Racial disparities in the attainment of textbook oncologic outcomes following colectomy for colon cancer: a national cancer database cohort study.

INTRODUCTION: Textbook oncologic outcome (TOO) is attained when all desired short-term quality metrics are met following an oncologic operation. The objective of this study was to determine the impact of race on TOO attainment following colectomy for colon cancer. METHODS: The 2004-2017 National Cancer Database was queried for patients with non-metastatic colon cancer who underwent colectomy. TOO was defined as: negative margins (R0), adequate lymphadenectomy (LAD) (n ≥ 12), no prolonged length of stay (LOS), no 30-day readmission or mortality, and initiation of systemic therapy in ≤ 12 weeks. Racial groups were defined as White, Black, or Hispanic. RESULTS: 508,312 patients were identified of which 34% achieved TOO. Blacks attained the least TOO (31.4%) as well as the TOO criteria of adequate LAD (81.1%), no prolonged LOS (52.3%), and no 30-day readmission (89.7%). Hispanics were least likely to have met the criteria of R0 resection (94.3%), no 30-day mortality (87.3%), and initiation of systemic therapy in ≤ 12 weeks (81.8%). Patients who attained TOO had a higher median overall survival (OS) than those without TOO (148.2 vs. 84.2 months; P < 0.001). Hispanic TOO patients had the highest median OS (181.2 months), while White non-TOO patients experienced the lowest (80.2 months, P < 0.001). Multivariate logistic regression models suggest that Black and Hispanic patients are less likely to achieve TOO than their White counterparts. CONCLUSIONS: Racial disparities exist in the achievement of TOO, with Blacks and Hispanics being less likely to attain TOO compared to their White counterparts.

Influence of contralateral prophylactic mastectomy on textbook outcome attainment at time of mastectomy.

INTRODUCTION: The objective of this study was to determine the incidence of textbook oncologic outcome (TOO) and its impact on overall survival (OS) among patients with invasive ductal carcinoma (IDC) following modified radical mastectomy (MRM) versus MRM with contralateral prophylactic mastectomy (MRM â€‹+ â€‹CPM). METHODS: The 2004-2017 National Cancer Database was queried for patients with IDC who underwent MRM and MRM â€‹+ â€‹CPM. TOO was defined as: resection with negative margins, adequate lymphadenectomy, length of stay ≤50th percentile, and no 30-day readmission or mortality. RESULTS: 87,573 patients were identified, of which 14.3% underwent MRM â€‹+ â€‹CPM. Logistic regression models revealed that MRM â€‹+ â€‹CPM is independently associated with a reduced likelihood of achieving TOO (AOR â€‹= â€‹0.71; P â€‹< â€‹0.001). MRM patients who achieved TOO had a higher median OS compared to those who did not (164.6 vs.142.2 months, P â€‹< â€‹0.001). CONCLUSIONS: MRM â€‹+ â€‹CPM is associated with a lower incidence of TOO attainment compared to MRM.

Impact of Palliative Interventions on Survival of Patients with Unresected Pancreatic Cancer: Review of the 2010-2016 National Cancer Database.

INTRODUCTION: Palliative interventions (PI) are offered to patients with pancreatic cancer with the aim of enhancing quality of life and improving overall survival (OS). The purpose of this study was to determine the impact of PI on survival amongst patients with unresected pancreatic cancer. METHODS: Patients with stage I-IV unresected pancreatic adenocarcinoma were identified using the 2010-2016 National Cancer Database. The cohort was stratified by PI received: palliative surgery (PS), radiation therapy (RT), chemotherapy (CT), pain management (PM), or a combination (COM) of the preceding. Kaplan-Meier method with log-rank test was used to compare and estimate OS based on the PI received. A multivariate proportional hazards model was utilized to identify predictors of survival. RESULTS: 25,995 patients were identified, of which 24.3% received PS, 7.7% RT, 40.8% CT, 16.6% PM, and 10.6% COM. The median OS was 4.9 months, with stage III patients having the highest and stage IV the lowest OS (7.8 vs 4.0 months). Across all stages, PM yielded the lowest median OS and CT the highest (P < .001). Despite this, the stage IV cohort was the only group in which CT (81%) accounted for the largest proportion of PI received (P < .001). Although all PI were identified as positive predictors of survival on multivariate analysis, CT had the strongest association (HR .43; 95% CI, .55-.60, P = .001). CONCLUSION: PI offers a survival advantage to patients with pancreatic adenocarcinoma. Further studies to examine the observed limited use of CT in earlier disease stages are warranted.

Assessment of Textbook Oncologic Outcomes Following Modified Radical Mastectomy for Breast Cancer.

INTRODUCTION: Textbook oncologic outcome (TOO) is a composite outcome measure attained when all desired short-term quality metrics are met following an oncologic operation. The objective of this study was to determine the incidence of TOO and its impact on the overall survival (OS) among patients with invasive ductal carcinoma (IDC) following modified radical mastectomy (MRM). METHODS: The 2004-2017 National Cancer Database was queried for patients with non-metastatic IDC who underwent MRM. TOO was defined as having attained five metrics: resection with negative microscopic margins, American Joint Committee on Cancer compliant lymph node evaluation (n ≥ 10), no prolonged length of stay (50th percentile by year), no 30-d readmission, and no 30-d mortality. OS was defined as the time in months between the date of diagnosis and the date of death or last contact. RESULTS: A total of 75,063 patients were identified, of which 40.8% achieved TOO. The TOO patients had a lower median age and were more likely to be White, privately insured, and without comorbidities. In terms of facility characteristics, patients with TOO were more likely to be seen in comprehensive community cancer programs with a high case-volume per year. The TOO group had a statistically significant higher median OS compared to the non-TOO group (165.6 versus 142.2 mo; P < 0.001). On multivariate analysis TOO was independently associated with a reduced risk of death (HR = 0.82; P < 0.001). CONCLUSIONS: TOO is achieved in approximately 41% of patients undergoing MRM for IDC. Achieving TOO is associated with improved median OS and reduced risk of death. TOO therefore merits further attention in efforts to improve surgical outcomes.