Lucy Hynds Karnell

The National Cancer Data Base Report on Cutaneous and Noncutaneous Melanoma A Summary of 84,836 Cases from the Past Decade

This study reviews the case‐mix characteristics, management, and outcomes of melanoma cases occuring in the U. S. within the last decade.

Laryngeal Cancer in the United States: Changes in Demographics, Patterns of Care, and Survival

Background: Survival has decreased among patients with laryngeal cancer during the past 2 decades in the United States. During this same period, there has been an increase in the nonsurgical treatment of laryngeal cancer.

National Cancer Data Base report on esophageal carcinoma

The prognosis for patients with esophageal carcinoma is poor, with less than fifty percent surviving 1 year after diagnosis. Although diagnostic and staging methods have improved, a large proportion of patients present with advanced disease. Research is being conducted to determine what multimodality treatment regimens provide the best local control and survival.

Presentation, treatment, and outcome of oral cavity cancer: A national cancer data base report

Oral cancer has been identified as a significant public health threat. Systematic evaluation of the impact of this disease on the US population is of great importance to health care providers and policy makers.

National Cancer Data Base Report on Malignant Paragangliomas of the Head and Neck

Malignant paragangliomas of the head and neck are rare, with previous reports limited to nine or fewer patients. The current review included 59 cases extracted from the National Cancer Data Base that were diagnosed between 1985–1996.

Adenocarcinoma of the small bowel

Small bowel adenocarcinoma (SBA) accounts for 2% of gastrointestinal (GI) tumors and 1% of GI cancer deaths. The objective of this study was to review the National Cancer Data Base (NCDB) to identify case‐mix characteristics, patterns of treatment, and factors influencing survival of patients with SBA.BACKGROUND Small bowel adenocarcinoma (SBA) accounts for 2% of gastrointestinal (GI) tumors and 1% of GI cancer deaths. The objective of this study was to review the National Cancer Data Base (NCDB) to identify case-mix characteristics, patterns of treatment, and factors influencing survival of patients with SBA. METHODS NCDB data from patients diagnosed with primary SBA between 1985-1995 were analyzed. Chi-square statistics were used to compare differences between groups. Disease specific survival (DSS) was calculated using the life table method for patients diagnosed between 1985-1990; univariate differences in survival were compared using the Wilcoxon statistic, and multivariate analyses were performed using a Cox regression model. RESULTS There were 4995 SBA cases reported to the NCDB between 1985-1995, 55% of which occurred in the duodenum, 18% in the jejunum, 13% in the ileum, and 14% in nonspecified sites. The overall 5-year DSS was 30.5%, with a median survival of 19.7 months. By multivariate analysis, factors significantly correlated with DSS included patient age, tumor site, disease stage, and whether cancer-directed surgery was performed. CONCLUSIONS SBA is found most commonly in the duodenum, and patient DSS is reduced at this site compared with those patients with jejunal or ileal tumors. This reduction in survival was associated with a lower percentage of cancer-directed surgery. Patients age > 75 years had a reduced DSS and more duodenal tumors, and were less frequently treated by cancer-directed surgery than their younger counterparts. This study reflects the experience with SBA from a large cross-section of U.S. hospitals, allowing for the identification of prognostic factors and providing a reference with which results from single institutions may be compared.

National patterns of care for pancreatic cancer. Results of a survey by the Commission on Cancer.

BACKGROUND The Commission on Cancer of the American College of Surgeons conducted a large, national survey to assess methods of diagnosis, American Joint Commission on Cancer staging, treatment, and outcome of patients with adenocarcinoma of the pancreas. STUDY DESIGN The survey questionnaire contained 160 questions and covered two study periods, 1983 to 1985 and 1990, for time-trend analysis. Nine hundred seventy-eight institutions throughout the United States voluntarily participated, contributing 8917 case reports for 1983 to 1985 and 8025 reports for 1990, resulting in a total of 16,942 patient reports. Most, but not all, of the participating hospitals maintain approval status with the Commission on Cancer of the American College of Surgeons. RESULTS The ratio of male-to-female cases was 1:1. Patient characteristics including age, ethnicity, neighborhood income, type of insurance coverage, and hospital characteristics--including annual caseload and type of facility (e.g., teaching, community)--appeared to influence surgical multimodality treatment patterns. The most common presenting symptom was abdominal pain. The reported history of smoking for these patients with pancreatic cancer was higher than U.S. population averages. The frequency of using abdominal computed tomography scans, endoscopic retrograde cholangiopancreatography, carcinoembryonic antigen, and CA 19-9 during patient evaluation all increased. Time trends toward lower operative mortality and more extirpative surgery were reported, as was a slightly higher survival for those patients who were resected surgically. CONCLUSIONS Pancreatic cancer continues to be a disease of older patients. There were slight improvements in operative mortality. For a highly selective category of patients, cancer-directed surgery offers a chance for cure with excellent operative mortality and acceptable complication rates, especially when performed in institutions that have a 20 or greater case per year experience.

National cancer database report on chondrosarcoma of the head and neck

Management of chondrosarcoma of the head and neck is largely based on single‐institution reports with small numbers accrued over several decades.

The National Cancer Data Base Report on age, gender, treatment, and outcomes of patients with chronic lymphocytic leukemia †

The natural history of chronic lymphocytic leukemia (CLL) is changing, although the reasons (potential changes in the diseases biology or in patterns in patient characteristics, treatment, or referral) are unclear.

National survey of head and neck verrucous carcinoma : Patterns of presentation, care, and outcome

Verrucous carcinoma is distinguished by controversy regarding appropriate diagnosis and treatment. This study provides a contemporary survey of demographics, patterns of care, and outcome for this disease in the United States.