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Carrato A, Guillén-Ponce C, Grande-Pulido E. [Antineoplastic drug-induced neutropenia: use of granulocyte colony stimulating factors]. FARMACIA HOSPITALARIA 2010; 34 Suppl 1:8-11. [PMID: 20920851 DOI: 10.1016/s1130-6343(10)70002-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Neutropenia is a frequent adverse event of the pharmacologic treatment of cancer. Morbidity and mortality-associated neutropenia can be successfully treated and prevented with granulocyte-colony stimulating factors (G-CSF). European and American Guidelines recommend their prophylactic use when the expected percentage of febrile neutropenia exceeds 20% or there are concomitant risk factors. Afebrile neutropenia is not considered to benefit from G-CSF treatment. Other approved indications include stem cell mobilization, and an adequate delivery of dose-intense and dose-dense chemotherapy regimens.
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Howard SC, Bustos A, Carrato A. Use of hospital-based cancer registries to evaluate the quality of cancer care: A survey to the international community of oncologists. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e16531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Aust DE, Lutz MP, Mauer M, Popov I, Baretton GB, Bedenne L, Carrato A, Kohne C. Lessons from PETACC 2: No prognostic impact of KRAS-/BRAF-status in stage III colon cancer treated with adjuvant 5-FU monotherapy. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.3591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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79
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Carrato A, Gomez A, Escudero MP, Chaves M, Rivera F, Marcuello E, González Flores E, Grávalos C, Constenla M, Aranda E. Panitumumab plus irinotecan, both given every 3 weeks (Q3W), as second-line treatment for irinotecan-naïve metastatic colorectal cancer (mCRC). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e14025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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80
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Prenen H, D'Haens G, Capdevila J, Carrato A, Sobrero A, Ducreux M, François E, Staines H, Amellal N, Van Cutsem E. A phase I dose escalation study of BIBF 1120 combined with FOLFOX in metastatic colorectal cancer (mCRC) patients (pts). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e14054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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81
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López-Pousa A, Rifà J, Casas de Tejerina A, González-Larriba JL, Iglesias C, Gasquet JA, Carrato A. Risk assessment model for first-cycle chemotherapy-induced neutropenia in patients with solid tumours. Eur J Cancer Care (Engl) 2010; 19:648-55. [PMID: 20088918 PMCID: PMC3082427 DOI: 10.1111/j.1365-2354.2009.01121.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
LÓPEZ-POUSA A., RIFÀ J., CASAS DE TEJERINA A., GONZÁLEZ-LARRIBA J.L., IGLESIAS C., GASQUET J.A. & CARRATO A. (2010) European Journal of Cancer CareRisk assessment model for first-cycle chemotherapy-induced neutropenia in patients with solid tumours Chemotherapy-induced neutropenia, the major dose-limiting toxicity of chemotherapy, is directly associated with concomitant morbidity, mortality and health-care costs. The use of prophylactic granulocyte colony-stimulating factors may reduce the incidence and duration of chemotherapy-induced neutropenia, and is recommended in high-risk patients. The objective of this study was to develop a model to predict first-cycle chemotherapy-induced neutropenia (defined as neutropenia grade ≥3, with or without body temperature ≥38°C) in patients with solid tumours. A total of 1194 patients [56% women; mean age 58 ± 12 years; 94% Eastern Cooperative Oncology Group (ECOG) status ≤1] with solid tumours were included in a multi-centre non-interventional prospective cohort study. A predictive logistic regression model was developed. Several factors were found to influence chemotherapy-induced neutropenia. Higher ECOG status values increased toxicity (ECOG 2 vs. 0, P= 0.003; odds ratio 3.12), whereas baseline lymphocyte (P= 0.011; odds ratio 0.67) and neutrophil counts (P= 0.026; odds ratio 0.90) were inversely related to neutropenia occurrence. Sex and treatment intention also significantly influenced chemotherapy-induced neutropenia (P= 0.012). The sensitivity and specificity of the model were 63% and 67% respectively, and the positive and negative predictive values were 17% and 94% respectively. Once validated, this model should be a useful tool for clinical decision making.
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Sastre J, Aranda E, Grávalos C, Massutí B, Varella-Garcia M, Rivera F, Soler G, Carrato A, Manzano JL, Díaz-Rubio E, Hidalgo M. First-line single-agent cetuximab in elderly patients with metastatic colorectal cancer. A phase II clinical and molecular study of the Spanish group for digestive tumor therapy (TTD). Crit Rev Oncol Hematol 2009; 77:78-84. [PMID: 20042346 DOI: 10.1016/j.critrevonc.2009.11.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Revised: 11/10/2009] [Accepted: 11/26/2009] [Indexed: 12/11/2022] Open
Abstract
PURPOSE to evaluate the efficacy and safety of first-line single-agent cetuximab in fit elderly patients with metastatic colorectal cancer, as well as potential molecular predictive factors for efficacy. PATIENTS AND METHODS patients aged 70 or older with metastatic CRC without criteria for frailty and no prior treatment for advanced disease were treated with single-agent cetuximab 400mg/m(2) followed by weekly 250mg/m(2) until disease progression or unacceptable toxicity. RESULTS forty-one patients were included. Two patients achieved a complete response and 4 patients had a partial response for an overall response rate of 14.6%. Fifteen patients (36.6%) remained stable. Median time to progression was 2.9 months and median overall survival 11.1 months despite two-third of patients received chemotherapy at progression. Forty-five percent of EGFR gene copy number positive patients by FISH were progression-free at 12 weeks, in contrast with 12% of FISH negative patients (p=0.04). Grade 3 skin toxicity was reported in 5 patients (12.2%). Hypersensitivity infusion reactions were not reported and there were no toxic deaths. CONCLUSION cetuximab is a safe monoclonal antibody with moderate activity in first-line metastatic colorectal cancer, but the present study does not support the use of cetuximab as single-agent in first-line fit elderly patients with metastatic CRC.
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Carrato A, Thomas M, Vergnenègre A, Cruciani G, Bischoff H, Medina E. 9053 Baseline population description of the EPICLIN-Lung epidemiological study in Non-Small Cell Lung Cancer (NSCLC) across Europe. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71766-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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84
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Molina-Garrido MJ, Guillén-Ponce C, Mora A, Ascuña E, Carrato A. [Multiple hepatic lesions suggestive of metastases in a patient with colorectal cancer]. Rev Clin Esp 2009; 209:309-10. [PMID: 19635255 DOI: 10.1016/s0014-2565(09)71479-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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85
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Molina-Garrido M, Guillen-Ponce C, Santiago J, Muñoz M, Olaverri A, Haro L, Carrato A. Barber test as a screening tool in multidimensional geriatric evaluation in elderly women with early breast cancer. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e20645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20645 Background: The Comprehensive Geriatric Assessment (CGA) is a key component of the treatment approach for older cancer patients, but it is time consuming. In this study, we have evaluated the validity of a brief frailty screening tool, the Barber test (BT), for identifying disability in older patients with early breast cancer (BC) in the University General Hospital in Elche. Methods: Between January 2007 and December 2007, a total of 41 patients older than 65 years who were actively receiving chemotherapy for early BC, were enrolled in our study. Eligible patients were screened with the Barber test and completed a standardized CGA (Activities of Daily Living measured by Barthel Scale, Instrumental Activities of Daily Living measured by Lawton-Brody Scale, cognitive evaluation measured by Pfeiffer Test, comorbidity (Charlson´s index), risk of malnutrition (Nutritive Initiative Screening), and ECOG). The validity of the BT in this population was assessed by comparing the BT results with results from a simultaneous CGA. A receiver operating characteristic (ROC) analysis was employed. The ROC evaluated the BT as a screening measure for impairment compared with the CGA (using the definition of impairment on the CGA as deficits on ≥2 individual tests within the battery, and on the BT as a score >0). The area under the ROC curve (AUC) was calculated to reflect the predictive value of the BT for identifying impairment. Results: Forty-one women were recruited. Median age was 72.88 years (range 65.03 to 85.46). 30 patients (73.2%) were older than 70 years. 36.6% were dependent in Barthel Scale, and 46,3% were dependent in Lawton-Brody Scale. 19,5% had cognitive impairment. The Barber test was moderate predictive for identifying impairment compared with the CGA, with an AUC of 0.730 (standard error, 0.081; 95% confidence interval for detecting asymptomatic normals, 0.571–0.889); p=0.012). Conclusions: Functional impairments are prevalent among older patients with early BC who receive adjuvant chemotherapy treatment. The current results indicate that the brief Barber test performed nearly as well as a conventional CGA in detecting geriatric impairment in this population. No significant financial relationships to disclose.
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Aranda E, Valladares M, Martinez-Villacampa M, Benavides M, Gomez A, Massutti B, Marcuello E, Constenla M, Cámara J, Carrato A, Dueñas R, Reboredo M, Navarro M, Díaz-Rubio E. Randomized study of weekly irinotecan plus high-dose 5-fluorouracil (FUIRI) versus biweekly irinotecan plus 5-fluorouracil/leucovorin (FOLFIRI) as first-line chemotherapy for patients with metastatic colorectal cancer: a Spanish Cooperative Group for the Treatment of Digestive Tumors Study. Ann Oncol 2009; 20:251-7. [DOI: 10.1093/annonc/mdn557] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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87
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Molina-Garrido M, Guillén-Ponce C, Molina M, Molina M, Carrato A. Analysis of differences of clinical and prognostic factors between multiple myeloma patients between 65 and 75 years or older than 75 years. Crit Rev Oncol Hematol 2008. [DOI: 10.1016/s1040-8428(08)70116-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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88
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Molina-Garrido M, Guillén-Ponce C, Guirado-Risueño M, Camacho M, Molina M, Molina M, Carrato A. Usefulness of the Barber test in compared with the comprehensive geriatric assessment for identifying disability in outpatients older than 65 years with breast cancer who receive chemotherapy. Crit Rev Oncol Hematol 2008. [DOI: 10.1016/s1040-8428(08)70072-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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89
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Molina-Garrido MJ, Mora A, Guillén-Ponce C, Guirado-Risueño M, Molina MJ, Molina MA, Carrato A. [Systemic mastocytosis: systematic review]. ANALES DE MEDICINA INTERNA (MADRID, SPAIN : 1984) 2008; 25:134-40. [PMID: 18560682 DOI: 10.4321/s0212-71992008000300008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Mastocytosis is a hematologic malignance characterized by an abnormal proliferation of mastocytes. In a consensus classification in 2001, it was distinguished between matters limited to skin and systemic matters (70% of osseous involvement and 50% of hepatomegaly). The most typical symptoms are skin lesions and systemic manifestations due to mediators secreted by tumoral cells. They are useful chemotherapy to reduce the tumoral burden and antihistaminic to control systemic manifestations. Interferon is useful in most of systemic and local manifestations, and it is recommended to use prednisona before the use of this medication.
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Popov I, Wils J, Carrato A, Sobrero A, Vincent M, Kerr DJ, Labianca R, Pignatti F, Praet M, Nordlinger B. Final results of the PETACC-1 trial of bolus 5-FU/LV vs raltitrexed: An unsuccessful story? J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.4053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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91
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Montenegro PC, Carrato A, Castillejo A, Balaguer TM, Barbera VM, Ochoa E, Andrada E, Guillen C, Casanova L, Soto J. Lack of an association between human papillomavirus (HPV) infection and colorectal cancer. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.15111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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92
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Starling N, Vázquez F, Cunningham D, Chau I, Ramos FJ, Saunders MP, Iveson TJ, Verkh L, Tursi J, Carrato A. Phase I study to evaluate the safety and efficacy of sunitinib in combination with FOLFIRI in treatment-naïve metastatic colorectal cancer (mCRC). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.3563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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93
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Pericay C, Valladares M, Benavides M, Massutí B, Aparicio J, Dueñas R, González-Flores E, Carrato A, Marcuello E, Aranda E. Oxaliplatin in combination with 5-fluorouracil (FU) in a 48-hour continuous infusion (CI) as first-line chemotherapy for elderly patients (pts) with metastatic colorectal cancer (mCRC). TTD phase II trial. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.4057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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94
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Castillejo A, Mata-Balaguer T, Sanchez T, Montenegro PC, Barberá VM, Ochoa E, Lázaro R, Guillén C, Carrato A, Soto J. TGFBR1*6A is not a susceptibility allele for colorectal cancer in a Spanish population. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.22202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Molina-Garrido MJ, Guillén-Ponce C, Mora A, Guirado-Risueño M, Molina MA, Molina MJ, Carrato A. Deposition-associated diseases related with a monoclonal compound. Clin Transl Oncol 2007; 9:777-83. [PMID: 18158981 DOI: 10.1007/s12094-007-0139-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Up to 3% of adults over 50 years of age show a monoclonal peak values in blood or urine. Findings and prognosis will be distinct in view of the nature of this factor. In B-cell neoplasias (multiple myeloma, Waldeström macroglobulinaemia, chronic myeloid leukaemia and non-Hodgkin lymphoma) the clinical pattern is dominated by the systemic effects produced by the expansion of the malign clone; the monoclonal protein may result in hyperviscosity syndrome or renal damage. On the other hand, there are other less frequent processes called diseases associated to monoclonal components, where the main clinical manifestations and prognosis depend of the biological effects of the monoclonal protein. With reference to this last group, which is the objective of this revision, no bone lesions, anaemia or a greater tendency to infections usually occur when compared with the first group. Even so, there are some cases of interposition between both groups: for instance, type IgM immunoglobulin present in Waldeström macroglobulinaemia may have cold agglutinin activity, and in the case of multiple myeloma, the clone may secrete amyloidogenic light chains.
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Serra C, Kogevinas M, Silverman DT, Turuguet D, Tardon A, Garcia-Closas R, Carrato A, Castaño-Vinyals G, Fernandez F, Stewart P, Benavides FG, Gonzalez S, Serra A, Rothman N, Malats N, Dosemeci M. Work in the textile industry in Spain and bladder cancer. Occup Environ Med 2007; 65:552-9. [PMID: 18045847 DOI: 10.1136/oem.2007.035667] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND/OBJECTIVE Textile manufacturing is a complex industry that has frequently been associated with bladder cancer. However, results have not been consistent. This study investigated the risk of bladder cancer in Spanish textile workers. METHODS We analysed data from a multicentre hospital-based case-control study carried out in Spain (1998-2001) including 1219 cases of bladder cancer and 1271 controls. Of those, 126 cases and 122 controls reported a history of employment in the textile industry. Lifetime occupational history was obtained using a computer-assisted personal interview. Occupations, locations and materials used in the textile industry were assessed using a detailed questionnaire and expert assessment. RESULTS Overall, no increased risk of bladder cancer was found for textile workers, including duration of employment analysis. Increased risks were observed for weavers (OR = 1.82, 95% CI 0.95 to 3.47), for workers in winding/warping/sizing (OR 4.11, 95% CI 1.58 to 10.71) and for those exposed to synthetic materials (OR 1.89, 95% CI 1.00 to 3.56). Working for more than 10 years appeared to be associated with an increased risk for weavers (OR 2.27, 95% CI 0.97 to 5.34), for those who had ever worked in winding/warping/sizing (OR 11.03, 95% CI 1.37, 88.89), for workers in the weaving room (OR 2.94, 95% CI 1.24 to 7.01) and for those exposed to synthetic (OR 2.62, 95% CI 1.14 to 6.01) or cotton (OR 2.00, 95% CI 1.04 to 3.87) materials. Statistically significant higher risks were also found for specific combinations of occupations or locations with exposure to synthetics and cotton. CONCLUSIONS There was no overall increased risk for textile workers, but increased risks were found for specific groups of workers. Our findings indicate that observed risks in previous studies may be better evaluated by analysis of materials used or section worked within the industry and occupation.
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Molina-Garrido M, Guillén-Ponce C, Guirado-Risueño M, Molina M, Molina M, Carrato A. P.24 Analysis of use of comprehensive geriatric assessment in elderly cancer patients in a universitary hospital. Crit Rev Oncol Hematol 2007. [DOI: 10.1016/s1040-8428(13)70197-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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98
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Molina-Garrido M, Guillén-Ponce C, Guirado-Risueño M, Molina M, Molina M, Carrato A. P.25 Is the social status associated to the risk of malnutrition in older cancer patients? Crit Rev Oncol Hematol 2007. [DOI: 10.1016/s1040-8428(13)70198-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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99
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Molina-Garrido M, Guillén-Ponce C, Guirado-Risueño M, Molina M, Molina M, Carrato A. P.23 Is Charlson index useful to predict the duration of hospitalization in oncologic patients? Crit Rev Oncol Hematol 2007. [DOI: 10.1016/s1040-8428(13)70196-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Samanic CM, Kogevinas M, Silverman DT, Tardón A, Serra C, Malats N, Real FX, Carrato A, García-Closas R, Sala M, Lloreta J, Rothman N, Dosemeci M. Occupation and bladder cancer in a hospital-based case-control study in Spain. Occup Environ Med 2007; 65:347-53. [PMID: 17951336 DOI: 10.1136/oem.2007.035816] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We investigated the association between occupation and bladder cancer in a hospital-based case-control study conducted in Spain. METHODS 1219 patients with transitional cell carcinoma of the urinary bladder and 1271 controls selected from 18 hospitals in Spain between June 1998 and September 2000 provided detailed information on life-time occupational history, smoking habits, medical history, and other factors. We used unconditional logistic regression to calculate odds ratios (OR) and 95% confidence intervals (CI) for each occupation and industry, adjusting for age, hospital region, smoking duration, and employment in a high-risk occupation for bladder cancer. RESULTS Statistically significant increased risks were observed among men employed as machine operators in the printing industry (OR 5.4; 95% CI 1.6 to 17.7), among men employed in the transportation equipment industry (OR 1.6; 95% CI 1.1 to 2.6) and among those who had worked for >/=10 years in the electrical/gas/sanitary services (OR 3.9; 95% CI 1.5 to 10.4) and in hotels and other lodgings (OR 3.1; 95% CI 1.3 to 7.3). Men who worked as miscellaneous mechanics and repairers (OR 2.0; 95% CI 1.1 to 3.6) and as supervisors in production occupations (OR 2.1; 95% CI 1.2 to 3.6) also had excess risks for bladder cancer. Male farmers and those who worked in crop and livestock production had decreased risks for bladder cancer. We found no significant associations between occupation or industry and bladder cancer risk among women. CONCLUSIONS We did not observe excess bladder cancer risk for many of the occupations identified as being a priori at high risk. Examination of more detailed job exposure information should help clarify these associations.
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