Functional Impairments and Quality of Life in Older Adults With Upper Gastrointestinal Cancers.

BACKGROUND: Functional impairments (measured by activities of daily living [ADLs]) and health-related quality of life (HRQOL) may complicate outcomes in older adults diagnosed with cancer. In this retrospective cohort analysis, we characterized ADLs and HRQOL in adults older than 65 y with upper gastrointestinal (UGI) cancers and evaluated for an association to cancer-specific survival. MATERIALS AND METHODS: Patients with UGI cancers aged 65 y or older were selected from the Surveillance, Epidemiology and End Results and the Medicare Health Outcomes Survey-linked database. Demographics, comorbidities, stage, ADLs, and HRQOL were summarized by patients managed with and without surgery. Because of the wide variety of cancers, we subdivided patients into cohorts of esophagogastric [EG; n = 88] or hepatobiliary/pancreatic [n = 68]. Cancer-specific survival curves were modeled for changes in ADL and HRQOL scores after diagnosis. Risk factors for cancer-specific survival were assessed with hazard ratios (HRs) and adjusted for demographics, stage, comorbidities, and disease cohorts. RESULTS: HRQOL scores declined after diagnosis, with a sharper decline in nonsurgery patients. On multivariate analysis, inability to perform specific ADLs was associated with worse survival in multiple cohorts: hepatobiliary/pancreatic nonsurgery patients unable to eat (HR 3.3 95% confidence interval (CI) 1.7-6.5); all patients with EG unable to use the toilet (HR 3.3 95% CI 1.5-7.9); EG nonsurgery cohort unable to dress or use the toilet (dress HR 14.1 95% CI 4.0-49.0; toilet HR 4.7 95% CI 1.8-12.3). CONCLUSIONS: Older survivors with UGI cancers report declines in HRQOL, especially those not undergoing surgery. The ability to perform ADLs may be linked to survival in this population.

Impact of rural-urban status on survival after mastectomy without reconstruction versus mastectomy with reconstruction.

BACKGROUND: Disparities in access to care exist for breast cancer patients, including access to surgeons performing reconstruction. We hypothesized rural patients have delayed time to surgery after mastectomy with reconstruction with implications on survival. METHODS: An observational study was conducted using the National Cancer Database on patients with breast cancer from 2003 to 2007 who underwent mastectomy, with or without reconstruction from 2003 to 2007 (n = 90,319). RESULTS: Patients with, and without, reconstruction varied by demographics, facility type and stage. Time to surgery was longer for mastectomy with reconstruction. Unadjusted analysis demonstrated marginally decreased survival for rural patients undergoing mastectomy alone but not for mastectomy with reconstruction. Cox proportional hazards analysis revealed no significant differences by rural-urban status, but a survival advantage was seen after mastectomy with reconstruction, which persisted up to a delay of 180 days. CONCLUSION: Patients who underwent reconstruction had improved survival. Time to surgery is shorter for rural patients (for all types of mastectomy). We found no significant rural-urban disparity in survival.

Improving resident performance on standardized assessments of medical knowledge: a retrospective analysis of interventions correlated to American Board of Surgery In-Service Training Examination performance.

BACKGROUND: American Board of Surgery In-Service Training Examination (ABSITE) scores are used to assess individual progress and predict board pass rates. We reviewed strategies to enhance ABSITE performance and their impact within a surgery residency. METHODS: Several interventions were introduced from 2010 to 2014. A retrospective review was undertaken evaluating these and correlating them to ABSITE performance. Analyses of variance and linear trends were performed for ABSITE, United States Medical Licensing Examination (USMLEs), mock oral, and mock ABSITE scores followed by post hoc analyses if significant. Results were correlated with core curricular changes. RESULTS: ABSITE mean percentile increased 34% in 4 years with significant performance improvement and increasing linear trends in postgraduate year (PGY)1 and PGY4 ABSITE scores. Mock ABSITE introduction correlated to significant improvement in ABSITE scores for PGY4 and PGY5. Mock oral introduction correlated with significant improvement in PGY1 and PGY3. CONCLUSIONS: Our study demonstrates an improvement in mean program ABSITE percentiles correlating with multiple interventions. Similar strategies may be useful for other programs.