In a meta-analysis of the available literature on time to AC, longer time to AC was associated with worse survival among patients with resected colorectal cancer.

No abstract

Delay in the initiation of RT is associated with an increase [corrected] in LRR in breast cancer and head and neck cancer. Delays in starting RT should be as short as reasonably achievable.

No abstract

BACKGROUND: Lower socioeconomic status (SES) is associated with worsened cancer survival. The authors evaluate the impact of SES on stage of cancer at diagnosis and survival in Ontario, Canada. METHODS: All incident cases of breast, colon, rectal, nonsmall cell lung, cervical, and laryngeal cancer diagnosed in Ontario during the years 2003‐2007 were identified by using the Ontario Cancer Registry. Stage information is captured routinely for patients seen at Ontario's 8 Regional Cancer Centers (RCCs). The Ontario population was divided into quintiles (Q1‐Q5) based on community median household income reported in the 2001 census; Q1 represents the poorest communities. Overall survival (OS) and cancer‐specific survival (CSS) were determined with Kaplan‐Meier methodology. A Cox model was used to evaluate the association between survival and SES, stage, and age. RESULTS: Stage at diagnosis was available for 38,431 of 44,802 (85%) of cases seen at RCCs. The authors observed only very small differences in stage distribution by SES. Across all cases in Ontario, the authors found substantial gradients in 5‐year OS and 3‐year CSS across Q1 and Q5 for breast (7% absolute difference in OS, P < .001; 4% CSS, P < .001), colon (8% OS, P < .001; 3% CSS, P = .002), rectal (9% OS, P < .001; 4% CSS, P = .096), nonsmall cell lung (3% OS, P = .002; 2% CSS, P = .317), cervical (16% OS, P < .001; 10% CSS, P = .118), and laryngeal cancers (1% OS, P = .045; 3% CSS, P = .011). Adjustments for stage and age slightly diminished the survival gradient only among patients with breast cancer. CONCLUSIONS: Despite universal healthcare, SES remains associated with survival among patients with cancer in Ontario, Canada. Disparities in outcome were not explained by differences in stage of cancer at time of diagnosis. Cancer 2010. © 2010 American Cancer Society.

Summary One hundred cancer patients undergoing active treatment were interviewed to determine how they perceived their illness and how their perceptions compared with those of their attending physicians.Ninety-eight patients recognized that they had cancer and 87 correctly identified the tumour type. Sixtyfour of 67 patients with local or regional disease were aware of this, but 11 of 33 patients with metastatic disease incorrectly believed that the cancer was localized. Five of 52 patients being treated for cure thought they were being treated palliatively, and 16 of 48 patients receiving palliative treatment believed that the doctor's aim was to cure them. Forty of these 48 patients significantly overestimated the probability that the treatment would prolong their lives. (Parsons, 1951). Others have since stressed that "mutual participation" must replace paternalism as the basis of the modern doctor-patient relationship, if physicians are to succeed in combating the public's growing distrust of the profession (Haug & Sussman, 1969;Brody, 1980;Jensen, 1981). It is now generally agreed by doctors and lay people in North America that patients should participate actively in decisions about their care. This participation can only be meaningful if the patient understands his situation well enough to perform the kind of cost-benefit analysis that has traditionally been left to the doctor. Thus it is now more important than ever for patients to be well-informed about their illness and its treatment.Patients must already give their 'informed consent' for any form of medical intervention, but 'informed consent' has proved difficult to define and even more difficult to realize in practice. Information is not always effectively transmitted to the patient, and it has been suggested that complex medical information may be of little value to those who do not have the educational background necessary to interpret it (Robinson and Merav, 1976;Cassileth et al., 1980a; Mackillop & Johnson, 1986 Over a three-month period we attempted to interview every available patient, but, if a member of the healthcare team preferred that the patient not be interviewed, these wishes were respected. One hundred and sixteen patients were approached. They were told that the aims of the study were to find out how well patients understand their illness and to learn if communication between doctors and patients is effective. Written consent was obtained from each participating patient. The consent form outlined the study's objectives and explained that the interview would be videotaped. Sixteen of the 116 patients who were approached chose not to participate. Eleven felt that the interview process would be too stressful and five felt that it would be too inconvenient. The interviewer (WES) is not medically trained and was unaware of the patient's diagnosis. Interviews were videotaped to avoid notetaking during the course of the conversation, but a checklist was used to ensure that all patients were asked the same questions. The content and format o...

The study was designed to determine which formats for displaying quantities, such as probabilities of treatment risks and benefits, are perceived most accurately and easily by patients. Accuracy and speed of processing were compared for six different presentation formats: pie charts, vertical bars, horizontal bars, numbers, systematic ovals, and random ovals. Quantities were used in two tasks: a choice task that required larger/smaller judgments and an estimate task that required more precise evaluation. The impacts of blue-yellow color and of a treatment-decision context on performance in the two tasks were also investigated. The study included four experiments. Taken together the results suggest that the formats best for making a choice differ from those best for estimating the size of an amount. For making a choice, vertical bars, horizontal bars, numbers, and systematic ovals were equally well perceived; pie charts and random ovals caused slower and less accurate performances. For estimating, numbers led to the most accurate estimates, followed by systematic ovals. The other four formats led to the least accurate estimates. Color and context did not alter which formats were best.

The use of data from the real world to address clinical and policy-relevant questions that cannot be answered using data from clinical trials is garnering increased interest. Indeed, data from cancer registries and linked treatment records can provide unique insights into patients, treatments and outcomes in routine oncology practice. In this Review , we explore the quality of real-world data (RWD), provide a framework for the use of RWD and draw attention to the methodological pitfalls inherent to using RWD in studies of comparative effectiveness. Randomized controlled trials and RWD remain complementary forms of medical evidence; studies using RWD should not be used as substitutes for clinical trials. The comparison of outcomes between nonrandomized groups of patients who have received different treatments in routine practice remains problematic. Accordingly , comparative effectiveness studies need to be designed and interpreted very carefully. With due diligence, RWD can be used to identify and close gaps in health care, offering the potential for short-term improvement in health-care systems by enabling them to achieve the achievable.