Publications by authors named "Vapiwala N"
Background: Technical efficiency evaluates a hospital's economic performance and plays an important role in variations in quality of care and outcomes. The study objective was to examine the association between hospital efficiency and quality of care among fee-for-service Medicare beneficiaries with prostate cancer and to assess if race moderates this association.
Design: Retrospective study using Surveillance, Epidemiological, and End Results-Medicare (SEER-Medicare) data from 1998 to 2016 for prostate cancer patients aged ≥ 66.
Importance: Asian American individuals are not underrepresented in medicine; however, aggregation in prior workforce analyses may mask underlying disparities.
Objective: To assess representation by Asian race and disaggregated subgroups in the US allopathic medical school workforce.
Design, Setting, And Participants: This cross-sectional study used Association of American Medical Colleges (AAMC) special reports, generated using the AAMC Applicant-Matriculant Data File, Student Records System, Graduate Medical Education Track Survey, and faculty roster.
Article Synopsis
- Innovations in advanced prostate cancer have improved outcomes, but there's still a lack of high-level evidence in clinical management, prompting the 2024 Advanced Prostate Cancer Consensus Conference to survey experts for insights.
- A panel of 120 international experts developed and voted on 183 consensus questions through a web-based survey prior to the conference, defining consensus as ≥75% agreement.
- The voting results highlight areas of agreement and disagreement that can guide clinical decisions and future research, with a focus on individualizing treatment based on patient characteristics and encouraging participation in clinical trials.
Purpose: Men with localized prostate cancer may receive either photon-based intensity modulated radiation therapy (IMRT) or proton beam therapy (PBT). The PARTIQoL trial (NCT01617161) demonstrates the feasibility of performing a large, multicenter phase 3 randomized trial comparing IMRT with PBT for localized prostate cancer. Here, we report baseline features of patients enrolled on this trial and present strategies to improve feasibility of other similar trials.
View Article and Find Full Text PDFArticle Synopsis
- Over half of cancer patients receive radiotherapy, but factors like location and demographics influence their access and completion of treatment.
- A study analyzed over 3 million patients with common solid tumors, finding that those living more than 50 miles from treatment centers were less likely to receive radiotherapy recommendations, and there were disparities based on race and insurance status.
- Understanding these geographic and sociodemographic factors is crucial for improving access to care and could help policymakers support at-risk patients more effectively.
Standardized template for clinical reporting of PSMA PET/CT scans.
Eur J Nucl Med Mol Imaging
December 2024
Article Synopsis
- * A consensus among medical professionals led to the creation of a standardized PSMA PET/CT reporting template, aimed at streamlining communication between radiologists and referring physicians.
- * The proposed template includes essential details like treatment history, tumor uptake information, and incidental findings, which are intended to improve the clarity and utility of imaging reports in patient management.
Purpose: The role of elective pelvic nodal irradiation in salvage radiotherapy (sRT) remains controversial. Utilizing 18F-DCFPyL PET/CT, this study aimed to investigate differences in disease distribution after whole pelvic (WPRT) or prostate bed (PBRT) radiotherapy and to identify risk factors for pelvic lymph node (LN) relapse.
Methods: This retrospective study included patients with PSA > 0.
Purpose: Most medical students have limited exposure to radiation oncology (RO) before deciding which specialty to choose for residency. This may limit the number and diversity of RO applicants. The purpose of this study was to determine students' views on a combined pathway program of RO with internal medicine (IM), as well as other related medical specialties, as a potential means of overcoming barriers to interest in RO and the early decision point to solo training in a highly specialized field.
View Article and Find Full Text PDFRecent Trends in "Manels" and Gender Representation Among Panelists at North American Annual Radiation Oncology Meetings.
Int J Radiat Oncol Biol Phys
September 2024
Article Synopsis
- The study aims to address gender equity in radiation oncology by investigating the prevalence of all-male panels, or "manels," at major conferences like ASTRO and CARO, noting the underrepresentation of women in these settings.
- Over four years, the study analyzed 765 panel sessions featuring nearly 3,000 faculty members, revealing that 16.6% of these sessions were manels and highlighting a decrease in manels over time.
- The research found a consistent male majority in panel chair roles, with a notable disparity in female representation based on session topics, suggesting areas for improvement in gender balance within the field.
Article Synopsis
- When evaluating an academic radiation oncology job offer, physicians should focus on three main factors: compensation, daily job responsibilities, and location.* -
- Compensation includes both direct salary and additional indirect payments.* -
- If a candidate finds two of the three domains (compensation, job duties, and location) to be "great" and the other to be "good," it's a good sign to accept the job offer.*
Article Synopsis
- * Four clusters of pain flares were identified, with 23% of patients experiencing a "high-occurrence" group suffering from more frequent and severe pain, higher depressive symptoms, and lower quality of life.
- * Key predictors for high-occurrence pain flares included socio-economic factors like income and employment status, education level, and opioid prescription patterns, emphasizing the need for tailored interventions in pain management.
Aims: For women with breast cancer, seminal studies have shown that adjuvant hypofractionated external beam radiation therapy (hEBRT) maintains similar outcomes and may reduce overall costs compared with conventionally fractionated external beam radiation therapy (cEBRT). However, it is unclear whether hEBRT may be associated with differential risk of development of radiation-induced second malignancies compared with cEBRT. Because the occurrence of second malignancies is small, large databases may improve our understanding of the relative risk of second malignancies between hEBRT and cEBRT.
View Article and Find Full Text PDFPurpose: Our purpose was to develop a summary of recommendations regarding the management of patients with clinically localized prostate cancer based on the American Urologic Association/ ASTRO Guideline on Clinically Localized Prostate Cancer.
Methods: The American Urologic Association and ASTRO convened a multidisciplinary, expert panel to develop recommendations based on a systematic literature review using an a priori defined consensus-building methodology. The topics covered were risk assessment, staging, risk-based management, principles of management including active surveillance, surgery, radiation, and follow-up after treatment.
Approach to Patients with High-Risk Localized Prostate Cancer: Radiation Oncology Perspective.
Curr Treat Options Oncol
January 2024
Article Synopsis
- High-risk localized prostate cancer is complex to treat, with varied responses to different treatment methods, and is increasingly common due to changes in prostate cancer screening recommendations.
- Current guidelines emphasize informed decision-making for screening, and efforts are being made to enhance targeted screening for high-risk groups.
- A multimodal treatment approach is necessary, involving radiation and personalized care, while balancing the effectiveness of treatment against possible side effects and impacts on long-term quality of life.
Article Synopsis
- The revised practice parameter is designed for licensed physicians using radiopharmaceuticals, outlining necessary written directives under federal regulations (NRC 10 CFR 35.300).
- Developed by key organizations in radiation and nuclear medicine, the parameter follows established processes for creating clinical guidelines.
- It details the roles of healthcare professionals involved in radiopharmaceutical therapy and provides insights into different types of therapeutic agents, their applications, and the competencies required for safe delivery.
Article Synopsis
- * A total of 287 patients received IMRT and 485 received PBT, with no significant differences found in late GI and GU toxicities between the two treatment methods after analysis.
- * The results suggest that both treatment modalities resulted in low rates of late toxicities, and the patient-reported outcomes were comparable when adjusting for factors like age and risk group.
Article Synopsis
- * A cross-sectional study analyzed first-time medical school applicants from 2017-2020, examining factors like family income, parental education, GPA, MCAT scores, and extracurricular involvement.
- * Results showed overall acceptance at 45.3%; FG, LI, and UiM applicants had rates of 37.9%, 39.6%, and 44.2%, respectively, with science GPA and UiM status being the most strongly associated with acceptance.
Purpose: Evidence supports the value of shorter, similarly efficacious, and potentially more cost-effective hypofractionated radiation therapy (RT) regimens in many clinical scenarios for breast cancer (BC) and prostate cancer (PC). However, practice patterns vary considerably. We used the most recent Centers for Medicare and Medicaid Services data to assess trends in RT cost and practice patterns among episodes of BC and PC.
View Article and Find Full Text PDF"Likely Pathogenic Heterozygous ATM Gene Mutation": Not Always What It Seems.
Int J Radiat Oncol Biol Phys
January 2024
Article Synopsis
- Novel hormonal therapy (NHT) agents improve survival rates in advanced prostate cancer, but there is limited data on their usage across different racial and ethnic groups.
- This study analyzed the use of NHT among men with de novo advanced prostate cancer using a large Medicare-linked database from 2011 to 2017.
- Findings revealed that White patients had the highest rate of NHT utilization (27%), compared to Hispanic (25%) and Black (8%) patients, highlighting potential disparities in treatment access and usage.
Purpose: Although both intensity-modulated radiation therapy (IMRT) and proton beam therapy (PBT) offer effective long-term disease control for localized prostate cancer (PCa), there are limited data directly comparing the 2 modalities.
Methods: The data from 334 patients treated with conventionally fractionated (79.2 GyRBE in 44 fractions) PBT or IMRT were retrospectively analyzed.
Fatigue is a common symptom associated with cancer treatments. Brain mechanisms underlying cancer-related fatigue (CRF) and its progression following therapy are poorly understood. Previous studies have suggested a role of the default mode network (DMN) in fatigue.
View Article and Find Full Text PDF