Primary Site Predicts Grade for Gastroenteropancreatic Neuroendocrine Tumors.

Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are rare and abstruse neoplasms with increasing incidence and clinical relevance. The National Cancer Data Base was examined to identify GEP-NET cases from 2004 to 2013. In total, 39,454 patients diagnosed with GEP-NET were identified. Median age was 61 years. Majority was female (50.13%), white (79.49%), and had low-grade neoplasms (84.39%). On univariate analysis, age, sex, race, primary site, tumor size, and regional lymph node involvement were associated with tumor grade (P < 0.0001). On multivariate analysis, older age [odds ratio (OR) = 9.57], gender (male, OR = 1.29), and race continued to be associated with high-grade neoplasms. The primary site also remained a significant predictor of tumor grade. High-grade neoplasms were more likely to arise from the esophagus (OR = 317.75), hepatobiliary system (OR = 23.15), colorectum (OR = 14.37), ampulla of Vater (OR = 11.61), and stomach (OR = 7.84) compared with the appendix (OR = 5.41), pancreas (OR = 5.31), and small bowel (referent). The tumor grade for GEP-NETs is highly dependent on the primary site, suggesting different sites may be biologically distinct diseases. A personalized approach to GEP-NET treatment, tailored to the site of origin, is imperative.

Development of a model web-based system to support a statewide quality consortium in radiation oncology.

PURPOSE: A database in which patient data are compiled allows analytic opportunities for continuous improvements in treatment quality and comparative effectiveness research. We describe the development of a novel, web-based system that supports the collection of complex radiation treatment planning information from centers that use diverse techniques, software, and hardware for radiation oncology care in a statewide quality collaborative, the Michigan Radiation Oncology Quality Consortium (MROQC). METHODS AND MATERIALS: The MROQC database seeks to enable assessment of physician- and patient-reported outcomes and quality improvement as a function of treatment planning and delivery techniques for breast and lung cancer patients. We created tools to collect anonymized data based on all plans. RESULTS: The MROQC system representing 24 institutions has been successfully deployed in the state of Michigan. Since 2012, dose-volume histogram and Digital Imaging and Communications in Medicine-radiation therapy plan data and information on simulation, planning, and delivery techniques have been collected. Audits indicated >90% accurate data submission and spurred refinements to data collection methodology. CONCLUSIONS: This model web-based system captures detailed, high-quality radiation therapy dosimetry data along with patient- and physician-reported outcomes and clinical data for a radiation therapy collaborative quality initiative. The collaborative nature of the project has been integral to its success. Our methodology can be applied to setting up analogous consortiums and databases.

A reflection and evaluation model of comparative thinking.

This article reviews research on counterfactual, social, and temporal comparisons and proposes a Reflection and Evaluation Model (REM) as an organizing framework. At the heart of the model is the assertion that 2 psychologically distinct modes of mental simulation operate during comparative thinking: reflection, an experiential ("as if") mode of thinking characterized by vividly simulating that information about the comparison standard is true of, or part of, the self; and evaluation, an evaluative mode of thinking characterized by the use of information about the standard as a reference point against which to evaluate one's present standing. Reflection occurs when information about the standard is included in one's self-construal, and evaluation occurs when such information is excluded. The result of reflection is that standard-consistent cognitions about the self become highly accessible, thereby yielding affective assimilation; whereas the result of evaluation is that comparison information is used as a standard against which one's present standing is evaluated, thereby yielding affective contrast. The resulting affect leads to either an increase or decrease in behavioral persistence as a function of the type of task with which one is engaged, and a combination of comparison-derived causal inferences and regulatory focus strategies direct one toward adopting specific future action plans.