e12129 Background: Interest in the use of neoadjuvant endocrine therapy (NET) has increased over the past decade, and recent studies have demonstrated similar response rates compared to neoadjuvant chemotherapy. We examined the associations between duration of NET and type of surgery and change from clinical stage to pathologic stage. Methods: We used the National Cancer Data Base to identify women diagnosed with stage II-III, ER and/or PR positive breast cancer who received endocrine therapy from 2004-2014 and underwent surgery. We classified patients according to timing and duration of NET. We performed logistic regression to examine the impact of NET duration on likelihood of 1) receiving breast conserving surgery (BCS) versus mastectomy and 2) being downstaged. Downstaging was defined as pathologic stage lower than clinical stage and upstaging as pathologic stage higher than clinical stage. Results: In our sample of 159,676 patients, 6584 received NET (4.1%). NET was more frequently used in older women with multiple comorbid conditions, larger tumors, and higher nodal stage. The highest rates of NET were in academic/research or integrated network cancer programs. Of patients who underwent NET, 26.5% received it for ≤3 months, 41.0% for 3-6 months, 27.7% for 6-12 months, and 4.9% for 12-24 months. Patients who received NET for 3-6, 6-12, and 12-24 months were all significantly more likely to receive BCS versus mastectomy than patients who did not receive NET (Table). Patients who underwent NET compared to adjuvant endocrine therapy were more likely to be downstaged (Table). Conclusions: The most common duration of NET was 3-6 months, but >26% of patients received NET for less than 3 months. Longer durations of NET were strongly associated with BCS and downstaging. Further research is needed to determine the population of patients mostly likely to benefit from NET and the optimal length of treatment. [Table: see text]
This news section offers Cancer readers timely information on events, public policy analysis, topical issues, and personalities.This edition looks at ways researchers are using nanotechnology to diagnose and treat cancer, and the results of a new study that show how aspirin may lower the risk of colorectal cancer in specific cases.
Objective To characterize Medicare expenditures on initial breast cancer care and examine variation in expenditures across hospital referral regions ( HRR s). Data Source We identified 29,110 women with localized breast cancer diagnosed in 2005–2008 and matched controls from the Surveillance, Epidemiology, and End Results‐Medicare linked database. Study Design Using hierarchical generalized linear models, we estimated per patient Medicare expenditure on initial breast cancer care across HRR s and assessed the contribution of patient, cancer, and treatment factors to regional variation via incremental models. Principal Findings Mean Medicare expenditure for initial breast cancer care was $19,255 per patient. The average expenditures varied from $15,053 in the lowest‐spending HRR quintile to $23,480 in the highest‐spending HRR quintile. Patient sociodemographic, comorbidity, and tumor characteristics explained only 1.8 percent of the difference in expenditures between the lowest‐ and highest‐spending quintiles, while use of specific treatment modalities explained 14.5 percent of the difference. Medicare spending on radiation therapy differed the most across the quintiles, with the use of intensity modulated radiation therapy increasing from 1.7 percent in the lowest‐spending quintile to 11.6 percent in the highest‐spending quintile. Conclusions Medicare expenditures on initial breast cancer care vary substantially across regions. Treatment factors are major contributors to the variation.
Previous comparative effectiveness studies have not demonstrated a benefit of proton beam therapy (PBT) compared with intensity-modulated radiation therapy (IMRT) for prostate cancer. An updated comparison of GI and genitourinary (GU) toxicity is needed.
The relationship between geography and cancer incidence and treatment is a critical area of health outcomes research. Geographical information systems (GIS) are software packages designed to store and analyze data related to geographic locations. Although more commonly associated with the social sciences and urban planning, the use of GIS software in medical research has been increasing. Moreover, since the 1999 establishment of the Geographical Informational Systems Special Interest Group (GISSIG) at the National Cancer Institute, oncology has been at the forefront of GIS-related health research. In this review, we discuss the potential applications and limitations of GIS software in oncology research. Our aims are to help clinicians and policy makers interpret studies generated using GIS, and to help clinical investigators implement GIS in future research.
