Kendall Walsh

Margin re‐excision and local recurrence in invasive breast cancer: A cost analysis using a decision tree model

SSO‐ASTRO recently published guidelines defining adequate margins in breast conservation therapy (BCT) as no tumor on ink based on studies demonstrating little difference in local recurrence (LR) with wider margins. We hypothesize that not routinely re‐excising close margins results in decreased costs without compromising care.

Reporting of mitotic rate in cutaneous melanoma: A study using the national cancer data base: Mitotic Rate in Cutaneous Melanoma

The seventh edition of the American Joint Commission on Cancer staging manual (AJCC7, published 2009), updated thin cutaneous melanoma staging protocols with the incorporation of mitotic rate (MR). In these patients, higher MR is associated with decreased survival. This study utilizes the National Cancer Data Base (NCDB) to evaluate MR reporting since AJCC7.

Changes in margin re‐excision rates: Experience incorporating the “no ink on tumor” guideline into practice

Prior to the “no ink on tumor” SSO/ASTRO consensus guideline, approximately 20% of women with stage I/II breast cancers undergoing breast conservation surgery at our institution underwent margin re‐excision. On May 20, 2013, our institution changed the definition of negative margins from 2 mm to “no ink on tumor.”

Using patient-reported religious/spiritual concerns to identify patients who accept chaplain interventions in an outpatient oncology setting

PurposeThe goals of this study were to (1) describe the prevalence and correlates of patient-reported religious/spiritual (R/S) needs in outpatient oncology patients and (2) estimate the associations of R/S concerns with acceptance of an R/S intervention offered by phone.MethodsThis was a retrospective analysis of data collected from distress screenings and spiritual care interventions at an outpatient cancer center from March 1, 2017 to May 9, 2017. Patients (n = 1249) used a tablet to self-report the following R/S concerns: spiritual or religious concern, isolation, struggle to find hope/meaning in life, concern for family, fear of death, shame/guilt, and doubts about faith. Patients were also screened for anxiety, depression, and distress. A chaplain contacted patients that reported one or more R/S concerns to offer R/S interventions via telephone or in person.ResultsApproximately one third (29.9%) of surveyed patients indicated at least one R/S need. Younger age, female gender, anxiety, depression, and distress were associated with indication of specific R/S concerns. Fear of death (OR 1.64 [1.02, 2.66], p = 0.043), struggle to find meaning/hope in life (OR 2.47 [1.39, 4.39], p = 0.002), and anxiety (p = 1.003) were associated with increased odds of intervention acceptance.ConclusionEffective screening practices are needed for chaplains to prioritize patients most in need. This exploratory study suggests that screening for struggle to find meaning/hope in life, fear of death, and anxiety will help chaplains identify patients who have R/S concerns and will likely accept R/S interventions. Developing effective telehealth practices like this is an important direction for the field.

Letter response: Reporting of mitotic rate in cutaneous melanoma

We appreciate the points raised by Roncati et al in their recent letter to the editor regarding our paper on reporting of mitotic rate in cutaneous melanoma. The primary aim of our paper was to determine whether or not physicians were following the guidelines as set forth in the AJCC 7th edition. We did not analyze or report the biological importance of mitotic rate based on data in the NCDB. As Roncati et al indicate, other patterns of behavior such as radial and vertical growth phase may be of use in understanding the metastatic potential of any given melanoma.

Application of ACOSOG Z1071: Effect of Results on Patient Care and Surgical Decision-Making

&NA; The translation of new clinical information into practice can be quite lengthy. We examined our experience in using new data showing that sentinel lymph node biopsy in women after neoadjuvant chemotherapy was feasible. Adoption of ACOSOG (American College of Surgeons Oncology Group) Z1071 was rapid with 73% of patients being treated with the new paradigm within 18 months. Background: The ACOSOG (American College of Surgeons Oncology Group) Z1071 assessed the feasibility of performing sentinel lymph node biopsy (SLNB) in node‐positive patients who completed neoadjuvant chemotherapy (NACT). Historically, adoption of clinical research into practice takes years. The goal of this study was to determine the effect of Z1071 on our practice. Materials and Methods: This is a retrospective review of Z1071’s influence on a single institution’s practice. Patients with biopsy‐proven positive axillary lymph nodes before NACT were eligible for the study. After NACT, patients with nodal response according to imaging and exam were candidates for SLNB. Two cohorts were stratified according to diagnosis date before and after Z1071 results were presented on December 5, 2012 at the San Antonio Breast Cancer Symposium. Fisher exact tests and nonparametric rank tests were used to compare cohorts. Results: The pre‐Z1071 cohort included 74 patients and the post‐Z1071 cohort 56 for a total of 130 patients. Post‐Z1071, 73% (41/56) underwent a SLNB with an average of 4 nodes removed. Moreover, 27% (15/56) of patients had an axillary lymph node dissection as first intervention post‐Z1071, compared with 99% (73/74) pre‐Z1071. Axillary pathologic complete response pre‐Z1071 was 35% (26/74) and post‐Z1071 was 27% (15/56) (P = .35). Conclusion: This report shows that meaningful practice changes can be implemented rapidly. Changes in practice generated by clinical trial results should be monitored and outcomes followed.

Frequency of unplanned surgical intervention in patients with stage IV colorectal cancer receiving palliative chemotherapy: An analysis of SEER-Medicare.

640 Background: Patients (pts) with synchronous stage IV colorectal cancer commonly begin palliative chemotherapy while the primary tumor remains. Single institution series report low rates of surgical intervention, but this has not been examined nationally. The present study utilizes a large national dataset to examine the natural history of unplanned surgical intervention in stage IV colorectal cancer pts on palliative chemotherapy. Methods: SEER-Medicare was queried for pts with metastatic colorectal cancer (1998-2009) who underwent resection or diversion (ICD9 procedure/CPT). The cohort was separated into 3 groups: elective (surgery on admission without urgent/emergent flag), urgent (surgery not on day of admission but within hospitalization or with urgent flag) and emergent (emergent flag). Pts who underwent any procedure for curative intent (elective colorectal surgery, liver directed therapy or surgery for pulmonary metastases) at any time were excluded. Demographics, tumor grade and comorbidities ...