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Kinnier C.V.,Northwestern University | Kinnier C.V.,Massachusetts General Hospital | Asare E.A.,Medical College of Wisconsin | Mohanty S.,Ford Motor Company | And 4 more authors.
Journal of Surgical Oncology | Year: 2014

Healthcare has increasingly focused on patient engagement and shared decision-making. Decision aids can promote engagement and shared decision making by providing patients and their providers with care options and outcomes. This article discusses decision aids for surgical oncology patients. Topics include: short-term risk prediction following surgery, long-term risk prediction of survival and recurrence, the combination of short- and long-term risk prediction to help guide treatment choice, and decision aid usability, transparency, and accessibility. © 2014 Wiley Periodicals, Inc. Source


Sherman K.L.,Northwestern Institute for Comparative Effectiveness Research NICER in Oncology | Sherman K.L.,Northwestern University | Kinnier C.V.,Northwestern Institute for Comparative Effectiveness Research NICER in Oncology | Kinnier C.V.,Northwestern University | And 12 more authors.
Journal of Surgical Oncology | Year: 2014

Background and Objectives: Lymph node evaluation recommendations for extremity soft tissue sarcoma (ESTS) are absent from national guidelines. Our objectives were (1) to assess rates and predictors of nodal evaluation, and (2) to assess rates and predictors of nodal metastases.Methods: ESTS patients from the National Cancer Data Base (2000.2009) were assessed, and regression models were used to identify factors associated with nodal evaluation and metastases.Results: Of 27,536 ESTS patients, 1,924 (7%) underwent nodal evaluation, and of these, 290 (15%) had nodal metastases. Nodal evaluation was most frequently performed for rhabdomyosarcoma (15.6%), angiosarcoma (10.0%), clear cell sarcoma (39.3%), epithelioid sarcoma (28.1%), and synovial sarcoma (9.3%). On multivariable analysis, factors associated with nodal evaluation included histologic subtype, tumor size, and grade. Nodal metastasis rates were highest among patients with rhabdomyosarcoma (32.1%), angiosarcoma (24.1%), clear cell sarcoma (27.7%), and epithelioid sarcoma (31.8%). On multivariable analysis, factors associated with nodal metastases included histologic subtype, tumor size, and grade.Conclusions: Nodal evaluation rates are highest among certain expected subtypes but are generally low. However, nodal metastasis rates for many histologic subtypes in patients selected for lymph node evaluation may be higher than previously reported. Multi-institutional studies should address nodal evaluation for ESTS. © 2014 Wiley Periodicals, Inc. Source


Kinnier C.V.,Northwestern Institute for Comparative Effectiveness Research NICER in Oncology | Kinnier C.V.,Northwestern University | Kinnier C.V.,Massachusetts General Hospital | Paruch J.L.,University of Chicago | And 9 more authors.
Annals of Surgery | Year: 2016

Objective: Our objectives were to examine whether hospital characteristics are associated with lower-and higher-than-expected sentinel lymph node biopsy (SLNB) positivity rates and whether hospitals with lower-or higherthan-expected SLNB positivity rates have worse patient outcomes. Background: Surgeon and pathologist SLNB technical errors may lead to incorrect melanoma staging. A hospital's SLNB positivity rate may reflect its SLNB proficiency for melanoma, but this has never been investigated. Methods: Stage IA-III melanoma patients undergoing SLNB were identified from the National Cancer Data Base (2004-2010). Hospital-level SLNB positivity rates were adjusted for patient-and tumor factors. Hospitals were divided into terciles of adjusted SLNB positivity rates. Hospital characteristics (using multinomial logistic regression) and survival (using Cox modeling) were examined across terciles. Results: Of 33,639 SLNB patients (from 646 hospitals), 2916 (8.7%) had at least 1 positive lymph node. Hospitals with lower-(low tercile) and higherthan-expected (high tercile) SLNB positivity rates were more likely to be lowvolume hospitals (low tercile: relative risk ratio (RRR)=2.57, P=0.002; high tercile: RRR=2.3, P=0.004) compared to hospitals with expected rates (middle tercile). Stage I patients treated at lower-than-expected SLNB positivity rate hospitals had worse 5-year survival than those treated at expected SLNB positivity rate hospitals (90.0% vs 91.9%, P=0.014; hazard ratio=1.28, 95% CI: 1.05-1.57); survival differences were not observed by SLNB positivity rates for stage II/III. Conclusions: Adjusted hospital SLNB positivity rates varied widely. Surgery at hospitals with lower-than-expected SLNB positivity rates was associated with decreased survival. Hospital SLNB positivity rates may be a novel measure to confidentially report to hospitals for internal quality assessment. © 2015 Wolters Kluwer Health, Inc. All rights reserved. Source

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