Linda Last | Capella University (original) (raw)

Papers by Linda Last

Research paper thumbnail of Outcomes of Salvage Surgery for Squamous Cell Carcinoma of the Anal Canal

Annals of Surgical Oncology, 2007

Background For patients with anal canal cancer who fail combined modality treatment (CMT), salvag... more Background For patients with anal canal cancer who fail combined modality treatment (CMT), salvage surgery (SS) offers the potential for long term survival. The literature regarding SS is limited by small patient numbers and/or heterogeneous treatment protocols. We report on a large series of patients initially treated with chemoradiation at a major referral center. Methods We identified 60 patients with persistent or recurrent anal cancer who had undergone SS; 20 were excluded. Overall and disease-free survival (OS, DFS) curves were constructed using the Kaplan Meier method. Univariate analysis was done using the Log-Rank test, and multivariable analysis using Cox proportional hazards. Results The 40 patients (29 women, 11 men, median age 57) underwent curative intent resection. The initial procedure was multivisceral resection (n = 24), abdominoperineal resection alone (n = 14) or local excision (n = 2). Postoperative mortality was 5%. Postoperative complications were seen in 72%. Median follow-up was 18 months overall and 36 months in survivors. Median OS was 41 months; OS and disease free survival at 5 years were 39% and 30%, respectively. Recurrence was present in 21 patients at time of analysis. Failure was locoregional in 86% (18 of 21) and distant in 48% (10 of 21). Independent predictors of poor OS were male gender, Charlson Comorbidity Score and tumor size. Independent predictors of poor disease free survival were positive margins and lymphovascular invasion. Conclusion SS for anal canal cancer was associated with significant morbidity. Long-term survival was achieved in 39% of patients. Comorbidities should guide patient selection, and R0 resection should be the goal.

Research paper thumbnail of Interest and Participation in Support Group Programs Among Patients With Colorectal Cancer

Cancer Nursing, 2002

Previous studies have demonstrated that support intervention improved quality of life and surviva... more Previous studies have demonstrated that support intervention improved quality of life and survival for patients with breast, melanoma, prostate, and gastrointestinal cancer. A standardized approach to encourage participation in support group programs among patients with colorectal cancer (CRC) had been initiated at this study site. The purpose of this study was to examine the characteristics of patients with CRC interested in this type of intervention and to identify barriers to attendance at an established patient support program. Consecutive patients with CRC were informed and encouraged to attend Wellspring, a nonprofit patient support program that offers a wide range of services. A patient survey was conducted and correlated with data on the clinical, social, and demographic characteristics of patients. Factors predictive of interest in the Wellspring support program and barriers to attendance were examined.Fifty-eight patients were eligible for this study. A total of 44 (76%) surveys were completed. Predictors of interest in patient support were age less than 65 years, encouragement from medical staff to attend, level of education, comfort in spiritual beliefs, religious affiliation, and complementary/alternative medicine use. Disease stage, gender, ethnicity, and level of social supports were not significant in this population. Although patients were routinely informed about the program in a standardized fashion, a significant proportion (36.4%) of patients did not recall receiving encouragement. Multiple logistic regression showed that level of education and recollection of encouragement from medical staff were independent predictors of interest. Although 14 patients were interested in attending (32%), only 4 ultimately attended Wellspring programs (9.1%). The most frequently cited barrier to attendance was a perception of adequate support at home, followed by living too far away, no perceived need of supports, and not feeling well.A significant proportion of patients with CRC are interested in structured support programs, but only a minority of patients ultimately participate in such programs. Further participation may be achieved by recognizing common barriers to participation and optimizing strategies to enhance attendance. Optimizing use of support services such as Wellspring has the potential to improve the effectiveness of the multidisciplinary cancer care of patients with CRC.

Research paper thumbnail of Lymph Node Retrieval and Assessment in Stage II Colorectal Cancer: A Population-Based Study

Annals of Surgical Oncology, 2003

Background: Adjuvant chemotherapy for patients with stage III (node-positive) colorectal cancer (... more Background: Adjuvant chemotherapy for patients with stage III (node-positive) colorectal cancer (CRC) reduces mortality by one third. Retrieval of an inadequate number of lymph nodes in the surgical specimen may result in incorrectly designating some patients as stage II (node negative), and consequently, such patients may not be offered appropriate chemotherapy. Recent National Cancer Institute guidelines suggest that a minimum of 12 nodes should be examined to ensure accurate staging. Methods: This population-based study identified stage II (T3N0 and T4N0) CRC cases by using CRC pathology reports (1997–2000) from the Ontario Cancer Registry. Patients aged 19 to 75 years were identified, and demographic, surgical, pathologic, and hospital data were extracted. Factors relating to the number of lymph nodes assessed were examined. Results: A total of 8848 CRC cases were reviewed, and 1789 stage II cases were identified. Seventy-three percent of cases were designated as node negative on the basis of assessment of Conclusions: A subset of patients with CRC in Ontario were assigned stage II disease on the basis of examination of relatively few lymph nodes.

Research paper thumbnail of Results of an Aggressive Approach to Resection of Locally Recurrent Rectal Cancer

Annals of Surgical Oncology, 2007

Background The value of resection for locally recurrent rectal cancer (LRRC) remains controversia... more Background The value of resection for locally recurrent rectal cancer (LRRC) remains controversial. We analyzed outcomes of an aggressive approach to resection of LRRC. Methods We conducted a retrospective chart review of 52 consecutive patients who underwent resection of LRRC from September 1997 through August 2005. Overall and disease-free survival (OS, DFS) curves were constructed by the Kaplan–Meier method, and compared by log-rank analysis. Median follow-up time was 29 months (range 3–72). Results Thirty-one patients (60%) were male. Median age was 60 years (range 36–88). Forty-six of the 52 patients were resected with curative intent, while 6 had known distant metastases at the time of resection. All 52 patients underwent grossly complete resection of local disease, and 41 (79%) had microscopically clear resection margins. An en bloc sacrectomy was performed in 28 (54%) patients. Postoperative mortality was nil; significant complications developed in 42% of patients. The complication rate was higher in patients with sacrectomy than without (50 vs. 33%, P = 0.017, Chi square). For the entire cohort of 52 patients, median OS and DFS were 40 and 24 months, respectively. Survival was equivalent in patients with and without sacrectomy. In the 46 patients who had resection with curative intent, 4-year OS was 48%. Median OS in the six patients with distant metastases at the time of resection was 21 months. OS was predicted by the presence of metastases (P = 0.01), and margin status (P P = 0.0001). Conclusions In this series of patients who underwent resection of LRRC, microscopic margin status was the most significant predictor of OS and DFS. Requirement for en bloc sacrectomy was not associated with inferior survival. Carefully selected patients with distant metastases may benefit from resection of LRRC.

Research paper thumbnail of Compliance, attitudes and barriers to post-operative colorectal cancer follow-up

Journal of Evaluation in Clinical Practice, 2008

Rationale Meta-analyses demonstrate that surveillance following curative-intent colorectal cance... more Rationale Meta-analyses demonstrate that surveillance following curative-intent colorectal cancer (CRC) surgery can improve survival. Our multidisciplinary team adopted a stringent CRC follow-up (FU) guideline in 2000. The purpose of this study was to assess adherence and barriers to FU for CRC.Methods Patients with primary CRC aged 19–75 years, treated with curative intent surgery from July 2000 to December 2002 were identified from a prospective database. Compliance with FU was assessed primarily by chart review. We also surveyed patients and providers to explore attitudes and barriers to surveillance adherence using tenets of the Health Belief Model.Results 96 patients met inclusion criteria and were appropriate for FU. Median FU was 34 months. Guideline targets were met for 70% of clinic visits; 49% of carcinoembryonic antigen (CEA) determinations; and 62% of abdominal imaging studies. Post-operative colonoscopy did not occur in 6/93 patients. Seventy per cent of health care providers and 55% of patients completed a survey. Access to testing and confusion about which provider orders investigations were identified as important barriers to FU.Conclusion Patterns of CRC FU were widely variable despite implementation of a guideline. Despite patient and provider agreement with the principles of CRC FU, adoption was inhibited by confusion among multiple providers regarding investigation coordination.

Research paper thumbnail of Outcomes of Salvage Surgery for Squamous Cell Carcinoma of the Anal Canal

Annals of Surgical Oncology, 2007

Background For patients with anal canal cancer who fail combined modality treatment (CMT), salvag... more Background For patients with anal canal cancer who fail combined modality treatment (CMT), salvage surgery (SS) offers the potential for long term survival. The literature regarding SS is limited by small patient numbers and/or heterogeneous treatment protocols. We report on a large series of patients initially treated with chemoradiation at a major referral center. Methods We identified 60 patients with persistent or recurrent anal cancer who had undergone SS; 20 were excluded. Overall and disease-free survival (OS, DFS) curves were constructed using the Kaplan Meier method. Univariate analysis was done using the Log-Rank test, and multivariable analysis using Cox proportional hazards. Results The 40 patients (29 women, 11 men, median age 57) underwent curative intent resection. The initial procedure was multivisceral resection (n = 24), abdominoperineal resection alone (n = 14) or local excision (n = 2). Postoperative mortality was 5%. Postoperative complications were seen in 72%. Median follow-up was 18 months overall and 36 months in survivors. Median OS was 41 months; OS and disease free survival at 5 years were 39% and 30%, respectively. Recurrence was present in 21 patients at time of analysis. Failure was locoregional in 86% (18 of 21) and distant in 48% (10 of 21). Independent predictors of poor OS were male gender, Charlson Comorbidity Score and tumor size. Independent predictors of poor disease free survival were positive margins and lymphovascular invasion. Conclusion SS for anal canal cancer was associated with significant morbidity. Long-term survival was achieved in 39% of patients. Comorbidities should guide patient selection, and R0 resection should be the goal.

Research paper thumbnail of Interest and Participation in Support Group Programs Among Patients With Colorectal Cancer

Cancer Nursing, 2002

Previous studies have demonstrated that support intervention improved quality of life and surviva... more Previous studies have demonstrated that support intervention improved quality of life and survival for patients with breast, melanoma, prostate, and gastrointestinal cancer. A standardized approach to encourage participation in support group programs among patients with colorectal cancer (CRC) had been initiated at this study site. The purpose of this study was to examine the characteristics of patients with CRC interested in this type of intervention and to identify barriers to attendance at an established patient support program. Consecutive patients with CRC were informed and encouraged to attend Wellspring, a nonprofit patient support program that offers a wide range of services. A patient survey was conducted and correlated with data on the clinical, social, and demographic characteristics of patients. Factors predictive of interest in the Wellspring support program and barriers to attendance were examined.Fifty-eight patients were eligible for this study. A total of 44 (76%) surveys were completed. Predictors of interest in patient support were age less than 65 years, encouragement from medical staff to attend, level of education, comfort in spiritual beliefs, religious affiliation, and complementary/alternative medicine use. Disease stage, gender, ethnicity, and level of social supports were not significant in this population. Although patients were routinely informed about the program in a standardized fashion, a significant proportion (36.4%) of patients did not recall receiving encouragement. Multiple logistic regression showed that level of education and recollection of encouragement from medical staff were independent predictors of interest. Although 14 patients were interested in attending (32%), only 4 ultimately attended Wellspring programs (9.1%). The most frequently cited barrier to attendance was a perception of adequate support at home, followed by living too far away, no perceived need of supports, and not feeling well.A significant proportion of patients with CRC are interested in structured support programs, but only a minority of patients ultimately participate in such programs. Further participation may be achieved by recognizing common barriers to participation and optimizing strategies to enhance attendance. Optimizing use of support services such as Wellspring has the potential to improve the effectiveness of the multidisciplinary cancer care of patients with CRC.

Research paper thumbnail of Lymph Node Retrieval and Assessment in Stage II Colorectal Cancer: A Population-Based Study

Annals of Surgical Oncology, 2003

Background: Adjuvant chemotherapy for patients with stage III (node-positive) colorectal cancer (... more Background: Adjuvant chemotherapy for patients with stage III (node-positive) colorectal cancer (CRC) reduces mortality by one third. Retrieval of an inadequate number of lymph nodes in the surgical specimen may result in incorrectly designating some patients as stage II (node negative), and consequently, such patients may not be offered appropriate chemotherapy. Recent National Cancer Institute guidelines suggest that a minimum of 12 nodes should be examined to ensure accurate staging. Methods: This population-based study identified stage II (T3N0 and T4N0) CRC cases by using CRC pathology reports (1997–2000) from the Ontario Cancer Registry. Patients aged 19 to 75 years were identified, and demographic, surgical, pathologic, and hospital data were extracted. Factors relating to the number of lymph nodes assessed were examined. Results: A total of 8848 CRC cases were reviewed, and 1789 stage II cases were identified. Seventy-three percent of cases were designated as node negative on the basis of assessment of Conclusions: A subset of patients with CRC in Ontario were assigned stage II disease on the basis of examination of relatively few lymph nodes.

Research paper thumbnail of Results of an Aggressive Approach to Resection of Locally Recurrent Rectal Cancer

Annals of Surgical Oncology, 2007

Background The value of resection for locally recurrent rectal cancer (LRRC) remains controversia... more Background The value of resection for locally recurrent rectal cancer (LRRC) remains controversial. We analyzed outcomes of an aggressive approach to resection of LRRC. Methods We conducted a retrospective chart review of 52 consecutive patients who underwent resection of LRRC from September 1997 through August 2005. Overall and disease-free survival (OS, DFS) curves were constructed by the Kaplan–Meier method, and compared by log-rank analysis. Median follow-up time was 29 months (range 3–72). Results Thirty-one patients (60%) were male. Median age was 60 years (range 36–88). Forty-six of the 52 patients were resected with curative intent, while 6 had known distant metastases at the time of resection. All 52 patients underwent grossly complete resection of local disease, and 41 (79%) had microscopically clear resection margins. An en bloc sacrectomy was performed in 28 (54%) patients. Postoperative mortality was nil; significant complications developed in 42% of patients. The complication rate was higher in patients with sacrectomy than without (50 vs. 33%, P = 0.017, Chi square). For the entire cohort of 52 patients, median OS and DFS were 40 and 24 months, respectively. Survival was equivalent in patients with and without sacrectomy. In the 46 patients who had resection with curative intent, 4-year OS was 48%. Median OS in the six patients with distant metastases at the time of resection was 21 months. OS was predicted by the presence of metastases (P = 0.01), and margin status (P P = 0.0001). Conclusions In this series of patients who underwent resection of LRRC, microscopic margin status was the most significant predictor of OS and DFS. Requirement for en bloc sacrectomy was not associated with inferior survival. Carefully selected patients with distant metastases may benefit from resection of LRRC.

Research paper thumbnail of Compliance, attitudes and barriers to post-operative colorectal cancer follow-up

Journal of Evaluation in Clinical Practice, 2008

Rationale Meta-analyses demonstrate that surveillance following curative-intent colorectal cance... more Rationale Meta-analyses demonstrate that surveillance following curative-intent colorectal cancer (CRC) surgery can improve survival. Our multidisciplinary team adopted a stringent CRC follow-up (FU) guideline in 2000. The purpose of this study was to assess adherence and barriers to FU for CRC.Methods Patients with primary CRC aged 19–75 years, treated with curative intent surgery from July 2000 to December 2002 were identified from a prospective database. Compliance with FU was assessed primarily by chart review. We also surveyed patients and providers to explore attitudes and barriers to surveillance adherence using tenets of the Health Belief Model.Results 96 patients met inclusion criteria and were appropriate for FU. Median FU was 34 months. Guideline targets were met for 70% of clinic visits; 49% of carcinoembryonic antigen (CEA) determinations; and 62% of abdominal imaging studies. Post-operative colonoscopy did not occur in 6/93 patients. Seventy per cent of health care providers and 55% of patients completed a survey. Access to testing and confusion about which provider orders investigations were identified as important barriers to FU.Conclusion Patterns of CRC FU were widely variable despite implementation of a guideline. Despite patient and provider agreement with the principles of CRC FU, adoption was inhibited by confusion among multiple providers regarding investigation coordination.