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Although pancreatic cancer is the fourth leading cause of cancer death, few studies have evaluated population-based trends in diagnosis, management, and outcome. We used the Surveillance, Epidemiology, and End Results (SEER) registry to evaluate treatment trends and outcomes for patients 18 or older with pancreatic adenocarcinoma diagnosed from 1988 through 2002. We identified 38,073 patients diagnosed with pancreatic cancer over this 15-year period; the age-adjusted incidence did not change over this period. Most patients were diagnosed with metastatic disease (50.3%), few of whom underwent irradiation or cancer-directed surgery (CDS). For patients with localized or regional disease (32.9%), 53% underwent some form of treatment. Importantly, the rate of CDS increased from 19% in 1988 to 35% in 2002 (P < 0.0001). In multivariate analysis, young age, married status, and localized disease were associated with significantly higher CDS rates. For patients with nonmetastatic disease, 2-year survival rate increased from 8% in 1988 to 15% in 2000. For patients with non-metastatic cancer who survived at least 3 months, CDS was associated with a significantly higher 2-year survival rate (CDS, 36%; non-CDS, 10%). Most patients with pancreatic cancer, even at the end of our 15-year study period, still presented with metastatic disease, and the survival rate for such patients did not change in a meaningful way over time. The proportion of patients with nonmetastatic pancreatic cancer who underwent potentially curative surgery increased over time in the U.S.; the 2-year survival rate for such patients improved, but remained poor.

Background Access to imaging reports and review of the breast imaging directly with a patient with breast cancer helps improve the understanding of disease extent and severity. A 3D printed breast model can further enhance a patient’s understanding and communication with the healthcare team resulting in improved patient comprehension and patient input with reduced treatment decision conflict. Furthermore, 3D printed models can facilitate training of residents and fellows involved in the diagnosis and treatment management of breast cancer. Case presentation We present a 3D printed breast tumor model segmented from positron electron tomography/computed tomography and fabricated via desktop vat polymerization as proof of concept for treatment planning for a patient diagnosed with triple negative inflammatory breast carcinoma. Conclusion We illustrate benefits and indications for 3D printing in the management of breast cancer and specifically inflammatory breast cancer in this case. Fabrication and implementation of 3D printed models enhances patient’s understanding and communication with the healthcare team regarding their condition, treatment options and anticipated outcomes. It provides personalized treatment planning by examining patient-specific pathology and the anatomic spatial relationships. Furthermore, 3D printed models facilitate medical education for trainees across disciplines involved in the patient’s care.

Introduction The timing of surgical resection for stage IV colon cancer with liver metastasis and the safety of simultaneous colon and liver resection remains controversial. The purpose of our study was to evaluate short-term outcomes after combined colon and liver resection (CCLR) versus colon resection (CR) or liver resection alone (LR) using a population database. Methods The National Inpatient Sample was used to select patients who had surgery for colon cancer from 2002 to 2006. We evaluated for in-hospital morbidity, mortality, and prolonged length of stay (PLOS). Our analysis was done using design-weighted unadjusted analysis and logistic regression. Results We identified 361,096 patients during our study period (CCLR 3,625; CR 322,286; LR 35,185). CCLR was not associated with an increased risk of complications (odds ratio (OR) 1.12; 95 % confidence interval (CI) 0.94–1.33; P  = 0.21) or PLOS (OR 1.19; 95 % CI 0.99–1.4; P  = 0.06) compared with CR. In-hospital mortality occurred in 3.5 % of patients who underwent CCLR and was not significantly associated with mortality compared with CR alone (OR 1.17; 95 % CI 0.79–1.74; P  = 0.43). Liver lobectomy with CR was associated with a PLOS and a trend toward increased morbidity and mortality. Significant predictors of complications, mortality, and PLOS included: age >70 years, male gender, nonprivate health insurance, and Elixhauser score >1. Conclusions CCLR with limited liver resection can be performed with similar morbidity and mortality to colectomy alone. For patients who require hepatic lobectomy, however, strong consideration should be given to a staged approach.

Background It is unclear whether the addition of chemoradiation (CRT) to adjuvant chemotherapy (CT) following upfront resection of pancreatic ductal adenocarcinoma (PDAC) provides any benefit. While some studies have suggested a benefit to combined modality therapy (CMT) (adjuvant CT plus CRT), it is not clear if this benefit was related to increased CT usage in patients who received CMT. We sought to clarify the use of CMT in patients who underwent upfront resection of PDAC. Methods Patients with non-metastatic PDAC were retrospectively identified from the linked SEER-Medicare database. Those who underwent upfront resection were identified and divided into two cohorts – patients who received adjuvant CT and patients who received adjuvant CMT. Cohorts were compared. Univariate analysis described patient characteristics. Kaplan-Meier and multivariable Cox proportional hazards modeling were used to estimate overall survival (OS). Results 3555 patients were identified; 856 (24%) received CT and 573 (16%) received CMT. The median number of CT doses was 11 for both groups. Patients who received CMT were younger, diagnosed in the earlier time frame, and had fewer comorbidities. The median OS was 21 months and 18 months for those treated with CMT and CT (P < .0001), respectively, but when stratified by nodal status, the association with improved OS in the CMT cohort was only observed in node-positive patients. On multivariable analysis, receipt of CMT and removal of >15 lymph nodes decreased the risk of death (P < .05). Discussion Receipt of CMT following upfront resection for PDAC was associated with improved survival, which was confined to node-positive patients. The role of adjuvant CMT in PDAC with nodal metastases warrants further study.

Purpose Appendiceal cancer is a rare and potentially aggressive malignancy. The objectives of this study were to characterize secular demographic patterns of disease and to determine survival by using a population-based data source. Methods Using the Surveillance, Epidemiology, and End Results database, we conducted a retrospective cohort analysis of patients treated from 2000–2009. Results We identified 4765 patients with appendiceal cancer. The incidence of appendiceal cancer increased by 54 % from 2000 (0.63 per 100,000) to 2009 (0.97 per 100,000 population). Incidence rates increased across all tumor types, stages, age groups, and gender. The most common malignancies were mucinous adenocarcinoma (38 %), followed by carcinoids (28 %), adenocarcinoma-not otherwise specified (NOS) (27 %), and signet ring cell adenocarcinoma (7 %). Larger tumor size and older patient age were significantly associated with higher relative odds of distant disease at diagnosis ( P  < 0.0001). Patient and demographic characteristics were significantly associated with higher relative hazard of death ( P  < 0.0001). Conclusions Although appendiceal cancer is rare, the incidence increased significantly in the USA from 2000 to 2009. The cause of this trend is not obvious. We did not observe increases differentially associated with stage, histology, or demographic characteristics. Further investigation is needed to examine factors underlying this increase.

Purpose: Previous studies have demonstrated that many healthcare workers in low‐ and middle‐income countries (LMICs) lack the appropriate training and knowledge to recognize and diagnose breast cancer at an early stage. As a result, women in LMICs are frequently diagnosed with late‐stage breast cancer (Stage III/IV) with a poor prognosis. Materials and Methods: We hosted a 1‐day breast cancer educational conference directed towards healthcare workers in Honduras. We conducted pre‐ and postcourse (1–2 months later) assessments that evaluated knowledge of screening, diagnosis, and treatment of breast cancer. Breast cancer specialists at the University of Minnesota and Honduras developed a 12‐question assessment tool in Spanish. Results: A total of 157 people attended the course, and 86 completed the precourse knowledge assessment. The overall percentage of correct responses was 70% in the precourse assessment. Postcourse knowledge assessments were completed by 94 participants. The overall percentage of correct responses was 80% in the postcourse assessment and was significantly higher than precourse assessment scores ( p < 0.0001). For the individual domains of screening, diagnosis, and treatment, the postcourse knowledge assessment scores were significantly improved as compared with the precourse scores ( p < 0.0001). Conclusion: In this study, we found that a 1‐day, in‐person breast cancer educational course directed towards healthcare workers in Honduras resulted in improved breast cancer knowledge assessment scores. Future research and implementation strategies will include training healthcare workers throughout Honduras and determining the impact of these educational interventions on the late‐stage presentation of breast cancer.

Background Multiple trials have demonstrated a survival benefit for adjuvant chemotherapy after resection of pancreatic adenocarcinoma. This study aimed to identify the rate for completion of adjuvant chemotherapy, factors associated with completion, and its impact on survival after surgical resection. Methods The Surveillance Epidemiology and End Results Medicare-linked data was used to identify patients who underwent upfront resection for pancreatic adenocarcinoma from 2004 to 2013. Billing codes were used to quantify receipt and completion of chemotherapy. Factors associated with completion of chemotherapy were identified using multivariable regression. Kaplan–Meier and Cox proportional-hazards modeling were used to examine survival. Results The inclusion criteria were met by 2440 patients. Of these patients, 65% received no adjuvant chemotherapy, 28% received incomplete therapy, and 7% completed chemotherapy. The factors associated with chemotherapy completion were nodal metastases and treatment at a National Cancer Institute-designated cancer center ( p  ≤ 0.05). Comorbidities decreased the odds of completion ( p  ≤ 0.05). The median overall survival (OS) was 14 months for the patients who received no adjuvant chemotherapy, 17 months for those who received incomplete adjuvant chemotherapy, and 22 months for those who completed adjuvant chemotherapy ( p  ≤ 0.05). More recent diagnosis, comorbidities, T stage, nodal metastases, and no adjuvant chemotherapy were associated with an increased hazard ratio for death ( p  ≤ 0.05). Evaluation of 15 or more nodes and completion of chemotherapy decreased the hazard ratio for death ( p  ≤ 0.05). Conclusions Only 7% of the Medicare patients who underwent upfront resection for pancreatic cancer completed adjuvant chemotherapy, yet completion of adjuvant chemotherapy was associated with improved OS. Completion of adjuvant chemotherapy should be the goal after upfront resection, but neoadjuvant chemotherapy may ensure that patients receive systemic chemotherapy.