Toms Vengaloor Thomas

University of Mississippi Medical Center

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Srinivasan Vijayakumar

University of Mississippi Medical Center

Eldrin Bhanat

University of Mississippi Medical Center

Ashley Albert

Arizona Oncology

Mary R Nittala

Jackson Memorial Hospital

William N Duggar

University of Mississippi Medical Center

Teessa Perekattu Kuruvilla

University of Mississippi Medical Center

Satyaseelan Packianathan

University of Mississippi Medical Center

Anu Abraham

Queen Elizabeth Hospital Birmingham

Paul Roberts

University Hospital Southampton NHS Foundation Trust

Linkan Bian

Mississippi State University

Cooperative Institutions

University of Mississippi Medical Center

Jackson Memorial Hospital

Sultan Qaboos University

University of Mississippi

Sultan Qaboos University Hospital

G.V. (Sonny) Montgomery VA Medical Center

State Street (United States)

The University of Texas Southwestern Medical Center

Texas Oncology

University of Michigan–Ann Arbor

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An Analysis of the Racial Disparities Among Cervical Cancer Patients Treated at an Academic Medical Center in the Southeastern United States

Cureus (2021)

Toms Vengaloor Thomas Shivanthidevi Gandhi Eldrin Bhanat Kati Krishna William H. Robinson

Objective The purpose of this study was to identify racial disparities in treatment outcomes, if any, among patients with carcinoma of the cervix treated at a tertiary care institution in the state of Mississippi. Methods A retrospective review of patients with carcinoma of the cervix treated in the Department of Radiation Oncology at our institution between 2010 and 2018 was performed. Data regarding demographics, disease stage, treatments administered, and follow-up were collected. Patient outcomes, including median survival and overall survival, were analyzed using the Kaplan-Meier method. All analyses were performed using SPSS Statistics version 24 (IBM, Armonk, NY). Results Between January 2010 and December 2018, a total of 165 patients with carcinoma of the cervix were treated at our institution. We had a significantly higher proportion of African American (AA) compared to Caucasian American (CA) patients (59.4 vs. 36.4%; p=0.03). There was a significant difference in the disease stage at the time of presentation between AA and CA in that compared to AA women, a higher number of CA patients presented with locally advanced disease [Federation of Gynecology and Obstetrics (FIGO) stages IB2 to IVA] (78.6 vs. 86.7%; p<0.001). However, a higher number of AA patients presented with metastatic disease at diagnosis compared to CA women (13.3 vs. 8.3%; p<0.001). Regarding their treatment, 157 (95.2%) underwent definitive chemoradiotherapy, while three (1.8%) had definitive surgery followed by adjuvant radiation or chemoradiation, depending on the risk factors identified operatively. The treatment details of five patients were not available. The median follow-up and the median survival of the entire cohort were 16 months and 79 months, respectively. In our cohort, there was no significant difference in overall survival between AA and CA patients at either three years (80 vs. 68%; p=0.883) or five years (77 vs. 68%; p=0.883). As expected, patients with locally advanced disease showed a significantly better median survival of 79 months compared to only 11 months for those with metastatic disease at their presentation (p<0.001). Conclusions Our study revealed that more AA women presented with metastatic disease compared to CA women. However, our analysis did not identify any racial disparities in the prognosis of the entire cohort.

Chemoradiotherapy

10.7759/cureus.13296

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Citations (4)

PA.26 Reviewing the practice of Ward Rounds in Obstetrics and Gynaecology: A snapshot at a busy District General Hospital

Archives of Disease in Childhood Fetal & Neonatal (2014)

E Quicke Connie Pidgeon Emily Tabb Toms Vengaloor Thomas

Background

The ward round often represents the mainstay of doctor-patient contact during a hospital stay. They give the opportunity for the multi-disciplinary team to tailor individual patient care and improve patient safety and experience. In 2012 the Royal Colleges of Physicians and Nursing created a set of best practice principles for ward rounds. This audit aimed to compare current practice to these best practice principles.

Methods

A prospective audit of 45 inpatients on the Obstetric and Gynaecology wards of Walsall Manor Hospital in nine days of April 2013. Standards set out in the document “Ward Rounds in medicine – Principles for best Practice” were used as a benchmark.

Results

89% (40/45) patients were reviewed by a doctor, 58% (23/40) of whom were reviewed before 10am, with 30% (12/40) being reviewed between 10:00 and 13:00. There was considerable variation between consultants as to the percentage of their patients which were reviewed (50–100%), the time of day at which the review took place and who reviewed the patient.

Conclusions

The majority of patients are probably being reviewed on most days of their hospital stay by a senior doctor. However there is considerable variation depending on the consultant responsible for the patients’ care. Reducing this variability may be important in improving patient experience and safety. By creating guidelines based on the best practice principles it may be possible to reduce variability and better involve members of the multidisciplinary team. It will also help define future audits and provide for meaningful national comparisons.

Best practice

10.1136/archdischild-2014-306576.69

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Quality assurance anecdotes: quality accountability at Flow Memorial Hospital.

PubMed (1980)

Toms Vengaloor Thomas

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Clinical Decision Support through Interpretable Machine Learning in Head and Neck Cancer

International Journal of Radiation Oncology*Biology*Physics (2022)

Toms Vengaloor Thomas Y. Wang William N Duggar P.R. Roberts R.T. Gatewood

Identification

10.1016/j.ijrobp.2022.07.907

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Gender Disparities In Radiation Oncology Residency Programs In The United States- Current Status

International Journal of Radiation Oncology*Biology*Physics (2019)

Toms Vengaloor Thomas Teessa Perekattu Kuruvilla Eldrin Bhanat Ashley Albert A Abraham

Radiation oncology

10.1016/j.ijrobp.2019.06.510

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Strategies to improve financial literacy and related outcomes among medical students, residents, and fellows in the United States: a scoping review protocol

JBI Evidence Synthesis (2020)

Toms Vengaloor Thomas Robin Christian Michelle Palokas Elizabeth Hinton Christian Pruett

The objective of this scoping review is to explore strategies to improve financial literacy and related outcomes among medical students, residents, and fellows in the United States. Financial wellness and literacy are essential parts of overall wellness for medical students, residents, and fellows. Financial illiteracy and increased financial debt have negative implications for medical professionals and health care. Burnout is common among medical students, residents, and practicing physicians, and financial stress is one of the causes. High medical school debt results in decreased interest in primary care specialties as the payments are lower, resulting in a shortage of primary care providers. The review will include studies that identify strategies to improve financial literacy among medical students, residents, and fellows in the United States. The proposed review will be conducted as per JBI methodology for scoping reviews. The search strategy will aim to locate both published and unpublished studies. The key databases to be searched include PubMed, Embase, Cochrane Library, Scopus, and Academic Search Premier. Two independent reviewers will screen titles and abstracts for assessment against the inclusion criteria for the review. The results of the search will be reported and presented in a PRISMA flow diagram. Data will be extracted from papers included in the scoping review using a data extraction tool. The extracted data will be presented in both diagrammatic and narrative forms.

Financial Literacy

10.11124/jbisrir-d-19-00422

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Predictors of Extracapsular Extension in Patients With Squamous Cell Carcinoma of the Head and Neck and Outcome Analysis

Cureus (2021)

Toms Vengaloor Thomas M.R. Kanakamedala Eldrin Bhanat Anu Abraham Eswar Mundra

Introduction Extracapsular extension (ECE) in the lymph nodes for patients with head and neck cancer has been found to be a poor prognostic factor in multiple studies. The purpose of the study is to evaluate the predictive factors for ECE on computer tomography (CT) imaging for patients undergoing surgery and to analyze outcomes. Methods We conducted an Institutional Review Board-approved, Health Insurance Portability and Accountability Act (HIPAA)-compliant retrospective review of 82 patients with biopsy-proven squamous cell carcinomas of the head and neck who underwent definitive surgery without neoadjuvant chemotherapy or radiation therapy. CT scans were evaluated for the level of involvement, size, and presence or absence of central necrosis. Extracapsular extension in lymph nodes on the postoperative pathology was correlated with the central necrosis in the lymph nodes appreciated on the CT neck with contrast. Survival estimates were evaluated using the Kaplan-Meier test. Results ECE on postoperative pathology was seen in 74.07% of patients who had evidence of central necrosis in lymph nodes on preoperative CT neck compared to 46.43% without CT necrosis (p=0.013). The incidence of ECE is higher in poorly differentiated tumors and also nodal stages >N2c at presentation. Patents with ECE had inferior disease-free and overall survival (OS). Conclusions Our results reveal that patients with necrosis on CT and with moderately to poorly differentiated tumors have a high incidence of extracapsular extension. There was no difference in local control (LC) between the groups of patients, but the OS was inferior in patients with ECE. Predicting extracapsular extension upfront helps to formulate the appropriate treatment. We propose to study additional chemotherapy to improve outcomes in patients with positive extracapsular extension.

Institutional review board

10.7759/cureus.16680

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Stage Migration in Cervical Cancer Using the FIGO 2018 Staging System: A Retrospective Survival Analysis Using a Single-Institution Patient Cohort

Cureus (2021)

Toms Vengaloor Thomas Kati K Reddy Shivanthidevi Gandhi Mary R Nittala Anu Abraham

Introduction The International Federation of Gynecology and Obstetrics (FIGO) changed the staging system for cervical cancer in 2018 and formally allowed cross-sectional imaging for staging purposes. Stage IB is now divided into three substages based on tumor size (IB1 < 2 cm, IB2 2-4 cm and IB3 > 4 cm). The presence of lymph nodes in the pelvis or para-aortic region will upstage the patient to stage IIIC. The purpose of this study was to evaluate the extent of stage migration using the FIGO 2018 staging system for cervical cancer and validate the new staging system by assessing the survival outcomes. Methods An Institutional Review Board-approved and Health Insurance Portability and Accountability Act-compliant retrospective analysis was performed on 158 patients from the cervical cancer database at the University of Mississippi Medical Center, USA. Patients had been treated between January 2010 and December 2018, and they were all staged according to the FIGO 2009 staging system previously. We collected data regarding tumor size, lymph node presence, and extent of metastatic disease in the pretreatment CT, positron emission tomography (PET), or MRI scans and restaged the patients using the FIGO 2018 system. The extent of stage migration was evaluated using the new staging system. We analyzed the three-year overall survival (OS) using both FIGO 2009 and 2018 staging systems for validation purposes. Kaplan-Meier analyses were performed using SPSS version 24. Results Fifty-nine percent of the patients were upstaged when they were restaged using the FIGO 2018 staging system. In the current 2018 staging system, Stage IB3 accounted for 4%, and Stage IIIC accounted for 48% of the patient cohort, while other stages accounted for the rest. The median overall survival of the entire cohort was 20.5 months. There was a change in the survival curves using FIGO 2018 stages compared to those of FIGO 2009. There was a numerical improvement in three-year OS in stages IB and III among the two staging systems; however, it was not statistically significant. Interestingly, the three-year overall survival of Stage IIIC patients was better when compared to Stages III A& B combined (61% vs. 25%, p=0.017). Conclusion The increased availability of cross-sectional imaging across the world has led to recent changes in the FIGO staging system for cervical cancer, which allowed imaging in staging. We identified a significant stage migration in our patient cohort with the FIGO 2018 staging system, but no difference in the three-year overall survival was observed. Local tumor extent may be a worse prognostic indicator than nodal metastasis among stage III patients.

TNM staging system

Cancer staging

Supraclavicular lymph nodes

AJCC staging system

10.7759/cureus.19289

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Citations (5)

Abstract PO-039: Artificial intelligence-based extracapsular extension prediction in head and neck cancer analysis

Clinical Cancer Research (2021)

Yibin Wang William N Duggar Toms Vengaloor Thomas Paul Roberts Linkan Bian

Abstract Extracapsular extension (ECE) is a decisive indication for treatment planning of patients with head and neck squamous cell carcinoma (HNSCC). ECE occurs when metastatic tumor cells within the lymph node break through the nodal capsule into surrounding tissues. It is crucial to identify whether ECE occurs in HNSCC patient treatment. Current ECE detection practice mainly relies on the visual identification of doctors and professionals, which can be extremely labor intensive and time-consuming. Therefore, we aim to automatically perform ECE detection using a machine learning technique to classify whether ECE appears or not. In this research, we propose a systematic machine learning approach to detect ECE from 3D computed tomography (CT) scans. The process includes four steps: 1) apply sliding-cube to extract small 3D samples from patient data; 2) various 3D features are extracted for each sample; and 3) three machine learning models, gradient boosting (GB), random forest (RF), and support vector machine (SVM), with feature extraction and selection approaches, are employed for sample classification task; 4) classify the patient based on sample classification result. Different training scenarios are designed for the experimental test. Based on five-fold cross-validation, the experimental results have demonstrated that our model is able to classify ECE and non-ECE patients. To check the explainability of the models, feature analysis is also conducted. The outcome of this research is expected to promote the implementation of artificial intelligence for ECE classification and detection as well as head and neck cancer diagnosis in the radiology computer vision field. Citation Format: Yibin Wang, William N. Duggar, Toms V. Thomas, Paul Roberts, Linkan Bian, Haifeng Wang. Artificial intelligence-based extracapsular extension prediction in head and neck cancer analysis [abstract]. In: Proceedings of the AACR Virtual Special Conference on Artificial Intelligence, Diagnosis, and Imaging; 2021 Jan 13-14. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(5_Suppl):Abstract nr PO-039.

Gradient boosting

10.1158/1557-3265.adi21-po-039

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Barriers and facilitators to cancer clinical trial enrollment and participation among rural populations: a scoping review protocol

JBI Evidence Synthesis (2022)

Michelle Palokas Robin Christian Elizabeth Hinton Roy J. Duhé Toms Vengaloor Thomas

The objective of this scoping review is to identify barriers and facilitators related to cancer clinical trial enrollment and participation among rural populations.Advancing the effectiveness of cancer treatment and increasing early detection of cancer relies on enrollment and participation of individuals in cancer clinical trials. Lack of enrollment and participation in trials is a concern, and there is evidence that individuals living in rural areas are unlikely to participate in such trials. Information on barriers to, and facilitators of, enrollment and participation in cancer clinical trials is needed for the development of evidence-based interventions to increase the enrollment and participation of rural populations.The review will consider studies on adults aged 18 years or older living in rural areas. Studies that report on barriers and facilitators to enrollment and participation in cancer clinical trials, including both cancer therapeutic and cancer early detection trials, will be included in the review. The review will consider quantitative, qualitative, and text and opinion papers for inclusion.The search strategy will aim to locate published primary studies, reviews, and opinion papers, the latter including those by professional oncology organizations. The databases to be searched include MEDLINE, CINAHL, Embase, Web of Science, and Cochrane Library. Gray literature databases will also be searched. Two independent reviewers will retrieve full-text studies and extract data. The results will be presented in diagrammatic format with a narrative summary.

CINAHL

10.11124/jbies-21-00256

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