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2.
Prensa méd. argent ; 105(9 especial): 546-555, oct 2019. fig
Artigo em Inglês | LILACS, BINACIS | ID: biblio-1046472

RESUMO

The article is devoted to the review of the most developed systems of registration and control of patients suffering from oncological diseases. The creation of registries is based on the public health needs of countries in monitoring, storing and analyzing national data on such serious chronic diseases as cancer. The world and national experience in creating data storage systems shows the need to unify the information collection, to consolidate sources, and to use high quality information technologies that make it possible to exchange, analyze, protect and store data. In European countries and the USA, registries have specialized websites and provide information on epidemiology, trends, forecasts, and survival rate. This information is public.


Assuntos
Humanos , Institutos de Câncer/estatística & dados numéricos , Literatura de Revisão como Assunto , Registros Eletrônicos de Saúde , Acesso a Medicamentos Essenciais e Tecnologias em Saúde
3.
Bull Cancer ; 106(10): 847-859, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31521255

RESUMO

INTRODUCTION: The Cancer Observatory, from the OMEDITs (Observatory for Medicines and Medical Devices and Treatment Innovations) of Bretagne and Pays de la Loire areas has conducted a survey aiming to know and map the current practices of management of patients by Oral Anti-cancer Drug (OAD) in inter-region. METHODS: Forty eight cancer centers received by e-mail in July and October 2016 a questionnaire concerning the management of OADs : from prescription by the specialist of oncology, to the intervention of the pharmacist (analysis and pharmaceutical consulting), to follow-up by nurse, as well as the financing of this activity and the feelings of the actors about this organizational set up. RESULTS: Fifty-seven professionals from 31 centers, including the most important ones, responded to the survey. As a result, half of the establishments carry out a pharmaceutical analysis for some or all of the OAD prescriptions and only 30% carry out a pharmaceutical consulting. The nurse consultation is, on the other hand, more largely implanted (74% of the centers) as well as the telephone follow-up (6%). More than 90% of professionals believe that the organizational set up could be improved and more secure by, at least, the stronger involvement of pharmacists, the development of tools for nurse (for monitoring, therapeutic education…) and by improving the city-hospital link. CONCLUSION: This survey shows the variability in the management of patients under OAD because of the lack of resources to ensure the fairness and sustainability of the organizational set up. The hospital/city link could still be optimized to secure patient care.


Assuntos
Antineoplásicos/administração & dosagem , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Neoplasias/tratamento farmacológico , Administração Oral , Institutos de Câncer/estatística & dados numéricos , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Prescrições de Medicamentos , França , Humanos , Papel do Profissional de Enfermagem , Objetivos Organizacionais , Satisfação do Paciente , Farmacêuticos , Padrões de Prática em Enfermagem/estatística & dados numéricos , Telefone
4.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(9): 869-875, 2019 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-31550827

RESUMO

Objective: To summarize the characteristics of abdominal-pelvic unplanned reoperation (URO) in a cancer hospital. Methods: Retrospectively descriptive cohort research was adopted. The classification of diseases was based on ICD-10, and surgical classification was based on ICD-9-CM-3. Medical record summary database from 2008 to 2018 in Beijing Cancer Hospital was collected, and all URO information of abdominal-pelvic surgery was retrieve. The time of URO, disease type, surgery type and cause were statistically analyzed. Distribution of main disease incidence and constituent ratio, and the application of major surgery and surgery type composition ratio were analyzed as well. Results: From 2008 to 2018, a total of 46854 cases underwent abdominal-pelvic surgery (including gastrointestinal, hepatic-biliary-pancreatic, gynecological, urological, or esophageal cancer surgery) and 713 patients received URO (1.52%), including 486 males and 227 females (2.14:1.00) with a mean age of (58.1±12.2) years. A total of 246 patients (34.50%) had comorbidity, and with comorbidity: without comorbidity was 1.13:1.00. The hospital stay was (44.5±43.0) days, and the total cost was (178000±112000) yuan. There were 22 deaths (3.09%). The median interval between URO and the first operation was 8 (0 to 131) days. The highest rate of URO was 2.45% (89/3629) in 2012, while the lowest was 0.95% (53/5596) in 2015. The top 3 major cancer types of URO included colorectal cancer (222 cases, 31.14%), gastric cancer (166 cases, 23.28%) and esophageal cancer (45 cases, 6.31%). The cancer types with the highest URO rate included pancreatic cancer (3.97%, 30/756), gastric cancer (1.81%, 166/9171) and colorectal cancer (1.80%, 222/12333). The top 3 surgical procedures resulting in URO were rectal resection (109 cases, 15.29%), total gastrectomy (79 cases, 11.08%), and total pancreatectomy (64 cases, 8.98%). Focusing on 497 URO cases from 2012 to 2018, 465 cases (93.56%) followed relatively difficult grade III and IV surgery, while only 32 cases (6.44%) followed grade I and II surgery. The top 5 main causes of URO were bleeding (225 cases, 31.56%), anastomotic leak (225 cases, 31.56%), infection (89 cases, 12.48%), intestinal obstruction (53 cases, 7.43%), and wound dehiscence (35 cases, 4.91%), adding up to a total of 87.94% of all URO. Conclusion: This study summarizes the epidemiology of abdominal - pelvic URO in our cancer institution, providing the solid baseline for future investigation of URO and the subsequent formulation of corresponding prevention and intervention measures.


Assuntos
Institutos de Câncer , Neoplasias , Reoperação , Universidades , Idoso , Institutos de Câncer/estatística & dados numéricos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Neoplasias/cirurgia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Universidades/estatística & dados numéricos
5.
Cancer Radiother ; 23(8): 847-852, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31375324

RESUMO

PURPOSE: Brachytherapy can be used for the treatment of every localized prostate cancer, notably as boost for intermediate- and high-risk prostate cancer. With the incidence of prostate cancer increasing significantly during the next decades and brachytherapy developing, we conducted a descriptive survey to analyse the current status of prostate brachytherapy in France to see if the future demands could be met. MATERIAL AND METHODS: All radiotherapy centres that declared providing brachytherapy were found from the French national institute of cancer registry and they were asked to reply to an online form in April 2018. RESULTS: Fifty-two of the 54-brachytherapy centres (96%) replied the form and 34 centres did prostate brachytherapy. Among those centres, 32 performed iodine 125 low-dose rate brachytherapy as monotherapy, 19 provided brachytherapy boost (eight centres low-dose rate 125I; seven centres high-dose rate; four centres both). Among the centres not performing brachytherapy boost, 18 wanted to do, eight did not want and nine did not reply. The main reasons for reluctance towards brachytherapy boost were: organization constraints (three centres), refer patients to a nearby brachytherapy centre (one centre), technical issues (two centres) and lack of strong scientific evidences (two centres). In terms of human resources, the mean number of trained physicians and physicists were two (range: 1-6) and three (range: 1-5) respectively. CONCLUSION: In France, the future needs for prostate brachytherapy cannot be met by the current health supply. Health authorities should firstly reimburse brachytherapy boost and redefine an optimal training and organization of centres such that every patient with prostate cancer can receive optimal treatment.


Assuntos
Braquiterapia/estatística & dados numéricos , Institutos de Câncer/estatística & dados numéricos , Neoplasias da Próstata/radioterapia , Institutos de Câncer/provisão & distribução , França , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Humanos , Radioisótopos do Iodo/uso terapêutico , Masculino , Neoplasias da Próstata/patologia , Dosagem Radioterapêutica , Radioterapia Adjuvante/estatística & dados numéricos
6.
Cancer Radiother ; 23(5): 395-400, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31331842

RESUMO

PURPOSE: Lung and some digestive tumours move during a respiratory cycle. Four-dimensional scanography (4D-CT) is commonly used in treatment planning to account for respiratory motion. Although many French radiotherapy centres are now equipped, there are no guidelines on this subject to date. We wanted to draw up a description of the use of the 4D-CT for the treatment planning in France. METHODS AND MATERIAL: We conducted a survey in all French radiotherapy centres between March and April 2017. RESULTS: One hundred and seventy-two were contacted. The participation rate was 88.37%. The use of the 4D-CT seems to be common and concerned planning for 15.28% of kidney and adrenal cancers, 19.72% of pancreatic cancers, 27.78% of oesophageal cancers and 73.24% of lung cancers in case of normofractionated treatments. The use of the 4D-CT was also widespread in the case of stereotactic body radiation therapy: with 61.11% in the case of pulmonary irradiation and 34.72% in the case of hepatic irradiation. Many centres declared they carried out several 4D-CT for treatment planning (29, 55% in case of stereotactic body radiation therapy for lung tumours and 20% for liver tumours). Private centres tend to repeat 4D-CT more. CONCLUSION: Although the use of the 4D-CT appears to be developing, it remains very heterogeneous. To date, the repetition of the 4D-CT has been very poorly studied and could be the subject of clinical studies, allowing to define in which indications and for which populations there is a real benefit.


Assuntos
Tomografia Computadorizada Quadridimensional , Planejamento da Radioterapia Assistida por Computador/métodos , Artefatos , Institutos de Câncer/estatística & dados numéricos , França , Pesquisas sobre Serviços de Saúde , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Humanos , Imagem Tridimensional/estatística & dados numéricos , Movimento (Física) , Neoplasias/diagnóstico por imagem , Neoplasias/radioterapia , Utilização de Procedimentos e Técnicas , Serviço Hospitalar de Radiologia/estatística & dados numéricos , Radiocirurgia/métodos , Planejamento da Radioterapia Assistida por Computador/estatística & dados numéricos , Planejamento da Radioterapia Assistida por Computador/tendências , Respiração
7.
BMC Cancer ; 19(1): 570, 2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-31185937

RESUMO

BACKGROUND: In response to the increasing cancer prevalence and the evolving health service landscape across the public and private health sectors in Australia, this study aimed to map cancer services and identify factors associated with service provision and important service gaps. METHODS: A prospective, cross-sectional survey was conducted throughout 2016. Extensive search strategies identified Government or privately-owned, hospital or community-based healthcare organisations with dedicated cancer services. One nominated staff member from each organisation answered a purpose specific online/paper questionnaire. Descriptive statistics, standardised rates, and single level and multilevel multinomial logistic regression were used to analyse the data. Analysis was augmented with a qualitative descriptive analysis of open-ended questions. RESULTS: From the 295 eligible organisations with a cancer service in Australia, 93.2% participated in the survey. After adjusting for remoteness, for-profit companies were significantly more likely than Government operated services to provide only one or two types of cancer services (e.g. radiotherapy) in a limited range of settings (e.g. day hospital with no in-patient or home care) (p < 0.001) and less likely to provide comprehensive cancer services (p < 0.001). After adjusting for ownership and the respondent's role in the organisation, respondents located in remote regions of Australia were more likely to identify cancer services that are dependent upon specialist medical practitioners as the most important service gaps in their region (p = 0.003). Despite 76.0% of organisations across Australia offering some type of supportive care or survivorship services, providers identified this group of services as the most pressing service gaps in major cities, rural and remote regions alike (standardised rate: 47.9% (95%CI: 43.6-57.4%); p < .000). This included the need for improved integration, outreach and affordability. CONCLUSIONS: The broad range of cancer services, settings and ownership identified by this survey highlights the complexity of the Australian healthcare system that cancer survivors must navigate and the challenges of providing comprehensive cancer care particularly in rural and remote regions. Whilst the significant role of supportive care and survivorship services are increasingly being recognised, the findings from this survey support calls for innovative service models and funding mechanisms that expand the focus from preventing and treating cancer to supporting cancer survivors throughout the cancer continuum and promoting the delivery of integrated and equitable cancer care across the public and private sectors.


Assuntos
Institutos de Câncer/estatística & dados numéricos , Assistência à Saúde , Neoplasias/epidemiologia , Neoplasias/terapia , Oncologistas , Especialização , Adolescente , Adulto , Austrália/epidemiologia , Sobreviventes de Câncer/psicologia , Criança , Estudos Transversais , Hospitais para Doentes Terminais , Humanos , Modelos Logísticos , Neoplasias/prevenção & controle , Propriedade , Cuidados Paliativos , Prevalência , Estudos Prospectivos , Saúde Pública , Pesquisa Qualitativa , Serviços de Saúde Rural , Inquéritos e Questionários
8.
Asian Pac J Cancer Prev ; 20(6): 1701-1708, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31244290

RESUMO

Objective: This report focuses on a private medical centre cancer care performance as measured by patient survival outcome for up to 5 years. Methods: All patients with nasopharyngeal cancer treated at SJMC between 2008 and 2012 were enrolled for this observational cohort study. Mortality outcome was ascertained through record linkage with national death register, linkage with hospital registration system and finally through direct contact by phone. Result: 266 patients treated between 2008 and 2012 were included for survival analysis. 31% of patients were diagnosed with Early NPC Cancer (Stage I or II), another 44% with Locally Advanced Cancer (Stage III) and 25% with late stage IV metastatic cancer. 2%, 27% and 67% had WHO Class I, II and III NPC respectively. The overall survival at 5 years was 100% for patients with Stage I disease, 91% for Stage II disease, 72% for Stage III disease, and decreasing to 44% for Stage IV disease. Overall survival at 5 years for all stages was 73%. Conclusion: SJMC is among the first hospitals in Malaysia to embark on routine measurement of the performance of its cancer care services and its results are comparable to any leading centers in developed countries.


Assuntos
Institutos de Câncer/estatística & dados numéricos , Quimiorradioterapia/mortalidade , Neoplasias Nasofaríngeas/mortalidade , Adulto , Feminino , Seguimentos , Humanos , Malásia , Masculino , Pessoa de Meia-Idade , Neoplasias Nasofaríngeas/patologia , Neoplasias Nasofaríngeas/terapia , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Fatores de Tempo
9.
Int J Radiat Oncol Biol Phys ; 105(1): 42-51, 2019 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-31082493

RESUMO

PURPOSE: To identify and report radiation oncologist (RO) workforce demographics, clinical workload trends, and equipment inventory in Canada. METHODS AND MATERIALS: The Canadian Association of Radiation Oncology (CARO) distributed an online survey to RO administrative leaders at 47 Canadian cancer centers providing radiation therapy services from June to December 2017. The survey queried RO staff demographics, clinical workload, and equipment inventory from 2014 to 2016. RESULTS: The response rate was 98% and represented 46 of 47 centers for analysis. In 2016, 510 ROs were in practice, with 98 ROs (19.2%) having <1.0 full-time equivalent (FTE) clinical work activities because of administration, research, or part-time employment. Most ROs worked full-time (92.0%), were affiliated with a university (77.5%), and worked in communities with a population >200,000 (84.9%). Approximately half (52.3%) were ≥46 years old. The male-to female ratio was 1.5:1 or higher in all regions of Canada except for Quebec, where there was no gender gap. Part-time employment was more common among female ROs (P < .01). Although FTE staff levels rose steadily between 2014 (456.3) and 2016 (475.8), an increase in patient workload resulted in a rise in the average annual consults per FTE-RO (from 257 to 267). Over a 2-year period, there were 63.5 FTE-recruitments and 44.0 FTE-departures (18.3 FTE-retirements; 25.7 FTE-migration) for a net gain of 19.5 RO-FTEs. An 8.4% increase in FTE staffing to 516 RO-FTEs in 2019 is anticipated, with 22 ROs expected to retire by 2019. There were 251 megavoltage linear accelerators across Canada, with most (39.8%) located in Ontario. Approximately one-fifth (20.7%) of these were older than 10 years and operating beyond the equipment's recommended life span. CONCLUSIONS: The Canadian RO workforce demonstrated incremental growth, but rising annual caseloads suggest that radiation therapy demand outpaced RO supply gains. Government funding is required to replace aging equipment in Canada.


Assuntos
Institutos de Câncer/estatística & dados numéricos , Aceleradores de Partículas/provisão & distribução , Radio-Oncologistas/estatística & dados numéricos , Radioterapia (Especialidade)/estatística & dados numéricos , Carga de Trabalho/estatística & dados numéricos , Adulto , Distribuição por Idade , Idoso , Canadá , Feminino , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Radio-Oncologistas/provisão & distribução , Radioterapia (Especialidade)/instrumentação , Radioterapia/estatística & dados numéricos , Aposentadoria/estatística & dados numéricos , Razão de Masculinidade , Sociedades Médicas
11.
Rev Bras Ginecol Obstet ; 41(3): 176-182, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30991432

RESUMO

OBJECTIVE: The aim of the present study was to describe and analyze data of 57 women with borderline ovarian tumors (BOTs) regarding histological characteristics, clinical features and treatment management at the Department of Obstetrics and Gynecology of the Universidade Estadual de Campinas (Unicamp, in the Portuguese acronym). METHODS: The present retrospective study analyzed data obtained from clinical and histopathological reports of women with BOTs treated in a single cancer center between 2010 and 2018. RESULTS: A total of 57 women were included, with a mean age of 48.42 years old (15.43-80.77), of which 30 (52.63%) were postmenopausal, and 18 (31.58%) were < 40 years old. All of the women underwent surgery. A total of 37 women (64.91%) were submitted to complete surgical staging for BOT, and none (0/57) were submitted to pelvic or paraortic lymphadenectomy. Chemotherapy was administered for two patients who recurred. The final histological diagnoses were: serous in 20 (35.09%) cases, mucinous in 26 (45.61%), seromucinous in 10 (17.54%), and endometrioid in 1 (1.75%) case. Intraoperative analyses of frozen sections were obtained in 42 (73.68%) women, of which 28 (66.67%) matched with the final diagnosis. The mean follow-up was of 42.79 months (range: 2.03-104.87 months). Regarding the current status of the women, 45 (78.95%) are alive without disease, 2 (3.51%) are alive with disease, 9 (15.79%) had their last follow-up visit > 1 year before the performance of the present study but are alive, and 1 patient (1.75%) died of another cause. CONCLUSION: Women in the present study were treated according to the current guidelines and only two patients recurred.


Assuntos
Neoplasias Ovarianas/patologia , Lesões Pré-Cancerosas/patologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Brasil , Institutos de Câncer/estatística & dados numéricos , Feminino , Humanos , Histerectomia/estatística & dados numéricos , Menopausa/fisiologia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/etiologia , Recidiva Local de Neoplasia/patologia , Tratamentos com Preservação do Órgão/estatística & dados numéricos , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/cirurgia , Lesões Pré-Cancerosas/tratamento farmacológico , Lesões Pré-Cancerosas/cirurgia , Estudos Retrospectivos , Salpingo-Ooforectomia/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
12.
CMAJ ; 191(16): E436-E445, 2019 04 23.
Artigo em Inglês | MEDLINE | ID: mdl-31015348

RESUMO

BACKGROUND: Patients with cancer have complex care requirements and frequently use the emergency department. The purpose of this study was to determine whether continuity of care, cancer expertise of an institution or both affect outcomes in patients with cancer in the emergency setting. METHODS: We conducted a retrospective cohort study using administrative databases from Ontario, Canada, involving records of patients aged 20 years and older who received chemotherapy or radiation in the 30 days before a cancer-related visit to the emergency department between 2006 and 2011. Patients seen in an emergency department at an alternative hospital (not the site where cancer treatment was given) were matched based on propensity score to patients who visited their original hospital (site where cancer treatment was given). Next, patients seen at an alternative emergency department that was in a general hospital (i.e., not a cancer centre) were matched to patients who visited their original hospital or a cancer centre. Outcomes were admission to hospital at the index visit to the emergency department, 30-day mortality, having imaging with computed tomography and return visits to the emergency department. RESULTS: We found 42 820 patients who were eligible for our study. Patients seen in the emergency departments at alternative hospitals were less likely to be admitted to hospital (odds ratio [OR] 0.78, 95% confidence interval [CI] 0.74-0.83) and had higher hazards of return visits to the emergency department than matched patients at original hospitals (hazard ratio [HR] 1.06, 95% CI 1.03-1.11). In comparison, patients at alternative general hospitals also had lower odds of admission to hospital (OR 0.83, 95% CI 0.79-0.88) and higher hazards of return visits to the emergency department (HR 1.07, 95% CI 1.03-1.11) compared with matched counterparts; however, these patients had higher 30-day mortality (OR 1.13, 95% CI 1.05-1.22) and lower odds of having CT imaging (OR 0.74, 95% CI 0.69-0.80). INTERPRETATION: Cancer expertise of an institution rather than continuity of care may be an important predictor of outcomes following emergency treatment of patients with cancer.


Assuntos
Institutos de Câncer , Continuidade da Assistência ao Paciente , Serviço Hospitalar de Emergência , Neoplasias/epidemiologia , Neoplasias/terapia , Institutos de Câncer/estatística & dados numéricos , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Serviços Médicos de Emergência , Serviço Hospitalar de Emergência/estatística & dados numéricos , Tratamento de Emergência , Humanos , Ontário/epidemiologia , Estudos Retrospectivos
13.
Acta Oncol ; 58(7): 1056-1061, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30938249

RESUMO

Background: Rapid diagnostics and treatment approaches have been applied in many countries to enhance patient satisfaction, but it is unknown whether this leads to improvements in survival. Material and methods: Symptoms initiation, referral, and investigations and their timing, and survival were retrospectively collected from all the patients diagnosed for lung cancer at Oulu University Hospital 2015-2016 (n = 221). Correlation of treatment delays to survival was evaluated in different categories and by tumor stages. Results: Survival analysis showed no statistical difference between patients having below or above median time for the whole clinical pathway (from symptoms to treatment). Subsection analysis of the clinical pathway and division of patients by stage showed improved survival for patients having longer than median times in referral to diagnosis (p = .03) and diagnosis to treatment (p < .0001) for the whole population and in the latter for the stage IV patients as well (p < .0001). In multivariate analysis, long diagnosis to treatment time associated with improved survival while statistical difference was lost in the referral to diagnosis interval. Conclusion: Longer time on diagnostic work-up of lung cancer does not worsen the survival suggesting that fast-track approaches might not improve lung cancer outcomes.


Assuntos
Diagnóstico Tardio/estatística & dados numéricos , Detecção Precoce de Câncer/estatística & dados numéricos , Neoplasias Pulmonares/diagnóstico , Idoso , Institutos de Câncer/estatística & dados numéricos , Feminino , Finlândia/epidemiologia , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Masculino , Estadiamento de Neoplasias , Estudos Retrospectivos , Análise de Sobrevida , Taxa de Sobrevida , Fatores de Tempo
14.
Indian J Cancer ; 56(1): 45-49, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30950444

RESUMO

CONTEXT: The management of breast cancer in older patients is challenging due to factors such as comorbidities, limited mobility, functional dependence, cognitive functions, and socioeconomic aspects. Data about the outcomes in elderly patients with breast cancer in our country are sparse. AIMS: The aim of this study was to evaluate and compare the clinical and pathological variables, treatment, and survival outcomes of elderly women (those of 70 years and above) with women under 50 years and those between the ages of 50 and 69 years treated at our center. SUBJECTS AND METHODS: Prospectively collected clinical and pathological data from January 2007 to December 2014 were recorded and entered into OncoCollect™ software. Statistical analysis was done using Microsoft R Open software. Survival analysis was estimated using Kaplan-Meier curves. RESULTS: A total of 1226 Stage I-III breast cancer patients were treated between January 2007 and December 2014. Of these, 11.3% (139) were aged 70 years and above. Invasive ductal carcinoma was predominant and majority had Stage II disease and grade 1 tumors. Receptor positivity was observed in 79% of elderly patients and 9% had triple-negative disease. Primary hormone therapy was given to 7% of the patients and chemotherapy was administered to 12%. The 5-year overall survival for patients 70 years and older is 85%. CONCLUSIONS: Elderly patients are more likely to have an indolent course with low grade and estrogen receptor-positive tumors. For healthy older women, treatment according to standard guidelines including surgery, chemotherapy, and radiation should be followed. However, for those who are unfit and cannot tolerate surgery, primary endocrine therapy is a suitable option.


Assuntos
Neoplasias da Mama/terapia , Institutos de Câncer/estatística & dados numéricos , Carcinoma Ductal de Mama/terapia , Idoso , Neoplasias da Mama/metabolismo , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/metabolismo , Carcinoma Ductal de Mama/patologia , Estudos de Casos e Controles , Terapia Combinada , Feminino , Seguimentos , Humanos , Índia , Pessoa de Meia-Idade , Receptor ErbB-2/metabolismo , Receptores Estrogênicos/metabolismo , Receptores de Progesterona/metabolismo , Taxa de Sobrevida , Resultado do Tratamento
15.
PLoS One ; 14(4): e0214382, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30951536

RESUMO

OBJECTIVES: To investigate the impact of provider payment reforms and associated care delivery models on cost and quality in cancer care. METHODS: Data sources/study setting: Review of English-language literature published in PubMed, Embase and Cochrane library (2007-2019). Study design: We performed a systematic literature review (SLR) to identify the impact of cancer care reforms. Primary endpoints were resource use, cost, quality of care, and clinical outcomes. Data collection/extraction methods: For each study, we extracted and categorized comparative data on the impact of policy reforms. Given the heterogeneity in patients, interventions and outcome measures, we did a qualitative synthesis rather than a meta-analysis. RESULTS: Of the 26 included studies, seven evaluations were in fact qualified as quasi experimental designs in retrospect. Alternative payment models were significantly associated with reduction in resource use and cost in cancer care. Across the seventeen studies reporting data on the implicit payment reforms through care coordination, the adoption of clinical pathways was found effective in reduction of unnecessary use of low value services and associated costs. The estimates of all measures in ACO models varied considerably across participating providers, and our review found a rather mixed impact on cancer care outcomes. CONCLUSION: The findings suggest promising improvement in resource utilization and cost control after transition to prospective payment models, but, further primary research is needed to apply robust measures of performance and quality to better ensure that providers are delivering high-value care to their patients, while reducing the cost of care.


Assuntos
Assistência à Saúde , Pessoal de Saúde , Neoplasias/epidemiologia , Institutos de Câncer/estatística & dados numéricos , Análise Custo-Benefício , Hospitais/estatística & dados numéricos , Humanos
16.
J Cancer Res Ther ; 15(1): 169-175, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30880775

RESUMO

Purpose: This trial studies the feasibility and potential utility of stereotactic body radiation therapy in patients with unresectable liver metastasis. Aims: (1) The aim of this study is to assess the local response of the liver lesions poststereotactic body radiation therapy regarding number and size of lesions and (2) to evaluate the toxicity to organ (s) at risk. Materials and Methods: A total of 15 patients were enrolled in this study from November 2014 to October 2015. The inclusion criteria for this study were patients having 1-3 liver metastasis from any solid tumor except germ cell tumor or lymphoma with no evidence of progressive disease (PD) outside the liver. A planning four dimensional-computed tomography (CT) scan was taken. Planning target volume was generated by giving margin of 5 mm. Dose prescribed was 36 Gy in 3#. Response was defined by CT abdomen done at 3 and 6 months poststereotactic body radiation therapy as per RECIST guideline (v1.1). Results: At 3 months poststereotactic body radiation therapy, five patients had partial response, five patients had stable disease, and five patients had PD as per RECIST criteria. Out of 20 assessable lesions, 16 were controlled at 3 months poststereotactic body radiation therapy. The actuarial local control rate was 86% at 3 months and 77% at 6 months poststereotactic body radiation therapy. The median progression free survival was 7 months. Two patients experienced Grade 2 gastric toxicity and one patient experienced Grade 2 small bowel toxicity. No cases of radiation-induced liver disease were observed. Conclusions: This trial examines the feasibility of stereotactic body radiotherapy to liver metastasis in the Indian scenario. It shows excellent tolerability and is a safe therapeutic option for inoperable patients, showing good local control.


Assuntos
Neoplasias Hepáticas/radioterapia , Lesões por Radiação/epidemiologia , Radiocirurgia/métodos , Adulto , Idoso , Institutos de Câncer/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Tomografia Computadorizada Quadridimensional/métodos , Humanos , Índia , Fígado/diagnóstico por imagem , Fígado/patologia , Fígado/efeitos da radiação , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Intervalo Livre de Progressão , Lesões por Radiação/etiologia , Radiocirurgia/efeitos adversos , Radiocirurgia/estatística & dados numéricos , Planejamento da Radioterapia Assistida por Computador/métodos , Critérios de Avaliação de Resposta em Tumores Sólidos , Centros de Atenção Terciária/estatística & dados numéricos
17.
Br J Radiol ; 92(1098): 20180988, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30924682

RESUMO

OBJECTIVE: Stereotactic ablative radiotherapy (SABR) has become the standard of care for suitable patients with peripherally located early stage non-small cell lung cancer. Lung SABR requires strict image-guided radiotherapy (IGRT) protocols to ensure its safe delivery. The aim of this survey was to provide an assessment of current lung SABR practice in the UK. METHODS: An online semi-structured survey containing a maximum of 32 questions regarding lung SABR, focussing on treatment image verification processes was piloted, developed and disseminated to the radiotherapy managers of 62 National Health Service centres across the UK. RESULTS: The survey had a 100% complete response from NHS centres. 36 centres (58%) currently deliver lung SABR, with half treating fewer than 50 patients per year. Six centres deliver SABR despite not being commissioned by the NHS to provide this service. There is wide variation in the use of IGRT. Eight different permutations of cone beam CT order within the workflow were reported. Almost half of lung centres (17/36, 47%) believe there is a need to update national image guidance associated with lung SABR, such as the use of 'day zero', mid treatment and post treatment cone beam CTs. CONCLUSION: Our results demonstrate wide variation in IGRT for lung SABR. There is an opportunity to develop existing IGRT workflows and the optimal approach to image guidance. Further work is required to investigate lung SABR provision and potential barriers to its implementation. ADVANCES IN KNOWLEDGE: This survey represents the most comprehensive and accurate assessment of lung SABR practice in the UK since the 2014 SABR consortium survey.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/radioterapia , Neoplasias Pulmonares/radioterapia , Radiocirurgia/tendências , Institutos de Câncer/organização & administração , Institutos de Câncer/estatística & dados numéricos , Protocolos Clínicos , Técnicas de Apoio para a Decisão , Tomografia Computadorizada Quadridimensional/estatística & dados numéricos , Humanos , Equipe de Assistência ao Paciente/organização & administração , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Utilização de Procedimentos e Técnicas , Radiologistas/estatística & dados numéricos , Radiocirurgia/estatística & dados numéricos , Radioterapia Guiada por Imagem/estatística & dados numéricos , Reino Unido
18.
Gynecol Oncol ; 153(3): 574-579, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30876675

RESUMO

OBJECTIVES: To evaluate trends in uptake of sentinel lymph node (SLN) procedures over time and associated factors in women with vulvar cancer. METHODS: A retrospective population-based cohort study identified women with invasive squamous cell carcinoma (SCC) of the vulva using health administrative data for the province of Ontario, Canada, between 2008 and 2016. Patients who underwent SLN procedures were compared to those who had groin node dissection (GND). Multivariable analysis was used to identify factors associated with SLN procedures. RESULTS: 1385 patients with SCC of the vulva were identified; 1079 had a surgical procedure. Only those with groin node assessment were included in the study cohort (n = 732, 68%). SLN procedures were done in 52%. When comparing SLN versus GND, the rate of SLNs was significantly different by year of diagnosis (P < 0.001), associated comorbidity (P < 0.001) and institution (P < 0.0001). The rates of SLNs by institution with gynecologic oncologist were variable and ranged from 32% to 79% among 9 centers. There were no differences in age, income quintile, and urban/rural residence. The proportion of SLN procedures increased from 30.1% (CI 18.9-45.6) in 2008 to 65.2% (CI 36.5-107.6) in 2016. On multivariate analysis, factors significantly associated with SLN procedures were more recent year of diagnosis (OR 7.9, CI 2.7-23.5) associated comorbidities (OR 2.7, CI 1.5-5.0) and institution (Site 5, OR 19.6 [CI 3.6-108.3] and Site 6, [OR 6, CI 1.1-33.4]). CONCLUSIONS: The proportion of SLN procedures in women with vulvar cancer has increased over time, but uptake is not uniform across institutions. Barriers to uptake should be explored.


Assuntos
Institutos de Câncer/estatística & dados numéricos , Carcinoma de Células Escamosas/cirurgia , Hospitais Comunitários/estatística & dados numéricos , Biópsia de Linfonodo Sentinela/tendências , Neoplasias Vulvares/cirurgia , Demandas Administrativas em Assistência à Saúde , Idoso , Idoso de 80 Anos ou mais , Institutos de Câncer/organização & administração , Carcinoma de Células Escamosas/secundário , Comorbidade , Feminino , Hospitais Comunitários/organização & administração , Humanos , Canal Inguinal , Excisão de Linfonodo/tendências , Metástase Linfática , Pessoa de Meia-Idade , Ontário , Estudos Retrospectivos , Linfonodo Sentinela/patologia , Linfonodo Sentinela/cirurgia , Neoplasias Vulvares/patologia
19.
Int J Radiat Oncol Biol Phys ; 104(4): 756-764, 2019 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-30885776

RESUMO

PURPOSE: To quantify the effects of opening a proton center (PC) on an academic medical center (AMC)/radiation oncology department. METHODS AND MATERIALS: Radiation treatment volume and relative value units from fiscal year 2015 (FY15) to FY17 were retrospectively analyzed at the AMC and 2 community-based centers. To quantify new patient referrals to the AMC, we reviewed the electronic medical record for all patients seen at the PC since consults were initiated in November 2015 (n = 1173). Patients were excluded if the date of entry into the AMC electronic medical record predated their PC consultation. Hospital resource use and professional and technical charges were obtained for these patients. Academic growth, philanthropy, and resident education were evaluated based on grant submissions, clinical trial enrollment, philanthropy, and pediatric case exposure, respectively, from PC opening through FY17. RESULTS: From FY15 to FY17, radiation fractions at the AMC and the 2 community sites decreased by 14% (95% confidence interval [CI], 12%-16%, P < .001) and increased by 19% (95% CI, 16%-23%, P < .001) and 2% (95% CI, -1.1 to 4.3%, P = NS), respectively; the number of new starts decreased by 3% (95% CI, -13% to 7%, P = NS) and 2% (95% CI, -20% to 16%, P = NS) and increased by 13% (95% CI -2% to 27%, P = NS), respectively. At the AMC, technical and professional relative value units decreased by 5% and 14%, respectively. The PC made 561 external referrals to the AMC, which resulted in $2.38 million technical and $2.13 million professional charges at the AMC. Fifteen grant submissions ($12.83 million) resulted in 6 awards ($3.26 million). Twenty-two clinical trials involving proton therapy were opened, on which a total of 5% (n = 54) of patients enrolled during calendar years 2017 and 2018. The PC was involved in gift donations of $1.6 million. There was a nonsignificant 37% increase in number of pediatric cases. CONCLUSIONS: Despite a slight decline in AMC photon patient volumes and relative value units, a positive downstream effect was associated with the addition of a PC, which benefited the AMC.


Assuntos
Centros Médicos Acadêmicos/estatística & dados numéricos , Institutos de Câncer/estatística & dados numéricos , Centros Comunitários de Saúde/estatística & dados numéricos , Terapia com Prótons/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Centros Médicos Acadêmicos/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Institutos de Câncer/economia , Criança , Pré-Escolar , Ensaios Clínicos como Assunto/estatística & dados numéricos , Centros Comunitários de Saúde/economia , Intervalos de Confiança , Eficiência Organizacional , Registros Eletrônicos de Saúde , Feminino , Organização do Financiamento/economia , Organização do Financiamento/estatística & dados numéricos , Obtenção de Fundos/economia , Obtenção de Fundos/estatística & dados numéricos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Fótons/uso terapêutico , Terapia com Prótons/economia , Radioterapia (Especialidade)/economia , Radioterapia (Especialidade)/educação , Encaminhamento e Consulta/economia , Escalas de Valor Relativo , Estudos Retrospectivos , Adulto Jovem
20.
World J Surg ; 43(7): 1777-1787, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30820734

RESUMO

INTRODUCTION: Intrahepatic cholangiocarcinoma (ICC) remains an uncommon disease with a rising incidence worldwide. We sought to identify trends in therapeutic approaches and differences in patient outcomes based on facility types. METHODS: Between January 1, 2004, and December 31, 2015, a total of 27,120 patients with histologic diagnosis of ICC were identified in the National Cancer Database and were enrolled in this study. RESULTS: The incidence of ICC patients increased from 1194 in 2004 to 3821 in 2015 with an average annual increase of 4.16% (p < 0.001). Median survival of the cohort improved over the last 6 years of the study period (2004-2009: 8.05 months vs. 2010-2015: 9.49 months; p < 0.001). Among surgical patients (n = 5943, 21.9%), the incidence of R0 resection, lymphadenectomy and harvest of ≥6 lymph nodes increased over time (p < 0.001). Positive surgical margins (referent R0: R1, HR 1.49, 95% CI 1.24-1.79, p < 0.001) and treatment at community cancer centers (referent academic centers; HR 1.24, 95% CI 1.04-1.49, p = 0.023) were associated with a worse prognosis. Patients treated at academic centers had higher rates of R0 resection (72.4% vs. 67.7%; p = 0.006) and lymphadenectomy (55.6% vs. 49.5%, p = 0.009) versus community cancer centers. Overall survival was also better at academic versus community cancer programs (median OS: 11 months versus 6 months, respectively; p < 0.001). CONCLUSIONS: The incidence of ICC has increased over the last 12 years in the USA with a moderate improvement in survival over time. Treatment at academic cancer centers was associated with higher R0 resection and lymphadenectomy rates, as well as improved OS for patients with ICC.


Assuntos
Neoplasias dos Ductos Biliares/epidemiologia , Neoplasias dos Ductos Biliares/cirurgia , Colangiocarcinoma/epidemiologia , Colangiocarcinoma/cirurgia , Instalações de Saúde/estatística & dados numéricos , Excisão de Linfonodo/tendências , Centros Médicos Acadêmicos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Ductos Biliares Intra-Hepáticos/cirurgia , Institutos de Câncer/estatística & dados numéricos , Bases de Dados Factuais , Feminino , Hospitais Comunitários/estatística & dados numéricos , Humanos , Incidência , Linfonodos/patologia , Linfonodos/cirurgia , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Neoplasia Residual , Taxa de Sobrevida/tendências , Resultado do Tratamento , Estados Unidos/epidemiologia
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