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Dive into the research topics where Isabel J. Boero is active.

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Featured researches published by Isabel J. Boero.


Journal of Clinical Oncology | 2016

Importance of Radiation Oncologist Experience Among Patients With Head-and-Neck Cancer Treated With Intensity-Modulated Radiation Therapy

Isabel J. Boero; Beibei Xu; Ezra E.W. Cohen; Loren K. Mell; Quynh-Thu Le; James D. Murphy

PURPOSE Over the past decade, intensity-modulated radiation therapy (IMRT) has replaced conventional radiation techniques in the management of head-and-neck cancers (HNCs). We conducted this population-based study to evaluate the influence of radiation oncologist experience on outcomes in patients with HNC treated with IMRT compared with patients with HNC treated with conventional radiation therapy. METHODS We identified radiation providers from Medicare claims of 6,212 Medicare beneficiaries with HNC treated between 2000 and 2009. We analyzed the impact of provider volume on all-cause mortality, HNC mortality, and toxicity end points after treatment with either conventional radiation therapy or IMRT. All analyses were performed by using either multivariable Cox proportional hazards or Fine-Gray regression models controlling for potential confounding variables. RESULTS Among patients treated with conventional radiation, we found no significant relationship between provider volume and patient survival or any toxicity end point. Among patients receiving IMRT, those treated by higher-volume radiation oncologists had improved survival compared with those treated by low-volume providers. The risk of all-cause mortality decreased by 21% for every additional five patients treated per provider per year (hazard ratio [HR], 0.79; 95% CI, 0.67 to 0.94). Patients treated with IMRT by higher-volume providers had decreased HNC-specific mortality (subdistribution HR, 0.68; 95% CI, 0.50 to 0.91) and decreased risk of aspiration pneumonia (subdistribution HR, 0.72; 95% CI, 0.52 to 0.99). CONCLUSION Patients receiving IMRT for HNC had improved outcomes when treated by higher-volume providers. These findings will better inform patients and providers when making decisions about treatment, and emphasize the critical importance of high-quality radiation therapy for optimal treatment of HNC.


International Journal of Radiation Oncology Biology Physics | 2015

Modern Radiation Therapy and Cardiac Outcomes in Breast Cancer

Isabel J. Boero; Daniel P. Triplett; Lindsay Hwang; Rayna K. Matsuno; Erin F. Gillespie; Catheryn M. Yashar; Vitali Moiseenko; John Einck; Loren K. Mell; Sahil A. Parikh; James D. Murphy

PURPOSE Adjuvant radiation therapy, which has proven benefit against breast cancer, has historically been associated with an increased incidence of ischemic heart disease. Modern techniques have reduced this risk, but a detailed evaluation has not recently been conducted. The present study evaluated the effect of current radiation practices on ischemia-related cardiac events and procedures in a population-based study of older women with nonmetastatic breast cancer. METHODS AND MATERIALS A total of 29,102 patients diagnosed from 2000 to 2009 were identified from the Surveillance, Epidemiology, and End Results-Medicare database. Medicare claims were used to identify the radiation therapy and cardiac outcomes. Competing risk models were used to assess the effect of radiation on these outcomes. RESULTS Patients with left-sided breast cancer had a small increase in their risk of percutaneous coronary intervention (PCI) after radiation therapy-the 10-year cumulative incidence for these patients was 5.5% (95% confidence interval [CI] 4.9%-6.2%) and 4.5% (95% CI 4.0%-5.0%) for right-sided patients. This risk was limited to women with previous cardiac disease. For patients who underwent PCI, those with left-sided breast cancer had a significantly increased risk of cardiac mortality with a subdistribution hazard ratio of 2.02 (95% CI 1.23-3.34). No other outcome, including cardiac mortality for the entire cohort, showed a significant relationship with tumor laterality. CONCLUSIONS For women with a history of cardiac disease, those with left-sided breast cancer who underwent radiation therapy had increased rates of PCI and a survival decrement if treated with PCI. The results of the present study could help cardiologists and radiation oncologists better stratify patients who need more aggressive cardioprotective techniques.


Cancer | 2015

Aspiration pneumonia after concurrent chemoradiotherapy for head and neck cancer

Beibei Xu; Isabel J. Boero; Lindsay Hwang; Quynh-Thu Le; Vitali Moiseenko; Parag Sanghvi; Ezra E.W. Cohen; Loren K. Mell; James D. Murphy

Aspiration pneumonia represents an under‐reported complication of chemoradiotherapy in patient with head and neck cancer. The objective of the current study was to evaluate the incidence, risk factors, and mortality of aspiration pneumonia in a large cohort of patients with head and neck cancer who received concurrent chemoradiotherapy.


Journal of Oncology Practice | 2015

Variation in the Cost of Radiation Therapy Among Medicare Patients With Cancer

Isabel J. Boero; Daniel P. Triplett; Lindsay Hwang; Rayna K. Matsuno; Beibei Xu; Loren K. Mell; James D. Murphy

PURPOSE Radiation therapy represents a major source of health care expenditure for patients with cancer. Understanding the sources of variability in the cost of radiation therapy is critical to evaluating the efficiency of the current reimbursement system and could shape future policy reform. This study defines the magnitude and sources of variation in the cost of radiation therapy for a large cohort of Medicare beneficiaries. PATIENTS AND METHODS We identified 55,288 patients within the SEER database diagnosed with breast, lung, or prostate cancer between 2004 and 2009. The cost of radiation therapy was estimated from Medicare reimbursements. Multivariable linear regression models were used to assess the influence of patient, tumor, and radiation therapy provider characteristics on variation in cost of radiation therapy. RESULTS For breast, lung, and prostate cancers, the median cost (interquartile range) of a course of radiation therapy was


Journal of Oncology Practice | 2017

Effect of Palliative Care on Aggressiveness of End-of-Life Care Among Patients With Advanced Cancer.

Daniel P. Triplett; Wendi G. Lebrett; Alex K. Bryant; Andrew R. Bruggeman; Rayna K. Matsuno; Lindsay Hwang; Isabel J. Boero; Eric Roeland; Heidi N. Yeung; James D. Murphy

8,600 (


International Journal of Radiation Oncology Biology Physics | 2017

The Impact of Radiation Oncologists on the Early Adoption of Hypofractionated Radiation Therapy for Early-Stage Breast Cancer

Isabel J. Boero; Erin F. Gillespie; Jiayi Hou; Ellen Kim; John Einck; Catheryn M. Yashar; Loren K. Mell; James D. Murphy

7,300 to


Radiotherapy and Oncology | 2015

The impact of radiotherapy costs on clinical outcomes in breast cancer

Isabel J. Boero; Daniel P. Triplett; Lindsay Hwang; Rayna K. Matsuno; Loren K. Mell; James D. Murphy

10,300),


Journal of Clinical Oncology | 2016

Palliative care and health care utilization at the end of life.

Daniel P. Triplett; Wendi G. Lebrett; Rayna K. Matsuno; Lindsay Hwang; Isabel J. Boero; Eric Roeland; Heidi Yeung; James D. Murphy

9,000 (


Journal of The National Comprehensive Cancer Network | 2016

Patterns of Palliative Care Consultation Among Elderly Patients With Cancer

Eric Roeland; Daniel P. Triplett; Rayna K. Matsuno; Isabel J. Boero; Lindsay Hwang; Heidi N. Yeung; Loren K. Mell; James D. Murphy

7,500 to


International Journal of Radiation Oncology Biology Physics | 2015

Geographic Disparity in the Use of Hypofractionated Radiation Therapy Among Elderly Women Undergoing Breast Conservation for Invasive Breast Cancer.

Erin F. Gillespie; Rayna K. Matsuno; Beibei Xu; Daniel P. Triplett; Lindsay Hwang; Isabel J. Boero; John Einck; Catheryn M. Yashar; James D. Murphy

11,100), and

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Loren K. Mell

University of California

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Beibei Xu

University of California

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Lindsay Hwang

University of California

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John Einck

University of California

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L. Hwang

Case Western Reserve University

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Eric Roeland

University of California

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