Cancer Center In Mexico Research Articles

Clinical and Epidemiological Profile of Breast Cancer in Mexico: Results of the Seguro Popular.

PurposeOne half of the Mexican population lacks comprehensive health care coverage. In 2003, a reform to the General Health Law was approved that led to the creation of the System of Social Protection in Health and made universal health coverage mandatory. The main innovation of this reform was Seguro Popular, which provided coverage for breast cancer. Here we report the outcomes of women with breast cancer treated at a cancer center in Mexico under Seguro Popular.Materials and MethodsThis was a retrospective cohort study that included all patients with breast cancer treated in the Instituto Nacional de Cancerología in Mexico City between January 2007 and December 2013 with Seguro Popular coverage. Demographic and clinical information were collected and survival outcomes were analyzed.ResultsA total of 4,300 women with breast cancer were included in this analysis. Most patients had locally advanced disease at diagnosis (53%, n = 2,293), and 13% (n = 558) presented with stage IV disease. Neoadjuvant chemotherapy was administered to 1,834 patients (52%), with a pathologic complete response in 25.1% (n = 460). Median follow-up was 40.5 months. Five-year survival for the entire cohort was 82% (95% CI, 81% to 84%). Five-year survival was 97% for early-stage disease (95% CI, 95% to 98%), 82% for locally advanced disease (95% CI, 80% to 84%), and 36% for metastatic disease (95% CI, 30% to 42%).ConclusionThis represents the first description of a cohort of patients with breast cancer treated in Mexico under Seguro Popular. Seguro Popular has allowed our institution, and other Mexican centers, to establish efficient standardized mechanisms to treat patients with breast cancer.

New oral anticoagulants

Dr. Jack Ansell from the York University School of Medicine, York, NY, and Lenox Hill Hospital, York, NY moderated the topic New Oral Anticoagulants with Drs. David Garcia from the University of Mexico Cancer Center, Albuquerque, NM, and Ken Mahaffey from Duke Clinical Research Institute, Durham, NC. The discussion focused primarily on: 1) classes of oral anticoagulants 2) target specific anticoagulants 3) pharmacokinetic parameters for new oral anticoagulants 4) differences between new anticoagulants and warfarin 5) efficacy and safety on clinical trials 6) clinical trials focused on treatment: venous thromboembolism trials 7) potential concerns of the new anticoagulants 8) patients that are candidates for the new target-specific anticoagulants. Med Roundtable Gen Med Ed. 2012;1(2):88–95.

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Click to increase image sizeClick to decrease image size Additional informationNotes on contributorsMichael A. CaligiuriMichael Caligiuri, MD, is director of The Ohio State University Comprehensive Cancer Center and CEO of the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio. William Dalton, PhD, MD, is CEO of M2Gen, Tampa, Fla. Lorna Rodriguez, MD, PhD, is director of the Precision Medicine Initiative at the Rutgers Cancer Institute of New Jersey, New Brunswick, N.J. Thomas Sellers, PhD, MPH, is executive vice president and director of the Moffitt Cancer Center, Tampa, Fla. Cheryl Willman, MD, is director and CEO of the University of New Mexico Cancer Center, Albuquerque, N.M.William S. DaltonMichael Caligiuri, MD, is director of The Ohio State University Comprehensive Cancer Center and CEO of the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio. William Dalton, PhD, MD, is CEO of M2Gen, Tampa, Fla. Lorna Rodriguez, MD, PhD, is director of the Precision Medicine Initiative at the Rutgers Cancer Institute of New Jersey, New Brunswick, N.J. Thomas Sellers, PhD, MPH, is executive vice president and director of the Moffitt Cancer Center, Tampa, Fla. Cheryl Willman, MD, is director and CEO of the University of New Mexico Cancer Center, Albuquerque, N.M.Lorna RodriguezMichael Caligiuri, MD, is director of The Ohio State University Comprehensive Cancer Center and CEO of the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio. William Dalton, PhD, MD, is CEO of M2Gen, Tampa, Fla. Lorna Rodriguez, MD, PhD, is director of the Precision Medicine Initiative at the Rutgers Cancer Institute of New Jersey, New Brunswick, N.J. Thomas Sellers, PhD, MPH, is executive vice president and director of the Moffitt Cancer Center, Tampa, Fla. Cheryl Willman, MD, is director and CEO of the University of New Mexico Cancer Center, Albuquerque, N.M.Thomas SellersMichael Caligiuri, MD, is director of The Ohio State University Comprehensive Cancer Center and CEO of the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio. William Dalton, PhD, MD, is CEO of M2Gen, Tampa, Fla. Lorna Rodriguez, MD, PhD, is director of the Precision Medicine Initiative at the Rutgers Cancer Institute of New Jersey, New Brunswick, N.J. Thomas Sellers, PhD, MPH, is executive vice president and director of the Moffitt Cancer Center, Tampa, Fla. Cheryl Willman, MD, is director and CEO of the University of New Mexico Cancer Center, Albuquerque, N.M.Cheryl L. WillmanMichael Caligiuri, MD, is director of The Ohio State University Comprehensive Cancer Center and CEO of the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio. William Dalton, PhD, MD, is CEO of M2Gen, Tampa, Fla. Lorna Rodriguez, MD, PhD, is director of the Precision Medicine Initiative at the Rutgers Cancer Institute of New Jersey, New Brunswick, N.J. Thomas Sellers, PhD, MPH, is executive vice president and director of the Moffitt Cancer Center, Tampa, Fla. Cheryl Willman, MD, is director and CEO of the University of New Mexico Cancer Center, Albuquerque, N.M.

NY Cancer Center Receives NCI Designation

Abstract In July, the Tisch Cancer Institute in New York became the 69th cancer center in the United States to earn NCI designation. Four other NCI-designated cancer centers attained comprehensive status: the University of Utah's Huntsman Cancer Institute; the University of Texas Southwestern's Simmons Cancer Center; Baylor College of Medicine's Duncan Cancer Center; and the University of New Mexico Cancer Center.

The impact of hospital-acquired infections with multidrug-resistant bacteria in an oncology intensive care unit

To describe overall site-specific hospital-acquired infection (HAI) rates and to describe the microbiological and antibiotic resistance profiles of infecting pathogens, together with their impact on multidrug-resistant (MDR) bacteria-associated mortality. We conducted a 5-year retrospective descriptive study of HAI in patients in the intensive care unit (ICU) of a cancer center in Mexico from January 2007 to December 2011. The following information was collected: patient characteristics and comorbidities, data related to the neoplasm and its treatment, microbiology, and the resistance pattern of all isolates. During the study period, 1418 patients were admitted to the ICU; 134 of them developed 159 infections, with an incidence of 11.2/100 hospitalized patients and 32.2/per 1000 patient-days. Two hundred sixty-six microorganisms were isolated. The overall prevalence of MDR-HAI was 39.5%. The most frequent organisms were as follows: 54 (20%) Escherichia coli (94.4% of these were extended-spectrum beta-lactamase producers), 32 (12%) Staphylococcus aureus (90.6% of these were methicillin-resistant), 32 (12%) Enterococcus faecium (18.7% of these were vancomycin-resistant), and 20 (6%) Acinetobacter baumannii (all were MDR). Among patients admitted to the ICU, 252 (17.8%) died. Death was related to the HAI in 58 (23%) of these patients (p<0.001) and 51 (88%) had a MDR organism isolated (p=0.05). The emergence of MDR bacteria poses a difficult task for physicians, who have limited therapeutic options. Critically ill cancer patients admitted to the ICU are at major risk of a bacterial MDR-HAI that will impact adversely on mortality.

Case study: Transforming cancer care at a community oncology practice

To assist practices and institutions throughout the country in implementing clinical redesign supported by - and aligned with - payment reform, we present a case study of the New Mexico Cancer Center (NMCC) based on numerous stakeholder interviews, literature reviews, and a comprehensive site visit. This study explores the complex barriers oncologists face in improving the quality and outcomes of cancer care and reducing overall costs in a sustainable way. This case will explore the following questions: How did the NMCC redesign care to improve quality, enhance patient experience and results, and reduce costs? How can an organization demonstrate they are improving quality to enable new payment contracts that enable sustainability? Are alternative payment models sustainable for an independent, community oncology practice?

Perspective on the q-bio Summer School and Conference: 2007 - 2014 and beyond.

The q-bio Conference and the associated q-bio Summer School were started in 2007 by a prescient group of researchers based at Los Alamos National Laboratory (LANL) and the University of New Mexico (J. Edwards, J. Faeder, W. Hlavacek, Y. Jiang, I. Nemenman and M. Wall) who envisioned a systems biology community focused on modeling, simulations and targeted experiments to advance the fundamental understanding of biological regulation. Sponsorship for the initial 2007 conference and school came from the Center for Nonlinear Studies at LANL, with additional support from the LANL Institute for Advanced Studies, the New Mexico Consortium, the Molecular Sciences Institute, the Center for the Spatiotemporal Modeling of Cell Signaling, and the University of New Mexico Cancer Center. q-bio is now a well-established international systems biology event in July/August of each year and is currently registering participants for its 8th meeting and summer school (http://q-bio.org/wiki/The_Eighth_q-bio_Conference or http://q-bio.org/wiki/The_Eighth_q-bio_Summer_School).

A phase II trial of combination oxaliplatin, capecitabine, and celecoxib with concurrent radiation for patients with newly diagnosed resectable rectal cancer.

487 Background: The goal of preoperative chemoradiation in rectal cancer is complete surgical resection without impairing sphincter function and to decrease local recurrence. The primary objective of the study was to determine complete pathological response rate (pCR) with capecitabine, oxaliplatin and celecoxib with concurrent radiation therapy. The secondary objectives were down staging rate, sphincter preservation rate, incidence and severity of adverse events. Methods: A total 37 out of 55 planned patients (pts) were enrolled by New Mexico cancer center consortium from 2005 to 2012. Inclusion criteria were: Resectable adenocarcinoma of the rectum within 12 cm of the anal verge, biopsy proven T3-4 N1-2 M0 based on endoscopic ultrasound, performance status of 0-2, adequate bone marrow reserve and liver functions. The neoadjuvant chemoradiation treatment was: capecitabine 850 mg/m2 bid Monday through Friday for 5 weeks, weekly oxaliplatin 50 mg/m2 IV, celecoxib 200 mg bid with concurrent 45 gray radiation therapy in 25 fractions over 5 weeks. Results: Only 21 of 37 pathology reports were assessable for the primary objective of pCR. 7/21 pts (33%, 95% CI, 0.14-0.56) had pCR and 4 had only microscopic residual disease. Thus, 11/21 pts (52%, 95% CI, 0.30-0.74) had an excellent response following chemoradiation. The secondary outcome analysis showed 19/21 pts (90%, 95% CI, 0.69-0.98) were down staged. Sphincter preservation rate was 71% (15/21) (95% CI, 0.47-0.88). Grade 3 and 4 toxicities were observed in 23% and included nausea, vomiting, diarrhea, dehydration, hypokalemia, lymphopenia and fatigue. Conclusions: We report the highest pathological CR so far in stage III rectal cancer with these early results. This could be due to anti-inflammatory activity of celecoxib leading to better tolerance of radiation therapy and possible synergistic anti-tumor activity. Final results will be reported upon completion of the trial. Clinical trial information: NCT00250835.

The Santa Fe Model: Music, the Brain, Medicine, and Wellness--A Scientific Dialogue Exemplifying Integrative Forums for Critical Topics

Construction and development of a conference involving music and medicine has enormous potential on many counts. This has article describes the intention of integrating medical music practices through direct event-conference thinking and through per- formance medium. This is a growing format that has important implications for expanding the role of the arts in health care. The Santa Fe Chamber Music Festival, the University of New Mexico Cancer Center, and Gabrielle’s Angels Foundation for Cancer Research will soon present ‘‘Music, the Brain, Medicine, and Wellness: A Scientific Dialogue.’’ This scientific symposium occurring from August 4 to 6, 2012, in Santa Fe, New Mexico, builds upon the knowledge of the state of the science and its impact of music on the developing brain, cognition, language, memory, and emotion. Music’s capacity to promote healing in patients with serious medical conditions including cancer, neurologic diseases, and developmental disorders as well as its influence on the well-being of individuals and their communities is critical to the expansive thinking in the integration of music and medicine.

Validation of the Mexican–Spanish version of the EORTC QLQ‐C15‐PAL questionnaire for the evaluation of health‐related quality of life in patients on palliative care

Health-related quality of life (HRQL) is an important outcome in oncology, particularly in the palliative care setting. The European Organization for Research and Treatment of Cancer (EORTC) QLQ-C15-PAL questionnaire is a brief version of QLQ-C30. Our aim is to validate the Mexican-Spanish version of the QLQ-C15-PAL questionnaire to measure HRQL in patients with terminal cancer. Consecutive patients with biopsy proven cancer were included in the study. All were treated in a cancer center in Mexico and were referred for palliative care because of far-advanced, recurrent or metastatic cancer. QLQ-C15-PAL questionnaire was applied in the first visit to the Unit and palliative care was offered to all patients depending on their specific necessities. Eighty-three patients were enrolled in this study (mean age, 61.2 years). Compliance rates were high; all patients completed to the questionnaire in <20 min and the instrument was well-received. Five missing values in five different items were found. QLQ-C15 scales distinguished between other clinically distinct groups of patients. Multi-trait scaling analysis demonstrated good convergent and discriminant validity. Cronbach's α coefficients were >0.7 in three of four multi-item scales (0.67 in the fourth). Test-retest scores were consistent in some scales, while improve or worsen in others. Better Global health, Dyspnea, Insomnia, Fatigue and Appetite scales were associated with longer survival. The Mexican-Spanish version of the EORTC QLQ-C15-PAL questionnaire is reliable and valid for HRQL measurement in patients with terminal cancer, and is appropriate for use in clinical trials of Mexican patients.

Does Ethnicity Influence Response To Docetaxel Based-Chemotherapy For Patients With Castration Resistant Prostate Cancer? The New Mexico Perspective.

INTRODUCTION: Metastatic prostate cancer is lethal in 15 % of the patients. Ethnic variations in response to docetaxel in patients with metastatic prostate cancer have not been studied. The aim of this study was to identify ethnic differences in the response to docetaxel, among patients with castration resistant metastatic prostate cancer.PATIENTS AND METHODS: We queried the New Mexico Cancer Registry then the electronic charts of all castration resistant metastatic prostate cancer patients who were treated with docetaxel between 1999 and 2010 at the University of New Mexico Cancer Center. Patient characteristics that might influence the response to docetaxel such as age, prior treatment including hormones, chemotherapy, radiotherapy, and surgery, concurrent chemotherapy, site of disease, baseline PSA, and number of docetaxel courses were recorded. Progression of disease after start of treatment was defined as identification of new lesions or a biochemical recurrence. The primary end point was overall survival. Secondary end points were progression-free survival and PSA response to docetaxel. RESULTS: Despite a lower incidence of prostate cancer in NM, the death rate is higher than the national average. Although not statistically significant, the overall survival for patients treated with docetaxel is highest among Non Hispanic Whites, followed by Native Americans and worst among the Hispanic population. The progression free survival was greatest in the Native American population followed by Non Hispanic Whites, followed by Hispanics. Compared to published data, the survival of New Mexicans with prostate cancer treated with docetaxel is worse.CONCLUSION: Hispanic males with castration resistant metastatic prostate cancer on docetaxel, tended to have the lowest overall survival and progression free survival, but overall the differences between New Mexican ethnicities were not statistically significant.

Breast Cancer in Young Women: The University of New Mexico Cancer Center (UNMCC) Experience.

Abstract Background: While only a small proportion of breast cancer is attributable to hereditary susceptibility, identifying high-risk individuals is essential for appropriate medical management. Furthermore, identifying individuals with inherited breast cancers have significant impact on both patient and their family. Beyond early age of onset, family history of multiple cancers may warrant a referral to cancer genetics professional. However, in a busy oncology practice, documentation of a full family history can be time consuming and referral opportunities for genetic counseling may be missed. In this study, we evaluated the strength of family history documentation in breast cancer patients' charts, and whether or not appropriate referrals to the Hereditary Cancer Assessment Program (HCAP) were made. Racial differences in these referral patterns were also assessed.Materials and Methods: All charts of patients last known to be living as of 03/29/06 per the UNMCC Tumor Registry with an invasive breast cancer who were 40 years old or younger at the time of diagnosis were reviewed. Baseline data included patient age at diagnosis, self-reported ethnicity, histology, bilaterality and cancer status. The presence or absence of family history of breast and other cancers, and referral to the HCAP was documented. Descriptive statistics were performed on baseline data. Correlative analyses were conducted to note any racial differences in referral to HCAP.Results: A total of 211 women met inclusion criteria. Patients in the Tumor Registry were seen at diagnosis at UNMCC from 01/01/67 through 12/31/04. Mean age was 35. Racial distribution was similar to that of the New Mexican population: 44% Caucasian, 41% Hispanic, 10% Native American (NA) and 3% African American. Predominant histology was infiltrating ductal carcinoma (79%); 10% of women had a second breast primary. 63% of women had a positive family history of cancer; however, family history was not recorded in 17%. After HCAP was established, 109 women were eligible for referral, yet 68 (62%) of women had not been referred for genetic counseling. Only 39% of Caucasian, 40% of Hispanic and 34% of NA eligible women were referred.Discussion: Women under the age of 40 at time of breast cancer diagnosis are more likely to have a hereditary cancer syndrome. In our population, 17% of women had no documentation of family history, and almost 70% were never referred for hereditary counseling. There was no difference in referral patterns among different racial/ethnic backgrounds. On the basis of this review, quality improvement initiatives were undertaken to improve referral patters of young women with breast cancer for genetic counseling and potential genetic testing. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4079.

Prevalence of BRCA1/2 Mutations and Variants in a Southwest Hispanic Population.

Abstract Background: There have been a limited number of studies of BRCA mutations in U.S. Hispanics. Of those previously published, two common mutations have been identified, and estimates of their prevalence vary, depending on the population studied. North American Hispanics are a heterogeneous population, consisting of Mexican, Caribbean, Central and South American descent. Furthermore, each of these groups has a significant admixture of other racial and ethnic groups. A limitation of most published studies is that they do not differentiate between these ethnically and genetically diverse Hispanics. In New Mexico, there is a large but relatively homogeneous Hispanic population. Since the University of New Mexico Cancer Center (UNMCC), sees a socially and economically diverse group of patients, the demographics of its Hispanic patients are similar to those of the whole state. Herein, we describe the prevalence of specific mutations and variants in Hispanics from a clinic-based population.Materials and Methods: A chart review of all patients evaluated for hereditary breast cancer risk from 1/1/2005 through 5/30/2009 was conducted. Data collected included patient age, self-reported ethnicity (including, if known, area of ancestral origin), cancer status, family history, BRCA testing status, including method (comprehensive analysis, Ashkenazi panel, single site, and/or comprehensive rearrangement testing), and what, if any, BRCA mutations or variants were found.Results: BRCA testing was performed on 312 patients, 70 of whom identified as NM Hispanic. Another 24 patients were of other Hispanic origins, mainly Mexican. Approximately 30% of those identified as NM Hispanic tested positive for mutations, and most mutations were found in BRCA1. All variants of uncertain significance in this group were found in BRCA2. Approximately 20% of other Hispanics tested positive for mutations, but variants of uncertain significance comprised a higher percentage of the results. In New Mexican Hispanics, 47% tested positive for BRCA1 187delAG, and another 19% tested positive for BRCA1 deletion of exons 9-12, both of which are previously described in the Hispanic populations from southern California and Colorado.Discussion: Although we found a large proportion of previously described mutations in our Hispanic population, 34% had other mutations. In this group, no mutation was seen more than once, indicating the need to offer these patients comprehensive BRCA testing or a combination of founder mutations testing followed by comprehensive sequencing. As most of our patients, even those identified as “Other Hispanic” have Colonial Spanish origins (via Mexico), this data is likely not applicable to Hispanics with other admixtures or historic arrival in the New World, such as Hispanics from the Caribbean. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4077.

963 PUBLICATION Concurrent radiation and weekly cisplatin for locally advanced cervical cancer (LACC) as routinary management. Results from a referral cancer center in mexico

963 PUBLICATION Concurrent radiation and weekly cisplatin for locally advanced cervical cancer (LACC) as routinary management. Results from a referral cancer center in mexico

A prospective, randomized phase III trial of test doses vs. full doses in taxane-naïve patients

8203 Background: The taxanes paclitaxel and docetaxel are an important class of semi-synthetic anti-cancer agents known to induce first dose hypersensitivity reactions (HSRs), which often limit their utility. A pilot 1mg taxane test dose program at the University of New Mexico Cancer Center showed that HSR severity and drug waste was reduced. To corroborate these findings, a Phase III test dose trial was instituted at four clinical sites in New Mexico and Texas. Methods: In this prospective, two-arm, randomized study, eligible participants were greater than 18 years and scheduled to receive their first taxane with standard premedications. Patients were randomized to receive the full prescribed dose with or without or a 1mg initial test dose. For sufficient statistical power the projected enrollment was targeted to 100 patients per arm. The primary outcomes for comparison were HSR severity (using the NCI common toxicity criteria for allergy/immunology) and drug wastage. Additional comparisons were made by gender, type of taxane, and presence or absence of preexisting allergies. All comparisons were evaluated for statistical significance using the Pearson chi-square test. An exact p-value <0.05 was considered significant. Results: An initial test dose was administered to 103 patients and 100 received the full taxane dose without a test dose. Six HSRs were observed in each group (5.9% overall). Paclitaxel was administered to 129 patients and 74 received docetaxel with no significant difference in HSR incidence between the two agents (6.2% vs. 5.4%). Only gender showed a significant difference: 9.3% of females experienced an HSR compared to only 2.1% of males (p=0.037). Approximately $12,000 (2004 AWP) of taxane was wasted by the full dose arm. Conclusions: Administration of test doses to taxane-naïve patients substantially reduced drug wastage but not HSR. Significantly more female patients experienced a HSR in comparison to male patients. No significant financial relationships to disclose.

Take Art

"Take Art." Oncology Issues, 19(4), p. 40 Additional informationNotes on contributorsBarbara McAnenyBarbara McAneny, MD, is a medical oncologist and hematologist and CEO of The New Mexico Cancer Center in Albuquerque, N.M. The artwork at the NMCC is shown by appointment. Please call ArtReach, 505.822.8900, to set up a visit. Proceeds from all sales benefit the lower-income patients via the New Mexico Cancer Center Foundation.

Helping Bone Marrow Cells to Regrow

THE ADVENT of hematopoietic colony-stimulating factors is making it possible to accelerate the growth of transplanted marrow cells, as well as helping marrow cells repopulate in patients who receive chemotherapy without a marrow transplant. At the American Cancer Society's seminar in Phoenix, Ariz, James A. Niedhart, MD, director of the University of New Mexico Cancer Center, Albuquerque, described the results of phase 1 trials of granulocyte macrophage colony-stimulating factor (GM-CSF) in patients who were treated with high-dose chemotherapy without a bone marrow transplant. The use of GM-CSF substantially reduced the duration of cytopenia, incidence of infection, and need for hospitalization, Niedhart reports. Trials are now under way using interleukin 3 alone and in combination with GM-CSF, he says. <h3>Score of Patients</h3> To date Neidhart's group has treated 19 patients with refractory lymphomas. "We have been able to obtain about a 50% complete remission rate in this very tough-to-treat group of

The New Mexico Melanoma Registry. A model of a statewide cooperative program.

The prevalence of cutaneous melanoma is high among Anglo residents of New Mexico. In order to achieve consistency in diagnosis and pathologic staging, a melanoma registry was established in 1980 in conjunction with the University of New Mexico Cancer Center. The registry functions through pathology panel review of newly diagnosed melanomas combined with collection of clinical data. Reports are submitted gratis to contributing pathologists and dermatologists. The melanoma registry works closely with the population-based New Mexico Tumor Registry. Acceptance of the melanoma registry has been excellent. We believe that in excess of 90% of new melanoma cases in the state are sent spontaneously to the registry. During 1986 approximately 150 melanomas were reviewed together with 450 atypical, benign pigmented lesions such as dysplastic nevi. In addition to pathology consultations, the registry serves an educational function and has potential for a variety of epidemiologic studies.