Laura Dover

Hospice care, cancer-directed therapy, and Medicare expenditures among older patients dying with malignant brain tumors

Background End-of-life care for older adults with malignant brain tumors is poorly understood. The purpose of this study is to quantify end-of-life utilization of hospice care, cancer-directed therapy, and associated Medicare expenditures among older adults with malignant brain tumors. Methods This retrospective cohort study included deceased Medicare beneficiaries age ≥65 with primary malignant brain tumor (PMBT) or secondary MBT (SMBT) receiving care within a southeastern cancer community network including academic and community hospitals from 2012-2015. Utilization of hospice and cancer-directed therapy and total Medicare expenditures in the last 30 days of life were calculated using generalized linear and mixed effect models, respectively. Results Late (1-3 days prior to death) or no hospice care was received by 24% of PMBT (n = 383) and 32% of SMBT (n = 940) patients. SMBT patients received late hospice care more frequently than PMBT patients (10% vs 5%, P = 0.002). Cancer-directed therapy was administered to 18% of patients with PMBT versus 25% with SMBT (P = 0.003). Nonwhite race, male sex, and receipt of any hospital-based care in the final 30 days of life were associated with increased risk of late or no hospice care. The average decrease in Medicare expenditures associated with hospice utilization for patients with PMBT was

Review: the re-emergence of brachytherapy as treatment for non-melanoma skin cancer

-12,138 (95% CI:

Successful hepatocellular carcinoma downstaging with transarterial chemoembolization followed by stereotactic radiotherapy

-18,065 to

Hospital-Based End-of-Life Care and Costs for Older Patients With Malignant Brain Tumors

-6210) and with SMBT was

Impact of adjuvant chemoradiation on survival in patients with resectable cholangiocarcinoma

-1,508 (95% CI:

Predictability of Life Expectancies of Malignant Brain Tumor Patients by Their Managing Physicians

-3,613 to

Impact of adjuvant therapies on survival in patients with cholangiocarcinoma.

598). Conclusions Receiving late or no hospice care was common among older patients with malignant brain tumors and was significantly associated with increased total Medicare expenditures for patients with PMBT.

End-of-Life Care Options and Decision Making for Older Patients With Malignant Brain Tumors—Reply

Abstract Electronic brachytherapy (EBT) has seen a significant rise in use over the past few years in treating non-melanoma skin cancer (NMSC). However, the current literature in EBT remains scarce. Existing data on high-dose rate brachytherapy (HDR-BT) with surface applicators is often used to justify its efficacy and safety. In this review we study the two treatment modalities on their efficacy in treating NMSC and we explore the reasons behind the recent uprise in EBT. A literature review using PubMed was performed for articles published until January 2017 studying efficacy of HDR-BT and EBT for treating NMSC. HDR-BT demonstrated effective local control ranging from 96.2% to 100% up to 66 months of follow-up with acceptable cosmesis. For EBT, local control rates ranged from 90% to 100% with generally favorable tolerance and cosmesis outcome after roughly one year. While longer term data on EBT is needed, its short term efficacy shows promise as a possible alternative to surgery or other radiation therapy in a select group of patients.

Palliative Care Practice Patterns among Patients with Lung Cancer Metastatic to the Brain

Approximately 16%-18% of liver transplants in the United States were performed for the oncologic treatment of hepatocellular carcinoma (HCC). Although transarterial chemoembolization (TACE)was themost common HCC bridging locoregional therapy while on the wait list (75%), TACE rarely sterilizes HCC, especially in larger tumors. Studies suggest that only 24%-90% of patients were successfully downstaged from stage T3-4 tumors to within Milan criteria using TACE as a sole downstaging modality. It is now appreciated that the usage of more than 1 locoregional therapy may be most effective in successful HCC downstaging of beyond Milan criteria tumors before liver transplantation. Radiation therapy is increasingly being used to treat large liver tumors where modern computer technology has overcome some of the historic drawbacks via accurate and targeted dose-delivery. The stereotactic radiotherapy (SRT) technique delivers treatment typically over 3-5 treatments, compared to the standard duration of 20-25 treatments over a 4to 5-week period. Accurate delivery of high doses to a small target over fewer treatments has been demonstrated to result in improved liver tumor control and reduced toxicities. Although TACE and SRT can be used independently, a combination of these therapies maximizes the strengths and reduces the limitations of these individual treatments. We previously reserved the combination of TACE and SRT to large inoperable HCC patients who were not eligible for liver transplantation. After being impressed with the effectiveness of this treatment combination, we began to use this approach for downstaging beyond Milan criteria HCC patients in an attempt to make them eligible for liver transplantation. The purpose of this study is to report a case series of 12 HCC patients who were treated with TACE followed by SRT in attempt to successfully down-stage for liver transplantation.