority of patients with the advanced stage head and neck carcinoma involving the carotid artery. Resection and reanastomosis of carotid artery, especially in the previously untreated carotid involved patients, is a feasible surgery and achieves better survival and disease control rates when compared with the unresected or recurrent disease patients. [source] Surgery by consultant gynecologic oncologists improves survival in patients with ovarian carcinomaCANCER, Issue 3 2006Mirjam J. A. Engelen M.D. Abstract BACKGROUND Consultant gynecologic oncologists from the regional Comprehensive Cancer Center assisted community gynecologists in the surgical treatment of patients with ovarian carcinoma when they were invited. For this report, the authors evaluated the effects of primary surgery by a gynecologic oncologist on treatment outcome. METHODS The hospital files from 680 patients with epithelial ovarian carcinoma who were diagnosed between 1994 and 1997 in the northern part of the Netherlands were abstracted. Treatment results were analyzed according to the operating physician's education by using survival curves and univariate and multivariate Cox regression analyses. RESULTS Primary surgery was performed on 184 patients by gynecologic oncologists, and on 328 patients by general gynecologists. Gynecologic oncologists followed surgical guidelines more strictly compared with general gynecologists (patients with International Federation of Gynecology and Obstetrics [FIGO] Stage I,II disease, 55% vs. 33% [P = 0.01]; patients with FIGO Stage III disease, 60% vs. 40% [P = 0.003]) and more often removed all macroscopic tumor in patients with FIGO Stage III disease (24% vs. 12%; P = 0.02). When patients were stratified according to FIGO stage, the 5-year overall survival rate was 86% versus 70% (P = 0.03) for patients with Stage I,II disease and 21% versus 13% (P = 0.02) for patients with Stage III,IV disease who underwent surgery by gynecologic oncologists and general gynecologists, respectively. The hazards ratio for patients who underwent surgery by gynecologic oncologists was 0.79 (95% confidence interval [95%CI], 0.61,1.03; adjusted for patient age, disease stage, type of hospital, and chemotherapy); when patients age 75 years and older were excluded, the hazards ratio fell to 0.71 (95% CI, 0.54,0.94) in multivariate analysis. CONCLUSIONS The surgical treatment of patients with ovarian carcinoma by gynecologic oncologists occurred more often according to surgical guidelines, tumor removal more often was complete, and survival was improved. Cancer 2006. © 2005 American Cancer Society. [source] Conservation laryngeal surgery versus total laryngectomy for radiation failure in laryngeal cancer,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 9 2006F. Christopher Holsinger MD Abstract Background. Total laryngectomy is the standard of care for surgical salvage of radiation failure in laryngeal cancer. However, the role of conservation laryngeal surgery in this setting remains unclear. The objective was to compare the efficacy of conservation versus total laryngectomy for salvage of radiation failure in patients who initially presented with T1 or T2 squamous cancer of the larynx. Methods. A 21-year retrospective analysis of patients who received surgery at a single comprehensive cancer center after definitive radiation therapy is reported. At recurrence, the patients were reevaluated and then underwent a total laryngectomy or, if possible, a conservation laryngeal procedure. The charts of 105 patients who failed radiation treatment for primary laryngeal cancer and who subsequently underwent surgical salvage were reviewed for this study. Eighty-nine were male (84.8%). The mean age was 60.3 years. The median follow-up time after surgery was 69.4 months. Most patients with recurrence after radiotherapy required total laryngectomy (69.5%; 73/105). Conservation laryngeal surgery was performed for 32 patients (31.5%). Concomitant neck dissections were performed on 45 patients (45.5%). Results. In 14 patients, local or regional recurrence developed after salvage surgery: 9 patients after total laryngectomy (12.3%; 9/73), and 5 patients (15.6%; 5/32) after conservation laryngeal surgery. This difference was not statistically significant, nor was there a difference in disease-free interval for the two procedures (p = .634, by log-rank test). Distant metastasis developed in 13 patients. Most developed in the setting of local and/or regional recurrence, but distant metastasis occurred as the only site of failure in 6 of the patients who had undergone total laryngectomy but in 1 of the conservation surgery patients treated for a supraglottic laryngeal cancer. The overall mortality for patients who underwent total laryngectomy was also higher: 73.74% (54/73) versus 59.4% (19/32) for patients who underwent a conservation approach (p = .011 by log-rank test). Conclusions. Although conservation laryngeal surgery was possible in a few patients with local failure after radiotherapy, conservation laryngeal surgery is an oncologically sound alternative to total laryngectomy for these patients. © 2006 Wiley Periodicals, Inc. Head Neck, 2006 [source] Neoadjuvant chemotherapy for squamous cell carcinoma of the oral tongue in young adults: A case seriesHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 9 2005Erich M. Sturgis MD Abstract Background. Squamous cell carcinoma of the oral tongue (SCCOT) in the young population has emerged as a growing worldwide health problem. Standard therapies, consisting primarily of surgery with possible adjuvant radiotherapy, have resulted in only modest improvements in survival in recent decades, whereas the treatments for SCCOT continue to impair oral function. With the increased use and improved functional results of neoadjuvant chemotherapy in the treatment of squamous cell carcinoma of other upper aerodigestive tract sites, we have reviewed our experience with neoadjuvant chemotherapy in young patients with SCCOT. Methods. A retrospective review was conducted of all patients younger than 45 years (N = 49) with previously untreated SCCOT evaluated at a comprehensive cancer center from July 1995 to August 2001. Charts were reviewed to obtain demographic data, comorbidities, nutritional status, tumor status, treatment and response information, and follow-up data. Results. Fifteen patients were identified who received neoadjuvant chemotherapy with taxane-based regimens before undergoing glossectomy and neck dissection. Thirteen of these patients (87%) exhibited stage III or IV disease at presentation, and all exhibited at least a partial response at the primary site. Pathologically positive nodes were identified in only six patients (40%), although 13 (87%) had clinically or radiographically suspicious nodes at presentation. Adjuvant radiation therapy was administered to seven patients (47%). With a median follow-up of 39 months, no patient has had local or regional recurrence, although three patients (20%) have had distant metastases develop; one patient with an isolated distant metastasis was successfully salvaged with radiation. By comparison during the same period, 34 young adult patients with SCCOT were treated with surgery with or without postoperative radiotherapy but without the use of chemotherapy. Although these patients had lower T classifications (18% vs 67% T3/T4; p = .0007), incidence of nodal metastases (15% vs 87% N+; p < .0001), and overall disease stage (24% vs 87% stage III/IV; p < .0001) than the neoadjuvant chemotherapy group, the overall survival (82%), disease-specific survival (88%), and recurrence-free survival (82%) of the surgery-first group was similar to that of the neoadjuvant chemotherapy group (87%, 87%, and 80%, respectively). Conclusions. This retrospective investigation demonstrates that neoadjuvant chemotherapy with taxane-based regimens may play a role in the successful treatment of SCCOT in young adult patients. Ultimately, this treatment plan may lead to improved functional outcomes in young patients with SCCOT by allowing function-sparing surgery and avoiding postoperative radiotherapy, without sacrificing disease control and survival, but a prospective trial is needed. We have initiated a prospective clinical trial to further investigate the impact of neoadjuvant chemotherapy in patients younger than 50 with SCCOT. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source] Survey of computer use for health topics by patients with head and neck cancerHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 1 2005Jane Lea BSc Abstract Background. Computers are potentially powerful tools for patient education. E-health, which refers to health services and information delivered through the Internet, is a growing phenomenon within the health-care field. We sought to describe computer use and interest in e-health resources among patients with head and neck cancer. Methods. A questionnaire was administered to 207 patients with head and neck cancer attending oncology follow-up clinics at a single comprehensive cancer center. Results. Forty-eight percent had never used a computer; 43% used one more than once a week. E-health information had been sought by 31%. Likelihood to access e-health information increased with education and income but decreased with age (p , .05). Conclusions. Many patients with head and neck cancer welcome information technology, but most prefer more traditional sources of information. Interventions to improve computer access and/or skills are largely undesired. Individuals seem to either embrace technology or not. In this respect, patients with head and neck cancer are similar to, rather than unique from, other patients with cancer. © 2004 Wiley Periodicals, Inc. Head Neck27: 8,14, 2005 [source] The Cancer Pain Inventory: preliminary development and validationPSYCHO-ONCOLOGY, Issue 7 2010Teresa L. Deshields Abstract Objective: The purpose of this study was to develop a Cancer Pain Inventory (CPI) that measures cancer patients' beliefs and concerns about pain. This paper describes development and pilot testing of a preliminary version of the CPI and describes its psychometric properties including its reliability and validity relative to established pain measures. Methods: Subjects were recruited from inpatient and outpatient oncology services of an NCI-designated comprehensive cancer center. Participants completed the 50 potential CPI items and these standard measures,Orientation-Memory-Concentration Test, Survey of Pain Attitudes, Brief Pain Inventory, Pain Disability Index, and Center for Epidemiological Studies,Depression Scale. The magnitude and significance of associations between the CPI and the other measures were examined. Results: Of 366 patients who were eligible and agreed to participate in the study, 262 completed the questionnaires. Principal components analyses were used to select items most appropriate for retention in the preliminary version of the CPI and to describe its factor structure. Based on the content of items that loaded on each factor, the five factors were labeled as Catastrophizing, Interference with Functioning, Stoicism, Social Aspects, and Concerns about Pain Medication. Correlations between the CPI and other measures supported construct validity of the five CPI factors. Conclusions: The results supported the validity of the CPI as a measure of five constructs relevant to the experience of pain in the cancer setting. The results also underscored the presence of unique features of cancer-related pain that clearly differ from commonly recognized dimensions of chronic, non-cancer-related pain. Copyright © 2009 John Wiley & Sons, Ltd. [source] Implementing touch-screen technology to enhance recognition of distressPSYCHO-ONCOLOGY, Issue 8 2009K. Clark Abstract Objective: The University of California, San Diego, Moores Cancer Center implemented a systematic approach for patients to communicate with their health-care team in real-time regarding psychosocial problem-related distress using touch-screen technology. The purpose of this report is to describe our experience in implementing touch-screen problem-related distress screening as the standard of care for all outpatients in a health-care setting. Although early identification of distress has recently gained wide attention, the practical issues of implementing psychosocial screening with and without the use of technology have not been fully addressed or investigated. Methods: ,The How Can We Help You and Your Family?' screening instrument was used to identify and address patient problem-related distress for clinical services, program development, research and education. Using a HIPPA-compliant approach, the touch-screen technology also helped to identify patients interested in clinical trials and additional support services. Results: We found that the biggest barrier to implementing this technology was the attitude of the front desk staff (i.e. schedulers, clerks, administrative staff) who felt that the touch-screen would be burdensome. Our experience suggested that it was essential to actively involve these personnel from the beginning of the planning process. As specifically acknowledged in the recent 2007 Institute of Medicine report (Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs. The National Academies Press: Washington, DC, 2007), use of this computerized version of the screening instrument was able to bridge the gap between the detection of problem-related distress and referrals for assessment or treatment. Conclusion: We found that it is feasible to implement a computerized problem-related distress screening program in a comprehensive cancer center. Copyright © 2008 John Wiley & Sons, Ltd. [source] Can older cancer patients tolerate chemotherapy?CANCER, Issue 4 2003A prospective pilot study Abstract BACKGROUND To the authors' knowledge, few data currently are available regarding the tolerance to chemotherapy in older cancer patients. This prospective pilot study evaluated the changes in functional, mental, nutritional, and comorbid status, as well as the quality of life (QOL), in geriatric oncology patients receiving chemotherapy. METHODS Sixty patients age , 70 years who were undergoing cancer chemotherapy were recruited in a university-based comprehensive cancer center. Changes in physical function were measured by the Eastern Cooperative Oncology Group performance status (ECOG PS) and Instrumental Activities of Daily Living (IADLs), mental health changes were measured by the Mini-Mental State Examination and the Geriatric Depression Scale (GDS), comorbidity was measured by Charlson's index and the Cumulative Illness Rating Scale-Geriatric, nutrition was measured by the Mini-Nutritional Assessment, and QOL was measured by the Functional Assessment of Cancer Therapy-General (FACT-G). Changes were assessed at baseline and at the end of treatment (EOT). Grade 4 hematologic and Grade 3,4 nonhematologic toxicities were recorded. RESULTS Thirty-seven patients (63%) completed both assessments. Older cancer patients demonstrated a significant decline in measurements of physical function after receiving chemotherapy, as indicated by changes in scores on the IADL (P = 0.04) and on the physical (P = 0.01) and functional (P = 0.03) subscales of the FACT-G. They also displayed worse scores on the GDS administered postchemotherapy (P < 0.01). Patients who experienced severe chemotoxicity had more significant declines in ECOG PS (P = 0.03), IADL (P = 0.03), and GDS (P = 0.04), and more gain in the social well-being subscale (P = 0.02) of the FACT-G, than those who did not experience severe chemotoxicity. However, changes in most scores were small in magnitude clinically. No significant change was found between baseline and EOT in nutrition, comorbidity, and other aspects of the FACT-G. CONCLUSIONS Older cancer patients undergoing chemotherapy may experience toxicity but generally can tolerate it with limited impact on independence, comorbidity, and QOL levels. It is important to recognize and monitor these changes during geriatric oncology treatment. Cancer 2003;97:1107,14. © 2003 American Cancer Society. DOI 10.1002/cncr.11110 [source] | ||||||||||