Greater Lymph Node Retrieval Improves Survival in Node-Negative Resected Gastric Cancer in the United States

PURPOSE: Guidelines in western countries recommend retrieving ≥15 lymph nodes (LNs) during gastric cancer resection. This study sought to determine whether the number of examined lymph nodes (eLNs), a proxy for lymphadenectomy, effects survival in node-negative disease. MATERIALS AND METHODS: The US National Cancer Database (2003–2011) was reviewed for node-negative gastric adenocarcinoma. Treatment was categorized by neoadjuvant therapy (NAT) vs. initial resection, and further stratified by eLN. Kaplan-Meier and Weibull models were used to analyze overall survival. RESULTS: Of the 1,036 patients who received NAT, 40.5% had ≤10 eLN, and most underwent proximal gastrectomy (67.8%). In multivariate analysis, greater eLN was associated with improved survival (eLN 16–20: HR, 0.71; P=0.039, eLN 21–30: HR, 0.55; P=0.001). Of the 2,795 patients who underwent initial surgery, 42.5% had ≤10 eLN, and the majority underwent proximal gastrectomy (57.2%). In multivariate analysis, greater eLN was associated with improved survival (eLN 11–15: HR, 0.81; P=0.021, eLN 16–20: HR, 0.73; P=0.004, eLN 21–30: HR, 0.62; P30: HR, 0.58; P<0.001). CONCLUSIONS: In the United States, the majority of node-negative gastrectomies include suboptimal eLN. In node-negative gastric cancer, greater LN retrieval appears to have therapeutic and prognostic value, irrespective of initial treatment, suggesting a survival benefit to meticulous lymphadenectomy.

Complementary and alternative medicine practices, traditional healing practices, and cultural competency in pediatric oncology in Hawai' i / 中西医结合学报

<p><b>OBJECTIVE</b>Hawai'i is an ethnically diverse island state with a high rate of both traditional healing (TH) and complementary and alternative medicine (CAM) use. The aim of this project was to assess TH and CAM use within the pediatric oncology population in Honolulu and improve the delivery of culturally competent care.</p><p><b>METHODS</b>A 9-item survey was distributed to all pediatric oncology patients at Kapi'olani Medical Center for Women and Children for 3 months. The survey inquired about patient ethnicity, TH practices, CAM practices and perception of cultural competence of the care received. Descriptive statistics were calculated for the survey items. Qualitative analysis was done with participant comments to identify themes.</p><p><b>RESULTS</b>Sixty-two surveys were completed. TH was used by 39% of the respondents in the home, and 10% in the hospital (top method was traditional foods). CAM was used by 27% of the respondents in the home, and 68% in the hospital (top method was healing touch). Ninety-seven percent of the respondents reported receiving culturally competent care. Areas for improvement included language services and dietary choices.</p><p><b>CONCLUSION</b>CAM and TH are used frequently by pediatric oncology patients in Hawai'i, and the vast majority of patients and families felt that the care they received was culturally competent.</p>