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New Haven, CT, United States

Bui D.L.,Yale University | Yu J.B.,Yale University | Yu J.B.,Yale Cancer Center | Yu J.B.,Effectiveness Research Center at Yale
Cancer Journal (United States) | Year: 2015

Cancer care is becoming increasingly complicated, in particular with the integration of radiation and surgery. Institutions may need to increase coordination between multidisciplinary clinical teams to optimize patient care. This study examines historical trends in adjuvant and neoadjuvant radiation therapy (ANRT) before or after cancer-directed surgery to identify disease sites that may benefit from coordinated care. Methods The Surveillance, Epidemiology, and End Results database was queried to identify patients with bladder cancer; breast cancer; cervical cancer; colorectal cancer; kidney cancer; cancer of the lung, bronchus, and pleura; lymphoma; melanoma; cancer of the oral cavity and pharynx; ovarian cancer; pancreatic cancer; prostate cancer; thyroid cancer; and uterine cancer from 1973 to 2011. Number and percentage of patients who received ANRT were calculated from 1973 to 2011. Results Adjuvant and neoadjuvant radiation therapy usage increased from 14% in 1973 to 19% in 2011. Adjuvant and neoadjuvant radiation therapy use for breast, oral cavity/pharynx, and thyroid cancers increased from 24%, 16%, and 9% in 1973 to 53%, 32%, and 46% in 2011, respectively. Changes in ANRT were seen in gynecologic and genitourinary cancers, with increased use of ANRT in cervical cancer and declines in uterine, ovarian, bladder, prostate, and kidney cancers. There were minimal changes in ANRT usage for patients within other diagnosis groups. Discussion Overall usage of ANRT is increasing over time, with increased need for coordinated care in breast and head and neck cancers. Adjuvant and neoadjuvant radiation therapy in genitourinary and gynecologic cancers is undergoing significant change. © 2015 Wolters Kluwer Health, Inc. Source


Wang E.H.,Yale University | Mougalian S.S.,Yale University | Mougalian S.S.,Yale Cancer Center | Mougalian S.S.,Effectiveness Research Center at Yale | And 8 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2015

Purpose: Intensity modulated radiation therapy (IMRT) is a newer method of radiation therapy (RT) that has been increasingly adopted as an adjuvant treatment after breast-conserving surgery (BCS). IMRT may result in improved cosmesis compared to standard RT, although at greater expense. To investigate the adoption of IMRT, we examined trends and factors associated with IMRT in women under the age of 65 with early stage breast cancer. Methods and Materials: We performed a retrospective study of early stage breast cancer patients treated with BCS followed by whole-breast irradiation (WBI) who were <65 years old in the National Cancer Data Base from 2004 to 2011. We used logistic regression to identify factors associated with receipt of IMRT (vs standard RT). Results: We identified 11,089 women with early breast cancer (9.6%) who were treated with IMRT and 104,448 (90.4%) who were treated with standard RT, after BCS. The proportion of WBI patients receiving IMRT increased yearly from 2004 to 2009, with 5.3% of WBI patients receiving IMRT in 2004 and 11.6% receiving IMRT in 2009. Further use of IMRT declined afterward, with the proportion remaining steady at 11.0% and 10.7% in 2010 and 2011, respectively. Patients treated in nonacademic community centers were more likely to receive IMRT (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.30-1.43 for nonacademic vs academic center). Compared to privately insured patients, the uninsured patients (OR, 0.81; 95% CI, 0.70-0.95) and those with Medicaid insurance (OR, 0.87; 95% CI, 0.79-0.95) were less likely to receive IMRT. Conclusions: The use of IMRT rose from 2004 to 2009 and then stabilized. Important nonclinical factors associated with IMRT use included facility type and insurance status. © 2015 Elsevier Inc. Source


Wang E.H.,Yale University | Mougalian S.S.,Yale University | Mougalian S.S.,Effectiveness Research Center at Yale | Soulos P.R.,Yale University | And 10 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2014

Purpose To evaluate the relationship of patient, hospital, and cancer characteristics with the adoption of hypofractionation in a national sample of patients diagnosed with early-stage breast cancer.Methods and Materials We performed a retrospective study of breast cancer patients in the National Cancer Data Base from 2004-2011 who were treated with radiation therapy and met eligibility criteria for hypofractionation. We used logistic regression to identify factors associated with receipt of hypofractionation (vs conventional fractionation).Results We identified 13,271 women (11.7%) and 99,996 women (88.3%) with early-stage breast cancer who were treated with hypofractionation and conventional fractionation, respectively. The use of hypofractionation increased significantly, with 5.4% of patients receiving it in 2004 compared with 22.8% in 2011 (P<.001 for trend). Patients living ≥50 miles from the cancer reporting facility had increased odds of receiving hypofractionation (odds ratio 1.57 [95% confidence interval 1.44-1.72], P<.001). Adoption of hypofractionation was associated with treatment at an academic center (P<.001) and living in an area with high median income (P<.001). Hypofractionation was less likely to be used in patients with high-risk disease, such as increased tumor size (P<.001) or poorly differentiated histologic grade (P<.001).Conclusions The use of hypofractionation is rising and is associated with increased travel distance and treatment at an academic center. Further adoption of hypofractionation may be tempered by both clinical and nonclinical concerns. © 2014 Elsevier Inc. Source


Wang E.H.,Yale University | Corso C.D.,Yale University | Rutter C.E.,Yale University | Rutter C.E.,Effectiveness Research Center at Yale | And 11 more authors.
Journal of Clinical Oncology | Year: 2015

Purpose To review trends in the use of postoperative radiotherapy (PORT) for stage II and III incompletely resected non-small-cell lung cancer (NSCLC) and evaluate the association between PORT and survival in such patients. Patients and Methods We identified patients with pathologic stage N0-2, overall American Joint Committee on Cancer stage II or III NSCLC within the National Cancer Data Base who had undergone a lobectomy or pneumonectomy with positive surgical margins. Only patients coded as receiving external-beam PORT at 50 to 74 Gy or observation were included. To account for perioperative mortality, we excluded patients who survived less than 4 months after diagnosis. Multivariable logistic regression was used to determine factors associated with PORT receipt. Cox proportional hazards regression was performed for multivariable analyses of overall survival. Results Among 3,395 included patients, 1,207 (35.6%) received PORT. Predictors for the use of PORT among this patient population included age less than 60 years, treatment in a nonacademic facility, earlier year of diagnosis, decreased travel distance, lower nodal stage, and chemotherapy receipt On multivariable analysis adjusting for demographic and clinicopathologic covariates, PORT (hazard ratio, 0.80; 95% CI, 0.70 to 092) was associated with improved survival. Subset analysis by nodal stage showed that PORT improved survival across all nodal stages. Conclusion PORT is associated with improved overall survival in patients with incompletely resected stage II or III N0-2 NSCLC. The use of PORT for this population in more recent years has been declining In the absence of randomized trials evaluating PORT utilization for this patient population, our findings strongly support the delivery of PORT in patients with incompletely resected NSCLC. Copyright © 2015 American Society of Clinical Oncology. All rights reserved. Source

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