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L H Karnell

Publications and source records attributed to L H Karnell.

36 records · Page 2Linked to original sources
PubMed1997

Patterns of care for cancer of the larynx in the United States.

OBJECTIVE: To assess case-mix characteristics, treatment patterns, and outcomes for laryngeal cancer using the largest series of patients to date. DESIGN: Analyses performed on retrospectively collected survey data submitted by hospitals for diagnostic periods 1980 through 1985 and 1990 through 1992 (with a 9-year follow-up for the long-term group). SETTING: Broad spectrum of US hospitals (N = 769). PATIENTS: Consecutively accrued series of patients with laryngeal cancer (N = 16,936), with only squamous cell carcinomas (N = 16,213) analyzed. INTERVENTIONS: Surgery, radiation therapy, and chemotherapy. MAIN OUTCOME MEASURES: Descriptive analyses of case-mix, diagnostic, and treatment characteristics plus recurrence and 5-year, disease-specific survival outcomes. RESULTS: There was a slight increase across these years in stage IV disease and in radiation therapy (with or without surgery and/or chemotherapy). Overall diversity of management of this disease (by site and stage) was apparent. Five-year survival rates indicated a large difference between modified groupings of the T and N classifications, separating stages III and IV cases into localized disease (87.5% for T1-T2; 76.0% for T3-T4 cases) and regional metastasis (46.2%). CONCLUSIONS: Regardless of improvements in entering data in hospital records (most commendably, staging), more rigorous standards are needed. Also, the small increase in advanced-stage patients indicates that efforts toward early detection have not been successful. The rise in radiation therapy perhaps reflected an increased use of nonsurgical treatment for early-stage patients and organ-sparing radiochemotherapy protocols for advanced-stage patients. Regrouping stages III and IV cases into localized disease vs regional metastasis appears to predict survival better. Ongoing refinements of the American Joint Committee on Cancer staging scheme will hopefully improve this cancer's classification.

Carcinoma, Squamous Cell↗
PubMed1997

Botulinum neurotoxin injection after total laryngectomy.

BACKGROUND: One of several causes of tracheoesophageal puncture (TEP) speech failure after total laryngectomy is disturbance in relaxation of the pharyngoesophageal (PE) segment. We introduce the use of chemical denervation of the PE segment through botulinum neurotoxin (Botox) injection to improve TEP speech. METHODS: An analysis was performed on eight patients who received Botox injections for TEP speech problems after total laryngectomy at the University of Iowa between June 4, 1991 and August 8, 1994. Retrospective chart review identified the evolution of pretreatment evaluation and injection technique which became standardized in April 1992. Prospective evaluation of results was recorded by a single speech pathologist who subjectively identified the response to Botox in all patients and recorded pressure readings at the tracheostoma site during speech in 6 patients. RESULTS: Seven of the eight patients were noted to have improved TEP speech following injection. Five of these seven patients experienced substantially improved speech, three of whom had no ability to produce speech prior to the Botox injection. CONCLUSION: Botox injection is a safe and effective method of improving TEP speech in selected patients with disturbed relaxation of pharyngoesophageal segment.

Adult↗
PubMed1997

Baseline and post-treatment assessment of the general health status of head and neck cancer patients compared with United States population norms.

BACKGROUND: It is a common perception that the overall health of patients with head and neck cancer (HNC) is likely to be poor compared with the general population. This project was undertaken to investigate the pre- and post-treatment, global health status of HNC patients in comparison with age-matched, U.S. population norms using a self-administered general health status survey. METHODS: Between July 1, 1993, and May 1, 1996, 180 patients underwent pretreatment and 6 month follow-up evaluation with the standard version of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). The SF-36 scale scores, means, standard deviations, and 95% confidence intervals were calculated for each SF-36 scale as well as for physical-health-component summary scores (PCS) and mental-health-component summary scores (MCS). Comparisons of these scores were made to U.S. population normative data. Pretreatment and 6-month follow-up SF-36 scores were compared. RESULTS: In the 45-54-year age group, all 8 SF-36 scale scores, the PCS, and MCS scores were significantly worse for the HNC patients in comparison with age-matched norms (p < .05). In the 55-64-year age group, the HNC patients were worse in 5 of the 8 SF-36 scale scores and the MCS score in comparison with age-matched norms (p < .05). In the 65-74-year age group, the HNC patients scored significantly worse in the mental health scale. In the comparison of pretreatment and 6-month follow-up scores, the HNC patients had significant decreases in the physical functioning scale (p = .003) and the PCS score (p = .047). The HNC patients showed significant improvement in the mental health scale (p = .049) and improvement in the bodily-pain scale, which approached significance (p = .053) at 6-month follow-up. The HNC patients showed a marked decrease in general health status with increasing stage of HNC. CONCLUSIONS: This work provides objective support for the perception that many HNC patients are initially seen for treatment with baseline health status functioning significantly below their age-matched contemporaries in the general population. An educated evaluation of global health outcomes following treatment in the HNC patient population must begin with an accurate pretreatment assessment of these parameters. Self-reported health-status assessment (HSA) is a useful means of evaluating global health status in this patient population.

Adult↗
PubMed1997

Hypopharyngeal cancer patient care evaluation.

A survey was conducted to identify demographics and standards of care for treatment of hypopharyngeal squamous cell carcinoma in the United States. Data were accrued from voluntary submission of cancer registry and medical chart information from 769 hospitals representing 2939 cases diagnosed from 1980 to 1985 and 1990 to 1992. Clinical findings, diagnostic procedures employed, treatment practices, and outcome are presented. Overall, 5-year disease-specific survival was 33.4%, which segregated to 63.1% (stage I), 57.5% (stage II), 41.8% (stage III), and 22% (stage IV). Survival was best for patients treated with surgery only (50.4%), similar with combined surgery and irradiation (48%), and worse with irradiation only (25.8%). This analysis provides a standard to which current treatment practice and future clinical trials may be compared.

Aged↗
PubMed1997

Organ preservation therapy for advanced-stage laryngeal carcinoma.

The standard treatment for patients with advanced laryngeal cancer remains total laryngectomy. Radiotherapy as a primary treatment modality is a reasonable alternative. Surgical salvage by total laryngectomy is an important part of the treatment plan when irradiation is used primarily to treat advanced laryngeal cancer. The value of induction and concomitant chemotherapy in laryngeal preservation protocols remains controversial. The currently accepted role for use of chemotherapy outside of research protocols is for palliation of incurable laryngeal cancers. The nonsurgical treatment of patients with advanced laryngeal cancers requires the coordinated efforts of a team with close patient follow-up in order that survival not be compromised.

Carcinoma↗
PubMed1996

The National Cancer Data Base report on soft tissue sarcoma.

BACKGROUND: Discernible improvements have taken place in soft tissue sarcoma patient survivorship and quality of life over the past 20 years, with overall 5-year survival currently at approximately 50%. Shifts in treatment have taken place over the past decade, from single-modality treatment involving radical surgery to sophisticated limb-salvage strategies combined with radiation therapy and protocol-administered chemotherapy. METHODS: To identify patterns of treatment and outcome, all soft tissue sarcoma cases diagnosed in 1988 and 1993 as recorded in the National Cancer Data Base were analyzed on the basis of histology and anatomic site. RESULTS: There was an increase in sarcomas originating in the pleura with a concurrent increase in mesotheliomas. A shift toward more advanced disease was also noted. Limb-sparing surgical procedures are now standard. However, it appears from stage subset analysis that many Stage II and III patients are undertreated due to lack of multimodality therapy usage. CONCLUSIONS: Use of pretreatment multimodality planning conferences will increase the likelihood that stage-appropriate combinations of surgery, radiation therapy, and chemotherapy will be used. In turn, election of multimodality approaches should increase the possibility of improved overall and disease free survival in the future.

Databases, Factual↗
PubMed1996

National Cancer Data Base report on esophageal carcinoma.

BACKGROUND: The prognosis for patients with esophageal carcinoma is poor, with less than fifty percent surviving 1 year after diagnosis. Although diagnostic and staging methods have improved, a large proportion of patients present with advanced disease. Research is being conducted to determine what multimodality treatment regimens provide the best local control and survival. METHODS: Using the National Cancer Data Base's most current accrual of oncologic data for cases diagnosed in 1988 and 1993, patterns of care and outcome were analyzed for esophageal carcinoma. RESULTS: A substantial increase was demonstrated between 1988 and 1993 in the proportion of esophageal adenocarcinomas and patients presenting with Stage IV disease. The therapeutic regimen most frequently employed in 1993 was combined radiation therapy and chemotherapy, which rose 8.2% from 2.2% in 1988. CONCLUSIONS: The dramatic rise across the years of this study in the occurrence of esophageal adenocarcinomas indicates a need for developing strategies to evaluate Barrett's preneoplastic mucosal changes more precisely. The increasing use of combined chemotherapy and radiation therapy reflects the results of randomized trials that have demonstrated improved response and outcome for this combined regimen compared with radiation therapy alone. There was no substantial increase in the use of surgical resection with chemotherapy and radiation therapy throughout these years.

Adenocarcinoma↗
PubMed1994

The National Cancer Data Base. Report on melanoma.

BACKGROUND: Previous Commission on Cancer Studies have examined time trends in stage of disease and treatment patterns for melanoma. Reported herein are the most current National Cancer Data Base (NCDB) data for melanoma. METHODS: Two calls for data have yielded 20,165 melanoma cases for 1985, 1988, and 1990 from hospital cancer registries across the country. RESULTS: There was a marked increase in Stage 0 (in situ) tumors between 1985 and 1990. NCDB data confirm a trend for more conservative surgical excision of skin melanoma. Use of multimodality therapy was infrequent. CONCLUSIONS: Survival data confirmed an excellent correlation between stage of disease and outcome. Early skin melanoma is highly curable.

Adult↗
PubMed1994

The National Cancer Data Base report on breast cancer.

BACKGROUND: Previous National Cancer Data Base data have been used to examine time trends in stage of disease and treatment patterns for breast cancer. The most current (1990) data are described here. METHODS: Two calls for data have yielded a total of 143,051 breast cancer cases for 1985, 1988, and 1990 from hospital cancer registries across the United States. RESULTS: The percentage of in situ cancers increased between 1985 and 1988 but was essentially constant between 1988 and 1990. The use of breast-conserving partial mastectomy across the country increased between 1988 and 1990. Some interesting regional differences appeared in the use of multimodality treatment. CONCLUSIONS: These data suggest a plateau in the use of mammographic screening.

Adult↗
PubMed1993

National survey of ovarian carcinoma. I. A patient care evaluation study of the American College of Surgeons.

BACKGROUND: The Commission on Cancer of the American College of Surgeons recently finished a national survey of patients with ovarian cancer patients. The goal was to compare the patterns of care over a 5-year period. METHODS: Data were collected from 25 consecutive patients whose disease was diagnosed first at 904 hospitals with cancer programs in 1983 and 1988. RESULTS: There was a total of 12,316 patients, of whom 80% were 45-85 years old. Contrary to popular belief, only 8.2% of patients were nulliparous; 85% of patients had one to five children. Of significance, 18.2% of patients with ovarian cancer had undergone a previous hysterectomy with ovarian preservation. Primary surgical treatment was used in 94.9% of patients and consisted of: oophorectomy, 81.9%; hysterectomy, 55.1%; and omentectomy, 59.0%. However, only 12-25% of patients had biopsies of the diaphragm, paracolic gutters, colon, small bowel, pelvic and paraaortic lymph nodes, and cul-de-sac to permit adequate surgical staging. The primary surgeons were: gynecologic oncologists, 21%; obstetrician-gynecologists, 45%; general surgeons, 21%; and others, 13%. CONCLUSIONS: These data indicate that additional resources are needed to improve the care of patients with ovarian cancer.

Adult↗
PubMed1991

The expert witness in malpractice suits.

This survey of 1,097 Fellows resulted in usable data from 336 surgeons, of whom 129 had claims (n = 212) against them from January 1, 1984, through December 31, 1989. Risk by specialty varied greatly, but population of practice area seemed unimportant. Plaintiff expert witnesses could be identified by 28 surgeons; four of these were from medical school faculties. Defense expert witnesses were identified by 37 surgeons, 18 of whom were from university faculties. We were unable to identify any repeat "itinerant" plaintiffs' expert witnesses from this five-year period in Tennessee. It seems obvious that surgeons, even those who have been sued, pay little attention to even the identification of opposing expert witnesses.

Age Factors↗