Comparative Age-Based Prospective Multi-Institutional Observations of 12,367 Patients Enrolled to the American College of Surgeons Oncology Group (ACOSOG) Z901101 Trials (Alliance).

Background: The risk of surgery, particularly for older cancer patients with serious, extensive comorbidities, can make this otherwise curative modality precarious. Leveraging data from the American College of Surgeons Oncology Group, this study sought to characterize age-based comparative demographics, adverse event rates, and study completion rates to define how best to conduct research in older cancer patients.

Methods: This study relied on clinical data from 21 completed studies to assess whether older patients experienced more grade 3 or worse adverse events and were more likely to discontinue study participation prematurely than their younger counterparts.

Developing NaviCanPlan: A Mobile Web Resource Locator for Cancer Providers and Survivors.

As of January, 2012, an estimated 13.7 million persons are living as cancer survivors. This population is expected to grow to nearly 18 million by 2022.

Adjuvant chemotherapy for stage III colon cancer in the oldest old: results beyond clinical guidelines.

Background: Randomized trials demonstrating the benefits of chemotherapy in patients with American Joint Committee on Cancer stage III colon cancer underrepresent persons aged ≥ 75 years. The generalizability of these studies to a growing elderly population remains unknown.

Methods: Using the California Cancer Registry for 1994 through 2008, the authors conducted a population-based study of postcolectomy patients aged 50 years to 94 years with stage III (N1M0) colon adenocarcinoma.

Features associated with successful recruitment of diverse patients onto cancer clinical trials: report from the American College of Surgeons Oncology Group.

Background: The clinical trials mechanism of standardized treatment and follow-up for cancer patients with similar stages and patterns of disease is the most powerful approach available for evaluating the efficacy of novel therapies, and clinical trial participation should protect against delivery of care variations associated with racial/ethnic identity and/or socioeconomic status. Unfortunately, disparities in clinical trial accrual persist, with African Americans (AA) and Hispanic/Latino Americans (HA) underrepresented in most studies.

Study Design: We evaluated the accrual patterns for 10 clinical trials conducted by the American College of Surgeons Oncology Group (ACOSOG) 1999-2009, and analyzed results by race/ethnicity as well as by study design.

A survey of environmental safety issues at 20 medical clinics.

In the study described in this article, the authors performed safety walk-throughs or inspections for 20 clinics located both inside a major medical center clinic (onsite) and away from the main clinic site (offsite). A checklist was used to evaluate compliance with institutional, local, state, and federal guidelines and regulations. The results obtained at onsite clinics were compared with the results from offsite clinics.

Genetic testing and cancer risk management recommendations by physicians for at-risk relatives.

Purpose: Sequence-based cancer susceptibility testing results are described as negative, deleterious mutation or variant of uncertain significance. We studied the impact of different types of test results on clinical decision making.

Methods: Practicing physicians from five specialties in Texas completed an online case-based survey (n = 225).

Progress in addressing disparities through comprehensive cancer control.

Cancer-related disparities are the significant differences in cancer incidence, cancer prevalence, cancer death, cancer survivorship, and burden of cancer or related health conditions that exist disproportionately in certain populations compared with the general population with respect to variables like race, ethnicity, and geography. The emergence of comprehensive cancer control efforts provides a framework to address the unequal disease burden felt by these groups. This article illustrates four distinct programs uniquely designed to fit at-risk populations.

Disparate inclusion of older adults in clinical trials: priorities and opportunities for policy and practice change.

Older adults are vastly underrepresented in clinical trials in spite of shouldering a disproportionate burden of disease and consumption of prescription drugs and therapies, restricting treatments' generalizability, efficacy, and safety. Eliminating Disparities in Clinical Trials, a national initiative comprising a stakeholder network of researchers, community advocates, policymakers, and federal representatives, undertook a critical analysis of older adults' structural barriers to clinical trial participation. We present practice and policy change recommendations emerging from this process and their rationale, which spanned multiple themes: (1) decision making with cognitively impaired patients; (2) pharmacokinetic differences and physiological age; (3) health literacy, communication, and aging; (4) geriatric training; (5) federal monitoring and accountability; (6) clinical trial costs; and (7) cumulative effects of aging and ethnicity.

A descriptive analysis of state legislation and policy addressing clinical trials participation.

Objectives: This report describes state policy and legislation related to clinical trials participation and Maryland's model to enhance clinical trial availability and participation.

Methods: Descriptive review of state policy and legislation related to coverage for clinical trials costs based on data from the National Cancer Institute (NCI) State Cancer Legislative Database, the American Cancer Society, and NCI; additionally, discussion of Maryland's comprehensive multilevel clinical trial model comprising policy initiatives, community engagement, research, education, and infrastructure support.

Results: Twenty-four states have mandated clinical trial coverage through specific legislation or agreements since 1994.

Human papillomavirus vaccine recommendations and agreement with mandated human papillomavirus vaccination for 11-to-12-year-old girls: a statewide survey of Texas physicians.

Background: The purpose of this study was to examine Texas physicians' recommendations for the quadrivalent human papillomavirus (HPV) vaccine in 11-to-12-year-old girls, intention to recommend HPV vaccines to 11-to-12-year-old boys, and attitudes about mandated HPV vaccination for 11-to-12-year-old girls.

Materials And Methods: We conducted a cross-sectional, web-based survey of Texas physicians who provide direct patient care in family medicine, pediatrics, obstetrics/gynecology, and internal medicine in September 2008. The three outcome variables were: HPV vaccine recommendations to 11-to-12-year-old girls, likelihood of recommending the vaccine to 11-to-12-year-old boys, and agreement with mandated vaccination of 11-to-12-year-old girls.

Low-literacy interventions to promote discussion of prostate cancer: a randomized controlled trial.

Background: Professional organizations recommend that physicians discuss prostate cancer with patients to make individual screening decisions. However, few studies have tested strategies to encourage such discussions, particularly among high-risk populations. We examined the effects of two low-literacy interventions on the frequency of prostate cancer discussion and screening.

Environmental health: a survey of Texas primary care physicians.

Although the role of environmental health hazards in cancer and other diseases is increasingly appreciated, most physicians have had little or no training in environmental health or in integrating exposure histories into their clinical practice. As part of the Texas Medical Association Physician Oncology Education Program, we mailed a questionnaire to 350 Texas primary care physicians (PCPs) to evaluate their attitudes, practice, training, and preferred sources for information regarding environmental health issues. Of the respondents, 86.

Increasing mammography screening through inpatient education.

Background: The reasons why women do not undergo regular screening mammograms have not been clearly defined. In this study, we addressed an educational intervention based on Health Belief Model constructs for 3 of the most common reasons why women do not participate in mammography screening: cost, fear, and lack of knowledge. The purpose of the project was to study whether an educational intervention addressing these factors could increase mammography screening among age-appropriate women who had not had a recommended mammogram within the previous 12 months.

The effect of statins on serum prostate specific antigen levels in a cohort of airline pilots: a preliminary report.

Purpose: Reports of the effect of treatment with statins on prostate cancer risk are inconsistent. We performed a pilot study to assess the effect of statin treatment on a surrogate marker for prostate cancer risk, that is serum prostate specific antigen (PSA), in a cohort of airline pilots from 1992 to 2001.

Materials And Methods: Subject medical records were abstracted for data on age, PSA testing, hyperlipidemia and treatment with statins.

Attitudes of primary care physicians and specialists about cancer clinical trials: a survey of Texas physicians.

A one-page questionnaire assessing physicians' prior involvement in and attitudes about clinical trials was distributed to primary care physicians (PCPs) and specialists practicing in Texas. The survey form was completed and returned by 57 PCPs and 80 specialists. The two physician groups agreed strongly about the value of what can be learned in clinical trials, and agreed that the greatest barriers to participation were paperwork requirements, time constraints, and concern for patient welfare.

Variation in prostate specific antigen results from 2 different assay platforms: clinical impact on 2304 patients undergoing prostate cancer screening.

Purpose: Urologists must contend with fluctuating prostate specific antigen (PSA) results from different assay platforms when deciding whether prostate biopsy is indicated. The contribution of cross-platform variation to these fluctuations is not well understood. To address this question we performed a cross-sectional study comparing 2 popular PSA assays during prostate cancer screening.

Primary care physicians' attitudes and practices regarding cancer genetics: a comparison of 2001 with 1996 survey results.

Background: To determine whether Texas primary care physicians' attitudes and practices regarding cancer genetics changed over a five-year period, a follow-up survey was conducted and the results obtained in 1996 were compared with those obtained in 2001.

Methods: A survey was mailed in 2001 to a random sample of 350 primary care physicians in Texas.

Results: More primary care physicians in 2001 were discussing the subject of genetic screening with their patients and more physicians were referring their patients for genetic evaluations and testing for cancer risk, compared with 1996.