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Biomedical subjects

L S McGinnis

Publications and source records attributed to L S McGinnis.

At least 19 recordsLinked to original sources
PubMed2000

Purchasing oncology services. Kerr L. White Institute/American Cancer Society Task Force on Purchasing Oncology Services.

BACKGROUND: A multidisciplinary panel representing various stakeholders in the health care delivery and oncology services marketplace was convened to develop specific criteria for healthcare purchasers to consider when evaluating the structures and processes of health plans. These rank ordered criteria also can be used by oncologic service providers and health plan designers as a yardstick for the services they offer. METHODS: A multidisciplinary 31-member Task Force was assembled by the Kerr L. White Institute and the American Cancer Society in March 1997. Task Force members were selected for their ability to offer expert insight as purchasers, suppliers, policymakers, consumers, or stakeholders in the health care marketplace. A preference-weighted majority voting rule was used to identify the three most important recommendations of the 10 that were generated through a modified Delphi technique. To test the practicality of the top three recommendations, leaders of large managed care organizations (MCOs) were surveyed; the results of this survey then were compared with the results of the Task Force survey. RESULTS: The three most important recommendations from the Task Force were that health plans provide access to: 1) comprehensive cancer care, 2) preventive and screening services, and 3) second opinions and treatment options supported by scientific evidence. The difference between the responses of the Task Force and the MCOs was that MCOs placed the highest importance on evidence-based decision-making, with their next three rankings coinciding with those identified by the Task Force. CONCLUSIONS: The value of these summary recommendations will be realized through their use by both purchasers and suppliers to influence the structure and content of the delivery of oncologic services.

Costs and Cost Analysis↗
PubMed2000

National Cancer Data Base survey of breast cancer management for patients from low income zip codes.

BACKGROUND: The National Cancer Data Base (NCDB), a joint project of the American College of Surgeons Commission on Cancer and the American Cancer Society, is a cancer management and outcomes data base for health care organizations. It provides a comparative summary of patient care that is used by participating hospitals and communities for self-assessment. The most current (1995-1996) breast cancer data on patients from low income zip codes are described here. METHODS: Since 1989, eight Calls for Data have been issued, yielding a total of 191,714 reports of non-Hispanic white patients with breast cancer for the years analyzed, 1995-1996. A total of 1961 hospital cancer registries have participated in at least one of the Calls for Data. RESULTS: A diverse range of breast cancer cases was reported from a variety of geographic locations and medical care environments. There were general similarities in the treatment of patients from the different income groups; however, some differences were reported. Among patients from lower income zip codes, 60.7% were age 60 years or older, compared with 55.1% from other income zip code groups. The AJCC stage distribution was reported as less favorable for patients from low income zip codes than for other patients. The percentage of patients from low income zip codes diagnosed as Stage 0 or I was 51.2%, compared with 55.9% of patients from the other income zip codes. Of patients from lower income zip codes, 12.1% were reported to have Stage III or IV disease, compared with 10.0% of patients from other income zip codes. Patients from low income zip codes received less tissue-sparing surgery. Of patients from low income zip codes, 14.9% received partial mastectomy with or without radiation or systemic therapy, compared with 18.3% of patients from other income zip codes. The percentage of patients from low income zip codes who received a partial mastectomy with axillary lymph node dissection was 23.3% for patients from other income zip codes, the percentage was 30.5%. Conversely, 49.8% of patients from lower income zip codes received a modified radical mastectomy, compared with 40.5% of patients from other income zip codes. CONCLUSIONS: Further improvements in the early diagnosis and surgical treatment of low income patients can probably be achieved. Programmatic activities that further explain or reduce the apparent nonpreferred treatment of some low income patients should be encouraged.

Adult↗
PubMed1996

The National Cancer Data Base. Report on colon cancer.

BACKGROUND: Commission on Cancer data from the National Cancer Data Base (NCDB) report time trends in stage of disease, treatment patterns, and survival for patients with selected cancers. The most current data (1993) for patients with colon cancer are described. METHODS: Five calls for data yielded 3,700,000 cases of cancer for the years 1985 through 1993 from hospital cancer registeries across the U.S., including 36,937 cases of colon cancer from 1988 and 44,812 from 1993. RESULTS: Interesting trends are as follows: (1) the elderly ( > 80 years) present with earlier stage disease than younger patients; (2) the National Cancer Institute recognized cancer centers have more patients with advanced disease than other types of hospitals; (3) all ethnic groups have generally similar stages of disease at presentation, except for African-Americans who have a slightly higher incidence of Stage IV disease; (4) the proximal migration of the primary cancer continues with 54.7% of primary colon cancer arising in the right colon in 1993 compared with 50.9% in 1988; (5) an interaction between grade and stage of cancer seems present; and (6) patients with Stage III colon cancer who received adjuvant chemotherapy had a 5% improvement in 5-year relative survival. CONCLUSIONS: The NCDB data are useful for reporting what cancer treatments are being administered and what outcomes are occurring in the U.S. The data suggest an important biologic role for grade of cancer. They also suggest that African-Americans and other ethnic groups have the same outcome as non-Hispanic whites but that access to medical care may still be less. Finally, the utility of adjuvant therapy for Stage III colon cancer may just be beginning to be appreciated.

Aged↗
PubMed1995

The National Cancer Data Base report on prostate cancer. American College of Surgeons Commission on Cancer and the American Cancer Society.

BACKGROUND: Previous Commission on Cancer data from the National Cancer Data Base (NCDB) examined time trends in disease stage, treatment patterns, and survival for patients with selected cancers. The most current (1992) data for prostate cancer are described in this Communication. METHODS: Calls for data yielded a total of 52,597 prostate cancer reports for 1986/1987 and 101,903 for 1992 from hospital cancer registries across the United States. RESULTS: Data were received for 154,500 patients with prostate cancer. Prostate cancer is detected increasingly at localized stages and among younger men. African American men have a continuing pattern of more advanced disease at diagnosis. Selection of prostatectomy as the primary treatment has increased, and its use varies by region and several patient and hospital characteristics. Selection of radiation treatment has increased to a lesser degree. The 5-year survival for patients diagnosed in 1986/1987 was 60%. Outcomes varied by stage, age, and race. CONCLUSION: The NCDB provides valuable information concerning patterns and trends in prostate cancer care in the United States. The data show that prostate cancer detection and treatment have changed markedly in recent years. These changes appear to be related to the increased use of early detection measures. The improvements in prostate cancer detection and trends in treatment have not affected the population evenly, with African American men having more advanced disease and lower survival. Continued monitoring of these important trends is needed.

Aged↗
PubMed1995

Conventional four-field pelvic radiotherapy technique without computed tomography-treatment planning in cancer of the cervix: potential geographic miss and its impact on pelvic control.

PURPOSE: To evaluate the impact of inadequate margins on pelvic control using the conventional four-field pelvic portals without computed tomography (CT)-treatment planning. METHODS AND MATERIALS: Between 1986 and 1991, 34 patients with invasive cancer of the cervix were eligible for outcome study of conventional four-field radiation therapy (10 Stage I, 16 Stage II, 8 Stage III). The eligibility for this study includes four-field pelvic technique, definitive radiation therapy, and diagnostic CT scan of the pelvis. For this study, an inadequate margin is arbitrarily defined as < or = 1.0 cm of normal tissue around the CT-defined tumor volume. RESULTS: All 34 patients had adequate margins for anterio-posterior/posterio-anterior portals. However, 19 patients had an inadequate margin at the posterior border (S2-S3 interspace) and/or custom-shaped rectal block for lateral pelvic portals. Two patients had inadequate margins at the anterior border (level of symphysis pubis) due to an enlarged uterus. With a median follow-up of 36 months, pelvic control for adequate margins and inadequate margins was 100% and 71% for Stage IB disease and 88% and 50% for Stage IIB disease, respectively. However, pelvic control for Stage IIIB disease was 50% for both groups. There was no difference in total dose to point A or point B between the two groups. CONCLUSION: Our preliminary data show higher local failure in patients with an inadequate margin. For four-field pelvic radiation therapy, we strongly recommend CT-treatment planning. Otherwise, anterio-posterior/posterio-anterior pelvic therapy is the most reliable treatment for cancer of the uterine cervix.

Female↗
PubMed1994

Surgical treatment options for colorectal cancer.

The aging of our national population is recognized as a major achievement of modern society. The National Institutes of Health have recently redefined "old" as beginning at age 70. This segment of our population lead active and productive lives. An unfortunate association of aging is the development of neoplasia. The incidence of colorectal cancer continues to escalate, with 150,000 cases expected each year, representing 15% of all cancer, two thirds of which are found in patients older than age 65. Forty percent of these patients present with advanced disease. Little change in survival by stage has been noted in the last 30 years. Surgical resection offers the only opportunity for cure as well as affording significant palliation in patients with advanced disease. Although age alone does not increase operative risks, comorbidity and emergency surgery are confounding factors. Repeated studies have shown that acceptable mortality and morbidity may be achieved by surgical resection for cure and for palliation in the elderly, thus age alone should not be a limiting factor. Key elements in management are early detection with surgical intervention before stage advancement or before complications occur (i.e., obstruction, perforation). When possible, comorbid factors, such as nutritional deficits, cardiovascular decompensation, and pulmonary insufficiency should be corrected. The appropriate use of mechanical bowel preparation and perioperative antibiotics should be emphasized. Surgical management should encourage adequate resection for cure or palliation rather than bypass or diversion. Proximal shifts in colon cancer location and improved technology frequently make resection with anastomosis possible rather than end colostomy. Multidisciplinary approaches to rectal cancer offer significant opportunities for sphincter preservation. Local excision with or without radiation therapy offers an occasional opportunity for treatment of rectal cancer in highly selective cases, also with sphincter preservation.

Aged↗
PubMed1994

Conventional four-field pelvic radiotherapy technique without CT treatment planning in cancer of the cervix: potential geographic miss.

The advantage of 4-field radiation to the pelvis is the use of lateral ports which spare the small bowel anteriorly and a portion of the rectum posteriorly from radiation. However, guidelines for the lateral pelvic ports are poorly defined. This is a comparative analysis to determine adequate margins by correlating conventional lateral pelvic treatment portals with CT defined tumor volume. The study included 52 patients treated definitively for carcinoma of the uterine cervix between 1986 and 1991. The most common site of inadequate margin (< or = 1.0 cm) was at the rectal block. The incidence of inadequate margin ranged from 39% to 50% and was independent of the stage of the disease except non-bulky stage IB disease. The next most common site was at the posterior border where frequency of inadequate margin for cervical tumor depended on stage with 8% of stage IB, 27% of stage IIB and 22% of stage IIIB/IVA disease. For the anterior border, an enlarged uterus was the only reason for inadequate margin rather than cervical tumor in 8% of stage IB, 18% of stage IIB, and 27% of stage IIIB/IVA disease. Without knowledge of precise tumor volume, the 4-field pelvic technique is potentially dangerous, risking underdosing of the tumor volume. For 4-field pelvic radiotherapy, we strongly recommend CT treatment planning.

Female↗
PubMed1991

Alternative therapies, 1990. An overview.

The availability of alternative therapies for many health problems is a well-documented historical fact. Alternative therapies are generally understood to be those therapies outside of the usually accepted medical therapies for disease processes, such as cancer, arthritis, diabetes, psoriasis, lupus, and AIDS. Some other descriptive terms utilized include questionable, unproven, dubious, unorthodox, and unconventional. These alternative therapies vary from active involvement in promotion of one's own health (exercise, diet) to quackery. In today's society, with emphasis on self-involvement with individual health, metabolic therapies have become the most widely practiced alternative therapy. In an antiestablishment, anti-intellectual climate, with an increasingly mobile, rootless population, alternative therapies are in somewhat of a renaissance. Some confusion exists regarding clinical trials and alternative therapies in the general population and in the noninvolved health profession. Various studies indicate that from 10% to 50% of cancer patients use some alternative therapy, with national expenditures ranging as high as $10 billion annually. Better-educated patients with higher-than-average income are more likely to choose alternative therapies and are frequently supported by a physician in this choice. Most cancer patients continue under a physician's care and continue usual therapy while pursuing alternative methods. Approximately 5% of cancer patients abandon appropriate therapy and pursue potentially harmful alternative methods. A variety of sociomedical questions are brought forth by studies of the use of alternative therapies. A great need for public and professional education regarding this subject is evident.

Attitude to Health↗
PubMed1989

Effect of kainate-induced seizures on tissue trace element concentrations in the rat.

It has been shown that epileptics have lower mean blood concentration of manganese than do controls but the cause of this abnormality has not been determined. In order to investigate the effects of seizures on manganese distribution in the body, rats were treated with kainic acid to produce spontaneous seizures which were quantitated for number and severity. Manganese, zinc, copper and iron concentrations were determined in blood, brain, liver, heart and kidney. Kainate-treated animals ate more food but gained less weight than controls. Liver and kidney manganese concentrations were significantly higher in kainate-treated animals than in controls. Blood manganese concentration showed a significant negative correlation with seizure index while heart manganese concentration showed a significant positive correlation with seizure index. None of the other trace elements showed a significant correlation between trace element concentration and seizure index in any of the tissues, although iron concentration was lower in brain and copper concentration was lower in kidney of kainate-treated animals than in their appropriate controls. These data show that manganese concentrations are generally elevated in tissues of kainate-treated animals. This increased manganese concentration may be related to the increased energy demand of these animals.

Animals↗