The National Cancer Data Base: Past, Present, and Future

Cancer Programs, American College of Surgeons, Chicago, IL, USA.
Annals of Surgical Oncology (Impact Factor: 3.93). 10/2009; 17(1):4-7. DOI: 10.1245/s10434-009-0771-3
Source: PubMed
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    ABSTRACT: Renal cell carcinoma is increasingly diagnosed at stage I, and among stage I cases mean tumor size has been decreasing. Previous reports suggest that nephron sparing surgery is underused for small renal cell carcinomas. We determined updated, population based treatment trends for stage I renal cell carcinoma. The National Cancer Data Base, which captures approximately 70% of all cancer diagnoses in the United States, was queried for renal cell carcinoma in adults diagnosed between 1993 and 2007. Trends in treatment, including no surgery, total nephrectomy, partial nephrectomy and focal ablation, were analyzed among all stage I tumors and small stage I tumors categorized by size. Logistic regression was used to identify predictors of nephron sparing surgery (partial nephrectomy or focal ablation). During the study period we identified 242,740 renal cell carcinomas, of which 127,691 were stage I. For all stage I tumors partial nephrectomy increased from 6.3% to 32.2% of cases and ablation increased from 1.0% to 6.8%. For tumors less than 2.0, 2.0 to 2.9 and 3.0 to 3.9 cm partial nephrectomy increased from 15.3% to 61.1%, 11.0% to 44.2% and 7.2% to 31.1%, respectively (each p<0.001). Female gender, black race, Hispanic ethnicity, lower income, older age and treatment at community hospitals were associated with lower use of nephron sparing. While total nephrectomy is still likely overused for small renal cell carcinoma, nephron sparing surgery for stage I renal cell carcinoma has increased substantially in the last 15 years with about 4-fold increases across tumor sizes. These trends appear to be ongoing but sociodemographic disparities exist which must be rectified.
    The Journal of urology 06/2011; 186(2):394-9. DOI:10.1016/j.juro.2011.03.130 · 4.47 Impact Factor
  • Archives of internal medicine 12/2011; 172(3):287-9. DOI:10.1001/archinternmed.2011.602 · 17.33 Impact Factor
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    ABSTRACT: Adherence to evidence-based treatment guidelines has been proposed as a measure of cancer care quality. We sought to determine rates of and factors associated with adherence to the National Comprehensive Cancer Network (NCCN) treatment guidelines for colon cancer. Patients within the National Cancer Data Base treated for colon adenocarcinoma (2003 to 2007) were identified. Adherence to stage-specific NCCN guidelines was determined based on disease stage. Hierarchical regression analyses were performed to identify factors predictive of adherence, overtreatment, and undertreatment. A total of 173,243 patients were included in the final cohort, 123,953 (71%) of whom were treated according to NCCN guidelines. Patients with stage I disease were more likely to receive guideline-based treatment (96%) than patients with stage II (low risk, 66%; high risk, 36%), III (71%), or IV (73%) disease (P < .001). Adherence to consensus-based guidelines increased over time. Factors associated with adherence across all stages included age, Charlson-Deyo comorbidity index score, later year of diagnosis, and insurance status. Among patients with high-risk stage II or stage III disease, older patients with pre-existing comorbidities and patients with lower socioeconomic status were less likely to be offered adjuvant chemotherapy. Among patients with stage I and II disease, young, healthy patients were more likely to be recommended chemotherapy, in discordance with NCCN guidelines. Significant variation exists in the treatment of colon cancer, particularly in treatment of high-risk stage II and stage III disease. The impact of nonadherence to guidelines on patient outcomes needs to be further elucidated.
    Journal of Clinical Oncology 02/2012; 30(9):972-9. DOI:10.1200/JCO.2011.39.6937 · 18.43 Impact Factor
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