Tina Rizack

Alpert Medical School - Brown University, Providence, Rhode Island, United States

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Publications (5)6.81 Total impact

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    ABSTRACT: Objective Age may affect the treatment choice and subsequent outcome in elderly patients with cervical cancer. Given the potential for cure with either surgery or chemoradiation in early stage disease, we aimed to determine whether a patient's age influenced treatment received and the ensuing outcome. Materials and Methods We identified 303 patients with stages IB1–IIB cervical carcinoma treated at our institution between 2000 and 2010, who were divided into two groups based on age at time of diagnosis: < 65 and ≥ 65 years. Adjusted odd ratios were calculated to determine variables associated with treatment received. Single and multivariate Cox proportional hazards modeling were used to estimate hazard ratios (HRs) for variables associated with disease-specific survival. Results Patients were more commonly < 65 years at diagnosis (83% versus 17% ≥ 65 years). There was no difference between the two groups in terms of tumor histology, stage at presentation, and grade. Women ≥ 65 years of age were less likely to receive primary surgical management (p = 0.03). Age did not influence disease-specific or all-cause mortality. However, women over 65 years who underwent primary surgery were at significantly increased risk of all-cause mortality compared to younger women (HR 6.53, 95% CI: 2.57–16.6). Conclusions Age appears to influence treatment received by patients with stages IB1–IIB cervical cancer. Although there was no difference in cancer-specific mortality stratified by type of treatment received, surgery was associated with a 6.5-fold increased risk of all-cause mortality among women 65 years or over.
    Journal of Geriatric Oncology 10/2013; 4(4):374–381. · 1.12 Impact Factor
  • The Breast Journal 04/2013; · 1.43 Impact Factor
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    ABSTRACT: OBJECTIVES:: There is a higher incidence of invasive vulvar cancer in the elderly population. With multiple medical comorbidities, radiation with sensitizing chemotherapy in the elderly can be complicated, yet the risks and benefits of chemoradiation have not been studied in this population. We investigate whether elderly patients are more likely to die of intercurrent disease (ICD) or of treatment complications. METHODS:: A meta-analysis was performed to compare remission rates, death from ICD or treatment complications, and rates of surgery in elderly and nonelderly patients with vulvar cancer treated with chemoradiation. Data were searched in the Cochrane Review. Eligibility criteria included: woman with advanced primary squamous cell carcinoma of the vulva, women receiving preoperative or primary chemoradiation treatment with curative intent, and prospective studies that reported the necessary data of interest. Data collected included: age (elderly, defined as 65 years and above), stage, treatment, and mortality. RESULTS:: Seventy subjects were identified from 7 studies that met eligibility criteria. Seventy-eight percent (25/32) of patients younger than 65 years were without evidence of disease after treatment versus 66% (25/38) of patients aged 65 years and above (P=0.30). Three percent (1/32) of patients younger than 65 years of age died of ICD or treatment complications versus 11% (4/38) of patients 65 years and above (P=0.37). CONCLUSIONS:: We noticed a trend demonstrating death from ICD or treatment complications was higher for elderly patients. Future research should focus on treatment with chemoradiation in the elderly population with regard to survival benefit, toxicity, and death from ICD or treatment complications.
    American journal of clinical oncology 04/2012; · 2.21 Impact Factor
  • Tina Rizack, Karen Rosene-Montella
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    ABSTRACT: Evaluation and treatment of hematologic disorders in pregnancy requires an understanding of normal physiologic changes during pregnancy. Hematologic disorders may be caused by preexisting conditions, normal physiologic changes, or can be acquired. A multidisciplinary approach is often necessary for monitoring and treatment of both the mother and the fetus. In general, outcomes are good for both the mother and the fetus.
    Hematology/oncology clinics of North America 04/2012; 26(2):409-32, x. · 2.05 Impact Factor
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    ABSTRACT: Carcinomas of the renal pelvis and ureter are rare diseases, accounting for only about 1% of all urogenital malignancies. Previous reports suggest that squamous cell histology is associated with inferior survival. We present the largest population based analysis to date of survival in patients with upper urinary tract malignancies. We analyzed the Surveillance, Epidemiology and End Results database for cancer specific survival rates in patients with renal pelvis and ureteral malignancies who were diagnosed between 1973 and 2003 in the SEER catchment geographic areas. The primary exposure of interest was the underlying histology, squamous cell versus transitional cell differentiation. We performed descriptive statistics, non parametric survival analysis, and cox proportional hazard analysis. We identified 13,213 eligible patients, 7,716 renal pelvis and 5,497 ureteral carcinomas. Among this cohort, 179 patients had squamous cell carcinoma (SCC), 12,395 had transitional cell carcinoma (TCC), including 121 papillary, and 619 had other histologies. Overall, patients with SCC histology fared worse. The median overall survival time was 10 months for SCC and 63 months for TCC. The cox analysis revealed a HR 3.7 (95% CI 3.0-4.5) for SCC when compared to TCC and corrected for decade of diagnosis, age, gender, prior treatment, and race. The difference between the two groups was entirely attributable to survival differences in patients with loco-regional disease. However, when stratified by lymph node involvement this difference disappeared for patients with locally involved lymph nodes (P = 0.84) and for patients with clear lymph nodes (P = 0.92). SCCs of the upper urinary tract present at a higher clinical stage and appear to represent more aggressive disease when compared to other histologies. However, when appropriately staged according to lymph node status, the survival of TCC and SCC of the upper urinary tract is identical when compared stage by stage.
    Clinical Medicine Insights: Oncology 01/2012; 6:11-8.