Anyone have access to NEJM for the full article?  It would be very interesting to see if they analysed the results according to type of endometrial cancer.

A more detailed article about the study:

News > Medscape Medical News > Oncology News

Chemo Alone in Advanced Endometrial Cancer?

Roxanne Nelson, RN, BSN
June 12, 2019

Among patients with advanced endometrial carcinoma, chemotherapy plus radiation was not associated with longer relapse-free survival than chemotherapy alone, according to new findings.

At 60 months, 59% of patients were alive and relapse free in the chemoradiotherapy group, vs 58% in the chemotherapy-only group (hazard ratio [HR], 0.90).

"Radiation has been used historically in this group of patients who are considered to be at high risk of both local and distant metastasis," said lead author Daniela Matei, MD, Diana Princess of Wales Professor in Cancer Research, Department of Obstetrics and Gynecology, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois.

"After the results of a previous study (GOG 122) that were reported approximately 15 years ago, systemic chemotherapy started to be included in the treatment of this patient population along with radiation," she told Medscape Medical News.

"The results of the current study (GOG 258) show that the combined-modality regimen did not result in an improvement in recurrence-free survival over chemotherapy alone and confirm the benefit of chemotherapy alone for patients with stage III uterine cancer," she said.

The study was published online June 13 in the New England Journal of Medicine.

Approached for comment, Kevin Holcomb, MD, associate professor of clinical obstetrics and gynecology at Weill Cornell Medical College, New York City, said that radiation has been a mainstay of treatment for endometrial cancer, but this is changing.

If you can get the same result by using one therapy, there is no reason to use two.Dr Kevin Holcomb

"In general, in cancer care, if you can get the same result by using one therapy, there is no reason to use two," he told Medscape Medical News. "If survival is similar, then you need to look at quality of life, and this will question the benefit of adding radiation."

Radiation and/or Chemotherapy

Pelvic or whole-abdominal radiotherapy has traditionally been used after surgical resection. Although it prevents pelvic recurrence, it has been less effective for preventing systemic recurrence, Matei explained. A randomized trial conducted by the Gynecologic Oncology Group (GOG) found that chemotherapy was superior to radiotherapy for treating locally advanced disease, and it subsequently became part of the standard protocol (J Clin Oncol. 2006;24:36-44).

However, chemotherapy alone has been associated with an increased risk for locoregional recurrence. Thus, note the authors, it was logical to hypothesize that the combined strategy might improve outcomes by preventing both local (pelvic) and distant recurrences.

Guidelines on the diagnosis, treatment, and follow-up of endometrial cancer were issueda few years ago by the European Society for Medical Oncology, the European Society for Radiotherapy and Oncology, and the European Society of Gynaecological Oncology.

"The most controversial areas related to the indications for brachytherapy or external-beam radiotherapy and the use of chemotherapy combined with, or instead of, radiotherapy," the lead author of the guidelines, Nicoletta Colombo, MD, from the European Institute of Oncology, University of Milan-Bicocca, Italy, told Medscape Medical News at the time.

For example, one previous study in women with early-stage, high-risk endometrial cancer showed that adding chemotherapy to radiotherapy was not superior to the standard treatment of radiotherapy alone.

No Difference in Treatment Arms

In the current trial (GOG 258), Matei and her colleagues evaluated the use of concurrent tumor volume–directed external-beam radiotherapy and chemotherapy compared with chemotherapy alone in women with advanced-stage endometrial cancer.

A total of 707 patients with stage III or IVA endometrial carcinoma were randomly assigned to receive either chemoradiotherapy (n = 346) or chemotherapy only (n = 361).

The chemoradiotherapy regimen included cisplatin (50 mg/m2 administered intravenously on days 1 and 29) and volume-directed external-beam radiotherapy, followed by carboplatin (dosed to achieve an area under the concentration–time curve [AUC] of 5 to 6 ) plus paclitaxel (175 mg/m2administered every 21 days for four cycles). The chemotherapy-only regimen consisted of carboplatin (to achieve an AUC of 6) plus paclitaxel (175 mg/m2 given every 21 days for six cycles).

The results for the primary endpoint of relapse-free survival did not reach significance. The null hypothesis that chemoradiotherapy is not superior to chemotherapy alone could not be rejected (P = .20 by one-tailed test).

To date, there have been a total 165 deaths — 86 in the chemoradiotherapy group, and 79 in the chemotherapy-only group. In the chemoradiotherapy group, 73% deaths occurred as a result of the progression of endometrial cancer progression; in the chemotherapy-only group, 81% such deaths occurred. However, between-group comparisons of overall survival could not be made because the data are not sufficiently mature, the authors comment.

Exploratory subgroup analyses failed to identify a subgroup of patients who may have benefited more from chemoradiotherapy than from chemotherapy alone.

Other analyses showed that the cumulative incidence of vaginal disease recurrence at 60 months was 2% in the chemoradiotherapy group and 7% in the chemotherapy-only group (HR, 0.36). For pelvic or para-aortic node recurrence, the cumulative incidence was 11% with chemotherapy-only, vs 20% with chemoradiotherapy (HR, 0.43).

The cumulative incidence of distant recurrence at 60 months' follow-up was 27% in the chemoradiotherapy group and 21% in the chemotherapy-only group (HR, 1.36). Coincident local and distant recurrences at first presentation were found in 2.2% and 4.9%, respectively.

Adverse events of grade 3 or greater were reported in 202 patients (58%) in the chemoradiotherapy group and 227 patients (63%) in the chemotherapy-only group. Both groups reported symptoms of neurotoxicityin association with treatment.

"Physicians may consider addition of radiation for selected patients considered at very high risk for local recurrence," said Matei. "However, completion of systemic chemotherapy in all patients remains key to achieving best outcomes."

Doesn't Close the Door

Commenting to Medscape Medical News, Holcomb said that radiotherapy has historically had a role in the adjuvant treatment in locally advanced endometrial cancer and has been the mainstay therapy for many years.

However, he pointed out that radiotherapy "has never been shown to improve overall survival, and many patients had distant recurrences that were not likely to be prevented by radiation."

Then the GOG 122 trial changed things. Whole-abdominal irradiation was compared with doxorubicin-cisplatin chemotherapy in women with stage III or IV endometrial carcinoma. "Many of us thought that radiation would be proven superior, given its historical role, but that wasn't the case," said Holcomb. "There was a significant improvement in survival with chemotherapy."

Although the current study used relapse-free survival as an endpoint, it is unlikely this will translate to a difference in survival between the two groups, he said.

In addition, although the chemotherapy group experienced a higher rate of adverse effects, these were acute events, whereas for the combination group, the rate of long-term events was higher. "While we always strive to limit acute toxicities during treatment," he said, "we really want to avoid the ones that 'hang around' long term."

However, Holcomb also noted that even though this study demonstrated that chemoradotherapy was not superior to chemotherapy alone, it does not close the door entirely on combination therapy.

"The study only looked at one way that chemotherapy and radiation therapy can be combined," he said. "There are other ways to give combination therapy."

For example, one method is to "sandwich" radiotherapy in between treatments with chemotherapy — give half of the chemotherapy, then give the radiation, and then give the remaining cycles. Another method is to administer chemotherapy and combination therapy sequentially. "We need better data on these methods, which will probably be studied in future trials," he said.

Unanswered Questions

Another expert feels that this is a complex topic and that the article leaves a number of questions unanswered. "Combined therapy is frequently used to treat subsets of patients included in this trial, and retrospective studies have repeatedly strongly suggested that radiation therapy is important for the subset of patients with involved nodes," said Patricia Eifel, MD, professor, Department of Radiation Oncology, Division of Radiation Oncology, the University of Texas MD Anderson Cancer Center, Houston. "These represented about 75% of patients."

She also pointed out that these results "certainly indicate that patients treated in the ways employed in this trial had similar relapse rates with or without radiation therapy. However, there is a lot of missing information in this study, which makes it difficult to know how to generalize the results to high, modern, optimized, multidisciplinary practice."

Eifel said that there is reason to think the radiotherapy given in the trial may not have been optimal, although the details are sparse. For example, the authors do not fully explain what was meant by "volume-directed RT," and that needs to be clarified.

More importantly, the maximum dose delivered was 45 Gy, even if there was gross residual disease (anything ≥1 cm), and "45 Gy would rarely be expected to control nodes of this size, even when combined with chemotherapy," she said. "It may seem that this would have little impact, since the rate of gross residual reported in the paper (2%) is so low. However, in our experience, this 2% rate is much lower than expected, particularly in a population that was not required to have a full, or even any, lymph node dissection."

The article did not clearly outline how patients were assessed for residual disease, she continued. Because postoperative imaging was not required, it must be assumed that assessment was based on surgical findings, she said. "In our experience, surgical assessment is inadequate, because some of the most frequently involved sites are behind the renal, aortocaval, and iliac vessels," said Eifel. "We often find residual positive or suspicious nodes on postoperative imaging, even when the surgeon failed to appreciate residual disease."

Eifel added that adjuvant radiotherapy is almost always ineffective for treating gross residual disease if the dose is not boosted higher, usually to 60 Gy. "This was not permitted in the trial, even if gross residual was known to be present," she noted.

The study was supported by grants from the National Cancer Institute (NCI) to the Gynecologic Oncology Group Administrative Office, the Gynecologic Oncology Group Statistical and Data Center, NRG Oncology, NRG Operations, and the NCI Community Oncology Research Program. Matei has received personal fees and nonfinancial support from Genentech, AstraZeneca, Clovis, Astex Inc, and the European Commission, and personal fees from Tesaro, all outside the submitted work. Several coauthors have also reported relationships with industry. Eifel has disclosed no relevant financial relationships.

N Engl J Med. Published online June 13, 2019. Abstract

Medscape Medical News © 2019 
Cite this: Chemo Alone in Advanced Endometrial Cancer? - Medscape - Jun 12, 2019

All material on this website is protected by copyright, Copyright © 1994-2019 by WebMD LLC. This website also contains material copyrighted by 3rd parties.

LisaPizza said:

A more detailed article about

A more detailed article about the study:

News > Medscape Medical News > Oncology News

Chemo Alone in Advanced Endometrial Cancer?

Roxanne Nelson, RN, BSN
June 12, 2019

 

Among patients with advanced endometrial carcinoma, chemotherapy plus radiation was not associated with longer relapse-free survival than chemotherapy alone, according to new findings.

 

At 60 months, 59% of patients were alive and relapse free in the chemoradiotherapy group, vs 58% in the chemotherapy-only group (hazard ratio [HR], 0.90).

 

"Radiation has been used historically in this group of patients who are considered to be at high risk of both local and distant metastasis," said lead author Daniela Matei, MD, Diana Princess of Wales Professor in Cancer Research, Department of Obstetrics and Gynecology, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois.

 

"After the results of a previous study (GOG 122) that were reported approximately 15 years ago, systemic chemotherapy started to be included in the treatment of this patient population along with radiation," she told Medscape Medical News.

 

"The results of the current study (GOG 258) show that the combined-modality regimen did not result in an improvement in recurrence-free survival over chemotherapy alone and confirm the benefit of chemotherapy alone for patients with stage III uterine cancer," she said.

 

The study was published online June 13 in the New England Journal of Medicine.

Approached for comment, Kevin Holcomb, MD, associate professor of clinical obstetrics and gynecology at Weill Cornell Medical College, New York City, said that radiation has been a mainstay of treatment for endometrial cancer, but this is changing.

 

If you can get the same result by using one therapy, there is no reason to use two.Dr Kevin Holcomb

 

"In general, in cancer care, if you can get the same result by using one therapy, there is no reason to use two," he told Medscape Medical News. "If survival is similar, then you need to look at quality of life, and this will question the benefit of adding radiation."

 

Radiation and/or Chemotherapy

 

Pelvic or whole-abdominal radiotherapy has traditionally been used after surgical resection. Although it prevents pelvic recurrence, it has been less effective for preventing systemic recurrence, Matei explained. A randomized trial conducted by the Gynecologic Oncology Group (GOG) found that chemotherapy was superior to radiotherapy for treating locally advanced disease, and it subsequently became part of the standard protocol (J Clin Oncol. 2006;24:36-44).

 

However, chemotherapy alone has been associated with an increased risk for locoregional recurrence. Thus, note the authors, it was logical to hypothesize that the combined strategy might improve outcomes by preventing both local (pelvic) and distant recurrences.

 

Guidelines on the diagnosis, treatment, and follow-up of endometrial cancer were issueda few years ago by the European Society for Medical Oncology, the European Society for Radiotherapy and Oncology, and the European Society of Gynaecological Oncology.

 

"The most controversial areas related to the indications for brachytherapy or external-beam radiotherapy and the use of chemotherapy combined with, or instead of, radiotherapy," the lead author of the guidelines, Nicoletta Colombo, MD, from the European Institute of Oncology, University of Milan-Bicocca, Italy, told Medscape Medical News at the time.

 

For example, one previous study in women with early-stage, high-risk endometrial cancer showed that adding chemotherapy to radiotherapy was not superior to the standard treatment of radiotherapy alone.

 

No Difference in Treatment Arms

 

In the current trial (GOG 258), Matei and her colleagues evaluated the use of concurrent tumor volume–directed external-beam radiotherapy and chemotherapy compared with chemotherapy alone in women with advanced-stage endometrial cancer.

 

A total of 707 patients with stage III or IVA endometrial carcinoma were randomly assigned to receive either chemoradiotherapy (n = 346) or chemotherapy only (n = 361).

 

The chemoradiotherapy regimen included cisplatin (50 mg/m2 administered intravenously on days 1 and 29) and volume-directed external-beam radiotherapy, followed by carboplatin (dosed to achieve an area under the concentration–time curve [AUC] of 5 to 6 ) plus paclitaxel (175 mg/m2administered every 21 days for four cycles). The chemotherapy-only regimen consisted of carboplatin (to achieve an AUC of 6) plus paclitaxel (175 mg/m2 given every 21 days for six cycles).

 

The results for the primary endpoint of relapse-free survival did not reach significance. The null hypothesis that chemoradiotherapy is not superior to chemotherapy alone could not be rejected (P = .20 by one-tailed test).

 

To date, there have been a total 165 deaths — 86 in the chemoradiotherapy group, and 79 in the chemotherapy-only group. In the chemoradiotherapy group, 73% deaths occurred as a result of the progression of endometrial cancer progression; in the chemotherapy-only group, 81% such deaths occurred. However, between-group comparisons of overall survival could not be made because the data are not sufficiently mature, the authors comment.

 

Exploratory subgroup analyses failed to identify a subgroup of patients who may have benefited more from chemoradiotherapy than from chemotherapy alone.

 

Other analyses showed that the cumulative incidence of vaginal disease recurrence at 60 months was 2% in the chemoradiotherapy group and 7% in the chemotherapy-only group (HR, 0.36). For pelvic or para-aortic node recurrence, the cumulative incidence was 11% with chemotherapy-only, vs 20% with chemoradiotherapy (HR, 0.43).

 

The cumulative incidence of distant recurrence at 60 months' follow-up was 27% in the chemoradiotherapy group and 21% in the chemotherapy-only group (HR, 1.36). Coincident local and distant recurrences at first presentation were found in 2.2% and 4.9%, respectively.

 

Adverse events of grade 3 or greater were reported in 202 patients (58%) in the chemoradiotherapy group and 227 patients (63%) in the chemotherapy-only group. Both groups reported symptoms of neurotoxicityin association with treatment.

 

"Physicians may consider addition of radiation for selected patients considered at very high risk for local recurrence," said Matei. "However, completion of systemic chemotherapy in all patients remains key to achieving best outcomes."

 

Doesn't Close the Door

 

Commenting to Medscape Medical News, Holcomb said that radiotherapy has historically had a role in the adjuvant treatment in locally advanced endometrial cancer and has been the mainstay therapy for many years.

 

However, he pointed out that radiotherapy "has never been shown to improve overall survival, and many patients had distant recurrences that were not likely to be prevented by radiation."

 

Then the GOG 122 trial changed things. Whole-abdominal irradiation was compared with doxorubicin-cisplatin chemotherapy in women with stage III or IV endometrial carcinoma. "Many of us thought that radiation would be proven superior, given its historical role, but that wasn't the case," said Holcomb. "There was a significant improvement in survival with chemotherapy."

 

Although the current study used relapse-free survival as an endpoint, it is unlikely this will translate to a difference in survival between the two groups, he said.

 

In addition, although the chemotherapy group experienced a higher rate of adverse effects, these were acute events, whereas for the combination group, the rate of long-term events was higher. "While we always strive to limit acute toxicities during treatment," he said, "we really want to avoid the ones that 'hang around' long term."

 

However, Holcomb also noted that even though this study demonstrated that chemoradotherapy was not superior to chemotherapy alone, it does not close the door entirely on combination therapy.

 

"The study only looked at one way that chemotherapy and radiation therapy can be combined," he said. "There are other ways to give combination therapy."

 

For example, one method is to "sandwich" radiotherapy in between treatments with chemotherapy — give half of the chemotherapy, then give the radiation, and then give the remaining cycles. Another method is to administer chemotherapy and combination therapy sequentially. "We need better data on these methods, which will probably be studied in future trials," he said.

 

Unanswered Questions

 

Another expert feels that this is a complex topic and that the article leaves a number of questions unanswered. "Combined therapy is frequently used to treat subsets of patients included in this trial, and retrospective studies have repeatedly strongly suggested that radiation therapy is important for the subset of patients with involved nodes," said Patricia Eifel, MD, professor, Department of Radiation Oncology, Division of Radiation Oncology, the University of Texas MD Anderson Cancer Center, Houston. "These represented about 75% of patients."

 

She also pointed out that these results "certainly indicate that patients treated in the ways employed in this trial had similar relapse rates with or without radiation therapy. However, there is a lot of missing information in this study, which makes it difficult to know how to generalize the results to high, modern, optimized, multidisciplinary practice."

 

Eifel said that there is reason to think the radiotherapy given in the trial may not have been optimal, although the details are sparse. For example, the authors do not fully explain what was meant by "volume-directed RT," and that needs to be clarified.

 

More importantly, the maximum dose delivered was 45 Gy, even if there was gross residual disease (anything ≥1 cm), and "45 Gy would rarely be expected to control nodes of this size, even when combined with chemotherapy," she said. "It may seem that this would have little impact, since the rate of gross residual reported in the paper (2%) is so low. However, in our experience, this 2% rate is much lower than expected, particularly in a population that was not required to have a full, or even any, lymph node dissection."

 

The article did not clearly outline how patients were assessed for residual disease, she continued. Because postoperative imaging was not required, it must be assumed that assessment was based on surgical findings, she said. "In our experience, surgical assessment is inadequate, because some of the most frequently involved sites are behind the renal, aortocaval, and iliac vessels," said Eifel. "We often find residual positive or suspicious nodes on postoperative imaging, even when the surgeon failed to appreciate residual disease."

 

Eifel added that adjuvant radiotherapy is almost always ineffective for treating gross residual disease if the dose is not boosted higher, usually to 60 Gy. "This was not permitted in the trial, even if gross residual was known to be present," she noted.

 

The study was supported by grants from the National Cancer Institute (NCI) to the Gynecologic Oncology Group Administrative Office, the Gynecologic Oncology Group Statistical and Data Center, NRG Oncology, NRG Operations, and the NCI Community Oncology Research Program. Matei has received personal fees and nonfinancial support from Genentech, AstraZeneca, Clovis, Astex Inc, and the European Commission, and personal fees from Tesaro, all outside the submitted work. Several coauthors have also reported relationships with industry. Eifel has disclosed no relevant financial relationships.

 

N Engl J Med. Published online June 13, 2019. Abstract

Medscape Medical News © 2019 
Cite this: Chemo Alone in Advanced Endometrial Cancer? - Medscape - Jun 12, 2019

All material on this website is protected by copyright, Copyright © 1994-2019 by WebMD LLC. This website also contains material copyrighted by 3rd parties.

So my onco at the time was right in not doing radiation as immediate frontline (though it might have helped months later, back when the cancer was controlled in a smaller area). 

However, I thought I saw another article that supported chemo and radiation for Stage 4 patients like me, so go figure. 

I still haven't been able to get at the full article from NEJM, but I think this is the report from the GOG-258.  I did take its preliminary results into account when I made my decision to have external beam pelvic after the chemo, because there were other studies that showed benefit to radiation.  Still, it's discouraging, because essentially what this study seems to say is that the die is cast before diagnosis.  If you have distant isolated cells or micrometastases beyond the field of radiation, that aren't killed by the chemo, that determines your outcome.

What they say about radiation possibly interfering with being able to complete chemo is true.  Had I done the "sandwich" protocol, I would not have been able to complete chemo afterwards, because of the serious decrease in hemoglobin, white count, and platelets that the radiation has caused.  In fact, I doubt I would have been able to tolerate chemo at all, if I'd had radiation done first.

The side effects from the chemo mostly are gone by a few weeks afterwards, except for the neuropathy that some of us have.  But I can tell you that 5 weeks after having finished external beam pelvic IMRT, although I don't have constant, intractible diarrhea any longer, I'm still bloated, still having a lot of GI discomfort, and some mild bladder discomfort, too.  Now, in light of the full results of the GOG-258, I don't know what I would advise someone newly diagnosed.  There have been studies that seemed to confirm the benefit of radiation (most recently, the PORTEC-3).

Thanks so much for posting the article on radiation treatment for early stage high risk patients, which is what I am.  I just started chemotherapy yesterday and have begun thinking about radiation therapy when I complete the six cycles.  I plan to ask the both my medical oncologist and my radiaiton oncologist (when I meet with her) about this study.  I don't find many articles/studies about my specific category so this felt especially helpful.  Mary Ann

NoTimeForCancer said:

I believe they are talking

I believe they are talking about Type 1, the "garden variety type": Endometrial cancer, which begins in the uterus, is the most common gynecologic cancer with most cases occurring in women after age 55. About 62,000 new cases will be diagnosed this year. Occurrence of and mortality from endometrial cancer is rising, which may be tied to the obesity epidemic, Matei said.

 

It also looks like it was a trial with Grade III/IVA

I didn't find where it said how many type 2 were enrolled,  but they were eligible, and could be stage 1 or 2,  whereas all others had to be stage 3 or 4.

Inclusion Criteria:

• All patients with surgical stage III or IVA endometrial carcinoma per FIGO 2009 staging criteria including clear cell and serous papillary and undifferentiated carcinoma

• Patients with FIGO 2009 surgical stage I or II endometrial clear cell or serous carcinoma and with positive peritoneal cytology.

mamlicsw said:

Thanks so much for posting

Thanks so much for posting the article on radiation treatment for early stage high risk patients, which is what I am.  I just started chemotherapy yesterday and have begun thinking about radiation therapy when I complete the six cycles.  I plan to ask the both my medical oncologist and my radiaiton oncologist (when I meet with her) about this study.  I don't find many articles/studies about my specific category so this felt especially helpful.  Mary Ann

"Still, it's discouraging, because essentially what this study seems to say is that the die is cast before diagnosis. If you have distant isolated cells or micrometastases beyond the field of radiation, that aren't killed by the chemo, that determines your outcome"

--- I think that's always been known to be true, for all types of cancer. Either adjuvant chemo kills those micromets or it doesn't. The problem is we don't know if it worked until a recurrence happens, or you die 20 years later from something else with no cancer recurrence."

"What they say about radiation possibly interfering with being able to complete chemo is true."

--- Agree. It would be interesting to know the recurrence and survival differences between just the subgroup that did actually receive the full planned course.

Even those who finished all treatments on time aren't directly comparable to many if us. For example, I had taxol/carbo (AUC6) x 6, followed by rads x 25. But the study group had concurrent cisplatin and radiation, followed by taxol/carbo (AUC 5 or 6) x 4 cycles instead of 6.

BluebirdOne said:

Thanks, Lisa

Thanks for posting the full article and clarification. 

I found this in the study results tab:   

Endometrial Cancer Grades   [1]  Measure Type: Count of Participants Unit of measure:  Participants	Number Analyzed	370 participants	366 participants	736 participants
Endometrioid Grade 1		87   23.5%	79   21.6%	166   22.6%
Endometrioid Grade 2		103   27.8%	118   32.2%	221   30.0%
Endometrioid Grade 3		66   17.8%	62   16.9%	128   17.4%
Serous		66   17.8%	65   17.8%	131   17.8%
Clear Cell		10    2.7%	12    3.3%	22    3.0%
Other		38   10.3%	30    8.2%	68    9.2%
		[1]   Measure Description: Grade 1 is 5% or less of a non-squamous or non-morular solid growth pattern. Grade 2 is 6 through 50% of a non squamous or non-morular solid growth pattern. Grade 3 is more than 50% of a non-squamous or non-morular solid growth pattern. Generally the higher the stage the worse the outcome.

Oops, we were posting at the same time!

Forherself said:

This article makes me sad.

This article makes me sad.  MD Anderson is a premiere cancer center.   It does 200,000 blood product treatments a year.  It sounds like one had a bad outcome.  It could be as simple as an employee making a mistake.   And then the oversight doctor says this makes them wonder if the hospital is safe for Medicare pateints.  Nothing is perfect.   Where would all those patients be treated go.  There are not hospitals standing by.   Work with MD Anderson.   They do millions of things right.

It just goes to show you that it's best to spend as little time in the hospital, any hospital, as is possible.

One, they are hot beds of infections.

Two, you are likely to get better care at home because,

Three, there's never the kind of staffing to get the kind of care you need and should get, so what's the point? 

To newbies, if you do get stuck staying in a hospital after surgery, push yourself to get up an walk because that will help you to get sent home quicker.