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Cancer-Directed Therapy and Hospice Care for Metastatic Cancer in American Indians and Alaska Natives.

https://arctichealth.org/en/permalink/ahliterature271321
Source
Cancer Epidemiol Biomarkers Prev. 2015 Jul;24(7):1138-43
Publication Type
Article
Date
Jul-2015
Author
Stacey Shiovitz
Aasthaa Bansal
Andrea N Burnett-Hartman
Andrew Karnopp
Scott V Adams
Victoria Warren-Mears
Scott D Ramsey
Source
Cancer Epidemiol Biomarkers Prev. 2015 Jul;24(7):1138-43
Date
Jul-2015
Language
English
Publication Type
Article
Keywords
Aged
Alaska - ethnology
Female
Hospice Care - methods
Humans
Incidence
Indians, North American
Male
Neoplasm Metastasis - therapy
Neoplasms - ethnology
Population Surveillance
Registries
United States - epidemiology
Abstract
Little has been reported regarding patterns of oncologic care in American Indian/Alaska Natives (AI/AN). Observed worse survival has been attributed to later-stage presentation. We aimed to evaluate racial differences in cancer-directed therapy and hospice care utilization in AI/ANs and non-Hispanic whites (NHW) with metastatic cancer.
The linked Surveillance, Epidemiology, and End Results (SEER)-Medicare claims database was accessed for AI/AN and NHW metastatic-cancer cases diagnosed between 2001 and 2007. Utilization of cancer-directed therapy (surgery, radiation, and/or chemotherapy) and/or hospice services was compared between AI/ANs and NHWs. Minimally adjusted (age, sex, diagnosis year) and fully-adjusted (also Klabunde comorbidity score, sociodemographic factors) regression models were used to estimate odds (OR) and hazard ratios (HR) for receipt of care.
AI/ANs were younger, more likely to reside in the West, be unmarried, have lower income, and live in a nonurban setting than NHWs. Fewer AI/ANs received any cancer-directed therapy (57% vs. 61% NHWs) within 3 months of diagnosis; sociodemographic factors accounted for much of this difference [fully-adjusted HR, 0.94; 95% confidence interval (CI), 0.83-1.08]. We noted differences in hospice utilization between AI/ANs (52%) and NHWs (61%). A significant difference in hospice utilization remained after adjustment for sociodemographics (OR, 0.78; 95% CI, 0.61-0.99).
Observed absolute differences in care for AI/ANs and NHWs with metastatic cancer were largely accounted for by adjusting for socioeconomics, comorbidities, and demographic factors. A significant association between race and hospice utilization was noted.
Efforts to improve metastatic-cancer care should focus on socioeconomic barriers and investigate the observed disparity in receipt of hospice services.
Notes
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PubMed ID
25987547 View in PubMed
Less detail

Factors important for efficacy of stereotactic body radiotherapy of medically inoperable stage I lung cancer. A retrospective analysis of patients treated in the Nordic countries.

https://arctichealth.org/en/permalink/ahliterature80617
Source
Acta Oncol. 2006;45(7):787-95
Publication Type
Article
Date
2006
Author
Baumann Pia
Nyman Jan
Lax Ingmar
Friesland Signe
Hoyer Morten
Rehn Ericsson Suzanne
Johansson Karl-Axel
Ekberg Lars
Morhed Elisabeth
Paludan Merete
Wittgren Lena
Blomgren Henrik
Lewensohn Rolf
Author Affiliation
Division of Oncology and Hospital Physics, Radiumhemmet Karolinska University Hospital, Sweden.
Source
Acta Oncol. 2006;45(7):787-95
Date
2006
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Carcinoma, Non-Small-Cell Lung - mortality - pathology - surgery
Denmark - epidemiology
Disease-Free Survival
Female
Humans
Lung Neoplasms - mortality - pathology - surgery
Male
Middle Aged
Neoplasm Metastasis - therapy
Neoplasm Recurrence, Local - mortality
Probability
Radiosurgery - methods
Retrospective Studies
Survival Analysis
Sweden - epidemiology
Treatment Failure
Treatment Outcome
Abstract
We reviewed results of SBRT treatment of 138 patients with medically inoperable stage I NSCLC treated during 1996-2003 at five different centres in Sweden and Denmark. Mean age was 74 years (range 56-90) with 69 men and 72 women. SBRT was delivered using a 3D conformal multifield technique and a stereotactic body frame. Doses delivered were 30-48 Gy (65% isodose at the periphery of planning target volume, PTV) in 2-4 fractions. Equivalent dose in 2 Gy fractions (EQD2) was in the range of 50-100 Gy. Mean gross tumour volume (GTV) was 39 cm3 (2-436), and planning target volume was 101 cm3 (11-719). Overall response rate (CR, PR) was 61% (84/138). SD was noted in 36% (50/138). During a median follow-up period of 33 months (1-107), 16 (12%) local failures occurred, ten of which also included distant metastases. Local failure was associated with tumour size, target definition and central or pleura proximity. Distant metastases occurred in 25% (35/138) of the patients. Ninety-one (65%) patients died during follow-up of which 55 patients (60%) died of other causes than lung cancer. Three- and 5-year overall survival was 52 and 26% respectively. Lung cancer specific 3- and 5-year overall survival was 66 and 40% respectively. Fifty nine percent (83/138) of the patients had no side effects. Fourteen patients experienced grade 3-4 toxicity according to radiation therapy oncology group (RTOG). EQD2 (> v.s.
PubMed ID
16982541 View in PubMed
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Individualised treatment of metastatic cancer.

https://arctichealth.org/en/permalink/ahliterature118878
Source
Tidsskr Nor Laegeforen. 2012 Nov 12;132(21):2358-9
Publication Type
Article
Date
Nov-12-2012
Author
Anne Hansen Ree
Source
Tidsskr Nor Laegeforen. 2012 Nov 12;132(21):2358-9
Date
Nov-12-2012
Language
English
Norwegian
Publication Type
Article
Keywords
Health Policy
Humans
Individualized Medicine
Neoplasm Metastasis - therapy
Neoplasms - therapy
Norway
PubMed ID
23160572 View in PubMed
Less detail