B. Ashleigh Guadagnolo

Bio: B. Ashleigh Guadagnolo is an academic researcher from University of Texas MD Anderson Cancer Center. The author has contributed to research in topics: Radiation therapy & Medicine. The author has an hindex of 29, co-authored 89 publications receiving 2751 citations. Previous affiliations of B. Ashleigh Guadagnolo include University of Texas at Austin.

Disparities in Stage at Diagnosis, Treatment, and Survival in Nonelderly Adult Patients With Cancer According to Insurance Status

Abstract: Purpose The purpose of this study was to determine the association of insurance status with disease stage at presentation, treatment, and survival among the top 10 most deadly cancers using the SEER database. Patients and Methods A total of 473,722 patients age 18 to 64 years who were diagnosed with one of the 10 most deadly cancers in the SEER database from 2007 to 2010 were analyzed. A Cox proportional hazards model was used for multivariable analyses to assess the effect of patient and tumor characteristics on cause-specific death. Results Overall, patients with non-Medicaid insurance were less likely to present with distant disease (16.9%) than those with Medicaid coverage (29.1%) or without insurance coverage (34.7%; P < .001). Patients with non-Medicaid insurance were more likely to receive cancer-directed surgery and/or radiation therapy (79.6%) compared with those with Medicaid coverage (67.9%) or without insurance coverage (62.1%; P < .001). In a Cox regression that adjusted for age, race, sex, m...

Association Between Geographic Access to Cancer Care, Insurance, and Receipt of Chemotherapy: Geographic Distribution of Oncologists and Travel Distance

Abstract: Purpose Geographic access to care may be associated with receipt of chemotherapy but has not been fully examined. This study sought to evaluate the association between density of oncologists and travel distance and receipt of adjuvant chemotherapy for colon cancer within 90 days of colectomy. Patients and Methods Patients in the National Cancer Data Base with stage III colon cancer, diagnosed between 2007 and 2010, and age 18 to 80 years were selected. Generalized estimating equation clustering by hospital service area was conducted to examine the association between geographic access and receipt of oncology services, controlling for patient sociodemographic and clinical characteristics. Results Of 34,694 patients in the study cohort, 75.7% received adjuvant chemotherapy within 90 days of colectomy. Compared with travel distance less than 12.5 miles, patients who traveled 50 to 249 miles (odds ratio [OR], 0.87; P = .009) or ≥ 250 miles (OR, 0.36; P < .001) had decreased likelihood of receiving adjuvant ch...

Osteosarcoma of the jaw/craniofacial region: outcomes after multimodality treatment.

Abstract: BACKGROUND: The current study was performed to evaluate outcomes in patients with osteosarcoma of the head and neck (OHN) who were treated with surgery with or without radiotherapy (RT). METHODS: Between 1960 and 2007, 119 patients with OHN underwent macroscopic total resection with or without RT. The median age of the patients was 33 years (range, 7-77 years). Of these 119 patients 92 (77%) underwent surgery alone whereas 27 (23%) patients were treated with combined modality treatment (CMT) comprised of surgery and RT (median dose, 60 Gray [Gy]; range, 50-66 Gy). RESULTS: The median follow-up was 5.8 years. Overall survival (OS) rates at 5 years and 10 years were 63% and 55%, respectively. Corresponding disease‒specific survival (DSS) rates were 67% and 61%, respectively. Stratified analysis by resection margin status demonstrated that CMT compared with surgery alone improved OS (80% vs 31%; P = .02) and DSS (80% vs 35%; P = .02) for patients with positive/uncertain resection margins. Multivariate analysis indicated that CMT for patients with positive/uncertain resection margins improved OS (P < .0001). A total of 44 (37%) patients experienced local disease recurrence (LR) and 25 (21%) developed distant metastases (DM). There was no difference noted with regard to DSS if disease recurrence was isolated (LR vs DM: 26% vs 29%, respectively, at 5 years; P = .48) The use of CMT versus surgery alone improved local control (LC) (75% vs 24%; P = .006) for patients with positive/uncertain resection margins. The rate of surgical complications was 28% at 5 years. The rates of RT-associated complications were 40% and 47% at 5 years and 10 years, respectively. CONCLUSIONS: The results of the current study indicated that RT in addition to surgery improves OS, DSS, and LC for patients with OHN who have positive/uncertain resection margins. Cancer 2009. © 2009 American Cancer Society.

Medical Mistrust and Less Satisfaction With Health Care Among Native Americans Presenting for Cancer Treatment

Abstract: Cancer mortality rates for Native Americans are among the highest of all racial and ethnic groups in the United States.1–3 Investigators have also reported other cancer-related disparities among Native Americans, such as lower rates of screening utilization1 and higher rates of advanced-stage disease at presentation.1,2,4–6 Furthermore, Native Americans in the Northern Plains region of the U. S. have age-adjusted mortality rates that are significantly higher than rates for Whites for certain cancers for which effective screening tests exist, such as cervical cancer (79% higher), colorectal cancer (58% higher), and prostate cancer (49% higher).7 A growing literature regarding health disparities has begun to illuminate causes for differences in health outcomes for various racial and ethnic groups.8,9 Root causes of such disparities are multiple. They arise from patient-, physician-, and health care system related factors. For Native Americans, patient-related factors may include mistrust of physicians or hospitals or lack of knowledge/health literacy concerning preventable diseases;10–12 physician-related factors may include lack of cultural competency in caring for this racial/ethnic group; and health-system-related factors may include issues related to the unique health care system (and its funding status) under which many Native Americans receive health care.13–15 However, scant literature focuses specifically on Native American health disparities and few studies have specifically sought to study causes of disparities disfavoring Native American cancer patients. Patient-related factors contributing to disparities include socioeconomic status, cultural differences, and limited health care literacy. Many interventions aimed at overcoming these impediments require trust between health care providers and vulnerable populations. Mistrust of and dissatisfaction with the health care system have been most thoroughly investigated as barriers for African American patient populations.16–19 Evidence exists that Native Americans also feel mistrust of health care providers and dissatisfaction with their health care experiences.20,21 However, no studies have been conducted that examine these attitudes among Native American cancer patients. Data exploring trust and perceptions of health care are critical in helping to formulate interventions in this vulnerable population. Effective clinical care for Native Americans requires understanding and sensitivity regarding attitudes and beliefs about health care. In 2003, a review of the Rapid City Regional Hospital (RCRH) (Rapid City, South Dakota) tumor registry (1990–2000) revealed that 50% of Native Americans presenting with breast, colorectal, prostate, cervical, or lung cancer presented with stage III–IV disease, compared with only 36% of non–Native Americans presenting with those cancers having the disease at an advanced stage.4,5 The RCRH is a regional facility that provides secondary and tertiary cancer care for approximately 60,000 adult Native Americans living on nearby reservations, in surrounding rural communities, and in Rapid City itself. In 2003, RCRH was awarded a Cancer Disparities Research Partnership (CDRP) grant to study the causes of cancer-related racial and ethnic disparities and to develop effective interventions to eliminate these disparities. Since that time, a multi-faceted, community-based participatory research and intervention effort has been forged to explore root causes of racial and ethnic disparities in Rapid City and surrounding areas, promote screening and prevention, enroll Native Americans in clinical trials, and provide patient navigation through cancer treatment.4,5,22 As part of this effort, we undertook a comparative study to examine mistrust and satisfaction with the health care system and to determine whether there are differences in these attitudes by race. We hypothesized that Native American cancer patients mistrust the health care system more and perceive the health care system more negatively than White patients.

Long-Term Outcomes for Desmoid Tumors Treated With Radiation Therapy

Abstract: Purpose To evaluate long-term outcomes in patients with desmoid fibromatosis treated with radiation therapy (RT), with or without surgery. Methods and Materials Between 1965 and 2005, 115 patients with desmoid tumors were treated with RT at our institution. The median age was 29 years (range, 8–73 years). Of the patients, 41 (36%) received RT alone (median dose, 56 Gy) for gross disease, and 74 (64%) received combined-modality treatment (CMT) consisting of a combination of surgery and RT (median dose, 50.4 Gy). Results Median follow-up was 10.1 years. Local control (LC) rates at 5 and 10 years were 75% and 74%, respectively. On univariate analysis, LC was significantly influenced by tumor size (≤5 cm vs. 5–10 cm vs. >10 cm) ( p = 0.02) and age (≤ 30 vs. >30 years) ( p = 0.02). There was no significant difference in LC for patients treated with RT alone for gross disease vs. CMT. For patients treated with CMT, only tumor size significantly influenced LC ( p = 0.02). Patients with positive margins after surgery did not have poorer LC than those with negative margins ( p = 0.38). Radiation-related complications occurred in 20 (17%) of patients and were associated with dose >56 Gy (p = 0.001), age ≤30 years ( p = 0.009), and receipt of RT alone vs. CMT (p = 0.01). Conclusions Desmoid tumors are effectively controlled with RT administered either as an adjuvant to surgery when resection margins are positive or alone for gross disease when surgical resection is not feasible. Doses >56 Gy may not be necessary to control gross disease and are associated with high rates of radiation-related complications.

Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care

Abstract: www.mobilehealthmap.org 617‐442‐3200 New research shows that mobile health clinics improve health outcomes for hard to reach populations in cost‐effective and culturally competent ways . A Harvard Medical School study determined that for every dollar invested in a mobile health clinic, the US healthcare system saves $30 on average. Mobile health clinics, which offer a range of services from preventive screenings to asthma treatment, leverage their mobility to treat people in the convenience of their own communities. For example, a mobile health clinic in Baltimore, MD, has documented savings of $3,500 per child seen due to reduced asthma‐related hospitalizations. The estimated 2,000 mobile health clinics across the country are providing similarly cost‐effective access to healthcare for a wide range of populations. Many successful mobile health clinics cite their ability to foster trusting relationships. Qualitative research in such mobile health clinics has found that patients value the informal, familiar environment in a convenient location, with staff who “are easy to talk to,” and that the staff’s “marriage of professional and personal discourses” provides patients the space to disclose information themselves. A communications academic argued that mobile health clinics’ unique use of space is important in facilitating these relationships. Mobile health clinics park in the heart of the community in familiar spaces, like shopping centers or bus stations, which lend themselves to the local community atmosphere.

Clinical practice guidelines in oncology

Abstract: Ductal carcinoma in situ (DCIS) of the breast represents a heterogeneous group of neoplastic lesions in the breast ducts. The goal for management of DCIS is to prevent the development of invasive breast cancer. This manuscript focuses on the NCCN Guidelines Panel recommendations for the workup, primary treatment, risk reduction strategies, and surveillance specific to DCIS.

Radiobiology for the Radiologist

Abstract: The text consists of two sections, one for those studying or practicing diagnostic radiology, nuclear medicine and radiation oncology; the other for those engaged in the study or clinical practice of radiation oncology--a new chapter, on radiologic terrorism, is specifically for those in the radiation sciences who would manage exposed individuals in the event of a terrorist event. The 17 chapters in Section I represent a general introduction to radiation biology and a complete, self-contained course especially for residents in diagnostic radiology and nuclear medicine that follows the Syllabus in Radiation Biology of the RSNA. The 11 chapters in Section II address more in-depth topics in radiation oncology, such as cancer biology, retreatment after radiotherapy, chemotherapeutic agents and hyperthermia.

Integration of Palliative Care Into Standard Oncology Care: American Society of Clinical Oncology Clinical Practice Guideline Update

Abstract: Purpose To provide evidence-based recommendations to oncology clinicians, patients, family and friend caregivers, and palliative care specialists to update the 2012 American Society of Clinical Oncology (ASCO) provisional clinical opinion (PCO) on the integration of palliative care into standard oncology care for all patients diagnosed with cancer. Methods ASCO convened an Expert Panel of members of the ASCO Ad Hoc Palliative Care Expert Panel to develop an update. The 2012 PCO was based on a review of a randomized controlled trial (RCT) by the National Cancer Institute Physicians Data Query and additional trials. The panel conducted an updated systematic review seeking randomized clinical trials, systematic reviews, and meta-analyses, as well as secondary analyses of RCTs in the 2012 PCO, published from March 2010 to January 2016. Results The guideline update reflects changes in evidence since the previous guideline. Nine RCTs, one quasiexperimental trial, and five secondary analyses from RCTs in the 2012 PCO on providing palliative care services to patients with cancer and/or their caregivers, including family caregivers, were found to inform the update. Recommendations Inpatients and outpatients with advanced cancer should receive dedicated palliative care services, early in the disease course, concurrent with active treatment. Referral of patients to interdisciplinary palliative care teams is optimal, and services may complement existing programs. Providers may refer family and friend caregivers of patients with early or advanced cancer to palliative care services.

Oral cavity and oropharyngeal squamous cell carcinoma—an update

Abstract: Oral cavity squamous cell carcinoma (OC-SCC) is the most common malignancy of the head and neck (excluding nonmelanoma skin cancer). Recent trends have shown a dramatic rise in the incidence of oropharyngeal squamous cell carcinoma (OP-SCC), with a marked increase in lesions related to human papillomavirus infection. This update presents the latest evidence regarding OC-SCC and OP-SCC. In particular, the authors compare and contrast tumors at these two sites with respect to epidemiology, etiopathogenesis, clinicopathologic presentation, clinical assessment, imaging, management, and prognosis. It is important for clinicians to be aware of differences between OC-SCC and OP-SCC so that appropriate patient education and multidisciplinary care can be provided to optimize outcomes.