Evidence map›Paper›PMID 40676421›Full record

ArticleAnnals of surgical oncology2025

Attrition after Neoadjuvant Chemotherapy in Foregut Cancer: Experience at a Tertiary Center in the Deep South.

Michelle Holland, Jaspinder Sanghera, Ioannis Liapis, Rida Ahmad, Krisha Amin, Ahmed Abdalla, Martin J Heslin, Smita Bhatia, Annabelle L Fonseca

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In one paragraph

Article in Annals of surgical oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Michelle Holland *Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA.
Jaspinder Sanghera *Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA.
Ioannis LiapisDepartment of Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA.
Rida AhmadDepartment of Surgery, The University of South Alabama, Mobile, AL, USA.
Krisha AminDepartment of Surgery, The University of South Alabama, Mobile, AL, USA.
Ahmed AbdallaDepartment of Medical Oncology, The University of South Alabama, Mobile, AL, USA.
Martin J HeslinDepartment of Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA.
Smita BhatiaInstitute for Cancer Outcomes and Survivorship, The University of Alabama at Birmingham, Birmingham, AL, USA.
Annabelle L FonsecaDepartment of Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA. afonseca@uabmc.edu.ORCID http://orcid.org/0000-0002-4972-5139

Funding

Surgical Oncology Research Training ProgramT32CA229102 · NCI · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI HERBERT CHEN · 2018 to 2026
$3.2M
Using Modifiable Factors to Predict Risk of non-Guideline Concordant Treatment in Foregut Cancers: A Novel Implementation Science-based approachK23MD018383 · NIMHD · UNIVERSITY OF SOUTH ALABAMA · PI Annabelle L Fonseca · 2023 to 2026
$647k
NCI NIH HHS T32 CA229102NIMHD NIH HHS K23 MD018383Surgical Oncology Research Training Program T32CA229102
6 · The paper itself

Abstract

backgroundNeoadjuvant chemotherapy (NAC) is increasingly used in the management of foregut cancers to downstage tumors, treat micrometastases, and improve oncological outcomes. However, many patients fail to undergo surgical resection after NAC. This study aims to identify the underlying causes of non-tumor biology-related attrition and thus evaluate the potentially modifiable factors contributing to pre-surgical attrition.

methodsA retrospective review was conducted of patients with non-metastatic gastric or pancreatic adenocarcinoma treated between 2018-2022 at a tertiary and safety net hospital in the Southeastern U.S. Multivariable logistic regression and a root cause analysis (RCA) were performed to examine the association of sociodemographic factors with attrition and delineate underlying root causes.

resultsOf 169 patients who received NAC, 47% (n = 80) experienced potentially modifiable attrition that was unrelated to disease progression. A diagnosis of pancreatic cancer (p = 0.001), age ≥ 75 (p = 0.04), and ≥ 3 ED visits after diagnosis (p=0.03) were independently associated with attrition on multivariable analysis. Four causes of non-tumor biology-related attrition were identified on RCA: physical deconditioning due to chemotherapy toxicity, malignancy or procedural complications, loss to follow-up resulting from missed appointments, healthcare delivery factors including delayed or absent referral to specialists, and patient refusal of treatment. Attrition was associated with significantly worse survival in both pancreatic and gastric cancer. DISCUSSION: Nearly 50% of patients receiving NAC for pancreatic and gastric cancer failed to undergo surgery due to potentially modifiable causes. Addressing the underlying barriers through the implementation of structured prehabilitation programs, symptom management clinics, and cancer care navigators may reduce non-tumor biology-related attrition and improve outcomes.

Indexed as

AdenocarcinomaNeoadjuvant TherapyPancreatic NeoplasmsStomach NeoplasmsAgedChemotherapy, AdjuvantFemaleFollow-Up StudiesHumansMaleMiddle AgedPrognosisRetrospective StudiesTertiary Care CentersAttritionDeconditioningGastric cancerNeoadjuvant chemotherapyPancreatic cancer

Identifiers

PMID40676421
PMCPMC12454533

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.